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Juesas A, Saez-Berlanga A, Babiloni-Lopez C, Martin EG, Garrigues-Pelufo L, Ferri-Caruana A, Gene-Morales J, Martin-Rivera F, Chulvi-Medrano I, Jiménez-Martínez P, Alix-Fages C, Cwiklinska M, Gallo V, Zarza V, Gargallo P, Fernandez-Garrido J, Caballero O, Casaña J, Moretti E, Grazioli E, Navarra GA, Bellafiore M, Janicijevic D, Hammami R, Colado JC. Effects of Accentuated Eccentric and Maximal Strength High-Resistance Training Programs with or Without a Curcumin-Based Formulation Supplement on Body Composition, Blood Pressure, and Metabolic Parameters in Older Adults. Diseases 2025; 13:62. [PMID: 39997069 PMCID: PMC11854016 DOI: 10.3390/diseases13020062] [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: 01/20/2025] [Revised: 02/09/2025] [Accepted: 02/12/2025] [Indexed: 02/26/2025] Open
Abstract
BACKGROUND/OBJECTIVES This study compared the effects of high-resistance training (RT) programs, with or without curcumin supplementation, on variables commonly associated with metabolic syndrome (MetS), including body composition, blood pressure, and metabolic parameters. METHODS Eighty-one older adults at risk of MetS (BMI > 25 kg/m2, fat mass > 32%, and systolic blood pressure > 130 mmHg in half of the participants) were randomly assigned to six groups, which were comprised as follows: four experimental groups involving either accentuated eccentric or maximal strength RT with curcumin or placebo and two control groups receiving either curcumin or placebo. Experimental groups completed a 16-week full-body RT with elastic bands, while controls did not exercise. RESULTS The results showed that (I) all experimental protocols significantly reduced fat mass (p ≤ 0.001), with the maximal strength RT group supplemented with curcumin (Max-Cur) showing the greatest reduction, at 14.3%; (II) muscle gains were significant and comparable across experimental groups (p ≤ 0.008); (III) both systolic and diastolic blood pressure decreased similarly across experimental groups (p ≤ 0.001); (IV) metabolic parameters significantly improved across experimental groups (p ≤ 0.037), except for creatinine, which showed an undesirable peak only in the Max-Cur group; (V) curcumin supplementation enhanced the effects of both RT programs; and (VI) between 54% and 100% of participants achieved clinically meaningful improvements in seven out of ten MetS-related variables across experimental groups. CONCLUSIONS Our findings indicate that high-RT programs combined with curcumin supplementation positively impacted all MetS-related variables. The Max-Cur RT group stood out as the most beneficial, with the greatest fat mass reductions, highlighting this approach as a promising strategy to reduce the risk of MetS in older adults.
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Affiliation(s)
- Alvaro Juesas
- Department of Education Sciences, CEU Cardenal Herrera University, 46115 Castellón, Spain;
- Department of Physical Education and Sports, University of Valencia, 46010 Valencia, Spain; (A.S.-B.); (F.M.-R.); (I.C.-M.); (J.C.C.)
| | - Angel Saez-Berlanga
- Department of Physical Education and Sports, University of Valencia, 46010 Valencia, Spain; (A.S.-B.); (F.M.-R.); (I.C.-M.); (J.C.C.)
- Research Group in Prevention and Health in Exercise and Sport (PHES), University of Valencia, 46010 Valencia, Spain; (C.B.-L.); (E.G.M.); (L.G.-P.); (P.J.-M.); (C.A.-F.); (P.G.)
| | - Carlos Babiloni-Lopez
- Research Group in Prevention and Health in Exercise and Sport (PHES), University of Valencia, 46010 Valencia, Spain; (C.B.-L.); (E.G.M.); (L.G.-P.); (P.J.-M.); (C.A.-F.); (P.G.)
| | - Ezequiel G. Martin
- Research Group in Prevention and Health in Exercise and Sport (PHES), University of Valencia, 46010 Valencia, Spain; (C.B.-L.); (E.G.M.); (L.G.-P.); (P.J.-M.); (C.A.-F.); (P.G.)
| | - Luis Garrigues-Pelufo
- Research Group in Prevention and Health in Exercise and Sport (PHES), University of Valencia, 46010 Valencia, Spain; (C.B.-L.); (E.G.M.); (L.G.-P.); (P.J.-M.); (C.A.-F.); (P.G.)
| | - Ana Ferri-Caruana
- Department of Physical Education and Sports, University of Valencia, 46010 Valencia, Spain; (A.S.-B.); (F.M.-R.); (I.C.-M.); (J.C.C.)
- Research Group in Prevention and Health in Exercise and Sport (PHES), University of Valencia, 46010 Valencia, Spain; (C.B.-L.); (E.G.M.); (L.G.-P.); (P.J.-M.); (C.A.-F.); (P.G.)
| | - Javier Gene-Morales
- Department of Physical Education and Sports, University of Valencia, 46010 Valencia, Spain; (A.S.-B.); (F.M.-R.); (I.C.-M.); (J.C.C.)
- Research Group in Prevention and Health in Exercise and Sport (PHES), University of Valencia, 46010 Valencia, Spain; (C.B.-L.); (E.G.M.); (L.G.-P.); (P.J.-M.); (C.A.-F.); (P.G.)
| | - Fernando Martin-Rivera
- Department of Physical Education and Sports, University of Valencia, 46010 Valencia, Spain; (A.S.-B.); (F.M.-R.); (I.C.-M.); (J.C.C.)
- Research Group in Prevention and Health in Exercise and Sport (PHES), University of Valencia, 46010 Valencia, Spain; (C.B.-L.); (E.G.M.); (L.G.-P.); (P.J.-M.); (C.A.-F.); (P.G.)
| | - Iván Chulvi-Medrano
- Department of Physical Education and Sports, University of Valencia, 46010 Valencia, Spain; (A.S.-B.); (F.M.-R.); (I.C.-M.); (J.C.C.)
- Research Group in Prevention and Health in Exercise and Sport (PHES), University of Valencia, 46010 Valencia, Spain; (C.B.-L.); (E.G.M.); (L.G.-P.); (P.J.-M.); (C.A.-F.); (P.G.)
| | - Pablo Jiménez-Martínez
- Research Group in Prevention and Health in Exercise and Sport (PHES), University of Valencia, 46010 Valencia, Spain; (C.B.-L.); (E.G.M.); (L.G.-P.); (P.J.-M.); (C.A.-F.); (P.G.)
- ICEN Institute, 28002 Madrid, Spain; (M.C.); (V.G.); (V.Z.)
| | - Carlos Alix-Fages
- Research Group in Prevention and Health in Exercise and Sport (PHES), University of Valencia, 46010 Valencia, Spain; (C.B.-L.); (E.G.M.); (L.G.-P.); (P.J.-M.); (C.A.-F.); (P.G.)
- ICEN Institute, 28002 Madrid, Spain; (M.C.); (V.G.); (V.Z.)
| | | | - Veronica Gallo
- ICEN Institute, 28002 Madrid, Spain; (M.C.); (V.G.); (V.Z.)
| | - Virginia Zarza
- ICEN Institute, 28002 Madrid, Spain; (M.C.); (V.G.); (V.Z.)
| | - Pedro Gargallo
- Research Group in Prevention and Health in Exercise and Sport (PHES), University of Valencia, 46010 Valencia, Spain; (C.B.-L.); (E.G.M.); (L.G.-P.); (P.J.-M.); (C.A.-F.); (P.G.)
| | - Julio Fernandez-Garrido
- Nursing Department, Faculty of Nursing and Podiatry, University of Valencia, 46010 Valencia, Spain; (J.F.-G.); (O.C.)
| | - Oscar Caballero
- Nursing Department, Faculty of Nursing and Podiatry, University of Valencia, 46010 Valencia, Spain; (J.F.-G.); (O.C.)
| | - Jose Casaña
- Exercise Intervention for Health Research Group (EXINH-RG), Physiotherapy Department, University of Valencia, 46010 Valencia, Spain;
| | - Elisa Moretti
- Department of Movement, Human and Health Science, Faculty of Sport Science, University of Rome “Foro Italico”, 00135 Rome, Italy; (E.M.); (E.G.)
| | - Elisa Grazioli
- Department of Movement, Human and Health Science, Faculty of Sport Science, University of Rome “Foro Italico”, 00135 Rome, Italy; (E.M.); (E.G.)
| | - Giovanni Angelo Navarra
- Sport and Exercise Sciences Research Unit, Department of Psychology, Educational Science and Human Movement, University of Palermo, 90133 Palermo, Italy; (G.A.N.); (M.B.)
| | - Marianna Bellafiore
- Sport and Exercise Sciences Research Unit, Department of Psychology, Educational Science and Human Movement, University of Palermo, 90133 Palermo, Italy; (G.A.N.); (M.B.)
| | - Danica Janicijevic
- Faculty of Sports Science, Ningbo University, Ningbo 315211, China;
- Department of Radiology, Ningbo No. 2 Hospital, Ningbo 315010, China
- Department of Sports Sciences and Physical Conditioning, Faculty of Education, Universidad Católica de la Santísima Concepción, Concepción 4090541, Chile
| | - Raouf Hammami
- Tunisian Research Laboratory ’Sports Performance Optimization’ (CNMSS-LR09SEP01), National Center of Medicine and Science in Sports (CNMSS), Tunis 1004, Tunisia;
- Higher Institute of Sport and Physical Education of Ksar Said, Manouba University, Manouba 2010, Tunisia
| | - Juan C. Colado
- Department of Physical Education and Sports, University of Valencia, 46010 Valencia, Spain; (A.S.-B.); (F.M.-R.); (I.C.-M.); (J.C.C.)
- Research Group in Prevention and Health in Exercise and Sport (PHES), University of Valencia, 46010 Valencia, Spain; (C.B.-L.); (E.G.M.); (L.G.-P.); (P.J.-M.); (C.A.-F.); (P.G.)
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Powell LH, Daniels BT, Drees BM, Karavolos K, Lohse B, Masters KS, Nicklas JM, Ruder EH, Suzuki S, Trabold N, Zimmermann LJ. Enhancing Lifestyles in the Metabolic syndrome (ELM) multisite behavioral efficacy trial. Design and baseline cohort. Am Heart J 2024; 270:136-155. [PMID: 38215918 DOI: 10.1016/j.ahj.2023.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 12/27/2023] [Accepted: 12/27/2023] [Indexed: 01/14/2024]
Abstract
BACKGROUND Prevalence of metabolic syndrome (MetS) increased from one-quarter to one-third of the U.S. adult population over 8 years and is spreading to young adults and Asian and Hispanic Americans. Diagnosed when >3 out of 5 cardiometabolic risk factors are present, there is widespread agreement that its fundamental roots are in a lifestyle characterized by poor dietary quality and physical inactivity. Past lifestyle trials for MetS produce benefits that have limited sustainability, suggesting the need for new treatment approaches. METHODS This is the design and baseline cohort of the Enhancing Lifestyles in the Metabolic Syndrome (ELM) multi-site trial. The trial tests the hypothesis that a habit-based lifestyle treatment offered over 6 months, followed by 18 monthly maintenance contacts, can produce 4 new diet, physical activity, and mindfulness habits and, if so, sustained MetS remission. The design is an individually randomized, partially clustered group treatment trial of 618 participants with the MetS recruited from 5 sites in the U.S. and randomized to a small group lifestyle treatment or an enhanced standard of care education comparator. The primary outcome is MetS remission at 24 months. Secondary outcomes compare arms at 6, 15, and 24 months on MetS components, lifestyle targets, weight, body mass index, hemoglobin A1c, LDL cholesterol, medications, quality of life, psychosocial factors, and cost-effectiveness. RESULTS The cohort of 618 participants was recruited by screening 14,817 over 2.5 years (screening to enrollment ratio 24:1). Recruitment exceeded the target of 600 despite 2 COVID-19 pauses. The mean age was 55.5 years, 24.3% were male, 25.5% were a racial minority, 9.7% identified as Hispanic, and 83.0% were classified as obese (body mass index >30). The most common MetS components were abdominal obesity (97.7%) and elevated blood pressure or antihypertensive medication (86.2%). CONCLUSIONS The geographic, sociodemographic, and clinical diversity of the cohort, combined with rigorous behavioral efficacy trial methods, will provide a conclusive answer to the question of whether this habit-based lifestyle program can produce sustained 24-month remission of the MetS and thereby help to curb a significant and growing public health problem.
