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Cao Y, Shrestha A, Janiczak A, Li X, Lu Y, Haregu T. Lifestyle Intervention in Reducing Insulin Resistance and Preventing type 2 Diabetes in Asia Pacific Region: A Systematic Review and Meta-Analysis. Curr Diab Rep 2024; 24:207-215. [PMID: 39083158 PMCID: PMC11303493 DOI: 10.1007/s11892-024-01548-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/14/2024] [Indexed: 08/07/2024]
Abstract
PURPOSE OF REVIEW To update the evidence of lifestyle interventions for the prevention of type 2 diabetes mellites (T2DM) in adults, particularly in the Asia Pacific region. The key questions to ask are: 1) How effective are lifestyle interventions in preventing T2DM among at-risk adults in the Asia Pacific Region? 2)What are the key characteristics of the implementation of lifestyle interventions for diabetes prevention? RECENT FINDINGS Lifestyle interventions for the prevention of T2DM have been suggested to be effective. There is evidence of ethnic differences in some glycaemic and anthropometric outcomes. The meta-analysis suggested a significant result in reducing waist circumference (standardised mean difference - 019, 95%CI ( -0.31, -0.06)), and no significant effects in other outcomes. However, the implementation outcomes suggested lifestyle intervention might be a cost-effective and sustainable approach in T2DM particularly in countries in the Asia Pacific Region. The focus of lifestyle intervention in the Asia Pacific Region should not only lie in the effectiveness of the trial but a thorough evaluation of the implementation outcomes, as well as cultural adaptations, with the support of all stakeholders through all stages of the implementation.
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Affiliation(s)
- Yingting Cao
- School of Allied Health, Human Services and Sport, La Trobe University, Plenty Road, Kingsbury Dr, Bundoora, VIC 3086, Australia.
- Non-communicable and implementation science lab, Baker Heart and Diabetes Institute, Alice Springs, Australia.
| | - Abha Shrestha
- Non-communicable and implementation science lab, Baker Heart and Diabetes Institute, Alice Springs, Australia
- School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - Amy Janiczak
- School of Allied Health, Human Services and Sport, La Trobe University, Plenty Road, Kingsbury Dr, Bundoora, VIC 3086, Australia
| | - Xia Li
- Statistics Consultancy Platform, La Trobe University, Melbourne, Australia
| | - Yang Lu
- Non-communicable and implementation science lab, Baker Heart and Diabetes Institute, Alice Springs, Australia
- School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
- School of Sociology and Population Studies, Nanjing University of Posts and Telecommunications, Nanjing, China
| | - Tilahun Haregu
- Non-communicable and implementation science lab, Baker Heart and Diabetes Institute, Alice Springs, Australia
- School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
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Tsoi KY, Chan RCM, Zhang C, Tam WH, Ma RCW. A randomized controlled trial to evaluate the effects of an early postnatal lifestyle modification program on diet, adiposity and metabolic outcome in mothers with gestational diabetes mellitus. Int J Gynaecol Obstet 2024; 166:1170-1182. [PMID: 38651286 DOI: 10.1002/ijgo.15521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 02/01/2024] [Accepted: 03/24/2024] [Indexed: 04/25/2024]
Abstract
OBJECTIVE The aim of the present study was to evaluate the effectiveness of a 12-month early postnatal lifestyle intervention program in women with gestational diabetes in a recent pregnancy. METHODS This study was a prospective randomized intervention study conducted at a diabetes center in Hong Kong. Chinese women aged 18-45 years, who developed gestational diabetes mellitus (GDM) in their most recent pregnancy, were invited. Eligible women were randomized in 1:1 ratio at baseline (6-12 weeks postpartum), to standard care or lifestyle intervention (diet and physical activity) groups for 12 months. A standardized biochemistry assessment including oral glucose tolerance test, blood lipids, complete blood count, renal and liver functions, were measured at baseline and at 12-month. Anthropometry assessment and lifestyle questionnaire were performed at various timepoints. RESULTS A total of 103 women were randomized at baseline and a total of 79 women (standard care, n = 39, intervention, n = 40) completed the assessment. After the 12-month study period, women in the intervention group had significantly lower energy intake (intervention, -497.6 ± 488.3 kcal; standard, -222.0 ± 390.0 kcal, P < 0.01) compared to the standard care group, and a trend towards greater weight reduction (intervention, -0.93 ± 4.68 kg; standard, -0.01 ± 3.12 kg, P = 0.36). CONCLUSION The lifestyle intervention implemented within 3 months postpartum appeared to promote postpartum weight loss. The early postnatal lifestyle intervention program may provide an opportunity to reduce the long-term risk of diabetes in this high-risk population.
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Affiliation(s)
- Kit Ying Tsoi
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Ruth C M Chan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Cuilin Zhang
- Global Center for Asian Women's Health & Bia-Echo Asia Center for Reproductive Longevity and Equality (ACRLE), Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Obstetrics and Gynecology, National University of Singapore, Singapore
| | - Wing Hung Tam
- Department of Obstetrics and Gynecology, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Ronald C W Ma
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong, China
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, The Chinese University of Hong Kong, Hong Kong, China
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Eng PC, Teo AED, Yew TW, Khoo CM. Implementing care for women with gestational diabetes after delivery-the challenges ahead. Front Glob Womens Health 2024; 5:1391213. [PMID: 39221169 PMCID: PMC11362992 DOI: 10.3389/fgwh.2024.1391213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Accepted: 07/31/2024] [Indexed: 09/04/2024] Open
Abstract
Gestational diabetes (GDM), defined as glucose intolerance during pregnancy, affects one in six pregnancies globally and significantly increases a woman's lifetime risk of type 2 diabetes mellitus (T2DM). Being a relatively young group, women with GDM are also at higher risk of developing diabetes related complications (e.g., cardiovascular disease, non-alcoholic fatty liver disease) later in life. Children of women with GDM are also likely to develop GDM and this perpetuates a cycle of diabetes, escalating our current pandemic of metabolic disease. The global prevalence of GDM has now risen by more than 30% over the last two decades, making it an emerging public health concern. Antepartum management of maternal glucose is unable to fully mitigate the associated lifetime cardiometabolic risk. Thus, efforts may need to focus on improving care for women with GDM during the postpartum period where prevention or therapeutic strategies could be implemented to attenuate progression of GDM to DM and its associated vascular complications. However, strategies to provide care for women in the postpartum period often showed disappointing results. This has led to a missed opportunity to halt the progression of impaired glucose tolerance/impaired fasting glucose to DM in women with GDM. In this review, we examined the challenges in the management of women with GDM after delivery and considered how each of these challenges are defined and could present as a gap in translating evidence to clinical care. We highlighted challenges related to postpartum surveillance, postpartum glucose testing strategies, postpartum risk factor modification, and problems encountered in engagement of patients/providers to implement interventions strategies in women with GDM after delivery. We reasoned that a multisystem approach is needed to address these challenges and to retard progression to DM and cardiovascular disease (CVD) in women with GDM pregnancies. This is very much needed to pave way for an improved, precise, culturally sensitive and wholistic care for women with GDM.
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Affiliation(s)
- Pei Chia Eng
- Department of Endocrinology, National University Health Systems, Singapore, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Digestion, Metabolism and Reproduction, Imperial College London, London, United Kingdom
| | - Ada Ee Der Teo
- Department of Endocrinology, National University Health Systems, Singapore, Singapore
| | - Tong Wei Yew
- Department of Endocrinology, National University Health Systems, Singapore, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Chin Meng Khoo
- Department of Endocrinology, National University Health Systems, Singapore, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Di J, Jia M, Zhou Y, Zhu Q, Wu L, Liu J. Motivational factors for dietary intake behavior in gestational diabetes mellitus: A cross-sectional study. Heliyon 2024; 10:e35317. [PMID: 39170276 PMCID: PMC11336641 DOI: 10.1016/j.heliyon.2024.e35317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 07/25/2024] [Accepted: 07/26/2024] [Indexed: 08/23/2024] Open
Abstract
Context Decision-making behavior pertains to the cognitive process where a patient evaluates the advantages and disadvantages of health-related decisions, taking into account their personal preferences, values, and cognitive factors. This behavior is central to the successful implementation of clinical care. Effective decision-making enhances an individual's or organization's response to challenges and opportunities, improves problem-solving capabilities, reduces risks and uncertainties, and facilitates the attainment of desired outcomes. Objective The goal of this study was to investigate the current status of dietary choice decision-making in gestational diabetes mellitus and to analyze its influencing factors, and then to find the determining factors and give targeted nursing interventions in order to improve the dietary decision-making ability of gestational diabetes mellitus patients and further standardize their dietary patterns. Methods A cross-sectional research design was employed in this study. Convenience sampling was utilized to survey 539 GDM patients attending the obstetrics outpatient clinic and obstetrics ward of a tertiary hospital in Wuxi City, China, from March 2023 to July 2023. The survey instruments used were the General Information Questionnaire, the Motivation to Protect Pregnant Women with Gestational Diabetes Mellitus Dietary Intake Questionnaire, and the Conflict in Decision-Making Scale. Results The findings were derived from data collected from 539 GDM cases. The participants' ages ranged from 19 to 52 years, with a mean age of 31.53 ± 4.37 years. The scores for GDM disease perceived susceptibility were 15.200 ± 3.481, disease perceived severity 18.455 ± 4.670, internal reward 13.226 ± 4.275, external reward 8.278 ± 2.923, response efficacy 15.078 ± 3.889, self-efficacy 18.952 ± 4.800, cost of response 14.540 ± 5.227, and decision conflict questionnaire score 70.96 ± 11.78. Conclusions The study revealed that GDM patients exhibited a moderate level of decision-making dilemma. Notably, the patients' perceived susceptibility and severity of the disease, along with their response efficacy and self-efficacy, positively influenced their dietary decision-making abilities. Specifically, enhancing patients' awareness of their condition and boosting their self-efficacy significantly improved their decision-making capabilities. Conversely, internal and external rewards, as well as the cost of response, exerted a negative impact on GDM patients' decision-making abilities. Therefore, it is imperative to mitigate potential barriers in GDM patients' dietary intake behaviors, thereby enhancing their decision-making skills related to dietary intake.
