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An X, Zhang Y, Sun W, Kang X, Ji H, Sun Y, Jiang L, Zhao X, Gao Q, Lian F, Tong X. Early effective intervention can significantly reduce all-cause mortality in prediabetic patients: a systematic review and meta-analysis based on high-quality clinical studies. Front Endocrinol (Lausanne) 2024; 15:1294819. [PMID: 38495794 PMCID: PMC10941028 DOI: 10.3389/fendo.2024.1294819] [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: 09/15/2023] [Accepted: 02/19/2024] [Indexed: 03/19/2024] Open
Abstract
Background Reducing the occurrence of diabetes is considered a primary criterion for evaluating the effectiveness of interventions for prediabetes. There is existing evidence that early lifestyle-based interventions can significantly decrease the incidence of diabetes. However, whether effective interventions can reduce long-term outcomes in patients, including all-cause mortality, cardiovascular risks, and the occurrence of microvascular complications, which are the most concerning issues for both patients and clinicians, remains a subject of inconsistent research findings. And there is no direct evidence to answer whether effective intervention has long-term benefits for prediabetic patients. Therefore, we conducted a systematic review and meta-analysis to assess the relationship between early effective intervention and macrovascular and microvascular complications in prediabetic patients. Methods PubMed, Embase, and Cochrane Central Register of Controlled Trials were searched for the randomized controlled trials of lifestyle or/and drugs intervention in prediabetes from inception to 2023.9.15. Two investigators independently reviewed the included studies and extracted relevant data. Random or fixed effects model meta-analysis to derive overall relative risk (RR) with 95% CI for all-cause mortality, cardiovascular events, and microvascular complications. Results As of September 15, 2023, a total of 7 effective intervention studies were included, comprising 26 articles out of 25,671 articles. These studies involved 26,389 patients with a total follow-up duration of 178,038.6 person-years. The results indicate that effective intervention can significantly reduce all-cause mortality in prediabetic patients without a history of cardiovascular disease by 17% (RR 0.83, 95% CI 0.70-0.98). Additionally, effective intervention reduced the incidence of retinopathy by 38% (RR 0.62, 95% CI 0.70-0.98). Furthermore, the study results suggest that women and younger individuals have lower all-cause mortality and cardiovascular mortality. Subsequently, we conducted an in-depth analysis of patients without a history of cardiovascular disease. The results revealed that prediabetic patients with a 10-year cardiovascular risk >10% experienced more significant benefits in terms of all-cause mortality (P=0.01). When comparing the results of all-cause mortality and cardiovascular mortality from the Da Qing Diabetes Prevention Outcome Study longitudinally, it was evident that the duration of follow-up is a key factor influencing long-term benefits. In other words, the beneficial effects become more pronounced as the intervention duration reaches a certain threshold. Conclusion Early effective intervention, which significantly reduces the incidence of diabetes, can effectively lower all-cause mortality in prediabetic patients without a history of cardiovascular disease (especially those with a 10-year cardiovascular risk >10%), with women and younger individuals benefiting more significantly. Additionally, the duration of follow-up is a key factor influencing outcomes. The conclusions of this study can provide evidence-based guidance for the clinical treatment of prediabetic patients to prevent cardiovascular and microvascular complications. Systematic review registration https://www.crd.york.ac.uk/prospero, identifier CRD42020160985.
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Affiliation(s)
- Xuedong An
- Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yuehong Zhang
- Fangshan Hospital of Beijing University of Chinese Medicine, Beijing, China
| | - Wenjie Sun
- Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Xiaomin Kang
- Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Hangyu Ji
- Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yuting Sun
- Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Linlin Jiang
- Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Xuefei Zhao
- Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Qing Gao
- Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Fengmei Lian
- Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Xiaolin Tong
- Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
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Doumbia L, Findley S, Ba HO, Maiga B, Ba A, Béréthé RK, Sangaré HM, Kachur SP, Besançon S, Doumbia S. Formative research to adapt the 'Diabetes Prevention Program- Power to Prevent' for implementation in Bamako, Mali. BMC Health Serv Res 2024; 24:61. [PMID: 38212794 PMCID: PMC10785539 DOI: 10.1186/s12913-023-10515-6] [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: 12/19/2022] [Accepted: 12/21/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND There are few community-level behaviors change interventions for reducing diabetes and hypertension risk in Africa, despite increasing cases of type 2 diabetes and cardiovascular diseases. Thus, this study was designed to adapt the United States Centers for Disease Control and Prevention's "Diabetes Prevention Program Power to Prevent" (DPP-P2P) for use in low-income urban communities of Bamako, Mali. METHODS Feedback was elicited on an initial French PowerPoint adaptation of the DPP-P2P session guidelines from stakeholders at the ministry of health, organizational partners, and medical care providers. Two community health centers in districts with high levels of diabetes or hypertension were selected to assist in developing the Malian adaptation. Focus groups were conducted with 19 community health workers (CHWs) of these centers. Based on feedback from these discussions, more graphics, demonstrations, and role plays were added to the PowerPoint presentations. The 19 CHWs piloted the proposed 12 sessions with 45 persons with diabetes or at-risk patients over a one-month period. Feedback discussions were conducted after each session, and changes in dietary and exercise habits were assessed pre and post participation in the program. This feedback contributed to finalization of a 14-session sequence. RESULTS The DPP-P2P session guidelines were adapted for use by low-literacy CHWs, converting the written English guidelines into French PowerPoint presentations with extensive use of pictures, role plays and group discussions to introduce diabetes, diet, and exercise concepts appropriately for the Bamako context. CHWs recommendations for a strong family-oriented program led to expanded sessions on eliciting support from all adults in the household. The 45 participants in the pilot adaptation were enthusiastic about the program. At the end of the program, there were significant increases in the frequency of daily exercise, efforts to limit fat intake, and goals for more healthy diets and exercise levels. CONCLUSION This study documents how an iterative process of developing the DPP-P2P adaptation led to the development of a culturally appropriate set of materials welcomed by participants and having promise for reaching the low-income, low-literacy population with or at risk for diabetes in Bamako, Mali.
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Affiliation(s)
- Lancina Doumbia
- University Clinical Research Center, Université des Sciences, des Techniques et des Technologies de Bamako, Point-G, Bamako, Bamako, Po Box 5445, Mali.
| | - Sally Findley
- Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Hamidou Oumar Ba
- University Clinical Research Center, Université des Sciences, des Techniques et des Technologies de Bamako, Point-G, Bamako, Bamako, Po Box 5445, Mali
| | - Bonkana Maiga
- University Clinical Research Center, Université des Sciences, des Techniques et des Technologies de Bamako, Point-G, Bamako, Bamako, Po Box 5445, Mali
| | - Aissata Ba
- University Clinical Research Center, Université des Sciences, des Techniques et des Technologies de Bamako, Point-G, Bamako, Bamako, Po Box 5445, Mali
| | - Rokiatou Koné Béréthé
- University Clinical Research Center, Université des Sciences, des Techniques et des Technologies de Bamako, Point-G, Bamako, Bamako, Po Box 5445, Mali
| | - Hadja Madjè Sangaré
- University Clinical Research Center, Université des Sciences, des Techniques et des Technologies de Bamako, Point-G, Bamako, Bamako, Po Box 5445, Mali
| | - S Patrick Kachur
- Mailman School of Public Health, Columbia University, New York, NY, USA
| | | | - Seydou Doumbia
- University Clinical Research Center, Université des Sciences, des Techniques et des Technologies de Bamako, Point-G, Bamako, Bamako, Po Box 5445, Mali
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Al-Mhanna SB, Rocha-Rodriguesc S, Mohamed M, Batrakoulis A, Aldhahi MI, Afolabi HA, Yagin FH, Alhussain MH, Gülü M, Abubakar BD, Ghazali WSW, Alghannam AF, Badicu G. Effects of combined aerobic exercise and diet on cardiometabolic health in patients with obesity and type 2 diabetes: a systematic review and meta-analysis. BMC Sports Sci Med Rehabil 2023; 15:165. [PMID: 38049873 PMCID: PMC10696788 DOI: 10.1186/s13102-023-00766-5] [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: 08/14/2023] [Accepted: 11/06/2023] [Indexed: 12/06/2023]
Abstract
BACKGROUND Lifestyle modifications involving diet and exercise are recommended for patients diagnosed with obesity and type 2 diabetes mellitus (T2DM). The purpose of this review was to systematically evaluate the effects of combined aerobic exercise and diet (AEDT) on various cardiometabolic health-related indicators among individuals with obesity and T2DM. METHODOLOGY A comprehensive search of the PubMed/Medline, Web of Science, Scopus, Science Direct, Cochrane, and Google Scholar databases was conducted for this meta-analysis. The Cochrane risk of bias tool was used to evaluate eligible studies, and the GRADE tool was used to rate the certainty of evidence. A random-effects model for continuous variables was used, and the results were presented as mean differences or standardised mean differences with 95% confidence intervals. RESULTS A total of 16,129 studies were retrieved; 20 studies were included, and data were extracted from 1,192 participants. The findings revealed significant improvements in body mass index, body weight, waist circumference, systolic blood pressure, diastolic blood pressure, total cholesterol, triglycerides, fasting blood glucose, fasting plasma insulin, glycated hemoglobin, leptin, interleukin-6, C-reactive protein, and adiponectin (p < 0.05) compared to the standard treatment (ST) group. No significant differences were observed between the AEDT and ST groups in fat mass, hip circumference, waist-to-hip ratio, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and tumor necrosis factor-alpha. The present findings are based on low- to moderate-quality evidence. CONCLUSIONS AEDT may be a critical behavior for holistic cardiometabolic health-related benefits as a contemporary anti-obesity medication due to its significant positive impact on patients with obesity and T2DM. Nevertheless, further robust evidence is necessary to determine whether AEDT is an effective intervention for lowering cardiovascular and metabolic risk factors among individuals with obesity and T2DM.
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Affiliation(s)
- Sameer Badri Al-Mhanna
- Center for Global Health Research, Saveetha Medical College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, New Delhi, India
- Department of Physiology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, 16150, Malaysia
| | - Sílvia Rocha-Rodriguesc
- Escola Superior Desporto e Lazer, Instituto Politécnico de Viana do Castelo, Viana do Castelo, Portugal
- Tumour & Microenvironment Interactions Group, INEB- Institute of Biomedical Engineering, i3S-Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
| | - Mahaneem Mohamed
- Department of Physiology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, 16150, Malaysia
| | - Alexios Batrakoulis
- Department of Physical Education and Sport Science, School of Physical Education, Sport Science and Dietetics, University of Thessaly, Trikala, Greece
| | - Monira I Aldhahi
- Department of Rehabilitation, College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Hafeez Abiola Afolabi
- Department of General Surgery, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Fatma Hilal Yagin
- Department of Biostatistics and Medical Informatics, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Maha H Alhussain
- Department of Food Science and Nutrition, College of Food and Agricultural Science, King Saud University, Riyadh, Saudi Arabia
| | - Mehmet Gülü
- Department of Sports Management, Faculty of Sport Sciences, Kirikkale University, Kirikkale, Turkey
| | - Bishir Daku Abubakar
- Department of Human Physiology, Federal University Dutse, Dutse, Jigawa State, Nigeria
| | - Wan Syaheedah Wan Ghazali
- Department of Physiology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, 16150, Malaysia.
| | - Abdullah F Alghannam
- Lifestyle and Health Research Center, Health Sciences Research Center, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Georgian Badicu
- Department of Physical Education and Special Motricity, Transilvania University of Brasov, Brasov, Romania
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Eriksson MCM, Lindblad U, Daka B, Lundgren J. Validation of a single question to measure internal health locus of control in Swedish primary care. Scand J Psychol 2023; 64:674-678. [PMID: 37102405 DOI: 10.1111/sjop.12923] [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: 10/28/2021] [Revised: 02/22/2023] [Accepted: 04/04/2023] [Indexed: 04/28/2023]
Abstract
BACKGROUND Behavioral risk factors are highlighted in the prevention of diabetes and cardiovascular disease. Screening for health locus of control could be a feasible way to better identify individuals who could benefit from preventive behavioral change interventions. The aim of the study was to investigate the correlation between a single question measuring internal health locus of control (IHLC) and the Multidimensional Health Locus of Control Scale (MHLC) and to assess how IHLC relates to the General Self-Efficacy scale (GSE) in a primary care setting. METHODS Primary care patients, aged 18 and older, attending three primary care centers in southwest Sweden were consecutively asked to anonymously participate in the study. The patients were given a questionnaire and instructed to return the questionnaire in a sealed box in the waiting room. RESULTS In all, 519 patients were included. The correlation between MHLC Internality and IHLC was weak (r = 0.21, p < 0.001). An increase of one point on the internality scale of the MHLC gave an odds ratio of 1.19 (95% CI 1.11-1.28) for reporting high IHLC, and thus a five-point increase gave a doubled likelihood, OR = 2.40, CI 1.67-3.46. The results for the other scales of the MHLC and GSE were similar. CONCLUSION In this study, we found weak but statistically significant support for the single-question IHLC as a measure of internal health locus of control. Given that the correlation was weak, we recommend using the MHLC when possible.
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Affiliation(s)
- Maria C M Eriksson
- Primary Health Care, School of Public Health and Community Medicine, Institute of Medicine, Gothenburg University, Gothenburg, Sweden
| | - Ulf Lindblad
- Primary Health Care, School of Public Health and Community Medicine, Institute of Medicine, Gothenburg University, Gothenburg, Sweden
| | - Bledar Daka
- Primary Health Care, School of Public Health and Community Medicine, Institute of Medicine, Gothenburg University, Gothenburg, Sweden
| | - Jesper Lundgren
- Department of Psychology, Gothenburg University, Gothenburg, Sweden
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Zhou Y, Xu P, Qin S, Zhu Y, Gu K. The associations between dietary flavonoid intake and the prevalence of diabetes mellitus: Data from the National Health and Nutrition Examination Survey 2007-2010 and 2017-2018. Front Endocrinol (Lausanne) 2023; 14:1250410. [PMID: 37664856 PMCID: PMC10474301 DOI: 10.3389/fendo.2023.1250410] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 08/03/2023] [Indexed: 09/05/2023] Open
Abstract
Background Diabetes mellitus (DM) is a prominent health concern worldwide, leading to the high incidence of disability and mortality and bringing in heavy healthcare and social burden. Plant-based diets are reported associated with a reduction of DM risk. Plant-based diets are rich in flavonoids, which possess properties such as scavenging free radicals and exerting both anti-inflammatory and antioxidant effects. Purpose However, whether dietary flavonoids are associated with the prevalence of DM remains controversial. The potential reasons for contradictory epidemiological outcomes on the association between dietary flavonoids and DM prevalence have not been determined. Methods To address these limitations, we employed data from 22,481 participants in the National Health and Nutrition Examination Survey to explore the association between the intake of flavonoids and DM prevalence by weighted Logistic regression and weighted restricted cubic splines. Results We found that the prevalence of DM was inversely associated with the intake of total flavonoids in the second quartile [Odds Ratio (OR) 0.78 95% confidence interval (CI) (0.63, 0.97), p = 0.028], in the third quartile [0.76 (0.60, 0.97), p = 0.031], and in the fourth quartile [0.80 (0.65, 0.97), p = 0.027]. However, the p for trend was not significant [0.94 (0.88, 1.01), p = 0.096]. Moreover, the association between DM prevalence and the intake of total flavonoids was significantly influenced by race (p for interaction = 0.006). In Mexican Americans, there was a significant positive association between DM prevalence and total flavonoid intake within the third quartile [1.04 (1.02, 1.07), p = 0.003]. Total flavan-3-ol and subtotal catechin intake exhibited a non-linear U-shaped association with DM prevalence (p for non-linearity < 0.0001 and p for non-linearity < 0.0001, respectively). Compared to the first quartile of corresponding intakes, consumption within the third quartile of subtotal catechins [0.70 (0.55, 0.89), p = 0.005] and total flavan-3-ols [0.65 (0.50, 0.84), p = 0.002] was associated with a lower prevalence of DM. Conclusion Taken together, our study may provide preliminary research evidence for personalized improvement of dietary habits to reduce the prevalence of diabetes.