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Chu NHS, He J, Leung KHT, Ma RCW, Lee JYS, Varney J, Chan JCN, Muir JG, Chow E. Higher Short-Chain Fermentable Carbohydrates Are Associated with Lower Body Fat and Higher Insulin Sensitivity in People with Prediabetes. Nutrients 2023; 15:5070. [PMID: 38140329 PMCID: PMC10745595 DOI: 10.3390/nu15245070] [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: 10/17/2023] [Revised: 12/06/2023] [Accepted: 12/07/2023] [Indexed: 12/24/2023] Open
Abstract
The quality of carbohydrates has metabolic consequences in people with prediabetes. However, the causality of short-chain fermentable carbohydrate intakes and metabolic parameters has not been explored in the prediabetic or diabetic population. We investigated associations between different types of carbohydrates, including fermentable oligosaccharides, disaccharides, monosaccharides, polyols (FODMAPs), and polysaccharides (dietary fibre), and body composition and glucose/insulin responses in subjects with prediabetes. In this prospective cross-sectional study, 177 subjects with impaired glucose tolerance (IGT) (mean age: 60 (54-62) years, 41% men) underwent an assessment of body composition and completed six-point oral glucose tolerance tests (OGTT), Homeostatic Model Assessment of Insulin Resistance (HOMA2-IR), insulin sensitivity, detailed 3-day food records, and physical activity questionnaire. Daily habitual FODMAP intake decreased progressively with increasing BMI, ranging from 7.9 (6.2-12.7) g/d in subjects with normal BMI and 6.6 (4.6-9.9) g/d in subjects with overweight to 5.8 (3.8-9.0) g/d in subjects with obesity (p = 0.038). After adjustment for age and gender, galactooligosaccharides (GOSs) were negatively correlated with body fat (Standardised Beta coefficient β = -0.156, p = 0.006) and positively associated with insulin sensitivity (β = 0.243, p = 0.001). This remained significant after adjustment for macronutrients, fibre, and physical activity (p = 0.035 and p = 0.010, respectively). In individuals with IGT, higher dietary GOS intake was associated with lower body fat and higher insulin sensitivity independent of macronutrients and fibre intake, calling for interventional studies to evaluate the effect of FODMAP intake in prediabetes.
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Affiliation(s)
- Natural H. S. Chu
- Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China; (N.H.S.C.)
| | - Jie He
- Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China; (N.H.S.C.)
| | - Kathy H. T. Leung
- Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China; (N.H.S.C.)
| | - Ronald C. W. Ma
- Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China; (N.H.S.C.)
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
| | - Jimmy Y. S. Lee
- Department of Gastroenterology, Monash University and Alfred Hospital, Melbourne, VIC 3004, Australia
| | - Jane Varney
- Department of Gastroenterology, Monash University and Alfred Hospital, Melbourne, VIC 3004, Australia
| | - Juliana C. N. Chan
- Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China; (N.H.S.C.)
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
| | - Jane G. Muir
- Department of Gastroenterology, Monash University and Alfred Hospital, Melbourne, VIC 3004, Australia
| | - Elaine Chow
- Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China; (N.H.S.C.)
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
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Manfredi JM, Jacob S, Norton E. A one-health lens offers new perspectives on the importance of endocrine disorders in the equine athlete. J Am Vet Med Assoc 2023; 261:153-164. [PMID: 36595370 DOI: 10.2460/javma.22.11.0485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Endocrine disorders are associated with joint pain and tendon injury in humans, but the effects in the horse are only starting to be understood. Similar patterns of clinical signs and injury appear to affect horses and humans for both orthopedic and endocrine disorders, supporting the use of a one-health approach to tackle these issues. In this Currents in One Health, we will discuss common equine endocrinopathies, current testing recommendations, dietary management, genetic predispositions, and endocrine disorders' effects on performance. Our aim is to use a one-health lens to describe current comparative research so that veterinarians can employ cutting-edge preventative, diagnostic, and therapeutic recommendations. Identified key gaps in knowledge include whether equine metabolic osteoarthritis exists, if steroid joint injections are safe in horses with endocrine disorders, and if the return to performance percentage improves with concurrent treatment of endocrine and musculoskeletal disorders. Key takeaways include that the relationship between endocrine disorders and musculoskeletal disease in the horse goes beyond laminitis to include lameness, muscle atrophy, suspensory ligament degeneration, osteochondritis dissecans, and potentially metabolic osteoarthritis. Approaches learned from human and equine comparative studies can offer insight into injury recognition and management, thus mitigating the impact of endocrine disorders on performance in both species. Readers interested in an in-depth description of current and future research involving pathophysiology, novel interventions, and multiomic approaches to identify individuals with athletic limitations induced by endocrine disorders are invited to read the companion Currents in One Health by Manfredi et al, AJVR, February 2023.
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Affiliation(s)
- Jane M Manfredi
- 1Department of Pathobiology and Diagnostic Investigation, College of Veterinary Medicine, Michigan State University, East Lansing, MI
| | - Sarah Jacob
- 1Department of Pathobiology and Diagnostic Investigation, College of Veterinary Medicine, Michigan State University, East Lansing, MI
| | - Elaine Norton
- 2Department of Animal and Comparative Biomedical Sciences, College of Agriculture and Life Sciences, University of Arizona, Tucson, AZ
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Hsu HF, Yeh YP, Hsiu-Hsi Chen T, Luh DL. Sex differences in the change of exercise behavior leading to incident metabolic syndrome reduction: A community-based prospective study. Prev Med Rep 2022; 31:102076. [PMID: 36505270 PMCID: PMC9727633 DOI: 10.1016/j.pmedr.2022.102076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 10/12/2022] [Accepted: 11/28/2022] [Indexed: 12/04/2022] Open
Abstract
This study was undertaken to assess the role of sex differences in the effects of exercise behavior change on incident metabolic syndrome (MetS) in Changhua County, Taiwan. Using data derived from the Changhua Community-based Integrated Screening (CHCIS), 22,594 eligible residents aged 40 years or older had the screening at least twice from 2005 to 2018. A prospective cohort study was designed to follow up the normal cohort without MetS at baseline to ascertain incident MetS in the light of the criteria of the Epidemiology Task Force Consensus Group. We then evaluated whether there was a sex difference in the outcome of incident MetS attributed to the change in exercise behavior from three (no, irregular, and regular exercise) maintained patterns already defined at baseline to either the enhanced pattern or the reduced pattern by the end of follow-up. We applied Cox proportional hazards regression model stratified by sex for estimating the hazard ratio of any two-group comparison. After adjustment for sociodemographic factors, the number of screenings attended, personal disease history, and other health behaviors, the influence of change in exercise behavior on incident MetS was statistically significant only in men. Specifically, maintaining no exercise showed a lower risk of MetS than maintaining regular exercise 21 % in men. Regarding the change in exercise behavior, men with the enhanced pattern reduced the risk of MetS by 15 % compared with those maintaining regular exercise. The findings suggest that positive changes in exercise behavior reduce the incidence of MetS in men but not in women.
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Affiliation(s)
- Hsiu-Fan Hsu
- Department of Public Health, Chung Shan Medical University, Taichung 402, Taiwan, ROC
| | - Yen-Po Yeh
- Changhua County Public Health Bureau, Changhua 500, Taiwan, ROC
| | - Tony Hsiu-Hsi Chen
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Room 533, Taipei 100, Taiwan, ROC
| | - Dih-Ling Luh
- Department of Public Health, Chung Shan Medical University, Taichung 402, Taiwan, ROC,Department of Family and Community Medicine, Chung Shan Medical University Hospital, Taichung 402, Taiwan, ROC,Corresponding author at: Department of Public Health, Chung Shan Medical University, 110 Sec. 1 Chien-Kuo N. Rd., Taichung 40201, Taiwan, ROC
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Zucatti KP, Teixeira PP, Wayerbacher LF, Piccoli GF, Correia PE, Fonseca NKO, Moresco KS, Guerra BA, Maduré MG, Farenzena LP, Frankenberg AD, Brietzke E, Halpern B, Franco O, Colpani V, Gerchman F. Long-term Effect of Lifestyle Interventions on the Cardiovascular and All-Cause Mortality of Subjects With Prediabetes and Type 2 Diabetes: A Systematic Review and Meta-analysis. Diabetes Care 2022; 45:2787-2795. [PMID: 36318674 DOI: 10.2337/dc22-0642] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 08/16/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Lifestyle interventions improve the metabolic control of individuals with hyperglycemia. PURPOSE We aimed to determine the effect of lifestyle interventions on cardiovascular and all-cause mortality in this population. DATA SOURCES Searches were made through MEDLINE, Cochrane CENTRAL, Embase, and Web of Science (no date/language restriction, until 15 May 2022). STUDY SELECTION We included randomized clinical trials (RCTs) of subjects with prediabetes and type 2 diabetes, comparing intensive lifestyle interventions with usual care, with a minimum of 2 years of active intervention. DATA EXTRACTION Data from the 11 RCTs selected were extracted in duplicate. A frequentist and arm-based meta-analysis was performed with random-effects models to estimate relative risk (RR) for mortality, and heterogeneity was assessed through I2 metrics. A generalized linear mixed model (GLMM) was used to confirm the findings. DATA SYNTHESIS Lifestyle interventions were not superior to usual care in reducing cardiovascular (RR 0.99; 95% CI 0.79-1.23) or all-cause (RR 0.93; 95% CI 0.85-1.03) mortality. Subgroup, sensitivity, and meta-regression analyses showed no influence of type of intervention, mean follow-up, age, glycemic status, geographical location, risk of bias, or weight change. All of these results were confirmed with the GLMM. Most studies had a low risk of bias according to the RoB 2.0 tool and the certainty of evidence was moderate for both outcomes. LIMITATIONS Most studies had a low risk of bias according to the RoB 2.0 tool, and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach resulted in moderate certainty of evidence for both outcomes. Differences in lifestyle programs and in usual care between the studies should be considered in the interpretation of our results. CONCLUSIONS Intensive lifestyle interventions implemented so far did not show superiority to usual care in reducing cardiovascular or all-cause mortality for subjects with prediabetes and type 2 diabetes.
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Affiliation(s)
- Kelly P Zucatti
- Division of Endocrinology and Metabolism, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil
- Postgraduate Program in Medical Sciences: Endocrinology, Department of Internal Medicine, Faculty of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Paula P Teixeira
- Division of Endocrinology and Metabolism, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil
- Postgraduate Program in Medical Sciences: Endocrinology, Department of Internal Medicine, Faculty of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Laura F Wayerbacher
- Faculdade de Medicina, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Giovana F Piccoli
- Division of Endocrinology and Metabolism, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil
- Postgraduate Program in Medical Sciences: Endocrinology, Department of Internal Medicine, Faculty of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Poliana E Correia
- Division of Endocrinology and Metabolism, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil
- Postgraduate Program in Medical Sciences: Endocrinology, Department of Internal Medicine, Faculty of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Natasha K O Fonseca
- Postgraduate Program in Psychiatry and Behavioral Sciences, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Karla S Moresco
- Postgraduate Program in Medical Sciences: Endocrinology, Department of Internal Medicine, Faculty of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Bruno A Guerra
- Faculdade de Nutrição, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | - Michelle G Maduré
- Faculdade de Nutrição, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Laura P Farenzena
- Faculdade de Medicina, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Anize D Frankenberg
- Postgraduate Program in Medical Sciences: Endocrinology, Department of Internal Medicine, Faculty of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Elisa Brietzke
- Department of Psychiatry, Queen's University School of Medicine, Kingston, Ontario, Canada
- Center of Neurosciences Studies (CND), Kingston, Ontario, Canada
| | - Bruno Halpern
- Obesity Group, Department of Endocrinology, Universidade de São Paulo, São Paulo, Brazil
- Weight Control Center, Hospital 9 de Julho, São Paulo, Brazil
| | - Oscar Franco
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
- Harvard T. H. Chan School of Public Health, Harvard University, Cambridge, MA
| | - Verônica Colpani
- Postgraduate Program in Medical Sciences: Endocrinology, Department of Internal Medicine, Faculty of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Fernando Gerchman
- Division of Endocrinology and Metabolism, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil
- Postgraduate Program in Medical Sciences: Endocrinology, Department of Internal Medicine, Faculty of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
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Tamaoki M, Honda I, Nakanishi K, Nakajima M, Cheam S, Okawada M, Sakakibara H. Lifestyle Factors Associated with Metabolic Syndrome in Urban Cambodia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10481. [PMID: 36078197 PMCID: PMC9518541 DOI: 10.3390/ijerph191710481] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 08/19/2022] [Accepted: 08/20/2022] [Indexed: 06/15/2023]
Abstract
This study aimed to identify lifestyle factors associated with metabolic syndrome (MetS) in urban Cambodia. In this cross-sectional study, we used existing health checkup data from a private hospital in Phnom Penh, Cambodia. The participants comprised 5459 Cambodians aged ≥20 years who underwent health checkups between 2017 and 2019. The harmonized diagnostic definition was used as the MetS criteria. The prevalence of MetS was 56.6% overall, 60.4% in men and 52.6% in women. The lifestyle factor significantly associated with MetS in both sexes were "eating quicker than others", (men: odds ratio [OR]= 2.25, 95% confidence interval [CI] = 1.68-3.03, women: OR = 1.92, 95%CI = 1.41-2.60), "walking faster than others", (men: OR = 0.78, 95% CI = 0.67-0.92, women: OR = 0.75, 95% CI = 0.62-0.89) and "drinking alcohol" (men: OR = 1.33, 95% CI = 1.10-1.61, women: OR = 1.33, 95% CI = 1.09-1.62). Other significant associations with MetS for men was "eating speed is normal", (OR = 1.73, 95%CI = 1.30-2.31), and, for women, "eating food after dinner at least 3 days a week", (OR = 1.25, 95%CI = 1.01-1.55), "skipping breakfast at least 3 days a week", (OR = 0.83, 95%CI = 0.69-0.99) and "getting enough rest from sleep" (OR = 1.19, 95% CI = 1.01-1.42) were significantly associated with MetS. Lifestyle interventions through health education and guidance may be effective in preventing MetS in Cambodia.