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Affiliation(s)
- Jiajin Di
- Jiangnan University Wuxi Medical College, Wuxi, Jiangsu, China
| | - Minjie Jia
- Jiangnan University Wuxi Medical College, Wuxi, Jiangsu, China
| | - Yunxu Zhou
- Jiangnan University Wuxi Medical College, Wuxi, Jiangsu, China
| | - Qingxian Zhu
- Jiangnan University Maternity Hospital, Wuxi, Jiangsu, China
| | - Lei Wu
- Jiangnan University Maternity Hospital, Wuxi, Jiangsu, China
| | - Jun Liu
- Jiangnan University Maternity Hospital, Wuxi, Jiangsu, China
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Alan Dikmen H, Gönenç İM, Ataş AN. Effects of peanut ball use on perceived labor pain, fatigue, and mother's perception of childbirth: a randomized controlled trial. Arch Gynecol Obstet 2024:10.1007/s00404-024-07656-2. [PMID: 39103620 DOI: 10.1007/s00404-024-07656-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 07/17/2024] [Indexed: 08/07/2024]
Abstract
PURPOSE The aim of this study was to evaluate the effects of using peanut balls on labor pain, fatigue, and the mother's perception of labor. METHODS This is a randomized controlled intervention trial. Data were collected from the Intervention (peanut ball) and Control groups between July 2022 and June 2023, with 45 pregnant women in each group. Data were collected using a personal information form, the Visual Analog Scale-Pain (VAS-P), the Visual Analog Scale for Fatigue (VAS-F), and the Maternal Perception of Childbirth Scale (MPCS). RESULTS The VAS-P scores of the intervention group were statistically significantly lower than those of the control group 15 min after peanut ball application (p = .000). Immediately after and 15 min after peanut ball application, the mean fatigue score of the Intervention group was statistically significantly lower than that of the Control group (p = .000). There was no statistically significant difference between the mean duration of labor minutes in the two groups (p = .177). The mean MPCS scores of the intervention group and control groups were 62.73 + 7.30 and 47.17 + 9.12, respectively, and the difference was statistically significant (p = .000). CONCLUSIONS The findings of this study indicate that the use of peanut balls during labor can effectively reduce labor pain and fatigue in pregnant women, without affecting the duration of labor. Additionally, the use of peanut balls has been shown to positively influence the perception of labor among pregnant women. Therefore, it is recommended that midwives educate pregnant women about the use of peanut balls during labor and provide support in their use.
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Affiliation(s)
- Hacer Alan Dikmen
- Faculty of Health Sciences, Department of Midwifery, Selcuk University, Selcuklu, 42250, Konya, Turkey.
| | | | - Ayşe Nur Ataş
- Faculty of Health Sciences, Department of Midwifery, Selcuk University, Konya, Turkey
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Wang Y, Wei W, Guo H, Wang D, Wei X, Zhang C, Zhang X, Huang Y. Postpartum life interventions to prevent type 2 diabetes in women with gestational diabetes: A systematic review and meta-analysis. J Diabetes Investig 2024; 15:1115-1128. [PMID: 38727771 PMCID: PMC11292388 DOI: 10.1111/jdi.14220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 03/14/2024] [Accepted: 04/08/2024] [Indexed: 08/02/2024] Open
Abstract
AIMS/INTRODUCTION Type 2 diabetes mellitus is a major metabolic disease that seriously endangers life and health, but women with gestational diabetes mellitus are at increased risk for developing type 2 diabetes mellitus. This study aimed to evaluate the effectiveness of postpartum lifestyle intervention on the prevention of type 2 diabetes mellitus, and the effect of lifestyle intervention on glycemic outcomes and anthropometric measures. MATERIALS AND METHODS We searched PubMed and other databases to retrieve articles published before May 21, 2023, on randomized controlled trials of postnatal lifestyle interventions (diet and/or physical activity) in women with gestational diabetes mellitus. We estimated the pooled odds ratios using fixed or random effects models and conducted a subgroup analysis of the different intervention methods to explore differences in the different lifestyle interventions. RESULTS The review included 17 randomized controlled trials. Overall, lifestyle changes started after a pregnancy complicated by gestational diabetes mellitus an 11% (RR = 0.89; 95% CI: 0.74-1.07) reduction in diabetes risk; significant differences were found for weight (MD = -1.33; 95% CI: [-1.76; -0.89], P < 0.00001) body mass index (MD = -0.53; 95% CI: [-0.74, -0.32], P < 0.00001), and waist circumference change (MD = -1.38; 95% CI: [-2.12; -0.64], P = 0.0002) but not for fasting glucose (MD = -0.06; 95% CI: [-0.19; 0.06], P = 0.32), 2 h glucose (MD = -0.12; 95% CI: [-0.30; 0.06], P = 0.19), and hemoglobin A1c (MD = -0.11; 95% CI: [-0.23; 0.02], P = 0.09). Subgroup analyses showed no significant differences in the effects of different lifestyle interventions on the incidence of type 2 diabetes, blood glucose levels, and anthropometric parameters. CONCLUSION Our comprehensive meta-analysis of lifestyle interventions can improve modifiable anthropometric measures in women with gestational diabetes. We need further research to provide more intensive lifestyle intervention, more scientific intervention methods, and to reduce the incidence of type 2 diabetes in patients with gestational diabetes.
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Affiliation(s)
- Yu Wang
- School of NursingSuzhou Medical College of Soochow UniversitySuzhouChina
- The Department of EndocrinologyThe Second Affiliated Hospital of Soochow UniversitySuzhouChina
| | - Wenjun Wei
- School of NursingSuzhou Medical College of Soochow UniversitySuzhouChina
| | - Heming Guo
- The Department of EndocrinologyThe Second Affiliated Hospital of Soochow UniversitySuzhouChina
| | - Dengmin Wang
- School of NursingSuzhou Medical College of Soochow UniversitySuzhouChina
| | - Xueli Wei
- The Department of EndocrinologyThe Second Affiliated Hospital of Soochow UniversitySuzhouChina
| | - Chunlan Zhang
- The Department of EndocrinologyThe Second Affiliated Hospital of Soochow UniversitySuzhouChina
| | - Xiaoyan Zhang
- The Department of EndocrinologyThe Second Affiliated Hospital of Soochow UniversitySuzhouChina
| | - Yun Huang
- The Department of EndocrinologyThe Second Affiliated Hospital of Soochow UniversitySuzhouChina
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Belsti Y, Moran LJ, Goldstein R, Mousa A, Cooray SD, Baker S, Gupta Y, Patel A, Tandon N, Ajanthan S, John R, Naheed A, Chakma N, Lakshmi JK, Zoungas S, Billot L, Desai A, Bhatla N, Prabhakaran D, Gupta I, de Silva HA, Kapoor D, Praveen D, Farzana N, Enticott J, Teede H. Development of a risk prediction model for postpartum onset of type 2 diabetes mellitus, following gestational diabetes; the lifestyle InterVention in gestational diabetes (LIVING) study. Clin Nutr 2024; 43:1728-1735. [PMID: 38909514 DOI: 10.1016/j.clnu.2024.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 04/18/2024] [Accepted: 06/07/2024] [Indexed: 06/25/2024]
Abstract
AIMS This study aimed to develop a prediction model for identifying a woman with gestational diabetes mellitus (GDM) at high risk of type 2 diabetes (T2DM) post-birth. METHODS Utilising data from 1299 women in the Lifestyle Intervention IN Gestational Diabetes (LIVING) study, two models were developed: one for pregnancy and another for postpartum. Key predictors included glucose test results, medical history, and biometric indicators. RESULTS Of the initial cohort, 124 women developed T2DM within three years. The study identified seven predictors for the antenatal T2DM risk prediction model and four for the postnatal one. The models demonstrated good to excellent predictive ability, with Area under the ROC Curve (AUC) values of 0.76 (95% CI: 0.72 to 0.80) and 0.85 (95% CI: 0.81 to 0.88) for the antenatal and postnatal models, respectively. Both models underwent rigorous validation, showing minimal optimism in predictive capability. Antenatal model, considering the Youden index optimal cut-off point of 0.096, sensitivity, specificity, and accuracy were measured as 70.97%, 70.81%, and 70.82%, respectively. For the postnatal model, considering the cut-off point 0.086, sensitivity, specificity, and accuracy were measured as 81.40%, 75.60%, and 76.10%, respectively. CONCLUSIONS These models are effective for predicting T2DM risk in women with GDM, although external validation is recommended before widespread application.