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Affiliation(s)
- Yanjun Zhou
- Department of Radiotherapy and Oncology, The Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu, China
| | - Peng Xu
- Population Health Sciences, German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Shaolei Qin
- Wuxi Medical College, Jiangnan University, Wuxi, Jiangsu, China
| | - Yan Zhu
- Department of Radiotherapy and Oncology, The Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu, China
| | - Ke Gu
- Department of Radiotherapy and Oncology, The Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu, China
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Salmela J, Konttinen H, Lappalainen R, Muotka J, Antikainen A, Lindström J, Tuomilehto J, Uusitupa M, Karhunen L. Eating behavior dimensions and 9-year weight loss maintenance: a sub-study of the Finnish Diabetes prevention study. Int J Obes (Lond) 2023:10.1038/s41366-023-01300-w. [PMID: 37149709 DOI: 10.1038/s41366-023-01300-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 03/03/2023] [Accepted: 03/17/2023] [Indexed: 05/08/2023]
Abstract
BACKGROUND Behavioral processes through which lifestyle interventions influence risk factors for type 2 diabetes (T2DM), e.g., body weight, are not well-understood. We examined whether changes in psychological dimensions of eating behavior during the first year of lifestyle intervention would mediate the effects of intervention on body weight during a 9-year period. METHODS Middle-aged participants (38 men, 60 women) with overweight and impaired glucose tolerance (IGT) were randomized to an intensive, individualized lifestyle intervention group (n = 51) or a control group (n = 47). At baseline and annually thereafter until nine years body weight was measured and the Three Factor Eating Questionnaire assessing cognitive restraint of eating with flexible and rigid components, disinhibition and susceptibility to hunger was completed. This was a sub-study of the Finnish Diabetes Prevention Study, conducted in Kuopio research center. RESULTS During the first year of the intervention total cognitive (4.6 vs. 1.7 scores; p < 0.001), flexible (1.7 vs. 0.9; p = 0.018) and rigid (1.6 vs. 0.5; p = 0.001) restraint of eating increased, and body weight decreased (-5.2 vs. -1.2 kg; p < 0.001) more in the intervention group compared with the control group. The difference between the groups remained significant up to nine years regarding total (2.6 vs. 0.1 scores; p = 0.002) and rigid restraint (1.0 vs. 0.4; p = 0.004), and weight loss (-3.0 vs. 0.1 kg; p = 0.046). The first-year increases in total, flexible and rigid restraint statistically mediated the impact of intervention on weight loss during the 9-year study period. CONCLUSIONS Lifestyle intervention with intensive and individually tailored, professional counselling had long-lasting effects on cognitive restraint of eating and body weight in middle-aged participants with overweight and IGT. The mediation analyses suggest that early phase increase in cognitive restraint could have a role in long-term weight loss maintenance. This is important because long-term weight loss maintenance has various health benefits, including reduced risk of T2DM.
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Affiliation(s)
- Jutta Salmela
- Department of Psychology, University of Jyväskylä, Jyväskylä, Finland
| | - Hanna Konttinen
- Social Psychology, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
| | - Raimo Lappalainen
- Department of Psychology, University of Jyväskylä, Jyväskylä, Finland
| | - Joona Muotka
- Department of Psychology, University of Jyväskylä, Jyväskylä, Finland
| | - Anne Antikainen
- Endocrinology and Clinical Nutrition, Kuopio University Hospital, Wellbeing Services County of North Savo, Kuopio, Finland
| | - Jaana Lindström
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Jaakko Tuomilehto
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
- Department of Public Health, University of Helsinki, Helsinki, Finland
- Saudi Diabetes Research Group, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Matti Uusitupa
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Leila Karhunen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.
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Chen Y, Zhong Q, Luo J, Tang Y, Li M, Lin Q, Willey JA, Chen JL, Whittemore R, Guo J. The 6-Month Efficacy of an Intensive Lifestyle Modification Program on Type 2 Diabetes Risk Among Rural Women with Prior Gestational Diabetes Mellitus: a Cluster Randomized Controlled Trial. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2022; 23:1156-1168. [PMID: 35773443 PMCID: PMC9489585 DOI: 10.1007/s11121-022-01392-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2022] [Indexed: 12/08/2022]
Abstract
This study aimed to evaluate the efficacy of an intensive lifestyle modification program tailored to rural Chinese women with prior gestational diabetes mellitus compared with usual care. In a cluster randomized controlled trial, 16 towns (clusters) in two distinct rural areas in China were randomly selected (8 towns per district); and 320 women with prior gestational diabetes mellitus were recruited from these towns. With stratification for the two study districts, eight towns (160 women) were randomly assigned to the intervention group of a tailored intensive lifestyle modification program and 8 towns (160 women) to the control group. Process measures were collected on attendance, engagement, fidelity, and satisfaction. Primary efficacy outcomes included glycemic and weight-related outcomes, while secondary efficacy outcomes were behavioral outcomes and type 2 diabetes risk score, which were collected at baseline, 3-month, and 6-month follow-up. Generalized estimation equations were used to analyze the data. High attendance (72% of sessions), engagement (67% of interactive activities and group discussions), fidelity (98%), and satisfaction (92%) with the tailored intensive lifestyle modification program were achieved. There were significant reductions in fasting blood glucose, oral glucose tolerance test 2 h, waist circumference, and type 2 diabetes risk score of participants in the intervention group compared to the control group (p < .05). There was no significant intervention effect on body mass index or behavioral outcomes (p > .05). In this study, we demonstrate the successful efficacy of an Intensive Lifestyle Modification Program in reducing type 2 diabetes risk among younger women with prior gestational diabetes mellitus. This tailored program delivered by local healthcare providers is a promising approach for diabetes prevention in rural China, reducing health disparities in rural communities about diabetes prevention. Registered in the Chinese Clinical Trial Registry (ChiCTR2000037956) on 3rd Jan 2018.
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Affiliation(s)
- Yao Chen
- Xiangya School of Nursing, Central South University, 172 Tongzipo Road, Changsha, 410013, Hunan, China
| | - Qinyi Zhong
- Xiangya School of Nursing, Central South University, 172 Tongzipo Road, Changsha, 410013, Hunan, China
| | - Jiaxin Luo
- Xiangya School of Nursing, Central South University, 172 Tongzipo Road, Changsha, 410013, Hunan, China
| | - Yujia Tang
- Xiangya School of Nursing, Central South University, 172 Tongzipo Road, Changsha, 410013, Hunan, China
| | - Mingshu Li
- Xiangya School of Public Health, Central South University, Changsha, 410078, Hinan, China
| | - Qian Lin
- Xiangya School of Public Health, Central South University, Changsha, 410078, Hinan, China
| | - James Allen Willey
- Philip R. Lee Institute for Health Policy Research, University of California, San Francisco, San Francisco, CA, 94118, USA
| | - Jyu-Lin Chen
- School of Nursing, University of California, San Francisco, San Francisco, CA, 94118, USA
| | | | - Jia Guo
- Xiangya School of Nursing, Central South University, 172 Tongzipo Road, Changsha, 410013, Hunan, China.
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Kivelä J, Meinilä J, Uusitupa M, Tuomilehto J, Lindström J. Longitudinal Branched-Chain Amino Acids, Lifestyle Intervention, and Type 2 Diabetes in the Finnish Diabetes Prevention Study. J Clin Endocrinol Metab 2022; 107:2844-2853. [PMID: 35917829 PMCID: PMC9516128 DOI: 10.1210/clinem/dgac463] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Indexed: 12/05/2022]
Abstract
CONTEXT Circulating branched-chain amino acids (BCAAs) are associated with the risk of type 2 diabetes (T2D). OBJECTIVE We examined to what extent lifestyle intervention aiming to prevent T2D interacts with this association and how BCAA concentrations change during the intervention. METHODS We computed trajectory clusters by k-means clustering of serum fasting BCAAs analyzed annually by mass spectrometry during a 4-year intervention. We investigated whether baseline BCAAs, BCAA trajectories, and BCAA change trajectories predicted T2D and whether BCAAs predicted T2D differently in the intervention (n = 198) and control group (n = 196). RESULTS Elevated baseline BCAAs predicted the incidence of T2D in the control group (hazard ratio [HR] 1.05 per 10 μmol/L, P = 0.01), but not in the intervention group. BCAA concentration decreased during the first year in the whole cohort (mean -14.9 μmol/L, P < 0.001), with no significant difference between the groups. We identified 5 BCAA trajectory clusters and 5 trajectory clusters for the change in BCAAs. Trajectories with high mean BCAA levels were associated with an increased HR for T2D compared with the trajectory with low BCAA levels (trajectory with highest vs lowest BCAA, HR 4.0; P = 0.01). A trajectory with increasing BCAA levels had a higher HR for T2D compared with decreasing trajectory in the intervention group only (HR 25.4, P < 0.001). CONCLUSION Lifestyle intervention modified the association of the baseline BCAA concentration and BCAA trajectories with the incidence of T2D. Our study adds to the accumulating evidence on the mechanisms behind the effect of lifestyle changes on the risk of T2D.
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Affiliation(s)
- Jemina Kivelä
- Correspondence: Jemina Kivelä, MSc, Finnish Institute for Health and Welfare (THL), Mannerheimintie 166, PO Box 30, FI-00271 Helsinki, Finland.
| | - Jelena Meinilä
- Department of Food and Nutrition, University of Helsinki, 00014 Helsinki, Finland
| | - Matti Uusitupa
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, 70211 Kuopio, Finland
| | - Jaakko Tuomilehto
- Population Health Unit, Finnish Institute of Health and Welfare, 00271 Helsinki, Finland
- Department of Public Health, University of Helsinki, 00014 Helsinki, Finland
- Saudi Diabetes Research Group, King Abdulaziz University, 80200 Jeddah, Saudi Arabia
- Department of International Health, National School of Public Health, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Jaana Lindström
- Population Health Unit, Finnish Institute of Health and Welfare, 00271 Helsinki, Finland
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Venojärvi M, Lindström J, Aunola S, Nuutila P, Atalay M. Improved Aerobic Capacity and Adipokine Profile Together with Weight Loss Improve Glycemic Control without Changes in Skeletal Muscle GLUT-4 Gene Expression in Middle-Aged Subjects with Impaired Glucose Tolerance. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148327. [PMID: 35886175 PMCID: PMC9320448 DOI: 10.3390/ijerph19148327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 06/01/2022] [Accepted: 07/04/2022] [Indexed: 11/26/2022]
Abstract
(1) Objective: The aim of this study was to clarify the role of adipokines in the regulation of glucose metabolism in middle-aged obese subjects with impaired glucose tolerance in response to a long-term exercise and dietary intervention. (2) Methods: Skeletal muscle, plasma and serum samples were examined in 22 subjects from an exercise−diet intervention study aiming to prevent type 2 diabetes. The subjects were further divided into two subgroups (non-responders n = 9 and responders n = 13) based on their achievement in losing at least 3 kg. (3) Results: The two-year exercise−diet intervention reduced leptin levels and increased adiponectin levels in responders; the changes in leptin levels were significantly associated with changes in their weights (r = 0.662, p < 0.01). In responders, insulin sensitivity (Bennett and McAuley index) increased and was associated with changes in maximal oxygen uptake (VO2peak) (r = 0.831, p < 0.010 and r = 0.890, p < 0.01). In addition, the VO2peak and oxidative capacity of skeletal muscle improved in responders, but not in non-responders. However, there were no changes between the two groups in expressions of the glucose transporter protein-4 (GLUT-4) gene or of AMP-activated protein kinase (AMPK)-α1 or AMPK-α2 proteins. (4) Conclusions: The exercise−diet intervention decreased serum leptin and increased serum adiponectin concentrations, improved glucose control without affecting GLUT-4 gene expression in the skeletal muscle in responders.
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Affiliation(s)
- Mika Venojärvi
- Institute of Biomedicine, Sport and Exercise Medicine, University of Eastern Finland, 70210 Kuopio, Finland
- Correspondence:
| | - Jaana Lindström
- Population Health Unit, Department of Public Health and Welfare, Finnish Institute for Health and Welfare, 00271 Helsinki, Finland;
| | - Sirkka Aunola
- Functional Capacity Unit, Department of Health, Functional Capacity and Welfare, National Institute for Health and Welfare, 20740 Turku, Finland;
| | - Pirjo Nuutila
- PET Centre, University of Turku, 20500 Turku, Finland;
| | - Mustafa Atalay
- Institute of Biomedicine, Physiology, University of Eastern Finland, 70210 Kuopio, Finland;
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10
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Preclinical and Clinical Role of Coenzyme Q10 Supplementation in Various Pathological States. Drug Res (Stuttg) 2022; 72:367-371. [PMID: 35724675 DOI: 10.1055/a-1835-1738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Coenzyme Q10 (CoQ10) is an efficient antioxidant produced endogenously in a living organism. It acts as an important cofactor in the electron transport system of mitochondria and reported as a safe supplement in humans and animals with minimal adverse effect. CoQ10 is found naturally, as a trans configuration, chemical nomenclature of which is 2,3- dimethoxy-5- methyl-6-decaprenyle -1,4-benzoquinone. It is found in the body in two forms. In quinone form (oxidized form), it serves as an electron transporter that transfers the electrons in the electron transport chain between various complexes, and in ubiquinol form (reduced form), it serves as potent antioxidants by scavenging free radicals or by tocopherol regeneration in the living organism. Its primary roles include synthesis of adenosine triphosphate (ATP), stabilizes lipid membrane, antioxidant activity, cell growth stimulation, and cell death inhibition. CoQ10 has shown a variety of pharmacological and clinical effects including neuroprotective, hepatoprotective, anti-atherosclerotic, anticonvulsant, antidepressant, anti-inflammatory, antinociceptive, cardiovascular, antimicrobial, immunomodulatory, and various effects on the central nervous system. Present review has set about to bring updated information regarding to clinical and preclinical activities of CoQ10, which may be helpful to researchers to explore a new bioactive molecules for various therapeutic application.
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11
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Alvear Durán S, Sanchez-Del-Hierro G, Gomez-Correa D, Enriquez A, Sanchez E, Belec M, Casapulla S, Grijalva MJ, Shubrook JH. A pilot of a modified diabetes prevention program in Quito, Ecuador. J Osteopath Med 2021; 121:905-911. [PMID: 34668365 DOI: 10.1515/jom-2020-0175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 07/12/2021] [Indexed: 11/15/2022]
Abstract
CONTEXT Diabetes has become a global noninfectious pandemic with rates rapidly rising around the globe. The major drivers of this increase in type 2 diabetes are obesity, an increase in processed foods, and a decrease in physical activity. In the United States, the National Diabetes Prevention Program (NDPP) has proven to be an effective lifestyle intervention to delay or prevent new-onset type 2 diabetes. However, there is limited evidence that such a lifestyle program will work in a South American community. OBJECTIVES This pilot program aims to determine if a modified version of the Centers for Disease Control and Prevention (CDC) Diabetes Prevention Program (DPP) would be feasible in an Ecuadorian population. The goals of this pilot program were a 7% weight loss, >150 min of physical activity per week, and a reduction of fat calories to yield a reduced risk of type 2 diabetes. This program was led by family medicine physicians and was offered to people with prediabetes in Quito, Ecuador. METHODS The program was modified to include only the first half of the DPP curriculum, which included a schedule of 16 classes in the first 6 months. Further, the program was provided in Spanish and modified to be more culturally specific to this population. Participants were recruited from the faculty and staff of Pontifical Catholic University of Ecuador (Pontificia Universidad Católica del Ecuador [PUCE]) in Quito. Outcomes measured included A1c reduction, weight loss, increase in physical activity minutes, and progression to type 2 diabetes mellitus (T2DM). RESULTS The sample included 33 people with prediabetes. The mean age of the participants was 52 years (range, 41-66 years), the mean body mass index (BMI) was 27.6 kg/m2 (range, 21.0-40.3 kg/m2), and the mean HbA1C was 6.2% (range, 5.7-6.4%). The attendance was 97.8% at 6 months. The mean weight loss was 3.4 kg per participant (range, 1.5 kg weight gain to 8.3 kg weight loss); in percentage points, this was a mean weight loss of 3.6% (range, 2.3% gain to 11.8% weight loss). Three-fourths of the participants lost weight (78.3%). The majority of participants (75.8%) met the target physical activity level of 150 min per week, and all participants increased their physical activity levels from baseline. No participants progressed to type 2 diabetes during this study. CONCLUSIONS The DPP 6 month pilot was effective in this population with prediabetes in Ecuador. The largest changes were made in physical activity time. Holding the program at worksites and providing lunch were key factors in the very high retention rate in this study.