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Affiliation(s)
- Miharu Tamaoki
- Department of Integrated Health Sciences, Graduate School of Medicine, Nagoya University, Nagoya 461-8673, Japan
| | - Ikumi Honda
- Department of Integrated Health Sciences, Graduate School of Medicine, Nagoya University, Nagoya 461-8673, Japan
| | - Keisuke Nakanishi
- Department of Integrated Health Sciences, Graduate School of Medicine, Nagoya University, Nagoya 461-8673, Japan
| | - Maki Nakajima
- Department of Integrated Health Sciences, Graduate School of Medicine, Nagoya University, Nagoya 461-8673, Japan
| | - Sophathya Cheam
- Department of Pediatric, Sunrise Japan Hospital Phnom Penh, Phnom Penh 121001, Cambodia
| | - Manabu Okawada
- Department of Pediatric, Sunrise Japan Hospital Phnom Penh, Phnom Penh 121001, Cambodia
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8
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Chen M, Moran LJ, Harrison CL, Ukke GG, Sood S, Bennett CJ, Bahri Khomami M, Absetz P, Teede H, Lim S. Ethnic differences in response to lifestyle intervention for the prevention of type 2 diabetes in adults: A systematic review and meta-analysis. Obes Rev 2022; 23:e13340. [PMID: 34528393 DOI: 10.1111/obr.13340] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 08/05/2021] [Accepted: 08/05/2021] [Indexed: 12/30/2022]
Abstract
The risk of type 2 diabetes mellitus (T2DM) varies by ethnicity, but ethnic differences in response to diabetes prevention interventions remain unclear. This systematic review and meta-analysis assessed ethnic differences in the effects of lifestyle interventions on T2DM incidence, glycemic outcomes (fasting glucose, 2-h glucose, HbA1c ), anthropometric measures (weight, BMI, waist circumference), and lifestyle behaviors (physical activity, energy intake, energy from fat, fiber intake). MEDLINE, EMBASE, and other databases were searched (to June 15, 2020) for randomized and non-randomized controlled trials on lifestyle interventions (diet and/or physical activity) in adults at risk of T2DM. Ethnicity was categorized into European, South Asian, East and Southeast Asian, Middle Eastern, Latin American, and African groups. Forty-four studies were included in meta-analyses. Overall, lifestyle interventions resulted in significant improvement in T2DM incidence, glycemic outcomes, anthropometric measures, physical activity, and energy intake (all P < 0.01). Significant subgroup differences by ethnicity were found for 2-h glucose, weight, BMI, and waist circumference (all P < 0.05) but not for T2DM incidence, fasting glucose, HbA1c , and physical activity (all P > 0.05). Few studies in non-European groups reported dietary intake. Lifestyle interventions in different ethnic groups may have similar effects in reducing incidence of T2DM although this needs to be confirmed in further studies.
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Affiliation(s)
- Mingling Chen
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Lisa J Moran
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Cheryce L Harrison
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Gebresilasea Gendisha Ukke
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Surbhi Sood
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Christie J Bennett
- Department of Nutrition, Dietetics and Food, School of Clinical Sciences, Monash University, Notting Hill, Victoria, Australia
| | - Mahnaz Bahri Khomami
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Pilvikki Absetz
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Helena Teede
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Siew Lim
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
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9
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von Loeffelholz C, Roth J, Coldewey SM, Birkenfeld AL. The Role of Physical Activity in Nonalcoholic and Metabolic Dysfunction Associated Fatty Liver Disease. Biomedicines 2021; 9:biomedicines9121853. [PMID: 34944668 PMCID: PMC8698784 DOI: 10.3390/biomedicines9121853] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 12/01/2021] [Accepted: 12/02/2021] [Indexed: 12/17/2022] Open
Abstract
Sedentary behavior constitutes a pandemic health threat contributing to the pathophysiology of obesity and type 2 diabetes (T2D). Sedentarism is further associated with liver disease and particularly with nonalcoholic/metabolic dysfunction associated fatty liver disease (NAFLD/MAFLD). Insulin resistance (IR) represents an early pathophysiologic key element of NAFLD/MAFLD, prediabetes and T2D. Current treatment guidelines recommend regular physical activity. There is evidence, that physical exercise has impact on a variety of molecular pathways, such as AMP-activated protein kinase and insulin signaling as well as glucose transporter 4 translocation, modulating insulin action, cellular substrate flow and in particular ectopic lipid and glycogen storage in a positive manner. Therefore, physical exercise can lead to substantial clinical benefit in persons with diabetes and/or NAFLD/MAFLD. However, experience from long term observational studies shows that the patients’ motivation to exercise regularly appears to be a major limitation. Strategies to integrate everyday physical activity (i.e., nonexercise activity thermogenesis) in lifestyle treatment schedules might be a promising approach. This review aggregates evidence on the impact of regular physical activity on selected molecular mechanisms as well as clinical outcomes of patients suffering from IR and NAFLD/MAFLD.
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Affiliation(s)
- Christian von Loeffelholz
- Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, 07747 Jena, Germany; (J.R.); (S.M.C.)
- Correspondence: ; Tel.: +49-3641-9323-177; Fax: +49-3641-9323-102
| | - Johannes Roth
- Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, 07747 Jena, Germany; (J.R.); (S.M.C.)
| | - Sina M. Coldewey
- Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, 07747 Jena, Germany; (J.R.); (S.M.C.)
- Septomics Research Center, Jena University Hospital, 07747 Jena, Germany
- Center for Sepsis Control and Care, Jena University Hospital, 07747 Jena, Germany
| | - Andreas L. Birkenfeld
- Department of Diabetology Endocrinology and Nephrology, Internal Medicine IV, University Hospital Tübingen, Eberhard Karls University Tübingen, 72074 Tübingen, Germany;
- Division of Translational Diabetology, Institute of Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Center Munich, Eberhard Karls University Tübingen, 72074 Tübingen, Germany
- Department of Diabetes, School of Life Course Science and Medicine, Kings College London, London WC2R 2LS, UK
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10
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Chen M, Ukke GG, Moran LJ, Sood S, Bennett CJ, Bahri Khomami M, Absetz P, Teede H, Harrison CL, Lim S. The Effect of Lifestyle Intervention on Diabetes Prevention by Ethnicity: A Systematic Review of Intervention Characteristics Using the TIDieR Framework. Nutrients 2021; 13:4118. [PMID: 34836372 PMCID: PMC8624360 DOI: 10.3390/nu13114118] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 11/09/2021] [Accepted: 11/12/2021] [Indexed: 11/16/2022] Open
Abstract
Lifestyle intervention is effective in preventing type 2 diabetes mellitus (T2DM), but the efficacy of intervention components across different ethnic groups is less clear. This systematic review examined the effects of intervention characteristics of lifestyle interventions on diabetes incidence and weight loss by ethnicity using the Template for Intervention Description and Replication (TIDieR) framework. MEDLINE, EMBASE and other databases were searched for randomized and non-randomized controlled trials on lifestyle interventions (diet and/or physical activity) in adults at risk of T2DM. Ethnicity was categorized into European, South Asian, East and Southeast Asian, Middle Eastern, Latin American and African groups. Forty-five studies (18,789 participants) were included in the systematic review and 41 studies in meta-analysis. Meta-analysis showed a high number of intervention sessions was significantly associated with a greater reduction in diabetes incidence (P = 0.043) and weight (P = 0.015), while other intervention characteristics including intervention provider and delivery format did not alter the outcomes (all P > 0.05). Additionally, narrative synthesis showed long-term interventions (≥12 months) were associated with significant diabetes risk reduction for all ethnic groups, while short-term interventions (<12 months) were more effective in weight loss in most ethnic groups. There may be ethnic preferences for the optimal number of intervention sessions.
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Affiliation(s)
- Mingling Chen
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, VIC 3168, Australia; (M.C.); (G.G.U.); (L.J.M.); (S.S.); (M.B.K.); (H.T.); (C.L.H.)
| | - Gebresilasea Gendisha Ukke
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, VIC 3168, Australia; (M.C.); (G.G.U.); (L.J.M.); (S.S.); (M.B.K.); (H.T.); (C.L.H.)
| | - Lisa J. Moran
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, VIC 3168, Australia; (M.C.); (G.G.U.); (L.J.M.); (S.S.); (M.B.K.); (H.T.); (C.L.H.)
| | - Surbhi Sood
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, VIC 3168, Australia; (M.C.); (G.G.U.); (L.J.M.); (S.S.); (M.B.K.); (H.T.); (C.L.H.)
| | - Christie J. Bennett
- Department of Nutrition, Dietetics and Food, School of Clinical Sciences, Monash University, Notting Hill, VIC 3168, Australia;
| | - Mahnaz Bahri Khomami
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, VIC 3168, Australia; (M.C.); (G.G.U.); (L.J.M.); (S.S.); (M.B.K.); (H.T.); (C.L.H.)
| | - Pilvikki Absetz
- Faculty of Social Sciences, Tampere University, 33014 Tampere, Finland;
| | - Helena Teede
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, VIC 3168, Australia; (M.C.); (G.G.U.); (L.J.M.); (S.S.); (M.B.K.); (H.T.); (C.L.H.)
- Diabetes and Endocrine Unit, Monash Health, Clayton, VIC 3168, Australia
| | - Cheryce L. Harrison
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, VIC 3168, Australia; (M.C.); (G.G.U.); (L.J.M.); (S.S.); (M.B.K.); (H.T.); (C.L.H.)
- Diabetes and Endocrine Unit, Monash Health, Clayton, VIC 3168, Australia
| | - Siew Lim
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, VIC 3168, Australia; (M.C.); (G.G.U.); (L.J.M.); (S.S.); (M.B.K.); (H.T.); (C.L.H.)
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11
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Yau JW, Thor SM, Ramadas A. Nutritional Strategies in Prediabetes: A Scoping Review of Recent Evidence. Nutrients 2020; 12:E2990. [PMID: 33003593 PMCID: PMC7650618 DOI: 10.3390/nu12102990] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 09/25/2020] [Accepted: 09/27/2020] [Indexed: 02/06/2023] Open
Abstract
Nutritional therapy has been conventionally recommended for people with prediabetes as a method to delay or halt progression to type 2 diabetes. However, recommended nutritional strategies evolve over time. Hence, we performed a scoping review on recently reported nutritional interventions for individuals with prediabetes. Ovid MEDLINE, PubMed, Embase, Scopus, CINAHL and PsycINFO databases were searched to identify relevant research articles published within the past 10 years. Ninety-five articles involving a total of 11,211 participants were included in this review. Nutritional strategies were broadly classified into four groups: low calorie diet, low glycemic index diet, specific foods, and a combination of diet and exercise. The most frequently assessed outcomes were plasma glucose, serum insulin, serum lipid profile, body mass index and body weight. More than 50% of reported interventions resulted in significant improvements in these parameters. Nutritional interventions have demonstrated feasibility and practicality as an effective option for prediabetes management. However, the intervention variability demonstrates the challenges of a 'one-size-fits-all' approach. Investigations in genetically diverse populations and objective assessment of progression rate to diabetes are necessary to better comprehend the impact of these nutritional strategies in prediabetes.
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Affiliation(s)
| | | | - Amutha Ramadas
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway 47500, Malaysia; (J.W.Y.); (S.M.T.)