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Affiliation(s)
- Yitayeh Belsti
- Monash Centre for Health Research and Implementation, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Lisa J Moran
- Monash Centre for Health Research and Implementation, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Rebecca Goldstein
- Monash Centre for Health Research and Implementation, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia; Monash Health, Melbourne, Australia
| | - Aya Mousa
- Monash Centre for Health Research and Implementation, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Shamil D Cooray
- Monash Centre for Health Research and Implementation, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia; Monash Health, Melbourne, Australia
| | - Susanne Baker
- Monash Centre for Health Research and Implementation, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Yashdeep Gupta
- All India Institute of Medical Sciences, New Delhi, India
| | - Anushka Patel
- The George Institute for Global Health, University of New South Wales, Newtown, NSW, Australia
| | - Nikhil Tandon
- All India Institute of Medical Sciences, New Delhi, India
| | | | - Renu John
- The George Institute for Global Health, New Delhi, India
| | - Aliya Naheed
- Non-Communicable Diseases, Nutrition Research Division, International Centre for Diarrhoeal Disease Research, Bangladesh
| | - Nantu Chakma
- Non-Communicable Diseases, Nutrition Research Division, International Centre for Diarrhoeal Disease Research, Bangladesh
| | - Josyula K Lakshmi
- Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India; The George Institute for Global Health, New Delhi, India; Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
| | - Sophia Zoungas
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Laurent Billot
- The George Institute for Global Health, New Delhi, India; Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
| | - Ankush Desai
- Department of Endocrinology, Goa Medical College, Goa, India
| | - Neerja Bhatla
- All India Institute of Medical Sciences, New Delhi, India
| | | | - Ishita Gupta
- Centre for Chronic Disease Control, New Delhi, India
| | - H Asita de Silva
- Clinical Trials Unit, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
| | - Deksha Kapoor
- All India Institute of Medical Sciences, New Delhi, India
| | - Devarsetty Praveen
- Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India; Faculty of Medicine and Health, University of New South Wales, Sydney, Australia; George Institute for Global Health, Hyderabad, India
| | - Noshin Farzana
- Non-Communicable Diseases, Nutrition Research Division, International Centre for Diarrhoeal Disease Research, Bangladesh
| | - Joanne Enticott
- Monash Centre for Health Research and Implementation, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.
| | - Helena Teede
- Monash Centre for Health Research and Implementation, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia; Monash Health, Melbourne, Australia
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Lee VY, Monjur MR, Santos JA, Patel A, Liu R, Di Tanna GL, Gupta Y, Goyal A, Ajanthan S, Praveen D, Lakshmi JK, de Silva HA, Tandon N. The efficacy of interventions to prevent type 2 diabetes among women with recent gestational diabetes mellitus-A living systematic review and meta-analysis. J Diabetes 2024; 16:e13590. [PMID: 39136500 PMCID: PMC11320752 DOI: 10.1111/1753-0407.13590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 04/05/2024] [Accepted: 05/13/2024] [Indexed: 08/16/2024] Open
Abstract
BACKGROUND While previously considered a transient condition, with no lasting adverse impact, gestational diabetes mellitus (GDM) is now a well-established risk factor for developing type 2 diabetes mellitus (T2DM). The risk of developing T2DM appears to be particularly high in the first few years after childbirth, providing a compelling case for early intervention. This review provides an up-to-date systematic review and meta-analysis to assess the effectiveness of interventions to reduce incidence of T2DM in women with a recent history of GDM. METHODS The search was conducted on October 20, 2023 with an annual surveillance planned for the next 5 years to maintain a living systematic review. The inclusion criteria were randomized controlled trials of any type in women within 5 years of GDM-complicated pregnancy that reported outcomes of T2DM diagnosis or measures of dysglycemia with a follow-up of at least 12 months. RESULTS Seventeen studies met our inclusion criteria and have been included in this review. There were 3 pharmacological and 14 lifestyle interventions. Intervention was not associated with significant reduction in the primary outcome of T2DM (risk ratio, 0.78; 95% confidence interval [CI]: 0.43-1.41; p = 0.41; I2 = 79%) compared with the control group (placebo or usual care). However, meta-analysis of the four studies reporting hazard ratios suggested a reduction in diabetes incidence (hazard ratio, 0.68; 95% CI: 0.48-0.97; p = 0.03; I2 = 31%). CONCLUSION This review provides equivocal evidence about the efficacy of interventions to reduce the risk of T2DM in women within 5 years of GDM-complicated pregnancy and highlights the need for further studies, including pharmacotherapy.
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Affiliation(s)
- Vivian Y. Lee
- The George Institute for Global HealthSydneyNew South WalesAustralia
- Faculty of MedicineUniversity of New South WalesKensingtonNew South WalesAustralia
| | - Mohammad R. Monjur
- South Eastern Sydney Local Health DistrictSydneyNew South WalesAustralia
| | | | - Anushka Patel
- The George Institute for Global HealthSydneyNew South WalesAustralia
- Faculty of MedicineUniversity of New South WalesKensingtonNew South WalesAustralia
| | - Rong Liu
- The George Institute for Global HealthSydneyNew South WalesAustralia
- Faculty of MedicineUniversity of New South WalesKensingtonNew South WalesAustralia
| | - Gian Luca Di Tanna
- The George Institute for Global HealthSydneyNew South WalesAustralia
- Faculty of MedicineUniversity of New South WalesKensingtonNew South WalesAustralia
- Department of Innovative TechnologiesUniversity of Applied Sciences and Arts of Southern SwitzerlandMannoSwitzerland
| | - Yashdeep Gupta
- Department of Endocrinology and MetabolismAll India Institute of Medical SciencesNew DelhiIndia
| | - Alpesh Goyal
- Department of Endocrinology and MetabolismAll India Institute of Medical SciencesNew DelhiIndia
| | | | - Devarsetty Praveen
- Faculty of MedicineUniversity of New South WalesKensingtonNew South WalesAustralia
- The George Institute for Global HealthNew DelhiIndia
- Prasanna School of Public HealthManipalIndia
| | - J. K. Lakshmi
- Faculty of MedicineUniversity of New South WalesKensingtonNew South WalesAustralia
- The George Institute for Global HealthNew DelhiIndia
- Prasanna School of Public HealthManipalIndia
| | - H. Asita de Silva
- Clinical Trials Unit, Department of Pharmacology, Faculty of MedicineUniversity of KelaniyaColomboSri Lanka
| | - Nikhil Tandon
- Department of Endocrinology and MetabolismAll India Institute of Medical SciencesNew DelhiIndia
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9
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Shen X, Guo G, Feng G, Wang Z. Effects of Different Carbohydrate Content Diet on Gut Microbiota and Aortic Calcification in Diabetic Mice. Diabetes Metab Syndr Obes 2024; 17:2327-2346. [PMID: 38881695 PMCID: PMC11178077 DOI: 10.2147/dmso.s456571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 05/28/2024] [Indexed: 06/18/2024] Open
Abstract
Introduction Vascular calcification is a major cause of cardiovascular accidents in patients with type 2 diabetes mellitus. This study aimed to investigate the impact of carbohydrates on gut microbiota and aortic calcification in diabetic ApoE-/- mice. Methods The diabetic ApoE-/- mice were randomly divided into 4 groups: ketogenic diet group, low carbohydrate diet group, medium carbohydrate diet group, and high carbohydrate diet group. The mice were fed continuously for 6 months, with blood glucose, blood ketone and body weight monitored monthly. Lipid metabolism indicators and inflammatory factors were detected using ELISA. The intestinal barrier, atherosclerotic lesion areas, and vascular calcifications were analyzed based on their morphology. Gut microbiota was analyzed using 16S rRNA genes. Results We found that ketogenic diet played some roles improving glucose, lipid metabolism, and inflammation. Ketogenic diet could improve the intestinal barrier to some extent and increase intestinal bacteria. Compared to the other three groups, the relative abundance of genus Allobaculum, species Blautia producta and Clostridium Ramosum in the ketogenic diet group was significantly increased (P <0.05), which has protective effects in diabetic ApoE-/- mice. Conclusion Ketogenic diet could delay the onset of aortic atherosclerosis, aortic calcification and improve intestinal barrier function in diabetic ApoE-/- mice.
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Affiliation(s)
- Xinyi Shen
- Department of Cardiology, Affiliated Hospital of Jiangsu University, Zhenjiang, 212000, People's Republic of China
- Institute of Cardiovascular Diseases, Jiangsu University, Zhenjiang, 212001, People's Republic of China
| | - Ge Guo
- Department of Cardiology, Affiliated Hospital of Jiangsu University, Zhenjiang, 212000, People's Republic of China
- Institute of Cardiovascular Diseases, Jiangsu University, Zhenjiang, 212001, People's Republic of China
| | - Guoquan Feng
- Imaging Department, Affiliated Hospital of Jiangsu University, Zhenjiang, 212000, People's Republic of China
| | - Zhongqun Wang
- Department of Cardiology, Affiliated Hospital of Jiangsu University, Zhenjiang, 212000, People's Republic of China
- Institute of Cardiovascular Diseases, Jiangsu University, Zhenjiang, 212001, People's Republic of China
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10
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Gupta Y, Kapoor D, Lakshmi JK, Praveen D, Santos JA, Billot L, Naheed A, de Silva HA, Gupta I, Farzana N, John R, Ajanthan S, Bhatla N, Desai A, Pathmeswaran A, Prabhakaran D, Teede H, Zoungas S, Patel A, Tandon N. Antenatal oral glucose tolerance test abnormalities in the prediction of future risk of postpartum diabetes in women with gestational diabetes: Results from the LIVING study. J Diabetes 2024; 16:e13559. [PMID: 38708437 PMCID: PMC11070840 DOI: 10.1111/1753-0407.13559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 02/27/2024] [Accepted: 03/19/2024] [Indexed: 05/07/2024] Open
Abstract
OBJECTIVES To explore associations between type and number of abnormal glucose values on antenatal oral glucose tolerance test (OGTT) with postpartum diabetes in South Asian women diagnosed with gestational diabetes (GDM) using International Association of the Diabetes and Pregnancy Study Groups criteria. METHODS This post-hoc evaluation of the Lifestyle Intervention IN Gestational Diabetes (LIVING) study, a randomized controlled trial, was conducted among women with GDM in the index pregnancy, across 19 centers in Bangladesh, India, and Sri Lanka. Postpartum diabetes (outcome) was defined on OGTT, using American Diabetes Association (ADA) criteria. RESULTS We report data on 1468 women with GDM, aged 30.9 (5.0) years, and with median (interquartile range) follow-up period of 1.8 (1.4-2.4) years after childbirth following the index pregnancy. We found diabetes in 213 (14.5%) women with an incidence of 8.7 (7.6-10.0)/100 women-years. The lowest incidence rate was 3.8/100 women years, in those with an isolated fasting plasma glucose (FPG) abnormality, and highest was 19.0/100 women years in participants with three abnormal values. The adjusted hazard ratios for two and three abnormal values compared to one abnormal value were 1.73 (95% confidence interval [CI], 1.18-2.54; p = .005) and 3.56 (95% CI, 2.46-5.16; p < .001) respectively. The adjusted hazard ratio for the combined (combination of fasting and postglucose load) abnormalities was 2.61 (95% CI, 1.70-4.00; p < .001), compared to isolated abnormal FPG. CONCLUSIONS Risk of diabetes varied significantly depending upon the type and number of abnormal values on antenatal OGTT. These data may inform future precision medicine approaches such as risk prediction models in identifying women at higher risk and may guide future targeted interventions.