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Affiliation(s)
- Susana Alvear Durán
- Facultad de Medicina, Center for Research on Health in Latin America, Pontifical Catholic University of Ecuador, Quito, Ecuador
| | - Galo Sanchez-Del-Hierro
- Facultad de Medicina, Center for Research on Health in Latin America, Pontifical Catholic University of Ecuador, Quito, Ecuador.,Department of Primary and Interdisciplinary Care, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - Diego Gomez-Correa
- Family Practice Resident, Facultad de Medicina, Hospital Vozandes Quito, Pontifical Catholic University of Ecuador, Quito, Ecuador
| | - Andrés Enriquez
- Family Practice Resident, Facultad de Medicina, Hospital Un Canto a la Vida, Pontifical Catholic University of Ecuador, Quito, Ecuador
| | - Enver Sanchez
- Family Practice Resident, Facultad de Medicina, Hospital Un Canto a la Vida, Pontifical Catholic University of Ecuador, Quito, Ecuador
| | - Melissa Belec
- Family Practice Resident, University of Minnesota - North Memorial, Minneapolis, MN, USA
| | - Sharon Casapulla
- Department of Primary Care, Office of Rural and Underserved Programs, Diabetes Institute, Infectious and Tropical Disease Institute, Heritage College of Osteopathic Medicine, Ohio University, Athens, OH, USA
| | - Mario J Grijalva
- Department of Biomedical Sciences, Infectious and Tropical Disease Institute, Heritage College of Osteopathic Medicine, Ohio University, Athens, OH, USA.,Center for Research on Health in Latin America, School of Biological Sciences, Pontifical Catholic University of Ecuador, Quito, Ecuador
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12
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Andari E, Atallah P, Azar S, Echtay A, Jambart S, Saab C, Howlett HCS, Al-Naqshbandi M. Experts' opinion on the detection and management of prediabetes in Lebanon. Sci Prog 2021; 104:368504211029439. [PMID: 34261386 PMCID: PMC10306136 DOI: 10.1177/00368504211029439] [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] [Indexed: 11/16/2022]
Abstract
Given that the complications of type 2 diabetes can start at an early stage, early detection and appropriate management of prediabetes are essential. We aimed to develop an expert opinion on prediabetes in Lebanon to pave the way for national guidelines tailored for the Lebanese population in the near future. A panel of seven diabetes experts conducted a thorough literature review and discussed their opinions and experiences before coming up with a set of preliminary recommendations for the detection and management of prediabetes in Lebanon. Lebanese physicians employ multiple tests for the diagnosis of prediabetes and no national cut-off values exist. The panel agreed that prediabetes screening should be focused on patients exceeding 45 years of age with otherwise no risk factors and on adults with risk factors. The panel reached that fasting plasma glucose (FPG) and HbA1c should be used for prediabetes diagnosis in Lebanon. FPG values of 100-125 mg/dL or HbA1c values of 5.7%-6.4% were agreed upon as indicative of prediabetes. For the management of prediabetes, a three-step approach constituting lifestyle modifications, pharmacological treatment and bariatric surgery is recommended. There should be more focus on research on prediabetes in Lebanon. This preliminary report will be further discussed with the Lebanese Society of Endocrinology, Diabetes and Lipids in 2021 in order to come up with the first Lebanese national guidelines for the detection and management of prediabetes in Lebanon.
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Affiliation(s)
- Emile Andari
- Notre Dame des Secours University
Hospital, Jbeil, Lebanon
| | - Paola Atallah
- Saint George Hospital University
Medical Center, Beirut, Lebanon
| | - Sami Azar
- American University of Beirut Medical
Center, Beirut, Lebanon
| | - Akram Echtay
- Rafik Hariri University Hospital,
Beirut, Lebanon
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13
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Zhu R, Fogelholm M, Larsen TM, Poppitt SD, Silvestre MP, Vestentoft PS, Jalo E, Navas-Carretero S, Huttunen-Lenz M, Taylor MA, Stratton G, Swindell N, Kaartinen NE, Lam T, Handjieva-Darlenska T, Handjiev S, Schlicht W, Martinez JA, Seimon RV, Sainsbury A, Macdonald IA, Westerterp-Plantenga MS, Brand-Miller J, Raben A. A High-Protein, Low Glycemic Index Diet Suppresses Hunger but Not Weight Regain After Weight Loss: Results From a Large, 3-Years Randomized Trial (PREVIEW). Front Nutr 2021; 8:685648. [PMID: 34141717 PMCID: PMC8203925 DOI: 10.3389/fnut.2021.685648] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 04/27/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Previous studies have shown an increase in hunger during weight-loss maintenance (WLM) after diet-induced weight loss. Whether a combination of a higher protein, lower glycemic index (GI) diet and physical activity (PA) can counteract this change remains unclear. Aim: To compare the long-term effects of two diets [high protein (HP)-low GI vs. moderate protein (MP)-moderate GI] and two PA programs [high intensity (HI) vs. moderate intensity (MI)] on subjective appetite sensations during WLM after ≥8% weight loss (WL). Methods: Data derived from the 3-years PREVIEW randomized intervention study. An 8-weeks WL phase using a low-energy diet was followed by a 148-weeks randomized WLM phase. For the WLM phase, participants were assigned to one of the four groups: HP-MI, HP-HI, MP-MI, and MP-HI. Available data from 2,223 participants with overweight or obesity (68% women; BMI ≥ 25 kg/m2). Appetite sensations including satiety, hunger, desire to eat, and desire to eat something sweet during the two phases (at 0, 8 weeks and 26, 52, 104, and 156 weeks) were assessed based on the recall of feelings during the previous week using visual analogue scales. Differences in changes in appetite sensations from baseline between the groups were determined using linear mixed models with repeated measures. Results: There was no significant diet × PA interaction. From 52 weeks onwards, decreases in hunger were significantly greater in HP-low GI than MP-moderate GI (P time × diet = 0.018, P dietgroup = 0.021). Although there was no difference in weight regain between the diet groups (P time × diet = 0.630), hunger and satiety ratings correlated with changes in body weight at most timepoints. There were no significant differences in appetite sensations between the two PA groups. Decreases in hunger ratings were greater at 52 and 104 weeks in HP-HI vs. MP-HI, and greater at 104 and 156 weeks in HP-HI vs. MP-MI. Conclusions: This is the first long-term, large-scale randomized intervention to report that a HP-low GI diet was superior in preventing an increase in hunger, but not weight regain, during 3-years WLM compared with a MP-moderate GI diet. Similarly, HP-HI outperformed MP-HI in suppressing hunger. The role of exercise intensity requires further investigation. Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT01777893.
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Affiliation(s)
- Ruixin Zhu
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark
| | - Mikael Fogelholm
- Department of Food and Nutrition, University of Helsinki, Helsinki, Finland
| | - Thomas M Larsen
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark
| | - Sally D Poppitt
- Human Nutrition Unit, School of Biological Sciences, Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Marta P Silvestre
- Human Nutrition Unit, School of Biological Sciences, Department of Medicine, University of Auckland, Auckland, New Zealand.,Center for Health Technology Services Research, NOVA Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Pia S Vestentoft
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark
| | - Elli Jalo
- Department of Food and Nutrition, University of Helsinki, Helsinki, Finland
| | - Santiago Navas-Carretero
- Department of Nutrition, University of Navarra, Pamplona, Spain.,CIBERobn, Instituto de Salud Carlos III, Madrid, Spain.,Precision Nutrition Program, IMDEA Food, Campus de Excelencia Internacional, Universidad Autónoma de Madrid + Consejo Superior de Investigaciones Científicas, Madrid, Spain
| | - Maija Huttunen-Lenz
- Institute for Nursing Science, University of Education Schwäbisch Gmünd, Schwäbisch Gmünd, Germany
| | - Moira A Taylor
- Division of Physiology, Pharmacology and Neuroscience, School of Life Sciences, Queen's Medical Centre, Nottingham, United Kingdom.,National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham, United Kingdom
| | - Gareth Stratton
- Applied Sports, Technology, Exercise and Medicine (A-STEM) Research Centre, Swansea University, Swansea, United Kingdom
| | - Nils Swindell
- Applied Sports, Technology, Exercise and Medicine (A-STEM) Research Centre, Swansea University, Swansea, United Kingdom
| | - Niina E Kaartinen
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Tony Lam
- NetUnion sarl, Lausanne, Switzerland
| | | | - Svetoslav Handjiev
- Department of Pharmacology and Toxicology, Medical University of Sofia, Sofia, Bulgaria
| | - Wolfgang Schlicht
- Exercise and Health Sciences, University of Stuttgart, Stuttgart, Germany
| | - J Alfredo Martinez
- Department of Nutrition, University of Navarra, Pamplona, Spain.,CIBERobn, Instituto de Salud Carlos III, Madrid, Spain.,Precision Nutrition Program, IMDEA Food, Campus de Excelencia Internacional, Universidad Autónoma de Madrid + Consejo Superior de Investigaciones Científicas, Madrid, Spain
| | - Radhika V Seimon
- The Boden Collaboration for Obesity, Nutrition, Exercise, and Eating Disorders, Faculty of Medicine and Health, Charles Perkins Centre, The University of Sydney, Camperdown, NSW, Australia
| | - Amanda Sainsbury
- School of Human Sciences (Exercise and Sports Science), Faculty of Science, The University of Western Australia, Crawley, WA, Australia
| | - Ian A Macdonald
- Division of Physiology, Pharmacology and Neuroscience, School of Life Sciences, Queen's Medical Centre, MRC/ARUK Centre for Musculoskeletal Ageing Research, ARUK Centre for Sport, Exercise and Osteoarthritis, National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham, United Kingdom
| | - Margriet S Westerterp-Plantenga
- Department of Nutrition and Movement Sciences, NUTRIM, School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, Netherlands
| | - Jennie Brand-Miller
- School of Life and Environmental Sciences and Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
| | - Anne Raben
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark.,Steno Diabetes Center Copenhagen, Gentofte, Denmark
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14
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Ismail L, Materwala H, Al Kaabi J. Association of risk factors with type 2 diabetes: A systematic review. Comput Struct Biotechnol J 2021; 19:1759-1785. [PMID: 33897980 PMCID: PMC8050730 DOI: 10.1016/j.csbj.2021.03.003] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 02/28/2021] [Accepted: 03/01/2021] [Indexed: 12/14/2022] Open
Abstract
Diabetes is the leading cause of severe health complications and one of the top 10 causes of death worldwide. To date, diabetes has no cure, and therefore, it is necessary to take precautionary measures to avoid its occurrence. The main aim of this systematic review is to identify the majority of the risk factors for the incidence/prevalence of type 2 diabetes mellitus on one hand, and to give a critical analysis of the cohort/cross-sectional studies which examine the impact of the association of risk factors on diabetes. Consequently, we provide insights on risk factors whose interactions are major players in developing diabetes. We conclude with recommendations to allied health professionals, individuals and government institutions to support better diagnosis and prognosis of the disease.
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Affiliation(s)
- Leila Ismail
- Intelligent Distributed Computing and Systems Research Laboratory, Department of Computer Science and Software Engineering, College of Information Technology, United Arab Emirates University, Al Ain, Abu Dhabi, 15551, United Arab Emirates
| | - Huned Materwala
- Intelligent Distributed Computing and Systems Research Laboratory, Department of Computer Science and Software Engineering, College of Information Technology, United Arab Emirates University, Al Ain, Abu Dhabi, 15551, United Arab Emirates
| | - Juma Al Kaabi
- College of Medicine and Health Sciences, Department of Internal Medicine, United Arab Emirates University, Al Ain, Abu Dhabi 15551, United Arab Emirates
- Mediclinic, Al Ain, Abu Dhabi, United Arab Emirates
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15
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Galekop MMJ, Uyl-de Groot CA, Ken Redekop W. A Systematic Review of Cost-Effectiveness Studies of Interventions With a Personalized Nutrition Component in Adults. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2021; 24:325-335. [PMID: 33641765 DOI: 10.1016/j.jval.2020.12.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 12/18/2020] [Accepted: 12/19/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVES Important links between dietary patterns and diseases have been widely applied to establish nutrition interventions. However, knowledge about between-person heterogeneity regarding the benefits of nutrition intervention can be used to personalize the intervention and thereby improve health outcomes and efficiency. We performed a systematic review of cost-effectiveness analyses (CEAs) of interventions with a personalized nutrition (PN) component to assess their methodology and findings. METHODS A systematic search (March 2019) was performed in 5 databases: EMBASE, Medline Ovid, Web of Science, Cochrane CENTRAL, and Google Scholar. CEAs involving interventions in adults with a PN component were included; CEAs focusing on clinical nutrition or undernutrition were excluded. The CHEERS checklist was used to assess the quality of CEAs. RESULTS We identified 49 eligible studies among 1792 unique records. Substantial variation in methodology was found. Most studies (91%) focused only on psychological concepts of PN such as behavior and preferences. Thirty-four CEAs were trial-based, 13 were modeling studies, and 4 studies were both trial- and model-based. Thirty-two studies used quality-adjusted life year as an outcome measure. Different time horizons, comparators, and modeling assumptions were applied, leading to differences in costs/quality-adjusted life years. Twenty-eight CEAs (49%) concluded that the intervention was cost-effective, and 75% of the incremental cost-utility ratios were cost-effective given a willingness-to-pay threshold of $50 000 per quality-adjusted life year. CONCLUSIONS Interventions with PN components are often evaluated using various types of models. However, most PN interventions have been considered cost-effective. More studies should examine the cost-effectiveness of PN interventions that combine psychological and biological concepts of personalization.
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Affiliation(s)
- Milanne M J Galekop
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
| | - Carin A Uyl-de Groot
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - W Ken Redekop
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
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16
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17
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Bevan G, De Poli C, Keng MJ, Raine R. How valid are projections of the future prevalence of diabetes? Rapid reviews of prevalence-based and Markov chain models and comparisons of different models' projections for England. BMJ Open 2020; 10:e033483. [PMID: 32132137 PMCID: PMC7059487 DOI: 10.1136/bmjopen-2019-033483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES To examine validity of prevalence-based models giving projections of prevalence of diabetes in adults, in England and the UK, and of Markov chain models giving estimates of economic impacts of interventions to prevent type 2 diabetes (T2D). METHODS Rapid reviews of both types of models. Estimation of the future prevalence of T2D in England by Markov chain models; and from the trend in the prevalence of diabetes, as reported in the Quality and Outcomes Framework (QOF), estimated by ordinary least squares regression analysis. SETTING Adult population in England and UK. MAIN OUTCOME MEASURE Prevalence of T2D in England and UK in 2025. RESULTS The prevalence-based models reviewed use sample estimates of past prevalence rates by age and sex and projected population changes. Three most recent models, including that of Public Health England (PHE), neither take account of increases in obesity, nor report Confidence Intervals (CIs). The Markov chain models reviewed use transition probabilities between states of risk and death, estimated from various sources. None of their accounts give the full matrix of transition probabilities, and only a minority report tests of validation. Their primary focus is on estimating the ratio of costs to benefits of preventive interventions in those with hyperglycaemia, only one reported estimates of those developing T2D in the absence of a preventive intervention in the general population.Projections of the prevalence of T2D in England in 2025 were (in millions) by PHE, 3.95; from the QOF trend, 4.91 and by two Markov chain models, based on our review, 5.64 and 9.07. CONCLUSIONS To inform national policies on preventing T2D, governments need validated models, designed to use available data, which estimate the scale of incidence of T2D and survival in the general population, with and without preventive interventions.
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Affiliation(s)
- Gwyn Bevan
- Department of Management, London School of Economics and Political Science, London, UK
| | - Chiara De Poli
- Department of Management, London School of Economics and Political Science, London, UK
| | - Mi Jun Keng
- Department of Management, London School of Economics and Political Science, London, UK
| | - Rosalind Raine
- Department of Applied Health Research, University College London, London, UK
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18
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Gómez-Peralta F, Abreu C, Cos X, Gómez-Huelgas R. When does diabetes start? Early detection and intervention in type2 diabetes mellitus. Rev Clin Esp 2020; 220:305-314. [PMID: 32107016 DOI: 10.1016/j.rce.2019.12.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 12/12/2019] [Accepted: 12/14/2019] [Indexed: 01/09/2023]
Abstract
Type 2 diabetes mellitus (DM2) is a progressive disease whose pathophysiological changes occur several years before its detection. An approach based on the pathophysiological development of DM2 and its complications emphasises the importance of early and intensive intervention, not only to prevent beta-cell dysfunction but also to act on the potential associated cardiovascular risk factors before reaching the blood glucose thresholds currently set for diagnosing DM2. In the field of recently diagnosed DM2, the VERIFY study has shown that early treatment combined with metformin-vildagliptin provides relevant improvements in long-term glycaemic control and can positively affect the disease's progression.