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12
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Mamun A, Kitzman H, Dodgen L. Reducing metabolic syndrome through a community-based lifestyle intervention in African American women. Nutr Metab Cardiovasc Dis 2020; 30:1785-1794. [PMID: 32605881 PMCID: PMC7494631 DOI: 10.1016/j.numecd.2020.06.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 05/09/2020] [Accepted: 06/01/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND AND AIMS Metabolic syndrome (MetS) increases the risk of cardiovascular disease and type 2 diabetes. Despite a higher prevalence of MetS in African American (AA) women, little is known about the effectiveness of lifestyle interventions in improving metabolic markers in this high-risk group. This study investigated the effectiveness of a community-based lifestyle intervention delivered by lay health coaches in reducing MetS among AA women. METHODS AND RESULTS A cluster-randomized diabetes prevention program (DPP) was implemented in 11 churches utilizing a community-based participatory research (CBPR) approach to develop and deliver the interventions. A total of 221 adults, AA women who were overweight or obese, and did not have diabetes were included in this study. The prevalence of MetS was 42.08% before receiving the DPP intervention and 31.22% after the intervention that represented a 10.86% absolute reduction and a 25.81% relative reduction from baseline. The adjusted odds ratio (OR) of being free from MetS at post-intervention in contrast to baseline was 2.14 (p = 0.02). Factors that increased the odds of being free from MetS were younger age, reduction in intake of total calories, total fat, saturated and trans-fat, and dietary sodium. CONCLUSION A faith adapted lifestyle intervention held in church settings and delivered by minimally trained lay health coaches reduced the prevalence of MetS in AA women who were overweight or obese. Findings from this study can be used to translate evidence into public health programs at the community level for the prevention of type 2 diabetes and cardiovascular disease. CLINICAL TRIAL REGISTRATION NUMBER NCT04082702 (www.clinicaltrials.gov).
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Affiliation(s)
- Abdullah Mamun
- Baylor Scott and White Health and Wellness Center, Dallas, TX, USA.
| | - Heather Kitzman
- Baylor Scott and White Health and Wellness Center, Dallas, TX, USA; University of North Texas Health Science Center, Fort Worth, TX, USA; Baylor University, Waco, TX, USA
| | - Leilani Dodgen
- Baylor Scott and White Health and Wellness Center, Dallas, TX, USA; University of North Texas Health Science Center, Fort Worth, TX, USA
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13
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Lifestyle Changes Observed among Adults Participating in a Family- and Community-Based Intervention for Diabetes Prevention in Europe: The 1 st Year Results of the Feel4Diabetes-Study. Nutrients 2020; 12:nu12071949. [PMID: 32629949 PMCID: PMC7399917 DOI: 10.3390/nu12071949] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 06/17/2020] [Accepted: 06/28/2020] [Indexed: 01/06/2023] Open
Abstract
The Feel4Diabetes intervention was a school and community-based intervention aiming to promote healthy lifestyle and tackle obesity and obesity-related metabolic risk factors for the prevention of type 2 diabetes (T2D) among families at risk of developing this disease. The current study aims to present the results on lifestyle behaviors obtained from parents during the first year of the Feel4Diabetes intervention. This multicomponent intervention had a cluster randomized design and was implemented in Belgium, Bulgaria, Finland, Greece, Hungary and Spain over two years (2016-2018). Standardized protocols and procedures were used by the participating centers in all countries to collect data on parents' lifestyle behaviors (diet, physical activity, sedentary behavior). The Feel4Diabetes intervention was registered at clinicaltrials.gov (registration number: NCT02393872). In total, 2110 high-risk parents participated in the baseline and 12-month follow-up examination measurements. Participants allocated to the intervention group reduced their daily consumption of sugary drinks (p = 0.037) and sweets (p = 0.031) and their daily screen time (p = 0.032), compared with the control group. In addition, participants in the intervention group in Greece and Spain increased their consumption of breakfast (p = 0.034) and fruits (p = 0.029), while in Belgium and Finland they increased their water intake (p = 0.024). These findings indicate that the first year of the Feel4Diabetes intervention resulted in the improvement of certain lifestyle behaviors in parents from high-risk families.
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14
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Alligier M, Barrès R, Blaak EE, Boirie Y, Bouwman J, Brunault P, Campbell K, Clément K, Farooqi IS, Farpour-Lambert NJ, Frühbeck G, Goossens GH, Hager J, Halford JCG, Hauner H, Jacobi D, Julia C, Langin D, Natali A, Neovius M, Oppert JM, Pagotto U, Palmeira AL, Roche H, Rydén M, Scheen AJ, Simon C, Sorensen TIA, Tappy L, Yki-Järvinen H, Ziegler O, Laville M. OBEDIS Core Variables Project: European Expert Guidelines on a Minimal Core Set of Variables to Include in Randomized, Controlled Clinical Trials of Obesity Interventions. Obes Facts 2020; 13:1-28. [PMID: 31945762 PMCID: PMC7098277 DOI: 10.1159/000505342] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 12/08/2019] [Indexed: 12/17/2022] Open
Abstract
Heterogeneity of interindividual and intraindividual responses to interventions is often observed in randomized, controlled trials for obesity. To address the global epidemic of obesity and move toward more personalized treatment regimens, the global research community must come together to identify factors that may drive these heterogeneous responses to interventions. This project, called OBEDIS (OBEsity Diverse Interventions Sharing - focusing on dietary and other interventions), provides a set of European guidelines for a minimal set of variables to include in future clinical trials on obesity, regardless of the specific endpoints. Broad adoption of these guidelines will enable researchers to harmonize and merge data from multiple intervention studies, allowing stratification of patients according to precise phenotyping criteria which are measured using standardized methods. In this way, studies across Europe may be pooled for better prediction of individuals' responses to an intervention for obesity - ultimately leading to better patient care and improved obesity outcomes.
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Affiliation(s)
- Maud Alligier
- FCRIN/FORCE Network, Centre de Recherche en Nutrition Humaine Rhône-Alpes, Lyon, France
| | - Romain Barrès
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ellen E Blaak
- Department of Human Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Yves Boirie
- University Clermont Auvergne, CHU Clermont-Ferrand, Clinical Nutrition Department, Unité de Nutrition Humaine, CRNH Auvergne, Clermont-Ferrand, France
| | - Jildau Bouwman
- TNO (Netherlands Organization for Applied Scientific Research), Microbiology and Systems Biology, Zeist, The Netherlands
| | - Paul Brunault
- Equipe de Liaison et de Soins en Addictologie, CHRU de Tours, and UMR 1253, iBrain, Université de Tours, Inserm, and Qualipsy EE 1901, Université de Tours, Tours, France
| | - Kristina Campbell
- KC Microbiome Communications Group, Victoria, British Columbia, Canada
| | - Karine Clément
- Sorbonne University/INSERM, Nutrition and Obesities, Systemic Approaches Research Unit, and Assistance Publique Hôpitaux de Paris, Nutrition Department, Pitié-Salpêtrière Hospital, Paris, France
| | - I Sadaf Farooqi
- Wellcome-MRC Institute of Metabolic Science and NIHR Biomedical Research Centre, University of Cambridge, Cambridge, United Kingdom
| | - Nathalie J Farpour-Lambert
- Obesity Prevention and Care Program Contrepoids, Service of Therapeutic Education for Chronic Diseases, Department of Community Health, Primary Care and Emergency, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Gema Frühbeck
- Department of Endocrinology and Nutrition, Clínica Universidad de Navarra, University of Navarra & CIBEROBN, IdiSNA, Pamplona, Spain
| | - Gijs H Goossens
- Department of Human Biology, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Jorg Hager
- Metabolic Phenotyping, Nestlé Institute of Health Sciences, Lausanne, Switzerland
| | - Jason C G Halford
- Psychological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Hans Hauner
- Institute of Nutritional Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - David Jacobi
- L'Institut du Thorax, INSERM, CNRS, UNIV Nantes, CHU Nantes, Nantes, France
| | - Chantal Julia
- Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center (CRESS), Inra, Cnam, Paris 13 University and Public Health Department, Avicenne Hospital, AP-HP, Bobigny, France
| | - Dominique Langin
- Institute of Metabolic and Cardiovascular Diseases, I2MC, Inserm, Paul Sabatier University, and Department of Medical Biochemistry, Toulouse University Hospitals, Toulouse, France
| | - Andrea Natali
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Martin Neovius
- Department of Medicine (Solna), Karolinska Institute, Stockholm, Sweden
| | - Jean Michel Oppert
- Department of Nutrition, Pitié-Salpêtrière Hospital (AP-HP), Sorbonne University, Institute of Cardiometabolism and Nutrition (ICAN), Paris, France
| | - Uberto Pagotto
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Policlinic S. Orsola, Endocrinology Unit, Bologna, Italy
| | - Antonio L Palmeira
- CIPER, PANO-SR, Faculty of Human Kinetics, University of Lisbon, Lisbon, Portugal
| | - Helen Roche
- Nutrigenomics Research Group, UCD Institute of Food & Health, University College Dublin, Dublin, Ireland
| | - Mikael Rydén
- Department of Medicine (H7), Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - André J Scheen
- Liège University, Division of Diabetes, Nutrition and Metabolic Disorders, CHU Liège, Liège, Belgium
| | - Chantal Simon
- CarMen Laboratory, INSERM 1060, INRA 1397, University of Lyon, Oullins, France
| | - Thorkild I A Sorensen
- Novo Nordisk Foundation Center for Basic Metabolic Research, and Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Luc Tappy
- Physiology Department, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Hannele Yki-Järvinen
- University of Helsinki, Helsinki University Hospital, and Minerva Foundation Institute for Medical Research, Helsinki, Finland
| | - Olivier Ziegler
- Department of Endocrinology, Diabetes and Nutrition, Hôpital Brabois Adultes, CHRU de Nancy, Vandoeuvre Lès Nancy, France
| | - Martine Laville
- FCRIN/FORCE Network, Centre de Recherche en Nutrition Humaine Rhône-Alpes, Université de Lyon, Hospices Civils de Lyon, Lyon, France,
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Myers J, Kokkinos P, Nyelin E. Physical Activity, Cardiorespiratory Fitness, and the Metabolic Syndrome. Nutrients 2019; 11:E1652. [PMID: 31331009 PMCID: PMC6683051 DOI: 10.3390/nu11071652] [Citation(s) in RCA: 332] [Impact Index Per Article: 55.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 07/08/2019] [Accepted: 07/17/2019] [Indexed: 12/18/2022] Open
Abstract
Both observational and interventional studies suggest an important role for physical activity and higher fitness in mitigating the metabolic syndrome. Each component of the metabolic syndrome is, to a certain extent, favorably influenced by interventions that include physical activity. Given that the prevalence of the metabolic syndrome and its individual components (particularly obesity and insulin resistance) has increased significantly in recent decades, guidelines from various professional organizations have called for greater efforts to reduce the incidence of this condition and its components. While physical activity interventions that lead to improved fitness cannot be expected to normalize insulin resistance, lipid disorders, or obesity, the combined effect of increasing activity on these risk markers, an improvement in fitness, or both, has been shown to have a major impact on health outcomes related to the metabolic syndrome. Exercise therapy is a cost-effective intervention to both prevent and mitigate the impact of the metabolic syndrome, but it remains underutilized. In the current article, an overview of the effects of physical activity and higher fitness on the metabolic syndrome is provided, along with a discussion of the mechanisms underlying the benefits of being more fit or more physically active in the prevention and treatment of the metabolic syndrome.