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Affiliation(s)
- Yashdeep Gupta
- Department of Endocrinology and MetabolismAll India Institute of Medical SciencesNew DelhiIndia
| | - Deksha Kapoor
- Department of Endocrinology and MetabolismAll India Institute of Medical SciencesNew DelhiIndia
| | - Josyula K. Lakshmi
- George Institute for Global HealthHyderabadIndia
- Faculty of Medicine and HealthUniversity of New South WalesSydneyNew South WalesAustralia
- Prasanna School of Public HealthManipal Academy of Higher EducationManipalIndia
| | - Devarsetty Praveen
- George Institute for Global HealthHyderabadIndia
- Faculty of Medicine and HealthUniversity of New South WalesSydneyNew South WalesAustralia
- Prasanna School of Public HealthManipal Academy of Higher EducationManipalIndia
| | | | - Laurent Billot
- Faculty of Medicine and HealthUniversity of New South WalesSydneyNew South WalesAustralia
- George Institute for Global HealthSydneyNew South WalesAustralia
| | - Aliya Naheed
- Initiative for Non Communicable Diseases, Nutrition Research DivisionInternational Centre for Diarrhoeal Disease Research (ICDDR, B)DhakaBangladesh
| | - H. Asita de Silva
- Clinical Trials Unit, Department of Pharmacology, Faculty of MedicineUniversity of KelaniyaKelaniyaSri Lanka
| | - Ishita Gupta
- Centre for Chronic Disease ControlNew DelhiIndia
| | - Noshin Farzana
- Initiative for Non Communicable Diseases, Nutrition Research DivisionInternational Centre for Diarrhoeal Disease Research (ICDDR, B)DhakaBangladesh
| | - Renu John
- George Institute for Global HealthHyderabadIndia
| | | | - Neerja Bhatla
- Department of Obstetrics and GynaecologyAll India Institute of Medical SciencesNew DelhiIndia
| | - Ankush Desai
- Department of EndocrinologyGoa Medical CollegeGoaIndia
| | | | - Dorairaj Prabhakaran
- Centre for Chronic Disease ControlNew DelhiIndia
- Public Health Foundation of IndiaNew DelhiIndia
- London School of Hygiene and Tropical MedicineLondonUK
| | - Helena Teede
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
| | - Sophia Zoungas
- School of Public Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
| | - Anushka Patel
- Faculty of Medicine and HealthUniversity of New South WalesSydneyNew South WalesAustralia
- George Institute for Global HealthSydneyNew South WalesAustralia
| | - Nikhil Tandon
- Department of Endocrinology and MetabolismAll India Institute of Medical SciencesNew DelhiIndia
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11
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Minschart C, Myngheer N, Maes T, De Block C, Van Pottelbergh I, Abrams P, Vinck W, Leuridan L, Driessens S, Mathieu C, Billen J, Matthys C, Laenen A, Bogaerts A, Benhalima K. Effectiveness of a blended mobile-based lifestyle intervention in women with glucose intolerance after a recent history of gestational diabetes (MELINDA): a 1-year, prospective, multicentre, randomised controlled trial. EClinicalMedicine 2024; 70:102523. [PMID: 38495521 PMCID: PMC10940944 DOI: 10.1016/j.eclinm.2024.102523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 02/02/2024] [Accepted: 02/20/2024] [Indexed: 03/19/2024] Open
Abstract
Background Women with glucose intolerance after gestational diabetes mellitus (GDM) are at high risk to develop type 2 diabetes. Traditional lifestyle interventions in early postpartum have limited impact. We investigated the efficacy of a blended mobile-based lifestyle intervention in women with glucose intolerance after a recent history of GDM. Methods Prospective, double-arm, non-masked, multicentre randomised controlled trial (RCT) in which women with glucose intolerance, diagnosed 6-16 weeks after a GDM-complicated pregnancy, were assigned 1:1 to a one-year blended-care, telephone- and mobile-based lifestyle program (intervention) or usual care (control). Primary endpoint was the proportion of women able to achieve their weight goal (≥5% weight loss if prepregnancy BMI ≥ 25 kg/m2 or return to prepregnancy weight if prepregnancy BMI < 25 kg/m2) in the intention-to-treat sample. Key secondary outcomes were frequency of glucose intolerance, diabetes and metabolic syndrome, and lifestyle-related outcomes assessed with self-administered questionnaires. The study was registered in ClinicalTrials.gov (NCT03559621). Findings Between April 10th 2019 and May 13th 2022, 240 participants were assigned to the intervention (n = 121) or control group (n = 119), of which 167 (n = 82 in intervention and n = 85 in control group) completed the study. Primary outcome was achieved by 46.3% (56) of intervention participants compared to 43.3% (52) in the control group [odds ratio (OR) 1.13, 95% confidence interval (CI) 0.63-2.03, p = 0.680; risk ratio 1.07, 95% CI (0.78-1.48)]. Women in the intervention group developed significantly less often metabolic syndrome compared to the control group [7.3% (6) vs. 16.5% (14), OR 0.40, CI (0.22-0.72), p = 0.002], reported less sedentary behaviour and higher motivation for continuing healthy behaviours. In the intervention group, 84.1% (69) attended at least eight telephone sessions and 70.7% (58) used the app at least once weekly. Interpretation A blended, mobile-based lifestyle intervention was not effective in achieving weight goals, but reduced the risk to develop metabolic syndrome. Funding Research fund of University Hospitals Leuven, Novo Nordisk, Sanofi, AstraZeneca, Boehringer-Ingelheim, Lilly.
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Affiliation(s)
- Caro Minschart
- Department of Endocrinology, University Hospitals Leuven, Leuven 3000, Belgium
| | - Nele Myngheer
- Department of Endocrinology, General Hospital Groeninge, Kortrijk 8500, Belgium
| | - Toon Maes
- Department of Endocrinology, Imelda Hospital, Bonheiden 2820, Belgium
| | - Christophe De Block
- Department of Endocrinology-Diabetology-Metabolism, Antwerp University Hospital, Edegem 2650, Belgium
| | | | - Pascale Abrams
- Department of Endocrinology, ZAS Sint-Vincentius, Antwerp 2018, Belgium
- Department of Endocrinology, ZAS Sint-Augustinus, Wilrijk 2610, Belgium
| | - Wouter Vinck
- Department of Endocrinology, ZAS Sint-Augustinus, Wilrijk 2610, Belgium
| | - Liesbeth Leuridan
- Department of Endocrinology, General Hospital Klina, Brasschaat 2930, Belgium
| | - Sabien Driessens
- Department of Endocrinology, General Hospital Klina, Brasschaat 2930, Belgium
| | - Chantal Mathieu
- Department of Endocrinology, University Hospitals Leuven, Leuven 3000, Belgium
- Clinical and Experimental Endocrinology, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven 3000, Belgium
| | - Jaak Billen
- Department of Laboratory Medicine, University Hospitals Leuven, Leuven 3000, Belgium
| | - Christophe Matthys
- Department of Endocrinology, University Hospitals Leuven, Leuven 3000, Belgium
- Clinical and Experimental Endocrinology, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven 3000, Belgium
| | - Annouschka Laenen
- Centre of Biostatics and Statistical Bioinformatics, KU Leuven, Leuven 3000, Belgium
| | - Annick Bogaerts
- Department of Development and Regeneration, KU Leuven, Leuven 3000, Belgium
- Faculty of Health, University of Plymouth, Devon PL4 8AA, United Kingdom
| | - Katrien Benhalima
- Department of Endocrinology, University Hospitals Leuven, Leuven 3000, Belgium
- Clinical and Experimental Endocrinology, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven 3000, Belgium
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12
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He J, Hu K, Wang B, Wang H. Effect of dietary and physical activity behavioral interventions on reducing postpartum weight retention among women with recent gestational diabetes: A systematic review and meta-analysis of randomized controlled trials. Obes Rev 2024; 25:1-771. [PMID: 38212255 DOI: 10.1111/obr.13689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 11/22/2023] [Accepted: 11/22/2023] [Indexed: 01/13/2024]
Abstract
Postpartum weight retention (PPWR) increases the risk of long-term obesity and metabolic disease in women with recent gestational diabetes mellitus (GDM). This systematic review aimed to assess the effectiveness of dietary and physical activity behavior interventions in reducing PPWR. We systematically searched 13 electronic databases to retrieve articles published in English or Chinese before October 22, 2022. Randomized controlled trials (RCTs) that assessed dietary and/or physical activity behaviors interventions on the outcomes of PPWR among women with recent GDM were included. Twelve studies researched a total of 5672 participants. The meta-analysis indicated that dietary and physical activity behaviors interventions showed significant effects on the pooled effect size of body weight changes (WMD = -2.19, 95% CIs: -3.39, -0.98 kg), body mass index (WMD = -0.98, 95% CIs: -1.56, -0.39 kg/m2 ), and waist circumference (WMD = -1.20, 95% CIs: -2.49, 0.08 cm). Furthermore, the intervention group was more likely to achieve weight reduction (OR = 0.76, 95% CIs: 0.67, 0.87) than the control group. Postpartum dietary and physical activity behavior interventions for women with a recent GDM can reduce PPWR, and 1 year postpartum may be a window of opportunity.