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Affiliation(s)
- F Gómez-Peralta
- Unidad de Endocrinología y Nutrición, Hospital General de Segovia, Segovia, España.
| | - C Abreu
- Unidad de Endocrinología y Nutrición, Hospital General de Segovia, Segovia, España
| | - X Cos
- Innovation and Health in Primary Care Barcelona City, Gerència Barcelona Ciutat, Institut Català de la Salut, Barcelona, España; Fundació Institut Universitari d'Investigació en Atenció Primària Jordi Gol i Gurina (IDIAPJGol), Barcelona, España
| | - R Gómez-Huelgas
- Departamento de Medicina Interna, Hospital Regional Universitario, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga (UMA), Málaga, España
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19
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Shibuya K, Ji X, Pfoh ER, Milinovich A, Weng W, Bauman J, Ganguly R, Misra-Hebert AD, Hobbs TM, Kattan MW, Pantalone KM, Ramasamy A, Burguera B. Association between shared medical appointments and weight loss outcomes and anti-obesity medication use in patients with obesity. Obes Sci Pract 2020; 6:247-254. [PMID: 32523713 PMCID: PMC7278906 DOI: 10.1002/osp4.406] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 01/17/2020] [Accepted: 01/21/2020] [Indexed: 01/19/2023] Open
Abstract
Objective In shared medical appointments (SMAs), multiple patients with a similar clinical diagnosis are seen by a multidisciplinary team for interactive group sessions. Very few studies have specifically studied SMAs and weight loss in patients with obesity. This study compared weight loss outcomes and anti‐obesity medication (AOM) access between patients with obesity managed through (SMAs) versus individual appointments. Methods Retrospective study of adults seen for obesity between September 2014 and February 2017 at Cleveland Clinic Institute of Endocrinology and Metabolism. Percent weight loss from baseline was compared between two propensity score‐matched populations: patients who attended ≥1 SMA and patients managed with individual medical appointments. Results From all eligible patients identified (n=310 SMA, n=1,993 non‐SMA), 301 matched pairs were evaluated for weight loss. The SMA group (n=301) lost a mean of 4.2%, 5.2% and 3.8% of baseline weight over 6, 12 and 24 months; the non‐SMA group (n=301) lost significantly less weight (1.5%, 1.8% and 1.6%, respectively) (paired t‐test, P<.05). All patients were eligible for US Food and Drug Administration‐approved AOMs based on obesity diagnosis; however, 49.8% (150/301) of matched SMA patients were prescribed an AOM versus 12.3% (37/301) of matched non‐SMA patients. Conclusion This study suggests that SMAs may offer a promising alterative for obesity management and one that may facilitate greater utilization of AOMs. In propensity score‐matched cohorts, SMAs were associated with greater weight loss outcomes when compared to usual care facilitated through individual medical appointments alone.
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Affiliation(s)
- Kelly Shibuya
- Cleveland Clinic Lerner College of Medicine Case Western Reserve University Cleveland Ohio
| | - Xinge Ji
- Cleveland Clinic Lerner College of Medicine Case Western Reserve University Cleveland Ohio.,Quantitative Health Sciences Cleveland Clinic Cleveland Ohio.,Department of Internal Medicine Cleveland Clinic Community Care Cleveland Ohio.,Health Economics and Outcomes Research Novo Nordisk Inc. Plainsboro New Jersey.,Diabetes, Chief Medical Officer Novo Nordisk Inc. Plainsboro New Jersey.,Endocrinology and Metabolism Institute Cleveland Clinic Cleveland New Jersey.,National Diabetes and Obesity Research Institute Tradition Mississippi
| | - Elizabeth R Pfoh
- Department of Internal Medicine Cleveland Clinic Community Care Cleveland Ohio
| | - Alex Milinovich
- Quantitative Health Sciences Cleveland Clinic Cleveland Ohio
| | - Wayne Weng
- Health Economics and Outcomes Research Novo Nordisk Inc. Plainsboro New Jersey
| | - Janine Bauman
- Quantitative Health Sciences Cleveland Clinic Cleveland Ohio
| | - Rahul Ganguly
- Health Economics and Outcomes Research Novo Nordisk Inc. Plainsboro New Jersey
| | - Anita D Misra-Hebert
- Quantitative Health Sciences Cleveland Clinic Cleveland Ohio.,Department of Internal Medicine Cleveland Clinic Community Care Cleveland Ohio
| | - Todd M Hobbs
- Diabetes, Chief Medical Officer Novo Nordisk Inc. Plainsboro New Jersey
| | | | - Kevin M Pantalone
- Endocrinology and Metabolism Institute Cleveland Clinic Cleveland New Jersey
| | - Abhilasha Ramasamy
- Health Economics and Outcomes Research Novo Nordisk Inc. Plainsboro New Jersey
| | - Bartolome Burguera
- Cleveland Clinic Lerner College of Medicine Case Western Reserve University Cleveland Ohio.,Endocrinology and Metabolism Institute Cleveland Clinic Cleveland New Jersey.,National Diabetes and Obesity Research Institute Tradition Mississippi
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20
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Stokes J, Gellatly J, Bower P, Meacock R, Cotterill S, Sutton M, Wilson P. Implementing a national diabetes prevention programme in England: lessons learned. BMC Health Serv Res 2019; 19:991. [PMID: 31870371 PMCID: PMC6929377 DOI: 10.1186/s12913-019-4809-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 12/04/2019] [Indexed: 11/23/2022] Open
Abstract
Background Type 2 diabetes mellitus is preventable through lifestyle intervention. Diabetes prevention programmes (DPPs) aim to deliver prevention-based behaviour change interventions to reduce incidence. Such programmes vary from usual primary care in terms of where, how, and by whom they are delivered. Implementation is therefore likely to face new commissioning, incentive and delivery challenges. We report on the implementation of a national DPP in NHS England, and identify lessons learned in addressing the implementation challenges. Methods In 2017/18, we conducted 20 semi-structured telephone interviews covering 16 sampled case sites with the designated lead(s) responsible for local implementation of the programme. Interviews explored the process of implementation, including organisation of the programme, expectations and attitudes to the programme, funding, target populations and referral and clinical pathways. We drew on constant comparative methods to analyse the data and generate over-arching themes. We complemented our qualitative data with a survey focused on variation in the financial incentives used across sites to ensure usual primary care services recruited patients to new providers. Results We identified five over-arching areas of learning for implementing this large-scale programme: 1) managing new providers; 2) promoting awareness of services; 3) recruiting patients; 4) incentive payments; and 5) mechanisms for sharing learning. In general, tensions appeared to be caused by a lack of clear roles/responsibilities between hierarchical actors, and lack of communication. Both local sites and the national NHS coordination team gained experience through learning by doing. Initial tensions with roles and expectations have been worked out during implementation. Conclusions Implementing a national disease prevention programme is a major task, and one that will be increasingly faced by health systems globally as they aim to adjust to demand pressures. We provide practical learning opportunities for the wider uptake and sustainability of prevention programmes. Future implementers might wish to define clear responsibilities for each actor prior to implementation, ensure early engagement with new providers, offer mechanisms/forums for sharing learning, generate evidence and provide advice on incentive payments, and prioritise public and professional awareness of the programme.
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Affiliation(s)
- Jonathan Stokes
- Centre for Primary Care and Health Services Research, University of Manchester, Manchester, UK.
| | - Judith Gellatly
- Division of Nursing, University of Manchester, Manchester, UK
| | - Peter Bower
- Centre for Primary Care and Health Services Research, University of Manchester, Manchester, UK
| | - Rachel Meacock
- Centre for Primary Care and Health Services Research, University of Manchester, Manchester, UK
| | - Sarah Cotterill
- Centre for Biostatistics, University of Manchester, Manchester, UK
| | - Matt Sutton
- Centre for Primary Care and Health Services Research, University of Manchester, Manchester, UK
| | - Paul Wilson
- Alliance Manchester Business School, University of Manchester, Manchester, UK
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21
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Inolopú J, Hilario-Huapaya N, Tantaleán-Del-Águila MA, Hurtado-Roca Y, Ugarte-Gil C. Interventions for the prevention of risk factors and incidence of type 2 diabetes in the work environment: a systematic review. Rev Saude Publica 2019; 53:101. [PMID: 31800912 PMCID: PMC6863112 DOI: 10.11606/s1518-8787.2019053001084] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Accepted: 03/17/2019] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To evaluate the effectiveness of interventions aimed at the prevention of risk factors and incidence of type 2 diabetes in the workers population. METHODS Systematic review of interventions aimed at adult workers at risk of type 2 diabetes published in Medline, Embase, Web of Science, Central Cochrane Registry of Controlled Trials, and Lilacs. Randomized trials, quasi-experimental research and cohort studies were selected; in English, Spanish and Portuguese; published from 2000 to 2017. Intervention effectiveness was evaluated concerning the incidence of type 2 diabetes and a significant reduction in body weight, or another anthropometric or metabolic parameter. RESULTS 3,024 articles were generated, of which 2,825 that did not answer the research question were eliminated, as well as 130 that did not evaluate original interventions, 57 carried out outside the workplace and two reviews; so that 10 selected items remained. Interventions based on structured programs previously evaluated and integrated into the workplace had a favorable impact on the reduction of body weight and other risk factors. CONCLUSIONS The effectiveness of lifestyle interventions for the prevention of type 2 diabetes should be based on structured programs with proven effectiveness and adapted to the workplace, with employer participation in the provision of schedules and work environments.
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Affiliation(s)
- Jorge Inolopú
- Universidad Peruana Cayetano Heredia. Instituto de Medicina Tropical Alexander von Humboldt. Lima, Perú.,Universidad Peruana Cayetano Heredia. Facultad de Salud Pública. Lima, Perú
| | - Nélida Hilario-Huapaya
- Universidad Peruana Cayetano Heredia. Instituto de Medicina Tropical Alexander von Humboldt. Lima, Perú.,Universidad Peruana Cayetano Heredia. Facultad de Salud Pública. Lima, Perú
| | | | - Yamilee Hurtado-Roca
- EsSalud. Instituto de Evaluación de Tecnologías en Salud e Investigación. Lima, Perú
| | - Cesar Ugarte-Gil
- Universidad Peruana Cayetano Heredia. Instituto de Medicina Tropical Alexander von Humboldt. Lima, Perú.,Universidad Peruana Cayetano Heredia. Facultad de Medicina. Lima, Perú
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22
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Razaz JM, Rahmani J, Varkaneh HK, Thompson J, Clark C, Abdulazeem HM. The health effects of medical nutrition therapy by dietitians in patients with diabetes: A systematic review and meta-analysis: Nutrition therapy and diabetes. Prim Care Diabetes 2019; 13:399-408. [PMID: 31186171 DOI: 10.1016/j.pcd.2019.05.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 04/29/2019] [Accepted: 05/12/2019] [Indexed: 11/15/2022]
Abstract
AIMS Intensive lifestyle, dietary interventions and patient education have been recommended as key milestones in to facilitate the management of Diabetes and contain the growing incidence. We performed a systematic review and meta-analysis to assess the health benefits of medical nutrition therapy among patients with diabetes. DESIGN A systematic search was performed in MEDLINE/PubMed, SCOPUS, and Cochrane library from onset up to February 2019 to identify trials investigating the health effect of Medical nutrition (MNT) in patients with diabetes. Random-effects models were used to calculate the effect sizes as weighted mean difference (WMD) and 95% confidence intervals (CI). RESULTS Eleven studies containing 1227 participants were included in the meta-analysis. Pooled results showed a significant reduction in Fasting blood sugar (FBS) (WMD= -8.85mg/dl, 95% CI: -14.41, -3.28), HbA1c (WMD: -0.43%, 95% CI: -0.69, -0.17), weight (WMD: -1.54kg, 95% CI: -2.44, -0.64), Body mass index (BMI) (WMD: -0.34 Kg/m2, 95% CI: -0.52, -0.17), waist circumference (WMD: -2.16cm, 95% CI: -4.09, -0.23), cholesterol (WMD: -4.06mg/dl, 95% CI: -7.31, -0.81), Systolic blood pressure (SBP) (WMD: -7.90mmHg, 95% CI: -13.03, -2.77). Results of meta-regression analysis based on age of participants and duration of intervention were not significant. CONCLUSIONS Patients with diabetes who received medical nutrition therapy showed significant improvements in outcome measures of FBS, HbA1c, weight, BMI, waist circumference, cholesterol, and SBP.
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Affiliation(s)
- Jalaledin Mirzay Razaz
- Department of Community Nutrition, Faculty of Nutrition and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Jamal Rahmani
- Department of Community Nutrition, Faculty of Nutrition and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamed Kord Varkaneh
- Department of Clinical Nutrition and Dietetics, Faculty of Nutrition and Food Technology, National Nutrition and Food Technology Research Institute, Student Research Committee, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Jacqueline Thompson
- Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, University of Oxford, Oxford, OX3 7LD, United Kingdom
| | - Cain Clark
- School of Life Sciences, Coventry University, Coventry, CV1 5FB, United Kingdom
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23
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Academy of Nutrition and Dietetics: Revised 2017 Standards of Practice and Standards of Professional Performance for Registered Dietitian Nutritionists (Competent, Proficient, and Expert) in Diabetes Care. J Acad Nutr Diet 2019; 118:932-946.e48. [PMID: 29703344 DOI: 10.1016/j.jand.2018.03.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 03/06/2018] [Indexed: 01/10/2023]
Abstract
There are 30.3 million people with diabetes and 86 million with prediabetes in the United States, underscoring the growing need for comprehensive diabetes care and nutrition for the management of diabetes and diabetes-related conditions. Management of diabetes is also critical for the prevention of diabetes-related complications such as cardiovascular and renal disease. The Diabetes Care and Education Dietetic Practice Group along with the Academy of Nutrition and Dietetics Quality Management Committee have updated the Standards of Practice (SOP) and Standards of Professional Performance (SOPP) for Registered Dietitian Nutritionists (RDNs) in Diabetes Care. The SOP and SOPP for RDNs in Diabetes Care provide indicators that describe three levels of practice: competent, proficient, and expert. The SOP utilizes the Nutrition Care Process and clinical workflow elements for care and management of those with diabetes and prediabetes. The SOPP describes six domains that focus on professionalism: Quality in Practice, Competence and Accountability, Provision of Services, Application of Research, Communication and Application of Knowledge, and Utilization and Management of Resources. Specific indicators outlined in the SOP and SOPP depict how these standards apply to practice. The SOP and SOPP are complementary resources for RDNs caring for individuals with diabetes or specializing in diabetes care or practicing in other diabetes-related areas, including research. The SOP and SOPP are intended to be used for RDN self-evaluation for ensuring competent practice and for determining potential education and training needs for advancement to a higher practice level in a variety of settings.
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Abstract
Type 2 diabetes mellitus (T2DM) is a common chronic metabolic condition. Before receiving this diagnosis, persons typically have a long period of prediabetes. There is good evidence that T2DM can often be prevented or delayed by means of lifestyle interventions (39%-71%), medications (28%-79%), or metabolic surgery (75%). However, despite consistent data demonstrating their efficacy, these tools are underused, and knowledge about them among primary care physicians is limited. In an effort to engage physicians in addressing this public health crisis more effectively, the authors reviewed the evidence that T2DM can be prevented or delayed in persons at risk.
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25
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McCrabb S, Lane C, Hall A, Milat A, Bauman A, Sutherland R, Yoong S, Wolfenden L. Scaling-up evidence-based obesity interventions: A systematic review assessing intervention adaptations and effectiveness and quantifying the scale-up penalty. Obes Rev 2019; 20:964-982. [PMID: 30868745 DOI: 10.1111/obr.12845] [Citation(s) in RCA: 124] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 02/07/2019] [Accepted: 02/09/2019] [Indexed: 01/06/2023]
Abstract
Maximizing the benefits of investments in obesity research requires effective interventions to be adopted and disseminated broadly across populations (scaled-up). However, interventions often need considerable adaptation to enable implementation at scale, a process that can reduce the effects of interventions. A systematic review was undertaken for trials that sought to deliver an obesity intervention to populations on a larger scale than a preceding randomized controlled trial (RCT) that established its efficacy. Ten scaled-up obesity interventions (six prevention and four treatment) were included. All trials made adaptations to interventions as part of the scale-up process, with mode of delivery adaptations being most common. A meta-analysis of body mass index (BMI)/BMI z score (zBMI) from three prevention RCTs found no significant benefit of scaled-up interventions relative to control (standardized mean difference [SMD] = 0.03; 95% CI, -0.09 to 0.15, P = 0.639 - I2 = 0.0%). All four treatment interventions reported significant improvement on all measures of weight status. Pooled BMI/zBMI data from prevention trials found significantly lower effects among scaled-up intervention trials than those reported in pre-scale-up efficacy trials (SMD = -0.11; 95% CI, -0.20 to -0.02, P = 0.018 - I2 = 0.0%). Across measures of weight status, physical activity/sedentary behaviour, and nutrition, the effects reported in scaled-up interventions were typically 75% or less of the effects reported in pre-scale-up efficacy trials. The findings underscore the challenge of scaling-up obesity interventions.