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Affiliation(s)
- Jonathan Myers
- Cardiology Division, Veterans Affairs Palo Alto Health Care System and Stanford University, Stanford, CA 94304, USA.
| | - Peter Kokkinos
- Cardiology Division, Washington DC Veterans Affairs Medical Center and Rutgers University, Washington, DC 20422, USA
| | - Eric Nyelin
- Endocrinology Division, Washington DC Veterans Affairs Medical Center, Washington, DC 20422, USA
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Sakane N, Kotani K, Suganuma A, Takahashi K, Sato J, Suzuki S, Izumi K, Kato M, Noda M, Nirengi S, Kuzuya H. Prevention of Metabolic Syndrome by Telephone-Delivered Lifestyle Intervention in a Real-World Setting: Sub-Analysis of a Cluster-Randomized Trial. Metab Syndr Relat Disord 2019; 17:355-361. [PMID: 31145031 DOI: 10.1089/met.2018.0130] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background: Evidence of the long-term benefits of telephone-delivered lifestyle interventions is limited. This study investigated the ability of telephone-delivered lifestyle intervention to reduce the incidence of metabolic syndrome (MetS) in subjects diagnosed with impaired fasting glucose (IFG) during health checkups. Methods: Our subjects were participants in the Japan Diabetes Outcome Intervention Trial-1 (J-DOIT1), a prospective, cluster-randomized controlled trial designed to investigate whether goal-focused lifestyle coaching over the telephone can effectively reduce the incidence of type 2 diabetes development in high-risk individuals in a primary health care setting. We extracted 753 and 844 J-DOIT1 participants from the intervention and controls arms, respectively, who had IFG but did not meet the MetS criteria at baseline. The intervention arm received goal-focused lifestyle support delivered by health care providers via telephone over a 1-year period. The endpoint was the development of incident MetS, defined based on the Adult Treatment Panel III criteria modified for Japan. Results: During the median follow-up period of 4.9 years, 8.0% of the intervention arm and 12.0% of the control arm developed MetS. Overall, the hazard ratio (HR) for the development of MetS was 0.75 [95% confidence interval (CI), 0.52-1.09; P = 0.14] in the intervention arm. However, the HR in overweight or obese [body mass index (BMI) ≥23 kg/m2] individuals was significantly reduced to 0.63 (95% CI, 0.41-0.95; P = 0.029), but not in lean (BMI <23 kg/m2) individuals. Conclusion: Telephone-delivered lifestyle intervention effectively reduced the incidence of MetS in overweight and obese subjects in a real-world setting. Clinical trial registration number: UMIN000000662 (registered March 30, 2007; https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000000798).
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Affiliation(s)
- Naoki Sakane
- Division of Preventive Medicine, Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Kazuhiko Kotani
- Division of Preventive Medicine, Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Kyoto, Japan.,Divison of Community and Family Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Akiko Suganuma
- Division of Preventive Medicine, Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Kaoru Takahashi
- Division of Preventive Medicine, Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Kyoto, Japan.,Hyogo Health Service Association, Kobe, Japan
| | - Juichi Sato
- Department of General Medicine/Family & Community Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Sadao Suzuki
- Department of Public Health, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Kazuo Izumi
- National Center for Global Health and Medicine, Tokyo, Japan
| | - Masayuki Kato
- Health Management Center and Diagnostic Imaging Center, Toranomon Hospital, Tokyo, Japan
| | - Mitsuhiko Noda
- Department of Endocrinology and Diabetes, Saitama Medical University, Saitama, Japan
| | - Shinsuke Nirengi
- Division of Preventive Medicine, Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Hideshi Kuzuya
- Division of Preventive Medicine, Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Kyoto, Japan.,Koseikai Takeda Hospital, Kyoto, Japan
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17
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Sisti LG, Dajko M, Campanella P, Shkurti E, Ricciardi W, de Waure C. The effect of multifactorial lifestyle interventions on cardiovascular risk factors: a systematic review and meta-analysis of trials conducted in the general population and high risk groups. Prev Med 2018; 109:82-97. [PMID: 29291422 DOI: 10.1016/j.ypmed.2017.12.027] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 12/21/2017] [Accepted: 12/24/2017] [Indexed: 01/31/2023]
Abstract
Cardiovascular diseases (CVDs) are the leading cause of premature mortality and disability accounting for one third of all deaths worldwide with considerable impacts on economics and on the quality of life. The evidence suggests that a multifactorial lifestyle intervention might have a role in the CVDs risk reduction, especially in the risk populations, nonetheless the effects on modifiable CVDs risk factors have not been completely explored. Our work aimed at evaluating the impact of multifactorial lifestyle interventions on cardiovascular risk modification, both in the general and risk population. A systematic review and meta-analysis of the randomized controlled trials (RCTs) were performed by including articles published up to April 16th, 2016. RCTs were selected if they had investigated the impact of multifactorial lifestyle interventions on lipids, blood pressure, BMI and waist circumference, smoking and physical activity. Changes in the level of modifiable risk factors from baseline were evaluated. Search resulted in 19,847 studies, of which 36 were included in the analysis. Compared to a usual care, the multifactorial lifestyle intervention is able to lower the blood pressure, total cholesterol, BMI and waist circumference, at both 6 and 12months, and to increase physical activity at 12months. Better results were obtained in primary prevention and in moderate and high risk groups. Multifactorial lifestyle interventions clearly represent a valid tool for reducing the cardiovascular risk factors and should be implemented in the risk groups and in primary prevention.
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Affiliation(s)
- L G Sisti
- Institute of Public Health, Section of Hygiene, Catholic University of the Sacred Heart, Rome, Italy.
| | - M Dajko
- Institute of Public Health, Section of Hygiene, Catholic University of the Sacred Heart, Rome, Italy
| | - P Campanella
- Institute of Public Health, Section of Hygiene, Catholic University of the Sacred Heart, Rome, Italy
| | - E Shkurti
- University of Medicine, Tirana, Albania
| | - W Ricciardi
- President - Italian National Institute of Health, Rome, Italy
| | - C de Waure
- Institute of Public Health, Section of Hygiene, Catholic University of the Sacred Heart, Rome, Italy
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18
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Zhang D, Liu X, Liu Y, Sun X, Wang B, Ren Y, Zhao Y, Zhou J, Han C, Yin L, Zhao J, Shi Y, Zhang M, Hu D. Leisure-time physical activity and incident metabolic syndrome: a systematic review and dose-response meta-analysis of cohort studies. Metabolism 2017; 75:36-44. [PMID: 28927737 DOI: 10.1016/j.metabol.2017.08.001] [Citation(s) in RCA: 123] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 07/13/2017] [Accepted: 08/01/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Leisure-time physical activity (LTPA) has been suggested to reduce risk of metabolic syndrome (MetS). However, a quantitative comprehensive assessment of the dose-response association between LTPA and incident MetS has not been reported. We performed a meta-analysis of studies assessing the risk of MetS with LTPA. METHOD MEDLINE via PubMed and EMBase databases were searched for relevant articles published up to March 13, 2017. Random-effects models were used to estimate the summary relative risk (RR) of MetS with LTPA. Restricted cubic splines were used to model the dose-response association. RESULTS We identified 16 articles (18 studies including 76,699 participants and 13,871 cases of MetS). We found a negative linear association between LTPA and incident MetS, with a reduction of 8% in MetS risk per 10 metabolic equivalent of task (MET) h/week increment. According to the restricted cubic splines model, risk of MetS was reduced 10% with LTPA performed according to the basic guideline-recommended level of 150min of moderate PA (MPA) per week (10METh/week) versus inactivity (RR=0.90, 95% CI 0.86-0.94). It was reduced 20% and 53% with LTPA at twice (20METh/week) and seven times (70METh/week) the basic recommended level (RR=0.80, 95% CI 0.74-0.88 and 0.47, 95% CI 0.34-0.64, respectively). CONCLUSION Our findings provide quantitative data suggesting that any amount of LTPA is better than none and that LTPA substantially exceeding the current LTPA guidelines is associated with an additional reduction in MetS risk.
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Affiliation(s)
- Dongdong Zhang
- Department of Preventive Medicine, Shenzhen University Health Sciences Center, Shenzhen, Guangdong, People's Republic of China; The Affiliated Luohu Hospital of Shenzhen University Health Sciences Center, Shenzhen, Guangdong, People's Republic of China
| | - Xuejiao Liu
- Department of Preventive Medicine, Shenzhen University Health Sciences Center, Shenzhen, Guangdong, People's Republic of China; The Affiliated Luohu Hospital of Shenzhen University Health Sciences Center, Shenzhen, Guangdong, People's Republic of China
| | - Yu Liu
- The Affiliated Luohu Hospital of Shenzhen University Health Sciences Center, Shenzhen, Guangdong, People's Republic of China
| | - Xizhuo Sun
- The Affiliated Luohu Hospital of Shenzhen University Health Sciences Center, Shenzhen, Guangdong, People's Republic of China
| | - Bingyuan Wang
- Department of Preventive Medicine, Shenzhen University Health Sciences Center, Shenzhen, Guangdong, People's Republic of China; The Affiliated Luohu Hospital of Shenzhen University Health Sciences Center, Shenzhen, Guangdong, People's Republic of China; Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Yongcheng Ren
- Department of Preventive Medicine, Shenzhen University Health Sciences Center, Shenzhen, Guangdong, People's Republic of China; The Affiliated Luohu Hospital of Shenzhen University Health Sciences Center, Shenzhen, Guangdong, People's Republic of China; Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Yang Zhao
- Department of Preventive Medicine, Shenzhen University Health Sciences Center, Shenzhen, Guangdong, People's Republic of China; The Affiliated Luohu Hospital of Shenzhen University Health Sciences Center, Shenzhen, Guangdong, People's Republic of China; Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Junmei Zhou
- Department of Preventive Medicine, Shenzhen University Health Sciences Center, Shenzhen, Guangdong, People's Republic of China; The Affiliated Luohu Hospital of Shenzhen University Health Sciences Center, Shenzhen, Guangdong, People's Republic of China
| | - Chengyi Han
- Department of Preventive Medicine, Shenzhen University Health Sciences Center, Shenzhen, Guangdong, People's Republic of China; The Affiliated Luohu Hospital of Shenzhen University Health Sciences Center, Shenzhen, Guangdong, People's Republic of China; Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Lei Yin
- Department of Prevention and Health Care, Military Hospital of Henan Province, Zhengzhou, Henan, People's Republic of China
| | - Jingzhi Zhao
- Department of Prevention and Health Care, Military Hospital of Henan Province, Zhengzhou, Henan, People's Republic of China
| | - Yuanyuan Shi
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Ming Zhang
- Department of Preventive Medicine, Shenzhen University Health Sciences Center, Shenzhen, Guangdong, People's Republic of China.
| | - Dongsheng Hu
- Department of Preventive Medicine, Shenzhen University Health Sciences Center, Shenzhen, Guangdong, People's Republic of China.
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Okada R, Tsushita K, Wakai K, Ishizaka Y, Kato K, Wada T, Watanabe K. Lower risk of progression from prediabetes to diabetes with health checkup with lifestyle education: Japan Ningen Dock study. Nutr Metab Cardiovasc Dis 2017; 27:679-687. [PMID: 28735816 DOI: 10.1016/j.numecd.2017.06.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 06/01/2017] [Accepted: 06/08/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND AIMS To investigate whether the progression from prediabetes to diabetes is lower among those who undertake Ningen Dock (comprehensive health checkups with lifestyle education and doctor's consultation) than those who undertake basic mandatory occupational health checkups. METHODS AND RESULTS Subjects aged 30-69 years with complete annual data from 2008 to 2012 for either Ningen Dock or basic health checkups were enrolled. Subjects with prediabetes (fasting plasma glucose 100-125 mg/dl or HbA1c 5.7-6.4%) at baseline were selected (14,928 in the comprehensive group and 10,433 in the basic group). The incidence of diabetes (fasting plasma glucose ≥ 126 mg/dl, HbA1c ≥ 6.5% or taking glucose-lowering drugs) and the reduction of risk factors were compared. After 4 years, 3226 cases of diabetes occurred among 25,361 subjects with prediabetes. The incidence of diabetes was lower in the comprehensive group than the basic group (2.9 vs. 3.8 cases/100 person-years, hazard ratio 0.75, 95% confidence interval 0.68-0.81 after adjustment). Moreover, more overweight subjects controlled their body mass index (16.2% vs. 13.2%) and more began a daily exercise habit (11.8% vs. 8.5%) in the comprehensive group than in the basic group. The incidence of diabetes was lower in subjects who could control their weight or start daily exercise at year 1 in the comprehensive group. CONCLUSION Progression from prediabetes to diabetes was significantly lower in subjects undertaking a comprehensive health checkup with lifestyle education. Lifestyle education at health checkup for people with prediabetes might prevent progression to diabetes by reducing modifiable risk factors.