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Affiliation(s)
- Jing He
- Nursing Department, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
- School of Nursing, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Kaili Hu
- Nursing Department, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Binghua Wang
- Nursing Department, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Hui Wang
- Nursing Department, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
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13
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Siddiqui SA, Erol Z, Rugji J, Taşçı F, Kahraman HA, Toppi V, Musa L, Di Giacinto G, Bahmid NA, Mehdizadeh M, Castro-Muñoz R. An overview of fermentation in the food industry - looking back from a new perspective. BIORESOUR BIOPROCESS 2023; 10:85. [PMID: 38647968 PMCID: PMC10991178 DOI: 10.1186/s40643-023-00702-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 10/25/2023] [Indexed: 04/25/2024] Open
Abstract
Fermentation is thought to be born in the Fertile Crescent, and since then, almost every culture has integrated fermented foods into their dietary habits. Originally used to preserve foods, fermentation is now applied to improve their physicochemical, sensory, nutritional, and safety attributes. Fermented dairy, alcoholic beverages like wine and beer, fermented vegetables, fruits, and meats are all highly valuable due to their increased storage stability, reduced risk of food poisoning, and enhanced flavor. Over the years, scientific research has associated the consumption of fermented products with improved health status. The fermentation process helps to break down compounds into more easily digestible forms. It also helps to reduce the amount of toxins and pathogens in food. Additionally, fermented foods contain probiotics, which are beneficial bacteria that help the body to digest food and absorb nutrients. In today's world, non-communicable diseases such as cardiovascular disease, type 2 diabetes, cancer, and allergies have increased. In this regard, scientific investigations have demonstrated that shifting to a diet that contains fermented foods can reduce the risk of non-communicable diseases. Moreover, in the last decade, there has been a growing interest in fermentation technology to valorize food waste into valuable by-products. Fermentation of various food wastes has resulted in the successful production of valuable by-products, including enzymes, pigments, and biofuels.
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Affiliation(s)
- Shahida Anusha Siddiqui
- Technical University of Munich, Campus Straubing for Biotechnology and Sustainability, Essigberg 3, 94315, Straubing, Germany.
- German Institute of Food Technologies (DIL E.V.), Prof.-Von-Klitzing Str. 7, 49610, Quakenbrück, Germany.
| | - Zeki Erol
- Department of Food Hygiene and Technology, Faculty of Veterinary Medicine, Burdur Mehmet Akif Ersoy University, İstiklal Campus, 15030, Burdur, Turkey
| | - Jerina Rugji
- Department of Food Hygiene and Technology, Faculty of Veterinary Medicine, Burdur Mehmet Akif Ersoy University, İstiklal Campus, 15030, Burdur, Turkey
| | - Fulya Taşçı
- Department of Food Hygiene and Technology, Faculty of Veterinary Medicine, Burdur Mehmet Akif Ersoy University, İstiklal Campus, 15030, Burdur, Turkey
| | - Hatice Ahu Kahraman
- Department of Food Hygiene and Technology, Faculty of Veterinary Medicine, Burdur Mehmet Akif Ersoy University, İstiklal Campus, 15030, Burdur, Turkey
| | - Valeria Toppi
- Department of Veterinary Medicine, University of Perugia, 06126, Perugia, Italy
| | - Laura Musa
- Department of Veterinary Medicine and Animal Sciences, University of Milan, 26900, Lodi, Italy
| | - Giacomo Di Giacinto
- Department of Veterinary Medicine, University of Perugia, 06126, Perugia, Italy
| | - Nur Alim Bahmid
- Research Center for Food Technology and Processing, National Research and Innovation Agency (BRIN), Gading, Playen, Gunungkidul, 55861, Yogyakarta, Indonesia
| | - Mohammad Mehdizadeh
- Faculty of Agriculture and Natural Resources, University of Mohaghegh Ardabili, Ardabil, Iran
- Ilam Science and Technology Park, Ilam, Iran
| | - Roberto Castro-Muñoz
- Tecnologico de Monterrey, Campus Toluca, Av. Eduardo Monroy Cárdenas 2000, San Antonio Buenavista, 50110, Toluca de Lerdo, Mexico.
- Department of Sanitary Engineering, Faculty of Civil and Environmental Engineering, Gdansk University of Technology, G. Narutowicza St. 11/12, 80-233, Gdansk, Poland.
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14
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Ukke GG, Boyle JA, Reja A, Lee WK, Chen M, Ko MSM, Alycia C, Kwon J, Lim S. Lifestyle Interventions to Prevent Type 2 Diabetes in Women with a History of Gestational Diabetes: A Systematic Review and Meta-Analysis through the Lens of Health Equity. Nutrients 2023; 15:4666. [PMID: 37960319 PMCID: PMC10649749 DOI: 10.3390/nu15214666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 10/20/2023] [Accepted: 10/30/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Type 2 diabetes mellites is one of the health problems disproportionally affecting people with low socioeconomic statuses. Gestational diabetes mellites increases the risk of type 2 diabetes by up to ten-fold for women. Lifestyle interventions prevent type 2 diabetes in women with prior gestational diabetes. However, it is unknown if similar effectiveness can be expected for all population subgroups. OBJECTIVE This study aims to assess the prevention of type 2 diabetes in women with prior gestational diabetes using population characteristics according to the PROGRESS (place of residence, race/ethnicity/culture/language, occupation, gender/sex, religion, education, socioeconomic status, and social capital) criteria. METHODS MEDLINE, CINAHL, EMBASE, PubMed, PsycINFO, Web of Science, and EBM Reviews databases were searched for interventional studies of diet, physical activity, or behavioural interventions published up to 21 February 2023. Random effects subgroup meta-analysis was conducted to evaluate the association of population characteristics and intervention effects. RESULTS All studies were conducted in high-income countries or middle-income countries. Two-thirds of the studies reported on race/ethnicity and education level. Less than one-third reported on place (urban/rural), occupation, and socioeconomic status. None reported on religion or social capital. Studies from high-income countries (MD = -1.46; 95% CI: -2.27, -0.66, I2 = 70.46, p < 0.001) showed a greater reduction in bodyweight compared with the studies conducted in middle-income countries (MD = -0.11; 95% CI: -1.12, 0.89, I2 = 69.31, p < 0.001) (p for subgroup difference = 0.04). CONCLUSION There are significant equity gaps in the evidence for the prevention of type 2 diabetes in women with prior gestational diabetes due to reports on population characteristics being poor. Interventions may be less effective in reducing bodyweight in women from middle-income countries compared to high-income countries. Collecting and analysing data related to equity is needed to understand the effect of lifestyle interventions on type 2 diabetes for different population subgroups.
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Affiliation(s)
- Gebresilasea Gendisha Ukke
- Health Systems and Equity, Eastern Health Clinical School, Monash University, Level 2, 5 Arnold Street, Box Hill, VIC 3128, Australia; (G.G.U.); (J.A.B.)
| | - Jacqueline A. Boyle
- Health Systems and Equity, Eastern Health Clinical School, Monash University, Level 2, 5 Arnold Street, Box Hill, VIC 3128, Australia; (G.G.U.); (J.A.B.)
| | - Ahmed Reja
- School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa 9086, Ethiopia;
| | - Wai Kit Lee
- Faculty of Medicine, Nursing and Health Sciences, Monash University, 264 Ferntree Gully Rd, Notting Hill, VIC 3168, Australia; (W.K.L.); (C.A.)
| | - Mingling Chen
- Monash Centre for Health Research and Implementation, Monash University, Level 1, 43-51 Kanooka Grove, Clayton, VIC 3168, Australia;
| | - Michelle Shi Min Ko
- MD Programme, Duke-NUS Medical School, 8 College Rd, Singapore 169857, Singapore;
| | - Chelsea Alycia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, 264 Ferntree Gully Rd, Notting Hill, VIC 3168, Australia; (W.K.L.); (C.A.)
| | - Jane Kwon
- Diabetes Victoria, Suite G01/15-31 Pelham St, Carlton, VIC 3053, Australia;
| | - Siew Lim
- Health Systems and Equity, Eastern Health Clinical School, Monash University, Level 2, 5 Arnold Street, Box Hill, VIC 3128, Australia; (G.G.U.); (J.A.B.)
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15
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Beyene HB, Giles C, Huynh K, Wang T, Cinel M, Mellett NA, Olshansky G, Meikle TG, Watts GF, Hung J, Hui J, Cadby G, Beilby J, Blangero J, Moses EK, Shaw JE, Magliano DJ, Meikle PJ. Metabolic phenotyping of BMI to characterize cardiometabolic risk: evidence from large population-based cohorts. Nat Commun 2023; 14:6280. [PMID: 37805498 PMCID: PMC10560260 DOI: 10.1038/s41467-023-41963-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 09/26/2023] [Indexed: 10/09/2023] Open
Abstract
Obesity is a risk factor for type 2 diabetes and cardiovascular disease. However, a substantial proportion of patients with these conditions have a seemingly normal body mass index (BMI). Conversely, not all obese individuals present with metabolic disorders giving rise to the concept of "metabolically healthy obese". We use lipidomic-based models for BMI to calculate a metabolic BMI score (mBMI) as a measure of metabolic dysregulation associated with obesity. Using the difference between mBMI and BMI (mBMIΔ), we identify individuals with a similar BMI but differing in their metabolic health and disease risk profiles. Exercise and diet associate with mBMIΔ suggesting the ability to modify mBMI with lifestyle intervention. Our findings show that, the mBMI score captures information on metabolic dysregulation that is independent of the measured BMI and so provides an opportunity to assess metabolic health to identify "at risk" individuals for targeted intervention and monitoring.