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Affiliation(s)
- Sam McCrabb
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia
| | - Cassandra Lane
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia
| | - Alix Hall
- Clinical Research Design, IT, and Statistical Support (CReDITSS) Unit, Hunter Medical Research Institute (HMRI), New Lambton Heights, New South Wales, Australia
| | - Andrew Milat
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Adrian Bauman
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Rachel Sutherland
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia.,Clinical Research Design, IT, and Statistical Support (CReDITSS) Unit, Hunter Medical Research Institute (HMRI), New Lambton Heights, New South Wales, Australia.,Hunter New England Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia
| | - Serene Yoong
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia.,Clinical Research Design, IT, and Statistical Support (CReDITSS) Unit, Hunter Medical Research Institute (HMRI), New Lambton Heights, New South Wales, Australia.,Hunter New England Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia
| | - Luke Wolfenden
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia.,Hunter New England Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia
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26
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Viswanathan V, Krishnan D, Kalra S, Chawla R, Tiwaskar M, Saboo B, Baruah M, Chowdhury S, Makkar BM, Jaggi S. Insights on Medical Nutrition Therapy for Type 2 Diabetes Mellitus: An Indian Perspective. Adv Ther 2019; 36:520-547. [PMID: 30729455 PMCID: PMC6824451 DOI: 10.1007/s12325-019-0872-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Indexed: 02/07/2023]
Abstract
It is critical to integrate medical nutrition therapy (MNT) provided by a registered dietician (RD) into primary care of type 2 diabetes mellitus (T2DM). This is necessary to achieve the goals of improving overall metabolic measures beyond calorie restriction and weight loss. Misconceptions about nutrition in T2DM add to the challenges of executing MNT in a culturally sensitive population. The current review provides insights into MNT for the prevention and management of T2DM in India, based on both evidence and experience. It revisits historical Indian studies and provides information on appropriate dietary intake of carbohydrates (60-70%), proteins (~ 20%) and fats (10%) that will be acceptable and beneficial in an Indian T2DM population. It discusses nuances of types of carbohydrates and fats and explains associations of increased dietary fiber intake, balanced intake of low and high glycemic index foods and substitution of saturated fats with plant-based polyunsaturated fats in improving outcomes of T2DM and attenuating risk factors. The article also deliberates upon special patient populations with comorbid conditions and diseases and the necessary adjustments needed in their nutritional care. It outlines a step-wise approach to MNT involving a careful interplay of nutrition assessment, diagnosis, individualization and patient counseling. Overall, the success of MNT relies on providing accurate, acceptable and appropriate dietary choices for continued patient adherence. Collaborative efforts from diabetologists, endocrinologists, internists and RDs are required to prioritize and implement MNT in diabetes practice in India.Funding: Signutra Inc.
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Affiliation(s)
- Vijay Viswanathan
- M.V. Hospital for Diabetes and Prof. M. Viswanathan Diabetes Research Centre (WHO Collaborating Centre for Research, Education and Training in Diabetes), Chennai, Tamil Nadu, India
| | | | - Sanjay Kalra
- Bharti Research Institute of Diabetes & Endocrinology (BRIDE), Karnal, Haryana, India.
| | | | | | - Banshi Saboo
- Dia Care-Diabetes and Hormone Centre, Ahmedabad, Gujarat, India
| | | | - Subhankar Chowdhury
- Institute of Postgraduate Medical Education and Research/SSKM Hospital, Kolkata, India
| | - B M Makkar
- Diabetes and Obesity Center, New Delhi, India
| | - Shalini Jaggi
- Dr. Mohan's Diabetes Specialties Centre, New Delhi, India
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27
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Wechkunanukul K, Benton F, May N. Effectiveness of lifestyle interventions on preventing diabetes in adults at high risk of type 2 diabetes: a systematic review protocol. JBI DATABASE OF SYSTEMATIC REVIEWS AND IMPLEMENTATION REPORTS 2019; 17:273-280. [PMID: 30875339 DOI: 10.11124/jbisrir-2017-003892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
REVIEW QUESTION The question of this review is: Is lifestyle intervention effective in preventing type 2 diabetes in adults identified as being at high risk of developing type 2 diabetes?Additional specific review sub-questions are.
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Affiliation(s)
- Kannikar Wechkunanukul
- Research and Service Development Section, Diabetes SA, Adelaide, Australia
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
- The Centre for Evidence-based Practice South Australia (CEPSA): a Joanna Briggs Institute Centre of Excellence
| | - Fiona Benton
- Research and Service Development Section, Diabetes SA, Adelaide, Australia
| | - Nikki May
- Library, Flinders University, Adelaide, Australia
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28
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Sranacharoenpong K, Praditsorn P, Churak P. Developing a diabetes prevention education program for community health care workers in Thailand: translation of the knowledge to at-risk people. J Public Health (Oxf) 2018. [DOI: 10.1007/s10389-018-0897-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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29
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Glechner A, Keuchel L, Affengruber L, Titscher V, Sommer I, Matyas N, Wagner G, Kien C, Klerings I, Gartlehner G. Effects of lifestyle changes on adults with prediabetes: A systematic review and meta-analysis. Prim Care Diabetes 2018; 12:393-408. [PMID: 30076075 DOI: 10.1016/j.pcd.2018.07.003] [Citation(s) in RCA: 103] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 05/14/2018] [Accepted: 07/01/2018] [Indexed: 01/19/2023]
Abstract
AIMS To assess the efficacy, safety, and cost-effectiveness of lifestyle intervention, compared with treatment as usual in people with prediabetes as defined by the American Diabetes Association. For older studies, we used the 1985 World Health Organization definition. METHODS We systematically searched multiple electronic databases and referenced lists of pertinent review articles from January 1980 through November 2015. We performed an update search in MEDLINE on April 26, 2017. Based on a priori established eligibility criteria, we dually reviewed the literature, extracted data, and rated the risk of bias of included studies with validated checklists. To assess the efficacy of lifestyle intervention to prevent or delay further progression to type 2 diabetes, we conducted a random-effects meta-analysis. We assessed the certainty of evidence using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. RESULT Pooled results of 16 randomized controlled trials showed that people with prediabetes who received lifestyle intervention had a lower rate of progression to type 2 diabetes after one (4% vs. 10%, RR 0.46 [CI 0.32, 0.66]) and three years of follow-up (14% vs. 23%, RR 0.64 [95% CI 0.53, 0.77]). The majority of the studies also showed a greater weight loss in lifestyle intervention participants, with a great variation between studies. Costs per quality-adjusted life-year were lower when the benefits of lifestyle intervention were analyzed over a lifelong time horizon compared to only the period of lifestyle intervention (three years) or to modeling over a ten-year period. CONCLUSION Lifestyle intervention is an efficacious, safe, and cost-effective measure to reduce the risk of progression to type 2 diabetes in people diagnosed with prediabetes. More research is necessary to compare the efficacy of various modes, frequencies, and intensities of lifestyle intervention across studies.
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Affiliation(s)
- Anna Glechner
- Danube University Krems, Department for Evidence-based Medicine and Clinical Epidemiology, Austria.
| | | | - Lisa Affengruber
- Danube University Krems, Department for Evidence-based Medicine and Clinical Epidemiology, Austria
| | - Viktoria Titscher
- Danube University Krems, Department for Evidence-based Medicine and Clinical Epidemiology, Austria
| | - Isolde Sommer
- Danube University Krems, Department for Evidence-based Medicine and Clinical Epidemiology, Austria
| | - Nina Matyas
- Danube University Krems, Department for Evidence-based Medicine and Clinical Epidemiology, Austria
| | - Gernot Wagner
- Danube University Krems, Department for Evidence-based Medicine and Clinical Epidemiology, Austria
| | - Christina Kien
- Danube University Krems, Department for Evidence-based Medicine and Clinical Epidemiology, Austria
| | - Irma Klerings
- Danube University Krems, Department for Evidence-based Medicine and Clinical Epidemiology, Austria
| | - Gerald Gartlehner
- Danube University Krems, Department for Evidence-based Medicine and Clinical Epidemiology, Austria; Research Triangle Institute (RTI) International, USA
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30
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Turgut M, Cinar V, Pala R, Tuzcu M, Orhan C, Telceken H, Sahin N, Deeh PBD, Komorowski JR, Sahin K. Biotin and chromium histidinate improve glucose metabolism and proteins expression levels of IRS-1, PPAR-γ, and NF-κB in exercise-trained rats. J Int Soc Sports Nutr 2018; 15:45. [PMID: 30219082 PMCID: PMC6139124 DOI: 10.1186/s12970-018-0249-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 09/05/2018] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Chromium histidinate (CrHis) and biotin are micronutrients commonly used to improve health by athletes and control glycaemia by patients with diabetes. This study investigates the effects of 8-week regular exercise training in rats together with dietary CrHis and biotin supplementation on glucose, lipids and transaminases levels, as well as protein expression levels of peroxisome proliferator-activated receptor gamma (PPAR-γ), insulin receptor substrate-1 (IRS-1) and nuclear transcription factor kappa B (NF-κB). METHODS A total of 56 male Wistar rats were randomly divided into 8 groups of 7 animals each and treated as follows: Control, CrHis, Biotin, CrHis+Biotin, Exercise, CrHis+Exercise, Biotin+Exercise, and CrHis+Biotin+Exercise. The doses of CrHis and biotin were 400 μg/kg and 6 mg/kg of diet, respectively. The training program consisted of running at 30 m/min for 30 min/day at 0% grade level, 5 days per week, once a day for 6 weeks. Serum glucose, total cholesterol (TC), high-density lipoprotein cholesterol (HDL), triglycerides (TG), aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels were measured with an automatic biochemical analyzer. Muscle and liver PPAR-γ, IRS-1 and NF-κB expressions were detected with real-time polymerase chain reaction. RESULTS Regular exercise significantly (p < 0.001) decreased glucose, TC and TG levels, but increased HDL cholesterol. Dietary CrHis and biotin supplementation exhibited a significant (p < 0.001) decrease in glucose (effect size = large; ƞ2 = 0.773) and TG (effect size = large; ƞ2 = 0.802) levels, and increase in HDL cholesterol compared with the exercise group. No significant change in AST and ALT (effect size = none) levels was recorded in all groups (p > 0.05). CrHis/biotin improves the proteins expression levels of IRS-1, PPAR-γ, and NF-κB (effect size: large for all) in the liver and muscle of sedentary and regular exercise-trained rats (p < 0.001). CONCLUSIONS CrHis/biotin supplementation improved serum glucose and lipid levels as well as proteins expression levels of PPAR-γ, IRS-1 and NF-κB in the liver and muscle of exercise-trained rats, with the highest efficiency when administered together. CrHis/biotin may represent an effective nutritional therapy to improve health.
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Affiliation(s)
- Mine Turgut
- Faculty of Sports Sciences, Firat University, Elazig, Turkey
| | - Vedat Cinar
- Faculty of Sports Sciences, Firat University, Elazig, Turkey
| | - Ragip Pala
- Faculty of Sports Sciences, Firat University, Elazig, Turkey
| | - Mehmet Tuzcu
- Department of Biology, Faculty of Science, Firat University, 23119 Elazig, Turkey
| | - Cemal Orhan
- Department of Animal Nutrition, Faculty of Veterinary Medicine, Firat University, Elazig, Turkey
| | - Hafize Telceken
- Department of Animal Nutrition, Faculty of Veterinary Medicine, Firat University, Elazig, Turkey
| | - Nurhan Sahin
- Department of Animal Nutrition, Faculty of Veterinary Medicine, Firat University, Elazig, Turkey
| | - Patrick Brice Defo Deeh
- Animal Physiology and Phytopharmacology Laboratory, University of Dschang, Dschang, Cameroon
| | - James R. Komorowski
- Scientific and Regulatory Affairs, Nutrition 21 Inc, 1 Manhattanville Road, Purchase, NY 10577 USA
| | - Kazim Sahin
- Department of Animal Nutrition, Faculty of Veterinary Medicine, Firat University, Elazig, Turkey
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31
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Guess ND. Dietary Interventions for the Prevention of Type 2 Diabetes in High-Risk Groups: Current State of Evidence and Future Research Needs. Nutrients 2018; 10:E1245. [PMID: 30200572 PMCID: PMC6163866 DOI: 10.3390/nu10091245] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 08/28/2018] [Accepted: 08/30/2018] [Indexed: 12/13/2022] Open
Abstract
A series of large-scale randomised controlled trials have demonstrated the effectiveness of lifestyle change in preventing type 2 diabetes in people with impaired glucose tolerance. Participants in these trials consumed a low-fat diet, lost a moderate amount of weight and/or increased their physical activity. Weight loss appears to be the primary driver of type 2 diabetes risk reduction, with individual dietary components playing a minor role. The effect of weight loss via other dietary approaches, such as low-carbohydrate diets, a Mediterranean dietary pattern, intermittent fasting or very-low-energy diets, on the incidence of type 2 diabetes has not been tested. These diets-as described here-could be equally, if not more effective in preventing type 2 diabetes than the tested low-fat diet, and if so, would increase choice for patients. There is also a need to understand the effect of foods and diets on beta-cell function, as the available evidence suggests moderate weight loss, as achieved in the diabetes prevention trials, improves insulin sensitivity but not beta-cell function. Finally, prediabetes is an umbrella term for different prediabetic states, each with distinct underlying pathophysiology. The limited data available question whether moderate weight loss is effective at preventing type 2 diabetes in each of the prediabetes subtypes.
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Affiliation(s)
- Nicola D Guess
- Department of Nutritional Sciences, King's College London, 150 Stamford Street, Room 4.13, London SE1 9NH, UK.
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Aregbesola A, de Mello VDF, Lindström J, Voutilainen S, Virtanen JK, Keinänen-Kiukaanniemi S, Tuomainen TP, Tuomilehto J, Uusitupa M. Serum adiponectin/Ferritin ratio in relation to the risk of type 2 diabetes and insulin sensitivity. Diabetes Res Clin Pract 2018; 141:264-274. [PMID: 29777745 DOI: 10.1016/j.diabres.2018.05.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 04/21/2018] [Accepted: 05/08/2018] [Indexed: 12/15/2022]
Abstract
AIMS Body iron inhibits the metabolism of adiponectin, an insulin sensitizing adipokine. We investigated the relationships of baseline and average of 4-year change in values of serum adiponectin (sA), serum ferritin (sF) and sA/sF ratio on type 2 diabetes (T2D) risk and insulin sensitivity (Matsuda ISI) and secretion (disposition index; DI30). METHODS Prospective analyses were conducted in participants with impaired glucose tolerance of the Finnish Diabetes Prevention Study (n = 516) recruited in 1993-1998. Cox and linear regression analyses were used to investigate the associations of sA, sF and sA/sF ratio, as continuous variables, with incident T2D, Matsuda ISI, and DI30. RESULTS During the mean follow-up of 8.2 years, 157 incident T2D cases occurred (intervention group, n = 65 and control group, n = 92). In adjusted models, baseline sA and sA/sF ratio were inversely associated with T2D risk (HR = 0.49, 95% CI 0.31-0.76, P = 0.002 and HR = 0.83, 95% CI 0.70-0.99, P = 0.044, respectively). Furthermore, a direct association was observed with Matsuda ISI (β=0.13, 95% CI 0.03-0.22, P = 0.009, for sA and β=0.04, 95% CI 0.01-0.07, P = 0.035, for sA/sF ratio) during the average 4-year follow-up. The changes in sA and sA/sF ratio were also inversely associated with T2D risk (HR = 0.36, 95% CI 0.20-0.63, P < 0.001 and HR = 0.76, 95% CI 0.62-0.92, P = 0.006, respectively), and directly with Matsuda ISI (β=0.27, 95% CI 0.17-0.38, P < 0.001, for sA and β=0.07, 95% CI 0.03-0.11, P < 0.001, for sA/sF ratio). No consistent associations were found with DI30. CONCLUSIONS: Baseline levels and changes during the follow-up in sA and sA/sF ratio are related to T2D risk and insulin sensitivity.