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Affiliation(s)
- R Okada
- Department of Preventive Medicine, Nagoya University Graduate School of Medicine, Japan.
| | - K Tsushita
- Comprehensive Health Science Center, Aichi Health Promotion Foundation, Japan
| | - K Wakai
- Department of Preventive Medicine, Nagoya University Graduate School of Medicine, Japan
| | - Y Ishizaka
- Center for Multiphasic Health Testing and Services, Mitsui Memorial Hospital, Japan
| | - K Kato
- Department of Laboratory Medicine and Clinical Epidemiology for Prevention of Noncommunicable Diseases, Graduate School of Medical and Dental Sciences, Niigata University, Japan
| | - T Wada
- Health Science, The Jikei University Graduate School of Medicine, Japan
| | - K Watanabe
- Tokyo Center for Laboratory Medicine, Japan
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Teuscher D, Bukman AJ, van Baak MA, Feskens EJM, Renes RJ, Meershoek A. A lifestyle intervention study targeting individuals with low socioeconomic status of different ethnic origins: important aspects for successful implementation. BMC Public Health 2017; 18:54. [PMID: 28743281 PMCID: PMC5526235 DOI: 10.1186/s12889-017-4592-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 07/13/2017] [Indexed: 12/28/2022] Open
Abstract
Background Evaluation of the implementation process of trials is important, because the way a study is implemented modifies its outcomes. Furthermore, lessons learned during implementation can inform other researchers on factors that play a role when implementing interventions described in research. This study evaluates the implementation of the MetSLIM study, targeting individuals with low socioeconomic status of different ethnic origins. The MetSLIM study was set up to evaluate the effectiveness of a lifestyle programme on waist circumference and other cardio-metabolic risk factors. The objective of this evaluation was to identify components that were essential for the implementation of the MetSLIM study and to inform other researchers on methodological aspects when working with inadequately reached populations in health research. Methods In this evaluation study the experiences of health professionals, study assistants, a community worker and regional research coordinators involved in the MetSLIM study were explored using semi-structured interviews. Questionnaires were used to evaluate participants’ satisfaction with the lifestyle intervention. Results Our analyses show that a flexible recruitment protocol eventually leads to recruitment of sufficient participants; that trust in the recruiter is an important factor in the recruitment of individuals with low socioeconomic status of different ethnic origins; and that health professionals will unavoidably shape the form of intervention activities. Furthermore, our evaluation shows that daily practice and research mutually influence each other and that the results of an intervention are a product of this interaction. Conclusions Health promotion research would benefit from a perspective that sees intervention activities not as fixed entities but rather as social interaction that can take on numerous forms. Analysing and reporting the implementation process of studies, like in this evaluation, will allow readers to get a detailed view on the appropriateness of the (intended) study design and intervention for the targeted population. Evaluation studies that shed light on the reasons for adaptations, rather than describing them as deviation from the original plan, would point out methodological aspects important for a study’s replication. Furthermore, they would show how various factors can influence the implementation, and therewith initiate a learning cycle for the development of future intervention studies. Trial registration Netherlands Trial Register NTR3721 (since November 27, 2012).
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Affiliation(s)
- Dorit Teuscher
- NUTRIM School for Nutrition and Translational Research in Metabolism, Department of Human Biology and Movement Sciences, Maastricht University Medical Centre+, P.O Box 616, 6200 MD, Maastricht, The Netherlands.
| | - Andrea J Bukman
- Division of Human Nutrition, Wageningen University, P.O Box 17, 6700 AA, Wageningen, The Netherlands
| | - Marleen A van Baak
- NUTRIM School for Nutrition and Translational Research in Metabolism, Department of Human Biology and Movement Sciences, Maastricht University Medical Centre+, P.O Box 616, 6200 MD, Maastricht, The Netherlands
| | - Edith J M Feskens
- Division of Human Nutrition, Wageningen University, P.O Box 17, 6700 AA, Wageningen, The Netherlands
| | - Reint Jan Renes
- Division of Strategic Communication, Wageningen University, P.O Box 8130, 6700 EW, Wageningen, The Netherlands
| | - Agnes Meershoek
- CAPHRI, Department of Health, Ethics and Society, Maastricht University Medical Centre+, P.O Box 616, 6200 MD, Maastricht, The Netherlands
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Bukman AJ, Duijzer G, Haveman-Nies A, Jansen SC, Ter Beek J, Hiddink GJ, Feskens EJM. Is the success of the SLIMMER diabetes prevention intervention modified by socioeconomic status? A randomised controlled trial. Diabetes Res Clin Pract 2017; 129:160-168. [PMID: 28528077 DOI: 10.1016/j.diabres.2017.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 04/11/2017] [Accepted: 05/04/2017] [Indexed: 11/20/2022]
Abstract
AIM To explore the role of socioeconomic status (SES) in participation, programme attendance, programme acceptability, adherence to lifestyle guidelines, drop-out, and effectiveness in the SLIMMER diabetes prevention intervention. METHODS SLIMMER was a randomised controlled intervention, carried out in a real-world setting, targeting 40- to 70-year-old adults at increased risk of developing type 2 diabetes (n=316). The intervention group participated in a 10-month combined dietary and physical activity programme. Measurements were carried out at baseline, 12months, and 18months. Effectiveness was determined for fasting insulin, HbA1c, weight, BMI, waist circumference, and waist-to-height-ratio. Differences between the low SES (no, primary, or lower secondary school) and higher SES group were tested using logistic regression and ANCOVA. RESULTS Fifty-two percent of the SLIMMER participants had a low SES. No differences in participation were observed between the low and higher SES group. The most important reason for non-participation in the low SES group was 'lack of interest' (32%), whereas in the higher SES group this was 'I already exercise enough' (31%). Attendance, acceptability, adherence, drop-out, and effectiveness after 12months were similar in the low and higher SES group. After 18months, the low SES group seemed to maintain slightly better effects for fasting insulin, HbA1c, and waist circumference. CONCLUSIONS The current study showed that participation, attendance, acceptability, adherence, drop-out, and effectiveness of the SLIMMER intervention were in general not modified by socioeconomic status. The SLIMMER intervention can contribute to health promotion for individuals in both low and higher socioeconomic groups.
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Affiliation(s)
- Andrea J Bukman
- Wageningen University, Division of Human Nutrition, P.O Box 17, 6700 AA Wageningen, The Netherlands.
| | - Geerke Duijzer
- Wageningen University, Division of Human Nutrition, P.O Box 17, 6700 AA Wageningen, The Netherlands.
| | - Annemien Haveman-Nies
- Wageningen University, Division of Human Nutrition, P.O Box 17, 6700 AA Wageningen, The Netherlands; GGD Noord- en Oost-Gelderland (Community Health Service), P.O Box 3, 7200 AA Zutphen, The Netherlands.
| | - Sophia C Jansen
- GGD Noord- en Oost-Gelderland (Community Health Service), P.O Box 3, 7200 AA Zutphen, The Netherlands.
| | - Josien Ter Beek
- GGD Noord- en Oost-Gelderland (Community Health Service), P.O Box 3, 7200 AA Zutphen, The Netherlands.
| | - Gerrit J Hiddink
- Wageningen University, Strategic Communication, Sub-department Communication, Philosophy and Technology: Centre for Integrative Development, Social Sciences, P.O Box 8130, 6700 EW Wageningen, The Netherlands.
| | - Edith J M Feskens
- Wageningen University, Division of Human Nutrition, P.O Box 17, 6700 AA Wageningen, The Netherlands.
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Watanabe M, Yokotsuka M, Yamaoka K, Adachi M, Nemoto A, Tango T. Effects of a lifestyle modification programme to reduce the number of risk factors for metabolic syndrome: a randomised controlled trial. Public Health Nutr 2017; 20:142-153. [PMID: 27469421 PMCID: PMC5197611 DOI: 10.1017/s1368980016001920] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 05/20/2016] [Accepted: 06/22/2016] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To determine the effectiveness of a personal support lifestyle education programme (PSMetS) for reducing risk factors in individuals with metabolic syndrome (MetS). DESIGN A two-arm randomised controlled trial. SETTING Companies in metropolitan Tokyo, Japan. SUBJECTS Male workers with diagnosed MetS or a high risk for MetS according to the Counselling Guidance Program, Japan (n 193). RESULTS The reduction in the number of risk factors for MetS (as defined according to the criteria published by the Japanese Ministry of Health, Labor and Welfare in April 2007 (MHLW-MetS)) in the PSMetS group was not significantly different from that in the usual care group by van Elteren's test (baseline-adjusted P=0·075) for intention-to-treat (ITT), while it was significant (baseline-adjusted P=0·038) for per-protocol set (PPS). The proportion of MHLW-MetS was significantly different between groups by van Elteren's test (baseline-adjusted P=0·031). Two components of MHLW-MetS showed significant reductions in the PSMetS group: waist circumference (baseline-adjusted P=0·001) and BMI (baseline-adjusted P=0·002). PPS and ITT analyses showed similar results. CONCLUSIONS For male workers with MHLW-MetS or a high risk of MHLW-MetS, PSMetS reduced the number of risk factors for MHLW-MetS.
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Affiliation(s)
| | | | - Kazue Yamaoka
- Teikyo University Graduate School of Public Health, 2-11-1 Kaga, Itabashi-ku, Tokyo 173-8605, Japan
| | - Misa Adachi
- Nutrition Support Network LLC, Kanagawa, Japan
| | - Asuka Nemoto
- Teikyo University Graduate School of Public Health, 2-11-1 Kaga, Itabashi-ku, Tokyo 173-8605, Japan
| | - Toshiro Tango
- Teikyo University Graduate School of Public Health, 2-11-1 Kaga, Itabashi-ku, Tokyo 173-8605, Japan
- Center for Medical Statistics, Tokyo, Japan
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Cezaretto A, de Barros CR, de Almeida-Pititto B, Siqueira-Catania A, Monfort-Pires M, Folchetti LGD, Ferreira SRG. Lifestyle intervention using the psychoeducational approach is associated with greater cardiometabolic benefits and retention of individuals with worse health status. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2017; 61:36-44. [PMID: 28273202 PMCID: PMC10522123 DOI: 10.1590/2359-3997000000185] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2015] [Accepted: 01/04/2016] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This study aimed to compare the effects of two lifestyle intervention programs for type 2 diabetes mellitus (T2DM) prevention - traditional or interdisciplinary psychoeducation-based intervention - in daily habits and cardiometabolic risk factors and investigate the role of the psychoeducational approach for the retention of individuals in the program. SUBJECTS AND METHODS Between 2008 and 2010, in a public health service, 183 pre-diabetic individuals were allocated to two 18-month interventions involving diet and physical activity. Physical activity, diet, quality of life (QOL) and depression and biochemical measurements were obtained. Linear mixed-effect models were used to assess the effect of the interventions. A student t test was used to compare dropouts versus non-dropouts. RESULTS Improvements in energy intake and physical activity were greater in the interdisciplinary than the traditional intervention. A decrease in fat mass and blood pressure was more pronounced with interdisciplinary intervention. Dropouts from the traditional intervention only had higher BMI and lower fiber intake and QOL than non-dropouts. CONCLUSION The interdisciplinary psychoeducation-based intervention revealed useful for reducing cardiometabolic risk and retaining individuals with worse health profiles. This approach represents a feasible strategy for motivating high-risk individuals to adopt a long-term healthy lifestyle.