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Affiliation(s)
- Habtamu B Beyene
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
- Baker Department of Cardiovascular Research Translation and Implementation, La Trobe University, Melbourne, VIC, Australia
- Baker Department of Cardiometabolic Health, Melbourne University, Melbourne, VIC, Australia
| | - Corey Giles
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
- Baker Department of Cardiovascular Research Translation and Implementation, La Trobe University, Melbourne, VIC, Australia
- Baker Department of Cardiometabolic Health, Melbourne University, Melbourne, VIC, Australia
| | - Kevin Huynh
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
- Baker Department of Cardiovascular Research Translation and Implementation, La Trobe University, Melbourne, VIC, Australia
- Baker Department of Cardiometabolic Health, Melbourne University, Melbourne, VIC, Australia
| | - Tingting Wang
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
- Baker Department of Cardiovascular Research Translation and Implementation, La Trobe University, Melbourne, VIC, Australia
- Baker Department of Cardiometabolic Health, Melbourne University, Melbourne, VIC, Australia
| | - Michelle Cinel
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | | | | | - Thomas G Meikle
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
- Baker Department of Cardiovascular Research Translation and Implementation, La Trobe University, Melbourne, VIC, Australia
| | - Gerald F Watts
- School of Medicine, University of Western Australia, Perth, WA, Australia
- Lipid Disorders Clinic, Department of Cardiology, Royal Perth Hospital, Perth, WA, Australia
| | - Joseph Hung
- School of Medicine, University of Western Australia, Perth, WA, Australia
| | - Jennie Hui
- PathWest Laboratory Medicine of Western Australia, Nedlands, WA, Australia
- School of Biomedical Sciences, University of Western Australia, Crawley, WA, Australia
- School of Population and Global Health, University of Western Australia, Crawley, WA, Australia
| | - Gemma Cadby
- School of Population and Global Health, University of Western Australia, Crawley, WA, Australia
| | - John Beilby
- School of Biomedical Sciences, University of Western Australia, Crawley, WA, Australia
| | - John Blangero
- South Texas Diabetes and Obesity Institute, The University of Texas Rio Grande Valley, Brownsville, TX, USA
| | - Eric K Moses
- School of Biomedical Sciences, University of Western Australia, Crawley, WA, Australia
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Jonathan E Shaw
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Dianna J Magliano
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia.
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia.
| | - Peter J Meikle
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia.
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia.
- Baker Department of Cardiovascular Research Translation and Implementation, La Trobe University, Melbourne, VIC, Australia.
- Baker Department of Cardiometabolic Health, Melbourne University, Melbourne, VIC, Australia.
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16
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Gupta Y, Kapoor D, Lakshmi JK, Praveen D, Santos JA, Billot L, Naheed A, de Silva HA, Gupta I, Farzana N, John R, Ajanthan S, Bhatla N, Desai A, Pathmeswaran A, Prabhakaran D, Teede H, Zoungas S, Patel A, Tandon N. The incidence and risk factors of postpartum diabetes in women from Bangladesh, India and Sri Lanka (South Asia) with prior gestational diabetes mellitus: Results from the LIVING study. Diabetes Res Clin Pract 2023; 204:110893. [PMID: 37657646 DOI: 10.1016/j.diabres.2023.110893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 08/24/2023] [Accepted: 08/30/2023] [Indexed: 09/03/2023]
Abstract
AIM To study, the incidence and risk factors for postpartum diabetes (DM), in women with gestational diabetes mellitus (GDM) from South Asia (Bangladesh, India and Sri Lanka), followed for nearly two years after delivery. METHODS Women with prior GDM diagnosed using IADPSG criteria were invited at 19 centres across Bangladesh, India and Sri Lanka for an oral glucose tolerance test (OGTT) following childbirth, and were enrolled in a randomized controlled trial. The glycaemic category (outcome) was defined from an OGTT based on American Diabetes Association criteria. RESULTS Participants (n = 1808) recruited had a mean ± SD age of 31.0 ± 5.0 years. Incident DM was identified, between childbirth and the last follow-up, in 310 (17.1 %) women [incidence 10.75/100 person years], with a median follow-up duration of 1.82 years after childbirth. Higher age, lower education status, higher prior pregnancy count, prior history of GDM, family history of DM, and postpartum overweight/obese status were significantly associated with incident DM. Women in Bangladesh had a higher cumulative incidence of DM [16.49/100 person years] than in Sri Lanka [12.74/100 person years] and India [7.21/100 person years]. CONCLUSIONS A high incidence of DM was found in women with prior GDM in South Asia, with significant variation between countries. Women from Bangladesh had a significantly higher pregnancy count, family history of DM and overweight/obese status, despite having significantly lower age, which could be responsible for their higher rates of DM. Registration of this study: The study was registered with the Clinical Trials Registry of India (CTRI/2017/06/008744), Sri Lanka Clinical Trials Registry (SLCTR/2017/001), and ClinicalTrials.gov (NCT03305939).
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Affiliation(s)
- Yashdeep Gupta
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India.
| | - Deksha Kapoor
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - Josyula K Lakshmi
- George Institute for Global Health, Hyderabad, India; Faculty of Medicine and Health, University of New South Wales, Sydney, Australia; Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| | - Devarsetty Praveen
- George Institute for Global Health, Hyderabad, India; Faculty of Medicine and Health, University of New South Wales, Sydney, Australia; Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| | | | - Laurent Billot
- Faculty of Medicine and Health, University of New South Wales, Sydney, Australia; George Institute for Global Health, Sydney, Australia
| | - Aliya Naheed
- Initiative for Non Communicable Diseases, Nutrition Research Division, International Centre for Diarrhoeal Disease Research (ICDDR, B), Dhaka, Bangladesh
| | - H Asita de Silva
- Clinical Trials Unit, Department of Pharmacology, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka
| | - Ishita Gupta
- Centre for Chronic Disease Control, New Delhi, India
| | - Noshin Farzana
- Initiative for Non Communicable Diseases, Nutrition Research Division, International Centre for Diarrhoeal Disease Research (ICDDR, B), Dhaka, Bangladesh
| | - Renu John
- George Institute for Global Health, Hyderabad, India
| | | | - Neerja Bhatla
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Ankush Desai
- Department of Endocrinology, Goa Medical College, Goa, India
| | | | - Dorairaj Prabhakaran
- Centre for Chronic Disease Control, New Delhi, India; Public Health Foundation of India, New Delhi, India; London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Helena Teede
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Sophia Zoungas
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Anushka Patel
- Faculty of Medicine and Health, University of New South Wales, Sydney, Australia; George Institute for Global Health, Sydney, Australia
| | - Nikhil Tandon
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
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Liew SJ, Soon CS, Chooi YC, Tint MT, Eriksson JG. A holistic approach to preventing type 2 diabetes in Asian women with a history of gestational diabetes mellitus: a feasibility study and pilot randomized controlled trial. FRONTIERS IN CLINICAL DIABETES AND HEALTHCARE 2023; 4:1251411. [PMID: 37841647 PMCID: PMC10569025 DOI: 10.3389/fcdhc.2023.1251411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 08/29/2023] [Indexed: 10/17/2023]
Abstract
Background Gestational Diabetes Mellitus (GDM) exposes women to future risk of Type 2 Diabetes. Previous studies focused on diet and physical activity, less emphasis was given to tackle intertwined risk factors such as sleep and stress. Knowledge remains scarce in multi-ethnic Asian communities. This study explored the: (1) feasibility of a holistic digital intervention on improving diet, physical activity (PA), sleep and stress of Asian women with a history of GDM, and (2) preliminary efficacy of the holistic intervention on women's physical and mental well-being via a pilot randomized controlled trial. Methods Female volunteers with a history of GDM but without pre-existing diabetes were recruited from multi-ethnic Singaporean community. Each eligible woman was given a self-monitoring opportunity using Oura Ring that provided daily feedback on step counts, PA, sleep and bedtime heart rate. Intervention group additionally received personalized recommendations aimed to reinforce healthy behaviors holistically (diet, PA, sleep and stress). Dietary intake was evaluated by a research dietitian, while step counts, PA, sleep and bedtime heart rate were evaluated by health coaches based on Oura Ring data. Perceived physical and mental health and well-being were self-reported. Clinical outcomes included glycemic status determined by HbA1c and OGTT tests, body mass index, blood pressures and lipid profile. Results Of 196 women from the community, 72 women completed diabetes screening, 61 women were eligible and 56 women completed the study. The 56 completers had mean age of 35.8 ± 3.7 years, predominantly Chinese, majority had their first GDM diagnosed at least 2 years ago and had two GDM-affected pregnancies. After intervention period, more women in the Intervention group achieved at least 8,000 steps/day and had at least 6 hours of sleep per night. Noticeable reduction of added sugar in their food and beverages were observed after the dietary intervention. Changes in body weight and mental well-being were observed but group differences were not statistically significant. Conclusions The holistic approach appeared feasible for personalizing lifestyle recommendations to promote physical and mental well-being among women with a history of GDM. Larger studies with sufficient assessment timepoints and follow-up duration are warranted to improve the evaluation of intervention effects on clinical outcomes. Clinical trial registration number https://clinicaltrials.gov/show/NCT05512871, NCT05512871.