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Affiliation(s)
- Alex Aregbesola
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Yliopistonranta 1C, P.O. Box 1627, FI70211 Kuopio, Finland.
| | - Vanessa D F de Mello
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Yliopistonranta 1C, P.O. Box 1627, FI70211 Kuopio, Finland
| | - Jaana Lindström
- Diabetes Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - Sari Voutilainen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Yliopistonranta 1C, P.O. Box 1627, FI70211 Kuopio, Finland
| | - Jyrki K Virtanen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Yliopistonranta 1C, P.O. Box 1627, FI70211 Kuopio, Finland
| | - Sirkka Keinänen-Kiukaanniemi
- Center for Life Course Health Research, University of Oulu, Finland; Medical Research Center and Unit of General Practice, Oulu University Hospital and Oulu Health Center, Oulu, Finland
| | - Tomi-Pekka Tuomainen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Yliopistonranta 1C, P.O. Box 1627, FI70211 Kuopio, Finland
| | - Jaakko Tuomilehto
- Centre for Vascular Prevention, Danube-University Krems, Krems, Austria; Dasman Diabetes Institute, Dasman, Kuwait; Diabetes Research Group, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Matti Uusitupa
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Yliopistonranta 1C, P.O. Box 1627, FI70211 Kuopio, Finland
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Hemmingsen B, Gimenez‐Perez G, Mauricio D, Roqué i Figuls M, Metzendorf M, Richter B. Diet, physical activity or both for prevention or delay of type 2 diabetes mellitus and its associated complications in people at increased risk of developing type 2 diabetes mellitus. Cochrane Database Syst Rev 2017; 12:CD003054. [PMID: 29205264 PMCID: PMC6486271 DOI: 10.1002/14651858.cd003054.pub4] [Citation(s) in RCA: 103] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND The projected rise in the incidence of type 2 diabetes mellitus (T2DM) could develop into a substantial health problem worldwide. Whether diet, physical activity or both can prevent or delay T2DM and its associated complications in at-risk people is unknown. OBJECTIVES To assess the effects of diet, physical activity or both on the prevention or delay of T2DM and its associated complications in people at increased risk of developing T2DM. SEARCH METHODS This is an update of the Cochrane Review published in 2008. We searched the CENTRAL, MEDLINE, Embase, ClinicalTrials.gov, ICTRP Search Portal and reference lists of systematic reviews, articles and health technology assessment reports. The date of the last search of all databases was January 2017. We continuously used a MEDLINE email alert service to identify newly published studies using the same search strategy as described for MEDLINE up to September 2017. SELECTION CRITERIA We included randomised controlled trials (RCTs) with a duration of two years or more. DATA COLLECTION AND ANALYSIS We used standard Cochrane methodology for data collection and analysis. We assessed the overall quality of the evidence using GRADE. MAIN RESULTS We included 12 RCTs randomising 5238 people. One trial contributed 41% of all participants. The duration of the interventions varied from two to six years. We judged none of the included trials at low risk of bias for all 'Risk of bias' domains.Eleven trials compared diet plus physical activity with standard or no treatment. Nine RCTs included participants with impaired glucose tolerance (IGT), one RCT included participants with IGT, impaired fasting blood glucose (IFG) or both, and one RCT included people with fasting glucose levels between 5.3 to 6.9 mmol/L. A total of 12 deaths occurred in 2049 participants in the diet plus physical activity groups compared with 10 in 2050 participants in the comparator groups (RR 1.12, 95% CI 0.50 to 2.50; 95% prediction interval 0.44 to 2.88; 4099 participants, 10 trials; very low-quality evidence). The definition of T2DM incidence varied among the included trials. Altogether 315 of 2122 diet plus physical activity participants (14.8%) developed T2DM compared with 614 of 2389 comparator participants (25.7%) (RR 0.57, 95% CI 0.50 to 0.64; 95% prediction interval 0.50 to 0.65; 4511 participants, 11 trials; moderate-quality evidence). Two trials reported serious adverse events. In one trial no adverse events occurred. In the other trial one of 51 diet plus physical activity participants compared with none of 51 comparator participants experienced a serious adverse event (low-quality evidence). Cardiovascular mortality was rarely reported (four of 1626 diet plus physical activity participants and four of 1637 comparator participants (the RR ranged between 0.94 and 3.16; 3263 participants, 7 trials; very low-quality evidence). Only one trial reported that no non-fatal myocardial infarction or non-fatal stroke had occurred (low-quality evidence). Two trials reported that none of the participants had experienced hypoglycaemia. One trial investigated health-related quality of life in 2144 participants and noted that a minimal important difference between intervention groups was not reached (very low-quality evidence). Three trials evaluated costs of the interventions in 2755 participants. The largest trial of these reported an analysis of costs from the health system perspective and society perspective reflecting USD 31,500 and USD 51,600 per quality-adjusted life year (QALY) with diet plus physical activity, respectively (low-quality evidence). There were no data on blindness or end-stage renal disease.One trial compared a diet-only intervention with a physical-activity intervention or standard treatment. The participants had IGT. Three of 130 participants in the diet group compared with none of the 141 participants in the physical activity group died (very low-quality evidence). None of the participants died because of cardiovascular disease (very low-quality evidence). Altogether 57 of 130 diet participants (43.8%) compared with 58 of 141 physical activity participants (41.1%) group developed T2DM (very low-quality evidence). No adverse events were recorded (very low-quality evidence). There were no data on non-fatal myocardial infarction, non-fatal stroke, blindness, end-stage renal disease, health-related quality of life or socioeconomic effects.Two trials compared physical activity with standard treatment in 397 participants. One trial included participants with IGT, the other trial included participants with IGT, IFG or both. One trial reported that none of the 141 physical activity participants compared with three of 133 control participants died. The other trial reported that three of 84 physical activity participants and one of 39 control participants died (very low-quality evidence). In one trial T2DM developed in 58 of 141 physical activity participants (41.1%) compared with 90 of 133 control participants (67.7%). In the other trial 10 of 84 physical activity participants (11.9%) compared with seven of 39 control participants (18%) developed T2DM (very low-quality evidence). Serious adverse events were rarely reported (one trial noted no events, one trial described events in three of 66 physical activity participants compared with one of 39 control participants - very low-quality evidence). Only one trial reported on cardiovascular mortality (none of 274 participants died - very low-quality evidence). Non-fatal myocardial infarction or stroke were rarely observed in the one trial randomising 123 participants (very low-quality evidence). One trial reported that none of the participants in the trial experienced hypoglycaemia. One trial investigating health-related quality of life in 123 participants showed no substantial differences between intervention groups (very low-quality evidence). There were no data on blindness or socioeconomic effects. AUTHORS' CONCLUSIONS There is no firm evidence that diet alone or physical activity alone compared to standard treatment influences the risk of T2DM and especially its associated complications in people at increased risk of developing T2DM. However, diet plus physical activity reduces or delays the incidence of T2DM in people with IGT. Data are lacking for the effect of diet plus physical activity for people with intermediate hyperglycaemia defined by other glycaemic variables. Most RCTs did not investigate patient-important outcomes.
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Affiliation(s)
- Bianca Hemmingsen
- Herlev University HospitalDepartment of Internal MedicineHerlev Ringvej 75HerlevDenmarkDK‐2730
| | - Gabriel Gimenez‐Perez
- Hospital General de Granollers and School of Medicine and Health Sciences. Universitat Internacional de Catalunya (UIC)Medicine DepartmentFrancesc Ribas s/nGranollersSpain08402
| | - Didac Mauricio
- Hospital Universitari Germans Trias i Pujol ‐ CIBERDEMDepartment of Endocrinology and NutritionCarretera Canyet S/NBadalonaSpain08916
| | - Marta Roqué i Figuls
- CIBER Epidemiología y Salud Pública (CIBERESP)Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau)Sant Antoni Maria Claret 171Edifici Casa de ConvalescènciaBarcelonaCatalunyaSpain08041
| | - Maria‐Inti Metzendorf
- Institute of General Practice, Medical Faculty of the Heinrich‐Heine‐University DüsseldorfCochrane Metabolic and Endocrine Disorders GroupMoorenstr. 5DüsseldorfGermany40225
| | - Bernd Richter
- Institute of General Practice, Medical Faculty of the Heinrich‐Heine‐University DüsseldorfCochrane Metabolic and Endocrine Disorders GroupMoorenstr. 5DüsseldorfGermany40225
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Flodgren G, Gonçalves‐Bradley DC, Summerbell CD. Interventions to change the behaviour of health professionals and the organisation of care to promote weight reduction in children and adults with overweight or obesity. Cochrane Database Syst Rev 2017; 11:CD000984. [PMID: 29190418 PMCID: PMC6486102 DOI: 10.1002/14651858.cd000984.pub3] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND The prevalence of overweight and obesity is increasing globally, an increase which has major implications for both population health and costs to health services. This is an update of a Cochrane Review. OBJECTIVES To assess the effects of strategies to change the behaviour of health professionals or the organisation of care compared to standard care, to promote weight reduction in children and adults with overweight or obesity. SEARCH METHODS We searched the following databases for primary studies up to September 2016: CENTRAL, MEDLINE, Embase, CINAHL, DARE and PsycINFO. We searched the reference lists of included studies and two trial registries. SELECTION CRITERIA We considered randomised trials that compared routine provision of care with interventions aimed either at changing the behaviour of healthcare professionals or the organisation of care to promote weight reduction in children and adults with overweight or obesity. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane when conducting this review. We report the results for the professional interventions and the organisational interventions in seven 'Summary of findings' tables. MAIN RESULTS We identified 12 studies for inclusion in this review, seven of which evaluated interventions targeting healthcare professional and five targeting the organisation of care. Eight studies recruited adults with overweight or obesity and four recruited children with obesity. Eight studies had an overall high risk of bias, and four had a low risk of bias. In total, 139 practices provided care to 89,754 people, with a median follow-up of 12 months. Professional interventions Educational interventions aimed at general practitioners (GPs), may slightly reduce the weight of participants (mean difference (MD) -1.24 kg, 95% confidence interval (CI) -2.84 to 0.37; 3 studies, N = 1017 adults; low-certainty evidence).Tailoring interventions to improve GPs' compliance with obesity guidelines probably leads to little or no difference in weight loss (MD 0.05 (kg), 95% CI -0.32 to 0.41; 1 study, N = 49,807 adults; moderate-certainty evidence).It is uncertain if providing doctors with reminders results in a greater weight reduction than standard care (men: MD -11.20 kg, 95% CI -20.66 kg to -1.74 kg, and women: MD -1.30 kg, 95% CI [-7.34, 4.74] kg; 1 study, N = 90 adults; very low-certainty evidence).Providing clinicians with a clinical decision support (CDS) tool to assist with obesity management at the point of care leads to little or no difference in the body mass index (BMI) z-score of children (MD -0.08, 95% CI -0.15 to -0.01 in 378 children; moderate-certainty evidence), CDS tools may lead to little or no difference in weight loss in adults: MD -0.095 kg (-0.21 lbs), P = 0.47; 1 study, N = 35,665; low-certainty evidence. Organisational interventions Adults with overweight or obesity may lose more weight if the care was provided by a dietitian (by -5.60 kg, 95% CI -4.83 kg to -6.37 kg) or by a doctor-dietitian team (by -6.70 kg, 95% CI -7.52 kg to -5.88 kg; 1 study, N = 270 adults; low-certainty evidence). Shared care leads to little or no difference in the BMI z-score of children with obesity (adjusted MD -0.05, 95% CI -0.14 to 0.03; 1 study, N = 105 children; low-certainty evidence).Organisational restructuring of the delivery of primary care (i.e. introducing the chronic care model) may result in a slightly lower increase in the BMI of children who received care at intervention clinics (BMI change: adjusted MD -0.21, 95% CI -0.50 to 0.07; 1 study, unadjusted MD -0.18, 95% CI -0.20 to -0.16; N=473 participants; moderate-certainty evidence).Mail and phone interventions probably lead to little or no difference in weight loss in adults (mean weight change (kg) using mail: -0.36, 95% CI -1.18 to 0.46; phone: -0.44, 95% CI -1.26 to 0.38; 1 study, N = 1801 adults; moderate-certainty evidence). Care delivered by a nurse at a primary care clinic may lead to little or no difference in the BMI z-score in children (MD -0.02, 95% CI -0.16 to 0.12; 1 study, N = 52 children; very low-certainty evidence).Two studies reported data on cost effectiveness: one study favoured mail and standard care over telephone consultations, and the other study achieved weight loss at a modest cost in both intervention groups (doctor and doctor-dietitian). One study of shared care reported similar adverse effects in both groups. AUTHORS' CONCLUSIONS We found little convincing evidence for a clinically-important effect on participants' weight or BMI of any of the evaluated interventions. While pooled results from three studies indicate that educational interventions targeting healthcare professionals may lead to a slight weight reduction in adults, the certainty of these results is low. Two trials evaluating CDS tools (unpooled results) for improved weight management suggest little or no effect on weight or BMI change in adults or children with overweight or obesity. Evidence for all the other interventions evaluated came mostly from single studies. The certainty of the included evidence varied from moderate to very low for the main outcomes (weight and BMI). All of the evaluated interventions would need further investigation to ascertain their strengths and limitations as effective strategies to change the behaviour of healthcare professionals or the organisation of care. As only two studies reported on cost, we know little about cost effectiveness across the evaluated interventions.
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Affiliation(s)
- Gerd Flodgren
- Norwegian Institute of Public HealthDivision for Health ServicesPilestredet Park 7OsloNorway0176
| | | | - Carolyn D Summerbell
- Queen's Campus, Durham UniversitySchool of Medicine, Pharmacy and Health, Wolfson Research InstituteUniversity BoulevardThornabyStockton‐on‐TeesUKTS17 6BH
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Medical Nutrition Therapy and Weight Loss Questions for the Evidence Analysis Library Prevention of Type 2 Diabetes Project: Systematic Reviews. J Acad Nutr Diet 2017; 117:1578-1611. [DOI: 10.1016/j.jand.2017.06.361] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 06/20/2017] [Indexed: 01/03/2023]
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Walle P, Takkunen M, Männistö V, Vaittinen M, Käkelä P, Ågren J, Schwab U, Lindström J, Tuomilehto J, Uusitupa M, Pihlajamäki J. Alterations in fatty acid metabolism in response to obesity surgery combined with dietary counseling. Nutr Diabetes 2017; 7:e285. [PMID: 28869586 PMCID: PMC5637104 DOI: 10.1038/nutd.2017.33] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 06/24/2017] [Accepted: 07/16/2017] [Indexed: 12/14/2022] Open
Abstract
Background: The effects of obesity surgery on serum and adipose tissue fatty acid (FA) profile and FA metabolism may modify the risk of obesity-related diseases. Methods: We measured serum (n=122) and adipose tissue (n=24) FA composition and adipose tissue mRNA expression of genes regulating FA metabolism (n=100) in participants of the Kuopio Obesity Surgery Study (KOBS, age 47.2±8.7 years, BMI 44.6±6.0, 40 men, 82 women) before and one year after obesity surgery. As part of the surgery protocol, all the subjects were instructed to add sources of unsaturated fatty acids, such as rapeseed oil and fatty fish, into their diet. The results were compared with changes in serum FA composition in 122 subjects from the Finnish Diabetes Prevention study (DPS) (age 54.3±7.1 years, BMI 32.2±4.6, 28 men, 94 women). Results: The proportion of saturated FAs decreased and the proportion of n-3 and n-6 FAs increased in serum triglycerides after obesity surgery (all P<0.002). Weight loss predicted changes in quantitative amounts of saturated FAs, monounsaturated FAs, n-3 and n-6 FAs in triglycerides (P<0.002 for all). Moreover, the changes in adipose tissue FAs reflected the changes in serum FAs, and some of the changes were associated with mRNA expression of elongases and desaturases in adipose tissue (all P<0.05). In line with this the estimated activity of elongase (18:1 n-7/16:1 n-7) increased significantly after obesity surgery in all lipid fractions (all P<4 × 10−7) and the increase in the estimated activity of D5D in triglycerides was associated with higher weight loss (r=0.415, P<2 × 10−6). Changes in serum FA profile were similar after obesity surgery and lifestyle intervention, except for the change in the absolute amounts of n-3 FAs between the two studies (P=0.044). Conclusions: Beneficial changes in serum and adipose tissue FAs after obesity surgery could be associated with changes in endogenous metabolism and diet.
