Effects of an internet-based lifestyle intervention on cardio-metabolic risks and stress in Korean workers with metabolic syndrome: a controlled trial

Effect of the national lifestyle guidance intervention for metabolic syndrome among middle-aged people in Japan

Background

Japan has implemented a national lifestyle guidance intervention programme for potential metabolic syndrome among adults aged 40-74 years; however, there is limited evidence regarding the causal impact of this intervention. The study aims to determine the causal effect of this intervention on health outcomes and health care utilisation.

Methods

We performed a regression discontinuity design study. A total of 46 975 adults with ≥1 cardiovascular risk factor in 2015 were included in the study. A two-stage evaluation process (stage 1: waist circumference ≥85 cm for men or ≥90 cm for women and ≥1 cardiovascular risk factor; stage 2: body mass index (BMI)≥25 kg/m2 and ≥2 cardiovascular risk factors) was applied. Changes in obesity, cardiovascular outcomes, and health care utilisation were evaluated in a one-year follow-up in the fiscal year 2016.

Results

Participants who received lifestyle guidance intervention based on the waist circumference had a statistically significant reduction in obesity outcomes (Δ weight: -0.30 kg, 95% CI = -0.46 to -0.11; Δ waist circumference: -0.26 cm, 95% CI = -0.53 to -0.02; Δ BMI = -0.09 kg/m2, 95% CI = -0.17 to -0.04) but not in other cardiovascular risk factors and health care utilisation. Analyses based on BMI and results according to demographic subgroups did not reveal significant findings.

Conclusions

The provision of this intervention had a limited effect on health improvement and a decrease in health care costs, health care visits, and length of stay. A more intensive intervention delivery could potentially improve the efficacy of this intervention programme.

Systematic review of electronically delivered behavioral obesity prevention interventions targeting men

Globally, obesity persists at epidemic rates. Men are underrepresented within behavior-based obesity prevention research. As men prefer individualized, self-guided interventions, electronic delivery of treatment modalities has potential to reach this population. The purpose of this study was to systematically review primary, secondary, or tertiary behavioral obesity prevention interventions that used controlled designs; targeted men; and incorporated at least one electronically delivered treatment modality explicitly designed to elicit an intervention effect. Literature searches were delimited to peer-reviewed articles; published between 2000 and 2021; in the English language; and indexed in PsycINFO, CINHAL, MEDLINE, CENTRAL, and WOS electronic databases. Interventions satisfying inclusion criteria were critiqued for methodological quality using the Jadad Scale (0 = lowest quality; 10 = highest quality). Eleven studies satisfied the inclusion criteria (n = 1748; total participants) with five reporting group-by-time intervention effects on the primary variable targeted. Jadad scale quality assessment scores ranged from 5.00 to 9.00 with a mean of 7.72. Majority of the interventions applied a randomized control trial design (n = 10). Most interventions were theory based, with eight rooted in social cognitive theory. Behavior change strategies included self-monitoring (n = 10), personalized feedback (n = 8), health counseling (n = 8), and goal setting (n = 9). Community-level theories have the potential to guide future obesity prevention interventions targeting men.

Effects of Work Stress and Period3 Gene Polymorphism and Their Interaction on Sleep Quality of Non-Manual Workers in Xinjiang, China: A Cross-Sectional Study

Work stress has been found to be associated with sleep quality in various occupational groups, and genetic factors such as variable number tandem repeat polymorphism in the Period3 (Per3) gene also influence the circadian sleep-wake process. Therefore, the present study aimed to evaluate the sleep quality status of non-manual workers in Xinjiang, China and to analyse the effects of work stress and Per3 gene polymorphism and their interaction on sleep quality. A cluster sampling method was used to randomly select 1700 non-manual workers in Urumqi, Xinjiang. The work stress and sleep quality of these workers were evaluated using the Effort−Reward Imbalance Inventory (ERI) and the Pittsburgh Sleep Quality Index (PSQI). Next, 20% of the questionnaire respondents were randomly selected for genetic polymorphism analysis. The polymerase chain reaction-restriction fragment length polymorphism technique was used to determine Per3 gene polymorphism. The detection rate of sleep quality problems differed between the different work stress groups (p < 0.05), suggesting that non-manual workers with high levels of work stress are more likely to have sleep quality problems. Regression analysis revealed that the Per3 gene (OR = 3.315, 95% CI: 1.672−6.574) was the influencing factor for poor sleep quality after adjusting for confounding factors, such as occupation, length of service, education, and monthly income. Interaction analysis showed that Per34/5,5/5 × high work stress (OR = 2.511, 95% CI: 1.635−3.855) had a higher risk of developing sleep quality problems as compared to Per34/4 × low work stress after adjusting for confounding factors. The structural equation modelling showed no mediating effect between work stress and Per3 gene polymorphism. The results of this study show that both work stress and Per3 gene polymorphism independently affect sleep quality of nonmanual workers from Xinjiang, and the interaction between these two factors may increase the risk of sleep quality problems. Therefore, to improve sleep quality, individuals with genetic susceptibility should avoid or reduce as much as possible self-stimulation by work-related exposures such as high levels of external work stress.