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Affiliation(s)
- Seaw Jia Liew
- Human Potential Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Chun Siong Soon
- Centre for Sleep and Cognition, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yu Chung Chooi
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Mya Thway Tint
- Human Potential Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Johan Gunnar Eriksson
- Human Potential Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
- Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Folkhälsan Research Center, Helsinki, Finland
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18
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Marschner S, Pant A, Henry A, Maple‐Brown LJ, Moran L, Cheung NW, Chow CK, Zaman S. Cardiovascular risk management following gestational diabetes and hypertensive disorders of pregnancy: a narrative review. Med J Aust 2023; 218:484-491. [PMID: 37149790 PMCID: PMC10953444 DOI: 10.5694/mja2.51932] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 03/21/2023] [Accepted: 03/24/2023] [Indexed: 05/08/2023]
Affiliation(s)
| | - Anushriya Pant
- Westmead Applied Research CentreUniversity of SydneySydneyNSW
| | - Amanda Henry
- University of New South WalesSydneyNSW
- St George HospitalSydneyNSW
| | - Louise J Maple‐Brown
- Diabetes across the Lifecourse: Northern Australia Partnership, Menzies School of Health ResearchDarwinNT
- Royal Darwin HospitalDarwinNT
| | - Lisa Moran
- Monash Centre for Health Research and ImplementationMonash UniversityMelbourneVIC
- Monash HealthMelbourneVIC
| | - N Wah Cheung
- Westmead Applied Research CentreUniversity of SydneySydneyNSW
- Westmead HospitalSydneyNSW
| | - Clara K Chow
- Westmead Applied Research CentreUniversity of SydneySydneyNSW
- Westmead HospitalSydneyNSW
| | - Sarah Zaman
- Westmead Applied Research CentreUniversity of SydneySydneyNSW
- Westmead HospitalSydneyNSW
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19
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Retnakaran M, Viana LV, Kramer CK. Lifestyle intervention for the prevention of type 2 diabetes in women with prior gestational diabetes: A systematic review and meta-analysis. Diabetes Obes Metab 2023; 25:1196-1202. [PMID: 36594235 DOI: 10.1111/dom.14966] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 12/20/2022] [Accepted: 12/30/2022] [Indexed: 01/04/2023]
Abstract
AIM To determine whether current evidence supports lifestyle intervention for type 2 diabetes (T2D) prevention in women with previous gestational diabetes (GD). METHODS We systematically searched MEDLINE/PubMed, Web of Science, EMBASE, The Cochrane Library, International Pharmaceutical Abstracts, Global Health, Sinomed and Clinicaltrials.gov for randomized controlled trials (published from 1 January 1950 to 14 December 2022) comparing lifestyle intervention with standard care in women with previous GD. Our primary outcome was incident T2D, with pooled estimates calculated by a fixed-effects model. RESULTS Of 1652 studies identified, 13 were eligible and were included in our analysis (N = 3745 women). Compared with standard care, lifestyle intervention yielded a reduction of 24% in the incidence of T2D (relative risk 0.76 [95% CI 0.63-0.93]). Meta-regression analyses revealed no impact of the duration of lifestyle intervention (P = .81) or baseline body mass index (P = .90) on the observed reduction in incident T2D. Importantly, this published literature shows evidence of publication bias on funnel plot and Egger test (P = .048). CONCLUSIONS Current published evidence suggests that lifestyle intervention can reduce the risk of T2D in women with prior GD. However, this finding should be interpreted with caution in the presence of documented publication bias.
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Affiliation(s)
- Matthew Retnakaran
- Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Luciana V Viana
- Division of Endocrinology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Post-graduate Program in Medical Sciences: Endocrinology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Serviço de Nutrologia - Comissão de Suporte Nutricional, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Caroline K Kramer
- Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto, Ontario, Canada
- Division of Endocrinology, University of Toronto, Toronto, Ontario, Canada
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada
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20
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Sharma A, Lee-Ødegård S, Qvigstad E, Sommer C, Sattar N, Gill JMR, Gulseth HL, Sollid ST, Nermoen I, Birkeland KI. β-Cell Function, Hepatic Insulin Clearance, and Insulin Sensitivity in South Asian and Nordic Women After Gestational Diabetes Mellitus. Diabetes 2022; 71:2530-2538. [PMID: 36112815 DOI: 10.2337/db22-0622] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 09/14/2022] [Indexed: 01/11/2023]
Abstract
South Asian women have a higher risk of type 2 diabetes after gestational diabetes mellitus (GDM) than Nordic women; however, the mechanisms behind this difference remain unclear. We investigated insulin sensitivity, β-cell function, and hepatic insulin clearance in 179 South Asian and 108 Nordic women ∼17 months after GDM (mean age 35.3 years, BMI 29.1 kg/m2) by oral glucose tolerance test using deconvolution of C-peptide kinetics. Thirty-one percent of South Asian and 53% of Nordic participants were normoglycemic at the time of measurement. South Asian women had higher areas under the curve (AUCs) for glucose, prehepatic insulin, and peripheral insulin and lower insulin sensitivity, disposition index, and fasting hepatic insulin clearance than Nordic women. In the group with prediabetes or diabetes, South Asian women had similar AUCs for glucose and prehepatic insulin but a higher AUC for peripheral insulin, lower disposition index, and lower fasting hepatic insulin clearance than Nordic women. The waist-to-height ratio mediated ∼25-40% of the ethnic differences in insulin sensitivity in participants with normoglycemia. Overall, our novel data revealed that South Asian women with normoglycemia after GDM showed lower insulin secretion for a given insulin resistance and lower hepatic insulin clearance than Nordic women. South Asian women are at high risk of developing type 2 diabetes after GDM, and preventive efforts should be prioritized.
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Affiliation(s)
- Archana Sharma
- Department of Endocrinology, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | | | - Elisabeth Qvigstad
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
| | - Christine Sommer
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, U.K
| | - Jason M R Gill
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, U.K
| | | | - Stina T Sollid
- Department of Medicine, Drammen Hospital, Vestre Viken Health Trust, Drammen, Norway
| | - Ingrid Nermoen
- Department of Endocrinology, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Kåre I Birkeland
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
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21
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Sagastume D, Siero I, Mertens E, Cottam J, Colizzi C, Peñalvo JL. The effectiveness of lifestyle interventions on type 2 diabetes and gestational diabetes incidence and cardiometabolic outcomes: A systematic review and meta-analysis of evidence from low- and middle-income countries. EClinicalMedicine 2022; 53:101650. [PMID: 36119561 PMCID: PMC9475282 DOI: 10.1016/j.eclinm.2022.101650] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 07/19/2022] [Accepted: 08/12/2022] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND As lifestyle modification offers a unique strategy to prevent diabetes, we evaluated the effectiveness of lifestyle interventions in the prevention of type 2 diabetes and gestational diabetes in low- and middle-income countries (LMICs). METHODS We did a systematic literature review and meta-analysis. We searched MEDLINE, Embase, Web of Science, and Cochrane Library for randomised controlled trials published in English, Spanish, French, and Portuguese between 1 January 2000 and 15 June 2022, evaluating multi-target and multi-component lifestyle interventions in at-risk populations conducted in LMICs. The main outcomes were incidence of type 2 diabetes and gestational diabetes, and indicators of glycaemic control. We assessed the methodological quality of the studies using the Cochrane risk of bias tool. Inverse-variance random-effects meta-analyses estimated the overall effect sizes. Sources of heterogeneity and study bias were evaluated. The study protocol was registered in PROSPERO (CRD42021279174). FINDINGS From 14 330 abstracts, 48 (0·3%) studies with 50 interventions were eligible of which 56% were conducted in lower-middle-income countries, 44% in upper-middle, and none in low-income. 54% of the studies were assessed as moderate risk of bias and 14% as high risk. A median of 246 (IQR 137-511) individuals participated in the interventions with a median duration of 6 (3-12) months. Lifestyle interventions decreased the incidence risk ratio of type 2 diabetes by 25% (0·75 [95% CI 0·61 to 0·91]), and reduced the levels of HbA1c by 0·15% [-0·25 to -0·05], fasting plasma glucose by 3·44 mg/dL [-4·72 to -2·17], and 2-hr glucose tolerance by 4·18 mg/dL [-7·35 to -1·02]. No publication bias was suggested for these outcomes. High levels of heterogeneity (I²≥ 81%) were found in most meta-analyses. Exploration using meta-regressions could not identify any explanatory variable, except for fasting glucose for which the quality score of the articles seems to be an effect modifier decreasing slightly the heterogeneity (72%) in the low risk of bias pooled estimate. The effect on gestational diabetes could not be evaluated due to the scarcity of available studies. INTERPRETATION Comprehensive lifestyle interventions are effective strategies to prevent type 2 diabetes among at-risk populations in LMICs. The heterogeneity identified in our results should be considered when using these interventions to address the onset of type 2 diabetes. FUNDING None.
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Affiliation(s)
- Diana Sagastume
- Corresponding author at: Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp, Belgium.
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22
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Al-kuraishy HM, Al-Fakhrany OM, Elekhnawy E, Al-Gareeb AI, Alorabi M, De Waard M, Albogami SM, Batiha GES. Traditional herbs against COVID-19: back to old weapons to combat the new pandemic. Eur J Med Res 2022; 27:186. [PMID: 36154838 PMCID: PMC9510171 DOI: 10.1186/s40001-022-00818-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 09/14/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Recently, the coronavirus (COVID-19) pandemic is a chief public health disaster caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). There are no established effective preventive or therapeutic anti-COVID-19 drugs available except for some recently approved vaccines. Still, countless recent studies recommend various alternative and complementary approaches against COVID-19, which are medicinal herbs employed as traditional remedies to enhance immunity to struggle with viral infections. In addition, physicians worldwide are highly interested in vitamin and mineral supplements to help them combat COVID-19 either through protection or treatment. Dietary supplements specifically vitamin D, vitamin C, and zinc provide good prophylactic and therapeutic support to the presently available treatment regimens. In the present work, we have focused on plant-based remedies with promising anti-COVID-19 activities. AIM To enable investigators and researchers to identify potential herbal compounds with anti-COVID activity to be used as promising therapies to combat this pandemic. MAIN BODY This review highlights the recently published studies concerning natural traditional herbs, herbal bioactive metabolites, dietary supplements, and functional foods that could help prevent and/or treat COVID-19. Herein, we explored medicinal herbs as potential inhibitors of SARS-CoV-2 and discussed how these studies help form larger discussions of diet and disease. Moreover, by investigating the herbal bioactive components, we have outlined several medicinal herbs that can fight against COVID-19 by hindering SARS-CoV-2 replication and entry to its host cells, deterring the cytokine storm, and several other means. Finally, we have summarized various herbal products, functional foods, and dietary supplements with potent bioactive compounds which can inhibit and/or prevent COVID-19 disease progression. CONCLUSIONS Based on the studies reviewed in this work, it was concluded with no doubt that phytochemical components present in various herbs could have a starring role in the deterrence and cure of coronavirus contagion.