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Affiliation(s)
- Adriana Cezaretto
- Departamento de EpidemiologiaFaculdade de Saúde PúblicaUniversidade de São PauloSão PauloSPBrasilDepartamento de Epidemiologia, Faculdade de Saúde Pública, Universidade de São Paulo (FSP-USP), São Paulo, SP, Brasil
| | - Camila Risso de Barros
- Departamento de EpidemiologiaFaculdade de Saúde PúblicaUniversidade de São PauloSão PauloSPBrasilDepartamento de Epidemiologia, Faculdade de Saúde Pública, Universidade de São Paulo (FSP-USP), São Paulo, SP, Brasil
| | - Bianca de Almeida-Pititto
- Departamento de EpidemiologiaFaculdade de Saúde PúblicaUniversidade de São PauloSão PauloSPBrasilDepartamento de Epidemiologia, Faculdade de Saúde Pública, Universidade de São Paulo (FSP-USP), São Paulo, SP, Brasil
| | - Antonela Siqueira-Catania
- Departamento de EpidemiologiaFaculdade de Saúde PúblicaUniversidade de São PauloSão PauloSPBrasilDepartamento de Epidemiologia, Faculdade de Saúde Pública, Universidade de São Paulo (FSP-USP), São Paulo, SP, Brasil
| | - Milena Monfort-Pires
- Departamento de EpidemiologiaFaculdade de Saúde PúblicaUniversidade de São PauloSão PauloSPBrasilDepartamento de Epidemiologia, Faculdade de Saúde Pública, Universidade de São Paulo (FSP-USP), São Paulo, SP, Brasil
| | - Luciana Gavilan Dias Folchetti
- Departamento de EpidemiologiaFaculdade de Saúde PúblicaUniversidade de São PauloSão PauloSPBrasilDepartamento de Epidemiologia, Faculdade de Saúde Pública, Universidade de São Paulo (FSP-USP), São Paulo, SP, Brasil
| | - Sandra Roberta Gouvea Ferreira
- Departamento de EpidemiologiaFaculdade de Saúde PúblicaUniversidade de São PauloSão PauloSPBrasilDepartamento de Epidemiologia, Faculdade de Saúde Pública, Universidade de São Paulo (FSP-USP), São Paulo, SP, Brasil
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Balk EM, Earley A, Raman G, Avendano EA, Pittas AG, Remington PL. Combined Diet and Physical Activity Promotion Programs to Prevent Type 2 Diabetes Among Persons at Increased Risk: A Systematic Review for the Community Preventive Services Task Force. Ann Intern Med 2015; 163:437-51. [PMID: 26167912 PMCID: PMC4692590 DOI: 10.7326/m15-0452] [Citation(s) in RCA: 222] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Trials have shown efficacy of rigorous diet and physical activity promotion programs to reduce diabetes incidence and improve glycemic measures in adults at increased risk for type 2 diabetes. PURPOSE To evaluate diet and physical activity promotion programs for persons at increased risk for type 2 diabetes, primarily to reduce diabetes risk and decrease body weight and glycemia. DATA SOURCES MEDLINE, the Cochrane Central Register of Controlled Trials, CAB Abstracts, Global Health, and Ovid HealthSTAR from 1991 through 27 February 2015, with no language restriction. STUDY SELECTION 8 researchers screened articles for single-group or comparative studies of combined diet and physical activity promotion programs with at least 2 sessions over at least 3 months in participants at increased risk for type 2 diabetes. DATA EXTRACTION 7 researchers extracted data on study design; participant, intervention, and outcome descriptions; and results and assessed study quality. DATA SYNTHESIS 53 studies (30 of diet and physical activity promotion programs vs. usual care, 13 of more intensive vs. less intensive programs, and 13 of single programs) evaluated 66 programs. Compared with usual care, diet and physical activity promotion programs reduced type 2 diabetes incidence (risk ratio [RR], 0.59 [95% CI, 0.52 to 0.66]) (16 studies), decreased body weight (net change, -2.2% [CI, -2.9% to -1.4%]) (24 studies) and fasting blood glucose level (net change, -0.12 mmol/L [-2.2 mg/dL] [CI, -0.20 to -0.05 mmol/L {-3.6 to -0.9 mg/dL}]) (17 studies), and improved other cardiometabolic risk factors. Evidence for clinical events was limited. More intensive programs were more effective. LIMITATIONS Wide variation in diet and physical activity promotion programs limited identification of features most relevant to effectiveness. Evidence on clinical outcomes and in children was sparse. CONCLUSION Combined diet and physical activity promotion programs are effective at decreasing diabetes incidence and improving cardiometabolic risk factors in persons at increased risk. More intensive programs are more effective. PRIMARY FUNDING SOURCE Centers for Disease Control and Prevention Community Preventive Services Task Force.
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Affiliation(s)
- Ethan M. Balk
- From Brown University School of Public Health, Providence, Rhode Island; Tufts Medical Center and Mapi Group, Boston, Massachusetts; and University of Wisconsin, Madison, Wisconsin
| | - Amy Earley
- From Brown University School of Public Health, Providence, Rhode Island; Tufts Medical Center and Mapi Group, Boston, Massachusetts; and University of Wisconsin, Madison, Wisconsin
| | - Gowri Raman
- From Brown University School of Public Health, Providence, Rhode Island; Tufts Medical Center and Mapi Group, Boston, Massachusetts; and University of Wisconsin, Madison, Wisconsin
| | - Esther A. Avendano
- From Brown University School of Public Health, Providence, Rhode Island; Tufts Medical Center and Mapi Group, Boston, Massachusetts; and University of Wisconsin, Madison, Wisconsin
| | - Anastassios G. Pittas
- From Brown University School of Public Health, Providence, Rhode Island; Tufts Medical Center and Mapi Group, Boston, Massachusetts; and University of Wisconsin, Madison, Wisconsin
| | - Patrick L. Remington
- From Brown University School of Public Health, Providence, Rhode Island; Tufts Medical Center and Mapi Group, Boston, Massachusetts; and University of Wisconsin, Madison, Wisconsin
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Abstract
The importance of chronic low-grade inflammation in the pathology of numerous age-related chronic conditions is now clear. An unresolved inflammatory response is likely to be involved from the early stages of disease development. The present position paper is the most recent in a series produced by the International Life Sciences Institute's European Branch (ILSI Europe). It is co-authored by the speakers from a 2013 workshop led by the Obesity and Diabetes Task Force entitled ‘Low-grade inflammation, a high-grade challenge: biomarkers and modulation by dietary strategies’. The latest research in the areas of acute and chronic inflammation and cardiometabolic, gut and cognitive health is presented along with the cellular and molecular mechanisms underlying inflammation–health/disease associations. The evidence relating diet composition and early-life nutrition to inflammatory status is reviewed. Human epidemiological and intervention data are thus far heavily reliant on the measurement of inflammatory markers in the circulation, and in particular cytokines in the fasting state, which are recognised as an insensitive and highly variable index of tissue inflammation. Potential novel kinetic and integrated approaches to capture inflammatory status in humans are discussed. Such approaches are likely to provide a more discriminating means of quantifying inflammation–health/disease associations, and the ability of diet to positively modulate inflammation and provide the much needed evidence to develop research portfolios that will inform new product development and associated health claims.
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26
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Bruno E, Gargano G, Villarini A, Traina A, Johansson H, Mano MP, Santucci De Magistris M, Simeoni M, Consolaro E, Mercandino A, Barbero M, Galasso R, Bassi MC, Zarcone M, Zagallo E, Venturelli E, Bellegotti M, Berrino F, Pasanisi P. Adherence to WCRF/AICR cancer prevention recommendations and metabolic syndrome in breast cancer patients. Int J Cancer 2015; 138:237-44. [PMID: 26175188 DOI: 10.1002/ijc.29689] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 06/18/2015] [Accepted: 07/01/2015] [Indexed: 12/18/2022]
Abstract
Metabolic syndrome (MetS), conventionally defined by the presence of at least three out of five dismetabolic traits (abdominal obesity, hypertension, low plasma HDL-cholesterol and high plasma glucose and triglycerides), has been associated with both breast cancer (BC) incidence and prognosis. We investigated the association between the prevalence of MetS and a score of adherence to the World Cancer Research Fund (WCRF) and American Institute for Cancer Research (AICR) recommendations for the prevention of cancer in a cross-sectional study of BC patients. The DIet and ANdrogen-5 study (DIANA-5) for the prevention of BC recurrences recruited 2092 early stage BC survivors aged 35-70. At recruitment, all women completed a 24-hour food frequency and physical activity diary on their consumption and activity of the previous day. Using these diaries we created a score of adherence to five relevant WCRF/AICR recommendations. The prevalence ratios (PRs) and 95% confidence intervals (CIs) of MetS associated with the number of recommendations met were estimated using a binomial regression model. The adjusted PRs of MetS decreased with increasing number of recommendations met (p < 0.001). Meeting all the five recommendations versus meeting none or only one was significantly associated with a 57% lower MetS prevalence (95% CI 0.35-0.73). Our results suggest that adherence to WCRF/AICR recommendations is a major determinant of MetS and may have a clinical impact.
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Affiliation(s)
- Eleonora Bruno
- Department of Preventive & Predictive Medicine, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Giuliana Gargano
- Department of Preventive & Predictive Medicine, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Anna Villarini
- Department of Preventive & Predictive Medicine, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Adele Traina
- Department of Oncology, A.R.N.A.S Ospedali Civico E Benfratelli G. Di Cristina E M. Ascoli, Palermo, Italy
| | - Harriet Johansson
- Division of Chemoprevention and Genetics, European Institute Of Oncology, Milan, Italy
| | - Maria Piera Mano
- Dipartimento Scienze Chirurgiche, Study University, Turin, Italy.,S.C. Epidemiologia Dei Tumori, AOU Città Della Salute E Della Scienza, CPO Piemonte, Turin, Italy
| | | | - Milena Simeoni
- Associazione LUMEN, San Pietro In Cerro (Piacenza), Italy
| | | | | | | | - Rocco Galasso
- Biostatistics and Cancer Registry, Unit Of Clinical Epidemiology, IRCCS Centro Di Riferimento Oncologico Di Basilicata, Rionero In Vulture (Potenza), Italy
| | | | - Maurizio Zarcone
- Department of Oncology, A.R.N.A.S Ospedali Civico E Benfratelli G. Di Cristina E M. Ascoli, Palermo, Italy
| | - Emanuela Zagallo
- Division of Chemoprevention and Genetics, European Institute Of Oncology, Milan, Italy
| | - Elisabetta Venturelli
- Department of Preventive & Predictive Medicine, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Manuela Bellegotti
- Department of Preventive & Predictive Medicine, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Franco Berrino
- Department of Preventive & Predictive Medicine, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Patrizia Pasanisi
- Department of Preventive & Predictive Medicine, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
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27
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Wang Y, Xie B, Tao Y, Ma Y, Zhang K. Impact of Community-Based Integrated Traditional Chinese and Western Medicine Metabolic Syndrome Intervention Technology in Rural Residents in Southern Jiangsu, China. Med Sci Monit 2015. [PMID: 26210819 PMCID: PMC4520418 DOI: 10.12659/msm.893972] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background To explore the feasibility and efficiency of community-based integrated traditional Chinese medicine (TCM) and Western medicine metabolic syndrome (MS) intervention in rural residents. Material/Methods The MS intervention was administered to 598 rural community residents aged 45 years and older in Zhoushi from 2011 to 2013. Subjects completed a health examination and health behavior questionnaire before and after the intervention. In the intervention, we designed a “healthy life self-help program” using TCM appropriate technologies for the subjects. Results After 2 years of intervention by means of integrated traditional Chinese and Western medicine, 57.0% (341 persons) of the subjects no longer suffered from MS. The recovery rate of BMI, blood pressure, FBG, TG, and HDL-C were 22.1%, 40.5%, 37.9%, 32.8%, and 62.4%, respectively. There were statistically significant differences in exercise, smoking, and alcohol drinking between baseline and 2 years later. Conclusions The integrated traditional Chinese and Western medicine MS intervention was effective in deceasing most of the parameters of MS, especially blood pressure, and helping people to do more exercise. The program would be useful to implement in other similar populations.
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Affiliation(s)
- Yuqing Wang
- School of Public Health, Southeast University, Nanjing, China (mainland)
| | - Bo Xie
- Department of Endocrinology, Institute of Diabetes, Medical School, Zhongda Hospital, Southeast University, Nanjing, China (mainland)
| | - Yanghong Tao
- School of Public Health, Southeast University, Nanjing, China (mainland)
| | - Yonghua Ma
- School of Public Health, Southeast University, Nanjing, China (mainland)
| | - Kaijin Zhang
- School of Public Health, Southeast University, Nanjing, China (mainland)
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28
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Hong KW, Chung M, Cho SB. Replication of Interactions between Genome-Wide Genetic Variants and Body Mass Index in Fasting Glucose and Insulin Levels. Genomics Inform 2015; 12:236-9. [PMID: 25705164 PMCID: PMC4330260 DOI: 10.5808/gi.2014.12.4.236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2014] [Revised: 11/24/2014] [Accepted: 11/24/2014] [Indexed: 11/23/2022] Open
Abstract
The genetic regulation of glucose and insulin levels might be modified by adiposity. With regard to the genetic factors that are altered by adiposity, a large meta-analysis on the interactions between genetic variants and body mass index with regard to fasting glucose and insulin levels was reported by the Meta-Analyses of Glucose- and Insulin-related trait Consortium (MAGIC), based on European ancestry. Because no replication study has been performed in other ethnic groups, we first examined the link between reported single-nucleotide polymorphisms (SNPs) and fasting glucose and insulin levels in a large Korean cohort (Korean Genome and Epidemiology Study cohort [KoGES], n = 5,814). The MAGIC study reported 7 novel SNPs for fasting glucose levels and 6 novel SNPs for fasting insulin levels. In this study, we attempted to replicate the association of 5 SNPs with fasting glucose levels and 5 SNPs with fasting insulin levels. One SNP (rs2293941) in PDX1 was identified as a significant obesity-modifiable factor in Koreans. Our results indicate that the novel loci that were identified by MAGIC are poorly replicated in other ethnic groups, although we do not know why.