A Technology-Mediated Interventional Approach to the Prevention of Metabolic Syndrome: A Systematic Review and Meta-Analysis

BACKGROUND

Technology-mediated interventions help overcome barriers to program delivery and spread metabolic syndrome prevention programs on a large scale. A meta-analysis was performed to evaluate the impact of these technology-mediated interventions on metabolic syndrome prevention.

METHODS

In this meta-analysis, from 30 January 2018, three databases were searched to evaluate interventions using techniques to propagate diet and exercise lifestyle programs for adult patients with metabolic syndrome or metabolic risk.

RESULTS

Search results found 535 citations. Of these, 18 studies met the inclusion criteria analyzed in this article. The median duration of intervention was 4 months and the follow-up period ranged from 1.5 to 30 months. The standardized mean difference (SMD) between the two groups was waist circumference -0.35 (95% CI -0.54, -0.15), triglyceride -0.14 (95% CI -0.26, -0.03), fasting blood glucose -0.31 (95% CI -0.42, -0.19), body weight -1.34 (95% CI -2.04, -0.64), and body mass index -1.36 (95% CI -2.21, -0.51). There was no publication bias in this study.

CONCLUSION

Technology-mediated intervention improved clinically important metabolic syndrome related indicators such as excess body fat around the waist, fasting glucose, and body mass index. These interventions will play an important role in the dissemination of metabolic syndrome prevention programs.

Effect of electronic health interventions on metabolic syndrome: a systematic review and meta-analysis

OBJECTIVE

We aimed to examine whether eHealth interventions can effectively improve anthropometric and biochemical indicators of patients with metabolic syndrome (MetS).

DESIGN

Systematic review and meta-analysis.

METHODS

PubMed, the Web of Science, Embase, Medline, CINAHL, PsycINFO, the Cochrane Library, the Chinese National Knowledge Infrastructure, the Wanfang and Weipu databases were comprehensively searched for papers that were published from database inception to May 2019. Articles were included if the participants were metabolic syndrome (MetS) patients, the participants received eHealth interventions, the participants in the control group received usual care or were wait listed, the outcomes included anthropometric and biochemical indicators of MetS, and the study was a randomised controlled trial (RCT) or a controlled clinical trial (CCT). The Quality Assessment Tool for Quantitative Studies was used to assess the methodological quality of the included articles. The meta-analysis was conducted using Review Manager V.5.3 software.

RESULTS

In our review, seven RCTs and two CCTs comprising 935 MetS participants met the inclusion criteria. The results of the meta-analysis revealed that eHealth interventions resulted in significant improvements in body mass index (standardised mean difference (SMD)=-0.36, 95% CI (-0.61 to -0.10), p<0.01), waist circumference (SMD=-0.47, 95% CI (-0.84 to -0.09), p=0.01) and systolic blood pressure(SMD=-0.35, 95% CI (-0.66 to -0.04), p=0.03) compared with the respective outcomes associated with the usual care or wait-listed groups. Based on the included studies, we found significant effects of the eHealth interventions on body weight. However, we did not find significant positive effects of the eHealth interventions on other metabolic parameters.

CONCLUSIONS

The results indicated that eHealth interventions were beneficial for improving specific anthropometric outcomes, but did not affect biochemical indicators of MetS. Therefore, whether researchers adopt eHealth interventions should be based on the purpose of the study. More rigorous studies are needed to confirm these findings.

Effectiveness of Mobile Health Interventions Promoting Physical Activity and Lifestyle Interventions to Reduce Cardiovascular Risk Among Individuals With Metabolic Syndrome: Systematic Review and Meta-Analysis

BACKGROUND

Physical activity and lifestyle interventions, such as a healthy diet, have been proven to be effective approaches to manage metabolic syndrome. However, these interventions require great commitment from patients and clinicians owing to their economic costs, time consumption, and lack of immediate results.

OBJECTIVE

The aim of this systematic review and meta-analysis was to analyze the effect of mobile-based health interventions for reducing cardiometabolic risk through the promotion of physical activity and healthy lifestyle behaviors.

METHODS

PubMed, Scopus, Web of Science, Cochrane Central Register of Controlled Trials, and SPORTdiscus databases were searched for experimental studies evaluating cardiometabolic risk indicators among individuals with metabolic syndrome who were included in technology-assisted physical activity and lifestyle interventions. Effect sizes, pooled mean changes, and their respective 95% CIs were calculated using the DerSimonian and Laird method. Outcomes included the following clinical and biochemical parameters: body composition (waist circumference [WC] and BMI), blood pressure (systolic blood pressure [SBP] and diastolic blood pressure [DBP]), glucose tolerance (fasting plasma glucose [FPG] and glycated hemoglobin A1c [HbA_1c]), and lipid profile (total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol [HDL-C], and triglycerides).