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Affiliation(s)
- P Walle
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - M Takkunen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - V Männistö
- Department of Medicine, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland
| | - M Vaittinen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - P Käkelä
- Department of Surgery, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland
| | - J Ågren
- Institute of Biomedicine, University of Eastern Finland, Kuopio, Finland
| | - U Schwab
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.,Clinical Nutrition and Obesity Center, Kuopio University Hospital, Kuopio, Finland
| | - J Lindström
- National Institute for Health and Welfare, THL, Helsinki, Finland
| | - J Tuomilehto
- National Institute for Health and Welfare, THL, Helsinki, Finland.,Center for Vascular Prevention, Danube University Krems, Krems, Austria.,Diabetes Research Group, King Abdulaziz University, Jeddah, Saudi Arabia.,Dasman Diabetes Institute, Dasman, Kuwait
| | - M Uusitupa
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - J Pihlajamäki
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.,Clinical Nutrition and Obesity Center, Kuopio University Hospital, Kuopio, Finland
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PREVIEW: Prevention of Diabetes through Lifestyle Intervention and Population Studies in Europe and around the World. Design, Methods, and Baseline Participant Description of an Adult Cohort Enrolled into a Three-Year Randomised Clinical Trial. Nutrients 2017. [PMID: 28632180 PMCID: PMC5490611 DOI: 10.3390/nu9060632] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Type-2 diabetes (T2D) is one of the fastest growing chronic diseases worldwide. The PREVIEW project has been initiated to find the most effective lifestyle (diet and physical activity) for the prevention of T2D, in overweight and obese participants with increased risk for T2D. The study is a three-year multi-centre, 2 × 2 factorial, randomised controlled trial. The impact of a high-protein, low-glycaemic index (GI) vs. moderate protein, moderate-GI diet in combination with moderate or high-intensity physical activity on the incidence of T2D and the related clinical end-points are investigated. The intervention started with a two-month weight reduction using a low-calorie diet, followed by a randomised 34-month weight maintenance phase comprising four treatment arms. Eight intervention centres are participating (Denmark, Finland, United Kingdom, The Netherlands, Spain, Bulgaria, Australia, and New Zealand). Data from blood specimens, urine, faeces, questionnaires, diaries, body composition assessments, and accelerometers are collected at months 0, 2, 6, 12, 18, 24, and 36. In total, 2326 adults were recruited. The mean age was 51.6 (SD 11.6) years, 67% were women. PREVIEW is, to date, the largest multinational trial to address the prevention of T2D in pre-diabetic adults through diet and exercise intervention. Participants will complete the final intervention in March, 2018.
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Zhang X, Devlin HM, Smith B, Imperatore G, Thomas W, Lobelo F, Ali MK, Norris K, Gruss S, Bardenheier B, Cho P, Garcia de Quevedo I, Mudaliar U, Jones CD, Durthaler JM, Saaddine J, Geiss LS, Gregg EW. Effect of lifestyle interventions on cardiovascular risk factors among adults without impaired glucose tolerance or diabetes: A systematic review and meta-analysis. PLoS One 2017; 12:e0176436. [PMID: 28493887 PMCID: PMC5426619 DOI: 10.1371/journal.pone.0176436] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 04/10/2017] [Indexed: 02/07/2023] Open
Abstract
Structured lifestyle interventions can reduce diabetes incidence and cardiovascular disease (CVD) risk among persons with impaired glucose tolerance (IGT), but it is unclear whether they should be implemented among persons without IGT. We conducted a systematic review and meta-analyses to assess the effectiveness of lifestyle interventions on CVD risk among adults without IGT or diabetes. We systematically searched MEDLINE, EMBASE, CINAHL, Web of Science, the Cochrane Library, and PsychInfo databases, from inception to May 4, 2016. We selected randomized controlled trials of lifestyle interventions, involving physical activity (PA), dietary (D), or combined strategies (PA+D) with follow-up duration ≥12 months. We excluded all studies that included individuals with IGT, confirmed by 2-hours oral glucose tolerance test (75g), but included all other studies recruiting populations with different glycemic levels. We stratified studies by baseline glycemic levels: (1) low-range group with mean fasting plasma glucose (FPG) <5.5mmol/L or glycated hemoglobin (A1C) <5.5%, and (2) high-range group with FPG ≥5.5mmol/L or A1C ≥5.5%, and synthesized data using random-effects models. Primary outcomes in this review included systolic blood pressure (SBP), diastolic blood pressure (DBP), total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), and triglycerides (TG). Totally 79 studies met inclusion criteria. Compared to usual care (UC), lifestyle interventions achieved significant improvements in SBP (-2.16mmHg[95%CI, -2.93, -1.39]), DBP (-1.83mmHg[-2.34, -1.31]), TC (-0.10mmol/L[-0.15, -0.05]), LDL-C (-0.09mmol/L[-0.13, -0.04]), HDL-C (0.03mmol/L[0.01, 0.04]), and TG (-0.08mmol/L[-0.14, -0.03]). Similar effects were observed among both low-and high-range study groups except for TC and TG. Similar effects also appeared in SBP and DBP categories regardless of follow-up duration. PA+D interventions had larger improvement effects on CVD risk factors than PA alone interventions. In adults without IGT or diabetes, lifestyle interventions resulted in significant improvements in SBP, DBP, TC, LDL-C, HDL-C, and TG, and might further reduce CVD risk.
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Affiliation(s)
- Xuanping Zhang
- Division of Diabetes Translation, National Centers for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- * E-mail:
| | - Heather M. Devlin
- Division of Diabetes Translation, National Centers for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Bryce Smith
- Division of Diabetes Translation, National Centers for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Giuseppina Imperatore
- Division of Diabetes Translation, National Centers for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - William Thomas
- Office of Public Health Scientific Services, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Felipe Lobelo
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Mohammed K. Ali
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Keri Norris
- Health Policy and Administration, Fulton-DeKalb Hospital Authority, Atlanta, Georgia, United States of America
| | - Stephanie Gruss
- Division of Diabetes Translation, National Centers for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Barbara Bardenheier
- Division of Diabetes Translation, National Centers for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Pyone Cho
- Division of Diabetes Translation, National Centers for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Isabel Garcia de Quevedo
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Uma Mudaliar
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Christopher D. Jones
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Jeffrey M. Durthaler
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Jinan Saaddine
- Division of Diabetes Translation, National Centers for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Linda S. Geiss
- Division of Diabetes Translation, National Centers for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Edward W. Gregg
- Division of Diabetes Translation, National Centers for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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Abstract
BACKGROUND The majority of patients with overweight and type 2 diabetes show insufficient levels of daily physical activity (PA) and usually are among the least likely to engage in or adhere to any form of generic PA. Active video games (exergames) may be a solution to motivate these individuals to overcome their sedentary lifestyle. OBJECTIVES This systematic review was conducted to review the current evidence for the effectiveness of exergaming in overweight and type 2 diabetes mellitus and thus to evaluate the suitability of these games to be used as tools for exercise promotion that meet current PA guidelines. METHODS We searched electronic bibliographic databases (PubMed, Embase, Web of Science, OpenGrey, and the Cochrane Central Register of Controlled Trials) up to March 2015. Randomized controlled trials (RCT) and cross-sectional studies published in English in a peer-reviewed journal and analyzing the effects of exergames on objectively measured intensity parameters of PA in overweight (body mass index [BMI] ≥25 kg/m(2)) adults (mean age ≥18 years) with and without type 2 diabetes were included. Study selection, data extraction, and quality assessment were performed independently by two review authors. Primary outcomes included changes in oxygen uptake (VO2), energy expenditure (EE), heart rate (HR), or activity counts. Secondary outcomes were enjoyment of treatment, exercise adherence, ratings of perceived exertion (RPE), changes in body composition, and changes in blood parameters (serum glucose, long-term blood glucose, blood cholesterol, triglycerides, or serum lactate). RESULTS Of 2845 records, 14 publications (11 studies) met the inclusion criteria. All included studies (ten experimental, cross-sectional laboratory studies and one RCT) were able to show increases in either VO2, EE, HR, or activity counts. However, effects of exergaming in terms of changes in these intensity parameters varied significantly between game modes and consoles as well as because of the vastly differing durations of exergame activity between studies. One of the included studies had a low risk of bias, and three had a high risk of bias; seven studies had an unclear risk of bias as the study description was insufficient. No studies were found investigating the changes in objectively measured PA intensity parameters in patients with type 2 diabetes. CONCLUSION This review suggests that exergames are able to increase PA among overweight individuals. However, the inconsistent results and the overall poor or moderate methodological quality do not permit judgment on whether exergames are suitable to meet PA guidelines in this target group. The lack of research regarding the effects of exergames in type 2 diabetes indicates a great need for future research.
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Höchsmann C, Walz SP, Schäfer J, Holopainen J, Hanssen H, Schmidt-Trucksäss A. Mobile Exergaming for Health-Effects of a serious game application for smartphones on physical activity and exercise adherence in type 2 diabetes mellitus-study protocol for a randomized controlled trial. Trials 2017; 18:103. [PMID: 28264717 PMCID: PMC5339965 DOI: 10.1186/s13063-017-1853-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 02/17/2017] [Indexed: 12/25/2022] Open
Abstract
Background Exergaming is a novel approach to increase motivation for regular physical activity (PA) among sedentary individuals such as patients with type 2 diabetes mellitus (T2DM). Because existing exergames do not offer fitness-level adjusted, individualized workouts and are normally stationary (TV bound), thus not enabling PA anywhere and at any time, we developed a smartphone-based, game-like software application (MOBIGAME) specifically designed for middle-aged T2DM patients to induce a healthier, more active lifestyle as part of successful T2DM treatment and management. In a randomized controlled trial we aim to examine whether our smartphone-based game application can lead to increases in daily PA in T2DM patients that are persistent in the mid to long term and whether these increases are greater than those in a control group. Methods This study is designed as a randomized controlled trial. We plan to recruit a total of 42 T2DM patients [45-70 years, body mass index (BMI) ≥25 kg/m2, low daily PA, regular smartphone use]. The experimental intervention (duration 24 weeks) includes individualized multidimensional home-based exercise and daily PA promotion administered through MOBIGAME. The control intervention consists of a one-time standard lifestyle counseling including the promotion of baseline activities. The primary outcome is daily PA measured as steps per day. Secondary outcome is exercise adherence measured via the usage data from the participants’ smartphones (experimental intervention) and as self-recorded exercise log entries (control intervention). We will test the hypothesis that there will be differences between the experimental and control group with respect to post-interventional daily PA (as well as all other outcomes) using analysis of covariance. For each analysis, an estimate (with 95% confidence interval) of the difference in outcome between both groups will be reported. Discussion This research will investigate the effectiveness of a novel smartphone-based, game-like software application to be used as a way to promote regular daily PA among inactive T2DM patients. The results of this trial may have important implications for future PA-promoting interventions and provide relevant information for the general transferability of such applications to be used as part of the treatment in other chronic diseases. Trial registration ClinicalTrials.gov, NCT02657018. Registered on 11 January 2016. Last status update on 3 May 2016. Kofam.ch, SNCTP-number:SNCTP000001652. Registered on 21 January 2016. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-1853-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Christoph Höchsmann
- Division of Sports and Exercise Medicine, Department of Sport, Exercise and Health, University of Basel, Birsstrasse 320 B, 4052, Basel, Switzerland
| | | | - Juliane Schäfer
- Division of Sports and Exercise Medicine, Department of Sport, Exercise and Health, University of Basel, Birsstrasse 320 B, 4052, Basel, Switzerland
| | | | - Henner Hanssen
- Division of Sports and Exercise Medicine, Department of Sport, Exercise and Health, University of Basel, Birsstrasse 320 B, 4052, Basel, Switzerland
| | - Arno Schmidt-Trucksäss
- Division of Sports and Exercise Medicine, Department of Sport, Exercise and Health, University of Basel, Birsstrasse 320 B, 4052, Basel, Switzerland.
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Sun Y, You W, Almeida F, Estabrooks P, Davy B. The Effectiveness and Cost of Lifestyle Interventions Including Nutrition Education for Diabetes Prevention: A Systematic Review and Meta-Analysis. J Acad Nutr Diet 2017; 117:404-421.e36. [PMID: 28236962 PMCID: PMC5330213 DOI: 10.1016/j.jand.2016.11.016] [Citation(s) in RCA: 107] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 11/28/2016] [Indexed: 12/24/2022]
Abstract
BACKGROUND Type 2 diabetes is a significant public health concern. With the completion of the Diabetes Prevention Program, there has been a proliferation of studies attempting to translate this evidence base into practice. However, the cost, effectiveness, and cost-effectiveness of these adapted interventions is unknown. OBJECTIVE The purpose of this systematic review was to conduct a comprehensive meta-analysis to synthesize the effectiveness, cost, and cost-effectiveness of lifestyle diabetes prevention interventions and compare effects by intervention delivery agent (dietitian vs non-dietitian) and channel (in-person vs technology-delivered). METHODS English and full-text research articles published up to July 2015 were identified using the Cochrane Library, PubMed, Education Resources Information Center, CAB Direct, Science Direct, and Google Scholar. Sixty-nine studies met inclusion criteria. Most employed both dietary and physical activity intervention components (four of 69 were diet-only interventions). Changes in weight, fasting and 2-hour blood glucose concentration, and hemoglobin A1c were extracted from each article. Heterogeneity was measured by the I2 index, and study-specific effect sizes or mean differences were pooled using a random effects model when heterogeneity was confirmed. RESULTS Participants receiving intervention with nutrition education experienced a reduction of 2.07 kg (95% CI 1.52 to 2.62; P<0.001; I2=90.99%, 95% CI 88.61% to 92.87%) in weight at 12 months with effect sizes over time ranging from small (0.17, 95% CI 0.04 to 0.30; P=0.012; I2= 86.83%, 95% CI 80.42% to 91.14%) to medium (0.65, 95% CI 0.49 to 0.82; P<0.001; I2=98.75%, 95% CI 98.52% to 98.94). Effect sizes for 2-hour blood glucose and hemoglobin A1c level changes ranged from small to medium. The meta-regression analysis revealed a larger relative weight loss in dietitian-delivered interventions than in those delivered by nondietitians (full sample: -1.0 kg; US subsample: -2.4 kg), and did not find statistical evidence that the delivery channel was an important predictor of weight loss. The average cost per kilogram weight loss ranged from $34.06 over 6 months to $1,005.36 over 12 months. The cost of intervention per participant delivered by dietitians was lower than interventions delivered by non-dietitians, although few studies reported costs. CONCLUSIONS Lifestyle interventions are effective in reducing body weight and glucose-related outcomes. Dietitian-delivered interventions, compared with those delivered by other personnel, achieved greater weight reduction. No consistent trend was identified across different delivery channels.
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Luo Y, Paul SK, Zhou X, Chang C, Chen W, Guo X, Yang J, Ji L, Wang H. Rationale, Design, and Baseline Characteristics of Beijing Prediabetes Reversion Program: A Randomized Controlled Clinical Trial to Evaluate the Efficacy of Lifestyle Intervention and/or Pioglitazone in Reversion to Normal Glucose Tolerance in Prediabetes. J Diabetes Res 2017; 2017:7602408. [PMID: 28168204 PMCID: PMC5266841 DOI: 10.1155/2017/7602408] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 11/28/2016] [Indexed: 12/12/2022] Open
Abstract
Background. Patients with prediabetes are at high risk for diabetes and cardiovascular disease (CVD). No study has explored whether intervention could revert prediabetes to normal glycemic status as the primary outcome. Beijing Prediabetes Reversion Program (BPRP) would evaluate whether intensive lifestyle modification and/or pioglitazone could revert prediabetic state to normoglycemia and improve the risk factors of CVD as well. Methods. BPRP is a randomized, multicenter, 2 × 2 factorial design study. Participants diagnosed as prediabetes were randomized into four groups (conventional/intensive lifestyle intervention and 30 mg pioglitazone/placebo) with a three-year follow-up. The primary endpoint was conversion into normal glucose tolerance. The trial would recruit 2000 participants (500 in each arm). Results. Between March 2007 and March 2011, 1945 participants were randomized. At baseline, the individuals were 53 ± 10 years old, with median BMI 26.0 (23.9, 28.2) kg/m2 and HbA1c 5.8 (5.6, 6.1)%. 85% of the participants had IGT and 15% had IFG. Parameters relevant to glucose, lipids, blood pressure, lifestyle, and other metabolic markers were similar between conventional and intensive lifestyle intervention group at baseline. Conclusion. BPRP was the first study to determine if lifestyle modification and/or pioglitazone could revert prediabetic state to normoglycemia in Chinese population. Major baseline parameters were balanced between two lifestyle intervention groups. This trial is registered with www.chictr.org.cn: ChiCTR-PRC-06000005.
