Data_Sheet_1_Impact of the COVID-19 Pandemic on the Effectiveness of a Metabolic Health Telemedicine Intervention for Weight Loss: A Propensity Score Matching Analysis.pdf

BackgroundCoronavirus disease 2019 (COVID-19) pandemic public health measures such as stay-at-home and mandatory work-from-home orders have been associated with obesogenic lifestyle changes, increased risk of weight gain, and their metabolic sequelae. We sought to assess the impact of this pandemic on weight loss from a telemedicine-delivered very-low-carbohydrate intervention targeting nutritional ketosis (NKI).
MethodsA total of 746 patients with a BMI ≥25kg/m2, enrolled between January and March 2020 and treated for at least 1 year with the NKI, were classified as pandemic cohort (PC). A separate cohort of 699 patients who received 1 year of the NKI in the preceding years, enrolled between January and March 2018, were identified as pre-pandemic cohort (Pre-PC). Demographic and clinical data were obtained from medical records to compare the cohorts and assess the outcomes. Using propensity score matching (PSM), balanced and matched groups of 407 patients in the Pre-PC and 407 patients in the PC were generated. Longitudinal change in absolute weight and percentage weight change from baseline to 1 year were assessed.
ResultsWeight significantly decreased in both PC and Pre-PC at 3, 6, 9, and 12 months. The weight loss trajectory was similar in both PC and Pre-PC with no significant weight differences between the two cohorts at 3, 6, 9, and 12 months. On an average, the PC lost 7.5% body weight while the Pre-PC lost 7.9% over 1 year, and the percent weight loss did not differ between the two cohorts (p = 0.50).
ConclusionA very-low-carbohydrate telemedicine intervention delivered comparable and medically significant weight loss independent of pandemic stress and lifestyle limitations.

研究背景
2019冠状病毒病（Coronavirus disease 2019，COVID-19）大流行期间，居家隔离及强制远程办公等公共卫生措施，与致肥胖性生活方式改变、体重增加风险升高及其代谢后遗症密切相关。本研究旨在评估此次大流行对远程医疗模式下靶向营养性酮症（nutritional ketosis，NKI）的极低碳水化合物干预方案所带来的体重减轻效果的影响。

研究方法
本研究共纳入2020年1月至3月期间入组、接受至少1年NKI干预且体质量指数（Body Mass Index，BMI）≥25kg/m²的746例患者，将其归类为大流行队列（pandemic cohort，PC）。另选取2018年1月至3月期间入组、此前接受过1年NKI干预的699例患者，归类为新冠大流行前队列（pre-pandemic cohort，Pre-PC）。
从电子病历中提取人口统计学及临床数据，以比较两个队列的基线特征并评估研究结局。通过倾向得分匹配（propensity score matching，PSM），分别从Pre-PC及PC队列中各匹配得到407例患者，形成均衡可比的配对队列。评估自基线至1年随访时的绝对体重变化及体重百分比变化的纵向改变情况。

研究结果
PC队列与Pre-PC队列患者在随访3、6、9及12个月时的体重均显著降低。两个队列的体重下降轨迹相似，在各随访时间点的体重差异均无统计学意义。随访1年时，PC队列患者平均体重下降7.5%，Pre-PC队列患者平均下降7.9%，两组的体重下降百分比无显著差异（p=0.50）。

结论
针对营养性酮症的远程医疗极低碳水化合物干预方案可带来具有临床意义的等效体重减轻效果，且该效果不受大流行相关应激及生活方式限制的影响。