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Affiliation(s)
- Kyung-Won Hong
- Division of Biomedical Informatics, Center for Genome Science, National Institute of Health, KCDC, Cheongju 363-951, Korea
| | - Myungguen Chung
- Division of Biomedical Informatics, Center for Genome Science, National Institute of Health, KCDC, Cheongju 363-951, Korea. ; Division of Molecular and Life Science, Hanyang University, Seoul 133-791, Korea
| | - Seong Beom Cho
- Division of Biomedical Informatics, Center for Genome Science, National Institute of Health, KCDC, Cheongju 363-951, Korea
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29
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Lifestyle modification for metabolic syndrome: a systematic review. Am J Med 2014; 127:1242.e1-10. [PMID: 25004456 DOI: 10.1016/j.amjmed.2014.06.035] [Citation(s) in RCA: 112] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 06/07/2014] [Accepted: 06/09/2014] [Indexed: 01/07/2023]
Abstract
BACKGROUND All 5 components of metabolic syndrome have been shown to improve with lifestyle and diet modification. New strategies for achieving adherence to meaningful lifestyle change are needed to optimize atherosclerotic cardiovascular risk reduction. We performed a systematic literature review, based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses framework (PRISMA), investigating optimal methods for achieving lifestyle change in metabolic syndrome. METHODS We submitted standardized search terms to the PubMed Central, CINAHL, Web of Science, and Ovid databases. Within those results, we selected randomized controlled trials (RCTs) presenting unique methods of achieving lifestyle change in patients with one or more components of the metabolic syndrome. Data extraction using the population, intervention, comparator, outcome, and risk of bias framework (PICO) was used to compare the following endpoints: prevalence of metabolic syndrome, prevalence of individual metabolic syndrome components, mean number of metabolic syndrome components, and amount of weight loss achieved. RESULTS Twenty-eight RCTs (6372 patients) were included. Eight RCTs demonstrated improvement in metabolic syndrome risk factors after 1 year. Team-based, interactive approaches with high-frequency contact with patients who are motivated made the largest and most lasting impact. Technology was found to be a useful tool in achieving lifestyle change, but ineffective when compared with personal contact. CONCLUSION Patient motivation leading to improved lifestyle adherence is a key factor in achieving reduction in metabolic syndrome components. These elements can be enhanced via frequent encounters with the health care system. Use of technologies such as mobile and Internet-based communication can increase the effectiveness of lifestyle change in metabolic syndrome, but should not replace personal contact as the cornerstone of therapy. Our ability to derive quantitative conclusions is limited by inconsistent outcome measures across studies, low power and homogeneity of individual studies, largely motivated study populations, short follow-up periods, loss to follow-up, and lack of or incomplete blinding.
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30
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Yu R, Yan LL, Wang H, Ke L, Yang Z, Gong E, Guo H, Liu J, Gu Y, Wu Y. Effectiveness of a community-based individualized lifestyle intervention among older adults with diabetes and hypertension, Tianjin, China, 2008-2009. Prev Chronic Dis 2014; 11:E84. [PMID: 24831288 PMCID: PMC4023677 DOI: 10.5888/pcd11.120333] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Introduction Though diet and exercise modification is effective in preventing diabetes and hypertension, community-based models for lifestyle intervention for managing these conditions that are practical and effective are few. Methods A community-based lifestyle intervention trial was conducted in 5 community clinics in Tianjin, China. Trained physicians used energy monitors and software as tools to provide eight individualized lifestyle consultation sessions (zhiji management) to 273 residents with mild hypertension (including prehypertension) or diabetes (including prediabetes). The recruitment was based on a waitlist control design. The early group (n = 175) received the 3-month intervention and the late group served as controls; afterward, the early group was followed up while the late group received the 3-month intervention. Selected characteristics between the 2 groups were compared by χ2 tests, continuous variables paired t tests, and independent t tests. Results Compared with baseline, the intervention significantly increased effective (3–6 metabolic equivalents and >6 minutes) physical activity by 54.6 kilocalories per day (P < .01) and decreased total dietary intake by 328.5 kilocalories per day (P < .01). The net differences between early group (intervention) and late group (control phase) were significant (P < .01) for weight, waist circumference, systolic and diastolic blood pressure, 2-hour postprandial glucose, and hemoglobin A1c. Conclusion This community-based lifestyle zhiji management program produced short-term beneficial changes in activity, diet, and clinical parameters in patients with mild diabetes or hypertension. Larger and longer trials are needed to fully evaluate the effectiveness and feasibility of this model.
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Affiliation(s)
- Ruijun Yu
- Tianjin Health Insurance Research Association, Tianjin, China
| | - Lijing L Yan
- The George Institute for Global Health at Peking University Health Science Center, Beijing, China, and Northwestern University, Chicago, Illinois
| | - Hanliang Wang
- Health Promotion Working Committee, National Center for Medical Education Development, Beijing, China
| | - Liang Ke
- The George Institute for Global Health at Peking University Health Science Center, Beijing, China
| | - Zhou Yang
- Health Promotion Working Committee, National Center for Medical Education Development, Beijing, China
| | - Enying Gong
- The George Institute for Global Health at Peking University Health Science Center, Beijing, China
| | - Hui Guo
- The George Institute for Global Health at Peking University Health Science Center, Beijing, China
| | - Jun Liu
- Tianjin Health Insurance Research Association, Tianjin, China
| | - Yuting Gu
- Department of Rehabilitation, The First Affiliated Hospital of Tianjin Chinese Traditional Medicine University, Tianjin, China
| | - Yangfeng Wu
- The George Institute for Global Health at Peking University Health Science Center, Floor 18, Tower B, Horizon Tower, No. 6 Zhichun Road, Haidian, Beijing, 100088 China. E-mail:
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31
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Thewissen MM, van de Gaar J, den Boer AT, Munsters MJ, Blaak EE, Duijvestijn A. Monocytes, but not T cells, respond to insulin with Akt(S473) phosphorylation independent of the donor glucometabolic state. Diabetes Metab Res Rev 2014; 30:323-32. [PMID: 24302564 DOI: 10.1002/dmrr.2498] [Citation(s) in RCA: 5] [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] [Received: 06/20/2013] [Revised: 10/15/2013] [Accepted: 11/14/2013] [Indexed: 01/04/2023]
Abstract
BACKGROUND Obesity is associated with insulin resistance and chronic low-grade inflammation. Insulin has been described to have anti-inflammatory effects in immune cells. Therefore, insulin resistance in immune cells can be expected to have important consequences for immune function. Here, we investigate whether freshly isolated monocytes and T cells, isolated from study subjects with a normal or disturbed glucometabolic state, respond to insulin with phosphorylation of Akt, a key molecule in the insulin signalling pathway. METHODS A total of 25 study subjects were enrolled in the study. An oral glucose tolerance test (OGTT) was performed, and from fasting insulin and glucose, the homeostasis model assessment of insulin resistance (HOMA-IR) index was calculated. Peripheral blood mononuclear cells were isolated from heparinized blood and phenotypically characterized by flow cytometry. Basal and insulin-induced fractions of pAkt(S473)-positive monocytes and T cells were determined by Phosflow. RESULTS On the basis of the OGTT, 11 subjects were classified as normal glucose tolerant (NGT), 9 had an impaired glucose metabolism (IGM) and 5 had type 2 diabetes (T2DM). The fraction of pAkt(S473)positive-T cells and monocytes, in the absence of insulin, was low in all subjects. Incubation with insulin did not induce Akt phosphorylation in CD4⁺ and CD8⁺ T cells in normal subjects. However, in the monocyte fraction, an insulin-dose-dependent increase of the pAkt(S473)positive-cell fraction was observed. This response did not differ between NGT, IGM and T2DM and was not correlated with HOMA-IR. CONCLUSIONS In this study, we show that freshly isolated monocytes, but not T cells, are insulin-sensitive cells and that this insulin sensitivity of monocytes is not negatively affected by the glucometabolic state of the donor.
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Affiliation(s)
- M M Thewissen
- Department of Internal Medicine, Division of Immunology, CARIM School for Cardiovascular Diseases, Maastricht University Medical Centre, Maastricht, The Netherlands
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32
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Okada R, Yasuda Y, Tsushita K, Wakai K, Hamajima N, Matsuo S. The number of metabolic syndrome components is a good risk indicator for both early- and late-stage kidney damage. Nutr Metab Cardiovasc Dis 2014; 24:277-285. [PMID: 24418372 DOI: 10.1016/j.numecd.2013.08.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Revised: 08/12/2013] [Accepted: 08/14/2013] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND AIMS Renal hyperfiltration (early-stage kidney damage) and hypofiltration (late-stage kidney damage) are common in populations at high risk of chronic kidney disease. This study investigated the associations of renal hyperfiltration and hypofiltration with the number of metabolic syndrome (MetS) components. METHODS AND RESULTS The study subjects included 205,382 people aged 40-74 years who underwent Specific Health Checkups in Aichi Prefecture, Japan. The prevalence of renal hyperfiltration [estimated glomerular filtration rate (eGFR) above the age-/sex-specific 95th percentile] and hypofiltration (eGFR below the 5th percentile) was compared according to the number of MetS components. We found that the prevalence of both hyperfiltration and hypofiltration increased with increasing number of MetS components (odds ratios for hyperfiltration: 1.20, 1.40, 1.42, 1.41, and 1.77; odds ratios for hypofiltration: 1.07, 1.25, 1.57, 1.89, and 2.21 for one, two, three, four, and five components, respectively, compared with no MetS components). These associations were observed in both normal weight [body mass index (BMI) < 25 kg/m(2)] and overweight (BMI ≥ 25 kg/m(2)) subjects. Renal hyperfiltration was associated with prehypertension and prediabetes, while hypofiltration was associated with dyslipidemia, abdominal obesity, overt hypertension, and overt diabetes. CONCLUSION The number of MetS components is a good risk indicator of early- and late-stage kidney damage. Therefore, kidney function should be monitored in subjects with MetS components. MetS components should be treated as early as possible to prevent the development of kidney damage and cardiovascular diseases in people with hyperfiltration, regardless of their body weight.
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Affiliation(s)
- R Okada
- Department of Preventive Medicine, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan.
| | - Y Yasuda
- Department of Nephrology, Internal Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - K Tsushita
- Comprehensive Health Science Center, Aichi Health Promotion Foundation, Aichi, Japan
| | - K Wakai
- Department of Preventive Medicine, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan
| | - N Hamajima
- Department of Young Leaders' Program in Health Care Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - S Matsuo
- Department of Nephrology, Internal Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Palermo A, Maggi D, Maurizi AR, Pozzilli P, Buzzetti R. Prevention of type 2 diabetes mellitus: is it feasible? Diabetes Metab Res Rev 2014; 30 Suppl 1:4-12. [PMID: 24353270 DOI: 10.1002/dmrr.2513] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Accepted: 12/19/2013] [Indexed: 12/16/2022]
Abstract
The increasing global prevalence of type 2 diabetes mellitus (T2DM) requires the implementation of preventive strategies to halt this trend, tailored to the specific needs of individual regions. Risk factors for T2DM are among the main targets for improving health outcomes and curbing the development of diabetes; excessive weight and obesity are two of the most important risk factors that need to be addressed. A growing body of evidence suggests that subjects with pre-diabetes who lose body weight and increase physical activity can delay or prevent the onset of T2DM, and in some cases, blood glucose levels may return to normal. Several studies have shown that moderate to intensive levels of exercise are effective in reducing both intra-abdominal and total adiposity among obese subjects, both improving cardiovascular risk profile and reducing the risk of T2DM development. These consistent observations have given rise to large-scale randomized controlled trials that use lifestyle intervention (including behavioural strategies for the reinforcement of prescribed changes in nutritional intake, physical activity or both), with or without pharmacological treatment, in populations at high risk of developing T2DM. In this review, large-scale national trials that have focused on the prevention of T2DM are critically evaluated.
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Affiliation(s)
- Andrea Palermo
- Department of Endocrinology and Diabetes, University Campus Bio-Medico, Rome, Italy
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34
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Abstract
Metabolic syndrome (MetS) is a cluster of metabolic abnormalities characterized by central obesity, dyslipidemias, hypertension, high fasting glucose, chronic low-grade inflammation and oxidative stress. This condition has become an increasing problem in our society where about 34 % of adults are diagnosed with MetS. In parallel with the adult situation, a significant number of children present lipid abnormalities and insulin resistance, which can be used as markers of MetS in the pediatric population. Changes in lifestyle including healthy dietary regimens and increased physical activity should be the first lines of therapy to decrease MetS. In this article, we present the most recent information on successful dietary modifications that can reduce the parameters associated with MetS. Successful dietary strategies include energy restriction and weight loss, manipulation of dietary macronutrients--either through restriction of carbohydrates, fat, or enrichment in beneficial fatty acids, incorporation of functional foods and bioactive nutrients, and adherence to dietary and lifestyle patterns such the Mediterranean diet and diet/exercise regimens. Together, the recent findings presented in this review serve as evidence to support the therapeutic treatment of MetS through diet.
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Affiliation(s)
- Catherine J Andersen
- Department of Nutritional Sciences, University of Connecticut, 3624 Horsebarn Road Ext., Unit 4017, Storrs, CT, 06269-4017, USA
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