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Affiliation(s)
- Yingying Luo
- Department of Endocrinology and Metabolism, Peking University People's Hospital, Beijing, China
| | - Sanjoy K. Paul
- Melbourne EpiCentre, University of Melbourne, Melbourne, VIC, Australia
- Clinical Trials and Biostatistics Unit, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Xianghai Zhou
- Department of Endocrinology and Metabolism, Peking University People's Hospital, Beijing, China
| | - Cuiqing Chang
- Institute of Sports Medicine, Peking University Third Hospital, Beijing, China
| | - Wei Chen
- Department of Parenteral and Enteral Nutrition, Peking Union Medical College Hospital, Beijing, China
| | - Xiaohui Guo
- Department of Endocrinology and Metabolism, Peking University First Hospital, Beijing, China
| | - Jinkui Yang
- Department of Endocrinology and Metabolism, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Linong Ji
- Department of Endocrinology and Metabolism, Peking University People's Hospital, Beijing, China
- *Linong Ji: and
| | - Hongyuan Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
- *Hongyuan Wang:
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Levine JA. The Application of Wearable Technologies to Improve Healthcare in the World’s Poorest People. ACTA ACUST UNITED AC 2017. [DOI: 10.4236/ti.2017.82007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Bogatyrev SN. Physical activity and type 2 diabetes mellitus risk: population studies review. DIABETES MELLITUS 2016. [DOI: 10.14341/dm8030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Physical activity is one of the most important components of a healthy lifestyle. Regular physical activity helps to maintain normal blood glucose levels and reduce the risk of type 2 diabetes mellitus. This review presents population studies investigating physical activity as a factor for type 2 diabetes mellitus risk. A search using the keywords ‘physical activity’, ‘type 2 diabetes mellitus’ and ‘risk’ identified more than 40 relevant original studies and meta-analyses, which are presented in this review. Different types of physical activity have positive protective effects on type 2 diabetes mellitus risk and reduce the risk of death in patients with type 2 diabetes mellitus.
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Ji J, Sundquist J, Sundquist K. Association between anorexia nervosa and type 2 diabetes in Sweden: Etiological clue for the primary prevention of type 2 diabetes. Endocr Res 2016; 41:310-316. [PMID: 26906648 DOI: 10.3109/07435800.2016.1141948] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
AIM Caloric restriction has been found to be protective against the development of type 2 diabetes mellitus (T2D) in experimental animal studies. However, studies examining this association in humans are limited. In the present study, we examined whether individuals with anorexia nervosa, one marker of severe caloric restriction in humans, have a low incidence of T2D by using several Swedish registries. METHODS Individuals with anorexia nervosa were identified from the Swedish Hospital Discharge Register and Outpatient Register between 1964 and 2010. Standardized incidence ratios (SIRs) for T2D were studied among individuals with anorexia nervosa compared to those without the disorder. RESULTS A total of 17,135 individuals were identified with anorexia nervosa in Sweden. From this tally, 34 of them developed T2D, demonstrating a reduced risk of T2D with a SIR of 0.70, compared to individuals without anorexia nervosa. Patients with severe anorexia, indicated by more frequent hospitalizations, had a statistically non-significant lower incidence of T2D than those with fewer hospitalizations. A sibling study, controlled for familial confounding, found a statistically non-significant association between anorexia nervosa and T2D. CONCLUSION Our study found that severe caloric restriction by using individuals with anorexia nervosa as a proxy was negatively associated with T2D, which might provide a biological basis for the primary prevention of T2D. Further studies are needed to explore whether moderate caloric restriction can effectively prevent the development of T2D in general population.
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Affiliation(s)
- Jianguang Ji
- a Center for Primary Health Care Research , Lund University/Region Skåne , Sweden
| | - Jan Sundquist
- a Center for Primary Health Care Research , Lund University/Region Skåne , Sweden
- b Stanford Prevention Research Center , Stanford University School of Medicine , Stanford , CA , USA
| | - Kristina Sundquist
- a Center for Primary Health Care Research , Lund University/Region Skåne , Sweden
- b Stanford Prevention Research Center , Stanford University School of Medicine , Stanford , CA , USA
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Ruffino JS, Davies NA, Morris K, Ludgate M, Zhang L, Webb R, Thomas AW. Moderate-intensity exercise alters markers of alternative activation in circulating monocytes in females: a putative role for PPARγ. Eur J Appl Physiol 2016; 116:1671-82. [PMID: 27339155 PMCID: PMC4983283 DOI: 10.1007/s00421-016-3414-y] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 06/06/2016] [Indexed: 02/07/2023]
Abstract
PURPOSE Monocytes may be primed towards differentiation into classically activated M1 macrophages or alternatively activated M2 macrophages. M1 macrophages greatly contribute to the inflammation which promotes insulin resistance, whereas M2 macrophages resolve inflammation. We have previously shown that exercise increases M2 marker expression in mixed mononuclear cells, possibly via activation of the nuclear transcription factor PPARγ. However, these effects have not been demonstrated specifically within monocytes. Thus, we aimed to investigate whether moderate-intensity exercise elicited similar effects on monocytic M1/M2 marker expression and PPARγ activity to those reported previously in mononuclear cells, so as to further elucidate the mechanisms by which exercise may alter inflammatory status and, accordingly, prevent insulin resistance. METHODS/RESULTS 19 sedentary females completed an 8 week moderate-intensity exercise programme (walking 45 min, thrice weekly). Monocytes were isolated from blood via immunomagnetic separation; monocyte expression of M2 markers (Dectin-1: 2.6 ± 1.9-fold; IL-10: 3.0 ± 2.8-fold) significantly increased, whilst the expression of the M1 marker MCP-1 significantly decreased (0.83 ± 0.2 cf. basal), over the duration of the programme. Serum PPARγ activity levels and PPARγ target-genes (CD36: 1.9 ± 1.5-fold; LXRα: 5.0 ± 4.7-fold) were significantly increased after the 8 week exercise programme. Associated with these effects were significant improvements in systemic insulin sensitivity (McAuley's ISI: Δ0.98 M/mU/L cf. basal). CONCLUSION Exercise participation suppressed M1 markers and induced M2 markers in monocytes, potentially via PPARγ-triggered signalling, and these effects may contribute (perhaps via priming of monocytes for differentiation into M2 tissue-macrophages) to improved systemic insulin sensitivity in exercising participants. These findings provide an alternative mechanism by which exercise may exert its anti-inflammatory effects in order to prevent insulin resistance and type 2 diabetes.
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Affiliation(s)
- J S Ruffino
- Centre for Biomedical Science, Cardiff Metropolitan University, Cardiff, CF5 2YB, UK
| | - N A Davies
- College of Medicine, Swansea University, Swansea, SA2 8PP, UK
| | - K Morris
- Centre for Endocrine & Diabetes Sciences, Cardiff University School of Medicine, Cardiff, CF14 4YU, UK
| | - M Ludgate
- Centre for Endocrine & Diabetes Sciences, Cardiff University School of Medicine, Cardiff, CF14 4YU, UK
| | - L Zhang
- Centre for Endocrine & Diabetes Sciences, Cardiff University School of Medicine, Cardiff, CF14 4YU, UK
| | - R Webb
- Centre for Biomedical Science, Cardiff Metropolitan University, Cardiff, CF5 2YB, UK
| | - A W Thomas
- Centre for Biomedical Science, Cardiff Metropolitan University, Cardiff, CF5 2YB, UK.
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Lindström J, Uusitupa M, Tuomilehto J, Peltonen M. Following in the Footsteps of the North Karelia Project: Prevention of
Type 2 Diabetes. Glob Heart 2016; 11:223-8. [DOI: 10.1016/j.gheart.2016.04.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 04/20/2016] [Indexed: 01/24/2023] Open
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Skau JKH, Nordin ABA, Cheah JCH, Ali R, Zainal R, Aris T, Ali ZM, Matzen P, Biesma R, Aagaard-Hansen J, Hanson MA, Norris SA. A complex behavioural change intervention to reduce the risk of diabetes and prediabetes in the pre-conception period in Malaysia: study protocol for a randomised controlled trial. Trials 2016; 17:215. [PMID: 27117703 PMCID: PMC4847351 DOI: 10.1186/s13063-016-1345-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 04/15/2016] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Over the past two decades, the population of Malaysia has grown rapidly and the prevalence of diabetes mellitus in Malaysia has dramatically increased, along with the frequency of obesity, hyperlipidaemia and hypertension. Early-life influences play an important role in the development of non-communicable diseases. Indeed, maternal lifestyle and conditions such as gestational diabetes mellitus or obesity can affect the risk of diabetes in the next generation. Lifestyle changes can help to prevent the development of type 2 diabetes mellitus. This is a protocol for an unblinded, community-based, randomised controlled trial in two arms to evaluate the efficacy of a complex behavioural change intervention, combining motivational interviewing provided by a community health promoter and access to a habit formation mobile application, among young Malaysian women and their spouses prior to pregnancy. METHOD/DESIGN Eligible subjects will be Malaysian women in the age group 20 to 39 years, who are nulliparous, not diagnosed with diabetes and own a smartphone. With an alpha-value of 0.05, a statistical power of 90 %, 264 subjects will need to complete the study. Subjects with their spouses will be randomised to either the intervention or the control arm for an 8-month period. The primary endpoint is change in waist circumference from baseline to end of intervention period and secondary endpoints are changes in anthropometric parameters, biochemical parameters, change in health literacy level, dietary habits, physical activity and stress level. Primary endpoint and the continuous secondary endpoints will be analysed in a linear regression model, whereas secondary endpoints on an ordinal scale will be analysed by using the chi-squared test. A multivariate linear model for the primary endpoint will be undertaken to account for potential confounders. This study has been approved by the Medical Research and Ethics Committee of the Ministry of Health Malaysia (protocol number: NMRR-14-904-21963) on 21 September 2015. DISCUSSION This study protocol describes the first community-based randomised controlled trial, to examine the efficacy of a complex intervention in improving the pre-pregnancy health of young Malaysian women and their spouses. Results from this trial will contribute to improve policy and practices regarding complex behavioural change interventions to prevent diabetes in the pre-conception period in Malaysia and other low- and middle-income country settings. TRIAL REGISTRATION This trial is registered with ClinicalTrials.gov (www.clinicaltrials.gov) on 30 November 2015, Identifier: NCT02617693 .
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Affiliation(s)
- Jutta K. H. Skau
- />MRC Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Julius C. H. Cheah
- />School of Medicine and Health Sciences, Monash University Malaysia, Jalan Lagoon Selatan, 46150 Bandar Sunway, Selangor, Malaysia
| | - Roslinah Ali
- />Institute of Health System Research, Ministry of Health, Selangor, Malaysia
| | - Ramli Zainal
- />Pharmaceutical Policy and Strategic Planning Division, Pharmaceutical Services Division, Ministry of Health Malaysia, Selangor, Malaysia
| | - Tahir Aris
- />Institute of Public Health, Ministry of Health, Kuala Lumpur, Malaysia
| | - Zainudin Mohd Ali
- />State Health Department Negeri Sembilan, Ministry of Health, Seremban, Malaysia
| | - Priya Matzen
- />Institute of Developmental Sciences, Faculty of Medicine, University of Southampton, Tremona Road, Southampton, SO16 6YD UK
| | - Regien Biesma
- />Institute of Developmental Sciences, Faculty of Medicine, University of Southampton, Tremona Road, Southampton, SO16 6YD UK
- />Department of Epidemiology and Public Health Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Jens Aagaard-Hansen
- />MRC Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- />Health Promotion Research, Steno Diabetes Center, Gentofte, Denmark
| | - Mark A. Hanson
- />Institute of Developmental Sciences, Faculty of Medicine, University of Southampton, Tremona Road, Southampton, SO16 6YD UK
| | - Shane A. Norris
- />MRC Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Nield L, Summerbell CD, Hooper L, Whittaker V, Moore HJ. WITHDRAWN: Dietary advice for the prevention of type 2 diabetes mellitus in adults. Cochrane Database Syst Rev 2016; 2016:CD005102. [PMID: 26790033 PMCID: PMC10641658 DOI: 10.1002/14651858.cd005102.pub3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Review status was set to withdrawn. The review is out of date and does not meet current Cochrane standards. It will be superseded by a new expanding Cochrane review on 'Diet, physical activity or both for the prevention or delay of type 2 diabetes mellitus and its associated complications in persons at increased risk'. The editorial group responsible for this previously published document have withdrawn it from publication.
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Affiliation(s)
- Lucie Nield
- University of TeessideSchool of Health and Social CareParkside WestMiddlesbroughTeessideUKTS1 3BA
| | - Carolyn D Summerbell
- Queen's Campus, Durham UniversitySchool of Medicine, Pharmacy and Health, Wolfson Research InstituteUniversity BoulevardThornabyStockton‐on‐TeesUKTS17 6BH
| | - Lee Hooper
- University of East AngliaNorwich Medical SchoolNorwich Research ParkNorwichNorfolkUKNR4 7TJ
| | - Victoria Whittaker
- University of TeessideSchool of Health and Social CareParkside WestMiddlesbroughTeessideUKTS1 3BA
| | - Helen J Moore
- Queen's Campus, Durham UniversitySchool of Medicine and Health, Wolfson Research InstituteUniversity BoulevardThornabyStockton‐on‐TeesUKTS17 6BH
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Lehtisalo J, Lindström J, Ngandu T, Kivipelto M, Ahtiluoto S, Ilanne-Parikka P, Keinänen-Kiukaanniemi S, Eriksson JG, Uusitupa M, Tuomilehto J, Luchsinger JA. Diabetes, glycaemia, and cognition-a secondary analysis of the Finnish Diabetes Prevention Study. Diabetes Metab Res Rev 2016; 32:102-10. [PMID: 26172529 DOI: 10.1002/dmrr.2679] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Revised: 06/28/2015] [Accepted: 06/30/2015] [Indexed: 01/02/2023]
Abstract
BACKGROUND Type 2 diabetes is linked with cognitive dysfunction and dementia in epidemiological studies, but these observations are limited by lack of data on the exact timing of diabetes onset. We investigated diabetes, dysglycaemia, and cognition in the Finnish Diabetes Prevention Study, in which the timing and duration of diabetes are well documented. METHODS The Finnish Diabetes Prevention Study comprised middle-aged, overweight participants with impaired glucose tolerance but no diabetes at baseline (n = 522), randomized to lifestyle intervention or a control group. After an intervention period (mean duration 4 years) and follow-up (additional 9 years), cognitive assessment with the CERAD test battery and Trail Making Test A (TMT) was executed twice within a 2-year interval. Of the 364 (70%) participants with cognitive assessments, 171 (47%) had developed diabetes. RESULTS Cognitive function did not differ between those who developed diabetes and those who did not. Lower mean 2-h glucose at an oral glucose tolerance test (OGTT) and HbA1C during the intervention period predicted better performance in the TMT (p = 0.012 and 0.024, respectively). Those without diabetes or with short duration of diabetes improved in CERAD total score between the two assessments (p = 0.001) whereas those with long duration of diabetes did not (p = 0.844). CONCLUSIONS Better glycemic control among persons with baseline impaired glucose tolerance predicted better cognitive performance 9 years later in this secondary analysis of the Finnish Diabetes Prevention Study population. In addition, learning effects in cognitive testing were not evident in people with long diabetes duration. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- Jenni Lehtisalo
- Department of Health, National Institute for Health and Welfare, Helsinki, Finland
- Department of Public Health, University of Helsinki, Finland
| | - Jaana Lindström
- Department of Health, National Institute for Health and Welfare, Helsinki, Finland
| | - Tiia Ngandu
- Department of Health, National Institute for Health and Welfare, Helsinki, Finland
| | - Miia Kivipelto
- Department of Health, National Institute for Health and Welfare, Helsinki, Finland
- Aging Research Center, Karolinska Institutet, Stockholm, Sweden
- Department of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Satu Ahtiluoto
- Department of Health, National Institute for Health and Welfare, Helsinki, Finland
- Espoo City Hospital, Espoo, Finland
| | - Pirjo Ilanne-Parikka
- Science Center, Tampere University Hospital, Tampere, Finland
- The Diabetes Center, Finnish Diabetes Association, Tampere, Finland
| | - Sirkka Keinänen-Kiukaanniemi
- Institute of Health Sciences (General Practice), University of Oulu, Oulu, Finland
- Unit of General Practice, Oulu University Hospital and Health Centre of Oulu, Oulu, Finland
| | - Johan G Eriksson
- Department of Health, National Institute for Health and Welfare, Helsinki, Finland
- Department of General Practice and Primary Health Care, University of Helsinki, Finland
- Folkhälsan Research Center, Helsinki, Finland
- Unit of General Practice, Helsinki University Central Hospital, Helsinki, Finland
| | - Matti Uusitupa
- Institute of Public Health and Clinical Nutrition, Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
- Research Unit, Kuopio University Hospital, Kuopio, Finland
| | - Jaakko Tuomilehto
- Center for Vascular Prevention, Danube University Krems, Krems, Austria
- Instituto de Investigacion Sanitaria del Hospital Universario LaPaz (IdiPAZ), Madrid, Spain
- Diabetes Research Group, King Abdulaziz University, Jeddah, Saudi Arabia
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