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physical activity, and cognitive-behavioural weight management or to a control intervention of low-intensity dietary advice. A core echocardiography lab evaluated left atrial (LA) strain, function, and volumes in 534 participants at baseline, 3-year, and 5-year follow-ups. Mixed models were used to evaluate the effect of the ILI on LA structure and function. In the subsample, the baseline mean age was 65 years [standard deviation (SD) 5 years], and 40% of the participants were women. The mean weight change after 5 years was \u22123.9\u2005kg (SD 5.3\u2005kg) in the ILI group and \u22120.3\u2005kg (SD 5.1\u2005kg) in the control group. Over the 5-year period, both groups experienced a worsening of LA structure and function, with increases in LA volumes and stiffness index and decreases in LA longitudinal strain, LA function index, and LA emptying fraction over time. Changes in the ILI and control groups were not significantly different for any of the primary outcomes {LA emptying fraction: \u22120.95% [95% confidence interval (CI) \u22120.93, \u22120.98] in the control group, \u22120.97% [95% CI \u22120.94, \u22121.00] in the ILI group, Pbetween groups = 0.80; LA longitudinal strain: 0.82% [95% CI 0.79, 0.85] in the control group, 0.85% [95% CI 0.82, 0.89] in the ILI group, Pbetween groups = 0.24} or any of the secondary outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In overweight or obese people with Mets, an ILI had no impact on the underlying structural and functional LA substrate measurements associated with AF risk.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/eurjpc\/zwad380","type":"journal-article","created":{"date-parts":[[2023,12,13]],"date-time":"2023-12-13T21:04:03Z","timestamp":1702501443000},"page":"629-639","source":"Crossref","is-referenced-by-count":18,"title":["Effect of an intensive lifestyle intervention on the structural and functional substrate for atrial fibrillation in people with metabolic syndrome"],"prefix":"10.1093","volume":"31","author":[{"given":"Xavier","family":"Rossello","sequence":"first","affiliation":[{"name":"Hospital Universitari Son Espases, Health Research Institute of the Balearic Islands (IdISBa) , Carretera de Valldemossa, 79, 07120 Palma , Spain"},{"name":"Cardiology Department, Hospital Universitari Son Espases , Palma , Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ra\u00fal","family":"Ramallal","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Hospital of Navarra, Servicio Navarro de Salud Osasunbidea, IDISNA , Pamplona , Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5762-8558","authenticated-orcid":false,"given":"Dora","family":"Romaguera","sequence":"additional","affiliation":[{"name":"Hospital Universitari Son Espases, Health Research Institute of the Balearic Islands (IdISBa) , Carretera de Valldemossa, 79, 07120 Palma , Spain"},{"name":"CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Carlos III Health Institute (ISCIII) , C\/Monforte de Lemos, 3\u20135, 28029 Madrid , Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u00c1ngel M","family":"Alonso-G\u00f3mez","sequence":"additional","affiliation":[{"name":"CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Carlos III Health Institute (ISCIII) , C\/Monforte de Lemos, 3\u20135, 28029 Madrid , Spain"},{"name":"Bioaraba Health Research Institute, Osakidetza Basque Health Service, Araba University Hospital, University of the Basque Country UPV\/EHU , Vitoria-Gasteiz , Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2225-8323","authenticated-orcid":false,"given":"Alvaro","family":"Alonso","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Rollins School of Public Health, Emory University , Atlanta, GA , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucas","family":"Tojal-Sierra","sequence":"additional","affiliation":[{"name":"CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Carlos III Health Institute (ISCIII) , C\/Monforte de Lemos, 3\u20135, 28029 Madrid , Spain"},{"name":"Bioaraba Health Research Institute, Osakidetza Basque Health Service, Araba University Hospital, University of the Basque Country UPV\/EHU , Vitoria-Gasteiz , Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlos","family":"Fern\u00e1ndez-Palomeque","sequence":"additional","affiliation":[{"name":"Hospital Universitari Son Espases, Health Research Institute of the Balearic Islands (IdISBa) , Carretera de Valldemossa, 79, 07120 Palma , Spain"},{"name":"Cardiology Department, Hospital Universitari Son Espases , Palma , Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5104-1262","authenticated-orcid":false,"given":"Miguel \u00c1ngel","family":"Mart\u00ednez-Gonz\u00e1lez","sequence":"additional","affiliation":[{"name":"CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Carlos III Health Institute (ISCIII) , C\/Monforte de Lemos, 3\u20135, 28029 Madrid , Spain"},{"name":"Department of Preventive Medicine and Public Health, University of Navarra, IdiSNA , Pamplona , Spain"},{"name":"Department of Nutrition, Harvard T.H. 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