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Affiliation(s)
- Hayder M. Al-kuraishy
- Department of Clinical Pharmacology and Medicine, College of Medicine, ALmustansiriyia University, Baghdad, Iraq
| | | | - Engy Elekhnawy
- Pharmaceutical Microbiology Department, Faculty of Pharmacy, Tanta University, Tanta, Egypt
| | - Ali I. Al-Gareeb
- Department of Clinical Pharmacology and Medicine, College of Medicine, ALmustansiriyia University, Baghdad, Iraq
| | - Mohammed Alorabi
- Department of Biotechnology, College of Sciences, Taif University, P.O.Box 11099, Taif, 21944 Saudi Arabia
| | - Michel De Waard
- Smartox Biotechnology, 6 rue des Platanes, 38120 Saint-Egrève, France
- L’institut du Thorax, INSERM, CNRS, UNIV NANTES, 44007 Nantes, France
- Université de Nice Sophia-Antipolis, LabEx «Ion Channels, Science & Therapeutics», 06560 Valbonne, France
| | - Sarah M. Albogami
- Department of Biotechnology, College of Science, Taif University, P.O.Box 11099, Taif, 21944 Saudi Arabia
| | - Gaber El-Saber Batiha
- Department of Pharmacology and Therapeutics, Faculty of Veterinary Medicine, Damanhour University, Damanhour, Egypt
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23
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Rossiter C, Henry A, Roberts L, Brown MA, Gow M, Arnott C, Salisbury J, Ruhotas A, Hehir A, Denney-Wilson E. Optimising mothers' health behaviour after hypertensive disorders of pregnancy: a qualitative study of a postnatal intervention. BMC Public Health 2022; 22:1259. [PMID: 35761317 PMCID: PMC9235190 DOI: 10.1186/s12889-022-13590-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 05/25/2022] [Indexed: 12/24/2022] Open
Abstract
Background Hypertensive disorders of pregnancy have longer-term implications, increasing women’s lifetime cardiovascular disease risk. The Blood Pressure Postpartum study is a multi-centre randomised three-arm trial of interventions, ranging in intensity and including education and lifestyle coaching, to support women to maintain or adopt healthy eating and physical activity during the first postpartum year. This qualitative sub-study nested within the main trial aimed to investigate whether and how women adopted healthy behaviours after a pregnancy complicated by a hypertensive disorder. Methods Semi-structured telephone interviews were recorded, transcribed and analysed thematically, following Braun and Clarke principles. They explored behaviour change among new mothers following their hypertensive pregnancy, and the intervention’s effect on their capacity and motivation to pursue healthy lifestyles. Results Thirty-four women from all three trial arms participated at 10–12 months postpartum. The three main themes were 1) Awareness of cardiovascular risk: some did not acknowledge the health risks, whereas others embraced this information. 2) Sources of motivation: while the majority were motivated to make a concerted effort to adapt their health behaviour, motivation often centred on their baby and family rather than their own needs. 3) Sustaining behaviour change with a new baby: women in the more intensive intervention arm demonstrated increased recognition of the importance of reducing cardiovascular health risks, with greater motivation and guidance to change their health behaviour. There was minimal evidence of crossover amongst groups, with women largely accepting their randomised level of intervention and not seeking additional help when randomised to minimal intervention. Conclusions Among women participating in an early post-hypertensive disorders of pregnancy randomised controlled trial aimed at improving their cardiovascular disease risk profile, the majority recognised the future health risks and appeared motivated to improve their lifestyle, particularly women in the highest-intensity intervention group. This highlights the importance of structured support to assist women embrace healthy lifestyles especially during the challenges of new parenthood. Trial registration The Blood Pressure Postpartum study was prospectively registered as a clinical trial with the Australian New Zealand Clinical Trials Registry (anzctr.org.au) on 13 December 2018 (registration number: ACTRN12618002004246). Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13590-2.
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Affiliation(s)
- Chris Rossiter
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Amanda Henry
- Discipline of Women's Health, Faculty of Medicine and Health, The University of New South Wales, Kensington, NSW, 1466, Australia. .,Department of Women's and Children's Health, St George Hospital, Kogarah, NSW, 2217, Australia.
| | - Lynne Roberts
- Department of Women's and Children's Health, St George Hospital, Kogarah, NSW, 2217, Australia.,St George and Sutherland Clinical School, The University of New South Wales, St George Hospital, Kogarah, NSW, 2217, Australia
| | - Mark A Brown
- Department of Renal Medicine, St George Hospital and the University of NSW, Sydney, Australia
| | - Megan Gow
- The University of Sydney Children's Hospital Westmead Clinical School, Westmead, NSW, 2145, Australia
| | - Clare Arnott
- The George Institute for Global Health, The University of New South Wales, 1 King Street, Newtown, NSW, 2042, Australia.,Department of Cardiology, Royal Prince Alfred Hospital, Camperdown, NSW, 2050, Australia
| | - Justine Salisbury
- NSW Ministry of Health, 1 Reserve Road, St Leonards, NSW, 2065, Australia
| | - Annette Ruhotas
- Consumer and Community Involvement Representative, Sydney, Australia
| | - Angela Hehir
- The George Institute for Global Health, The University of New South Wales, 1 King Street, Newtown, NSW, 2042, Australia
| | - Elizabeth Denney-Wilson
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2006, Australia.,Sydney Local Health District, Royal Prince Alfred Hospital, Camperdown, NSW, 2050, Australia
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24
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Rastogi YR, Thakur R, Thakur P, Mittal A, Chakrabarti S, Siwal SS, Thakur VK, Saini RV, Saini AK. Food fermentation – Significance to public health and sustainability challenges of modern diet and food systems. Int J Food Microbiol 2022; 371:109666. [DOI: 10.1016/j.ijfoodmicro.2022.109666] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 03/27/2022] [Accepted: 03/29/2022] [Indexed: 11/28/2022]
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25
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Ramezani Tehrani F, Rahmati M, Farzadfar F, Abedini M, Farahmand M, Hosseinpanah F, Hadaegh F, Torkestani F, Valizadeh M, Azizi F, Behboudi-Gandevani S. One-step versus two-step screening for diagnosis of gestational diabetes mellitus in Iranian population: A randomized community trial. Front Endocrinol (Lausanne) 2022; 13:1039643. [PMID: 36818463 PMCID: PMC9932332 DOI: 10.3389/fendo.2022.1039643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 12/19/2022] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES There is considerable worldwide controversy regarding optimal screening and diagnostic approaches for GDM. This study aimed to compare the prevalence, maternal and neonatal outcomes of a One-step with a Two-step approach for the screening and diagnosis of GDM in a large community sample of pregnant women. METHODS We conducted a secondary analysis of a randomized community non-inferiority trial of GDM screening in Iran. For the current study, all pregnant women who met the inclusion criteria were randomized into two groups for GDM screening. The first group of women (n = 14611) was screened by a One-step screening approach [75-g 2-h oral glucose tolerance test (OGTT)] and the second group (n = 14160) by a Two-step method (the 50-g glucose challenge test followed by the 100-g OGTT). All study participants were followed up until delivery, and the adverse maternal and neonatal outcomes were recorded in detail. RESULTS GDM was diagnosed in 9.3% of the pregnant women who were assigned to the One-step and in 5.4% of those assigned to the Two-step approach with a statistically significant difference between them (p < 0.001). Intention-to-treat analyses showed no significant differences between the One-step and the Two-step group in the unadjusted risks of the adverse pregnancy outcomes of macrosomia, primary cesarean-section, preterm birth, hypoglycemia, hypocalcemia, hyperbilirubinemia, preeclampsia, neonatal intensive care unit admission, birth trauma, low birth weight, and intrauterine fetal death. Results remained unchanged after adjustment for potential confounder variables including gestational age at enrollment and delivery, maternal body mass index, gestational weight gain, type of delivery, treatment modality, and GDM diagnosis in the first trimester. CONCLUSION We found that although the rates of GDM more than doubled with the One-step strategy, the One-step approach was similar to the Two-step approach in terms of maternal and neonatal outcomes. These findings may warn that more caution should be exercised in adopting the One-step method worldwide. Future research is needed to assess the long-term harm and benefits of those approaches to GDM screening for both mothers and their offspring. CLINICAL TRIAL REGISTRATION https://www.irct.ir/trial/518, identifier (IRCT138707081281N1).
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Affiliation(s)
- Fahimeh Ramezani Tehrani
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Rahmati
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farshad Farzadfar
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehrandokht Abedini
- Infertility and Cell Therapy Office, Transplant & Disease Treatment Center, Ministry of Health and Medical Education, Tehran, Iran
| | - Maryam Farahmand
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farhad Hosseinpanah
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farzad Hadaegh
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Majid Valizadeh
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Samira Behboudi-Gandevani
- Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway
- *Correspondence: Samira Behboudi-Gandevani,
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