RESULTS

A total of nine studies were included in the meta-analysis. Owing to the scarcity of studies, only pooled mean pre-post changes in the intervention groups were estimated. Significant mean changes were observed for BMI (-1.70 kg/m2, 95% CI -3.20 to -0.20; effect size: -0.46; P=.03), WC (-5.77 cm, 95% CI -9.76 to -1.77; effect size: -0.54; P=.005), SBP (-7.33 mmHg, 95% CI -13.25 to -1.42; effect size: -0.43; P=.02), DBP (-3.90 mmHg, 95% CI -7.70 to -0.11; effect size: -0.44; P=.04), FPG (-3.65 mg/dL, 95% CI -4.79 to -2.51; effect size: -0.39; P<.001), and HDL-C (4.19 mg/dL, 95% CI 2.43-5.95; effect size: 0.23; P<.001).

CONCLUSIONS

Overall, mobile-based health interventions aimed at promoting physical activity and healthy lifestyle changes had a strong positive effect on cardiometabolic risk indicators among individuals with metabolic syndrome. Nevertheless, further research is required to compare this approach with usual care in order to support the incorporation of these technologies in health systems.

TRIAL REGISTRATION

PROSPERO CRD42019125461; https://tinyurl.com/y3t4wog4.

Semisupervised Physical Exercise and Lifestyle Counseling in Cardiometabolic Risk Management in Sedentary Adults: Controlled Randomized Trial (BELLUGAT)

BACKGROUND

The purpose of this study was to evaluate the feasibility and effectiveness of a high-intensity semisupervised exercise program alongside lifestyle counseling as an intervention for managing cardiometabolic risk in sedentary adults.

METHODS

A 40-week 3-arm randomized controlled clinical trial (16-wk intervention and 24-wk follow-up) was used. Seventy-five sedentary adults (34-55 y) with at least 1 cardiometabolic risk factor were randomized into one of the following arms: (1) aerobic interval training (AIT) plus lifestyle counseling (n = 25), (2) low- to moderate-intensity continuous training plus lifestyle counseling (traditional continuous training, TCT) (n = 27), or (3) lifestyle counseling alone (COU) (n = 23). Metabolic syndrome severity scores, accelerometer-based physical activity, and self-reported dietary habits were assessed at baseline, after the intervention, and at follow-up.

RESULTS

AIT was well accepted with high enjoyment scores. All groups showed similar improvements in metabolic syndrome severity scores (standardized effect size = 0.46) and dietary habits (standardized effect size = 0.30). Moderate to vigorous physical activity increased in all study groups, with the number of responders higher in AIT and TCT groups (50%) than in COU group (21%). Both AIT and TCT had a greater impact on sedentary behavior than COU (63.5% vs 30.4% responders).

CONCLUSIONS

AIT appears to be a feasible and effective strategy in sedentary individuals with cardiometabolic risk factors. AIT could be included in intervention programs tackling unhealthy lifestyles.

Epidemiology of childhood overweight, obesity and their related factors in a sample of preschool children from Central Iran

BACKGROUND

Childhood overweight and obesity are strongly associated with the psychological and physical health of those for the duration of the lifetime. The purpose of this study was to assess the epidemiology of childhood overweight and obesity and their related factors in Zarandieh city, of Iran, in 2017.

METHODS

In a cross-sectional study, 572 preschool-mother dyads from primary care Clinics were selected by multi-stage sampling method. BMI of the children and mothers were calculated using standard method and the demographic, children nutrition and physical activity habits; the mothers perceived threat toward obesity, and their life style data were collected by self-report questionnaires for the literate mothers and interviewing for illiterate mothers.

RESULT

The prevalence of overweight and obesity in mothers was 30.8 and 20.3% respectively. This rate in children was 15.5 and 9.9% respectively. The multiple logistic regression analysis showed that variables of mother's BMI, Birth weight, Mother's employment, watching TV > 2 h/day, Computer games> 2 h/day and daily breakfast eating (≥4/week), perceived threat, health responsibility, stress management, physical activity, and healthy eating were the significant predictors of the child's BMI respectively.

CONCLUSIONS

Our results indicated that the prevalence of overweight and obesity are high in preschool children and their mothers. It seems that necessary to have suitable intervention programs to help mothers understand the serious risk of childhood obesity and the importance of creating a healthy lifestyle by them in childhood.

The Impact Of Structured Exercise Programs On Metabolic Syndrome And Its Components: A Systematic Review

BACKGROUND

The metabolic syndrome (MetS) is highly prevalent and associated with higher risk of diabetes and cardiovascular events. Exercise programs have been shown to improve components of MetS, but the optimal design of a structured exercise program for treatment of the MetS remains unclear.

PURPOSE

To assess the impact of different exercise programs on the MetS and its components.

METHODS

MEDLINE via PubMed and Embase was searched. Randomized controlled trials of supervised exercise alone and in combination with nutrition programs compared with usual care in adults with the MetS were selected. Two authors independently reviewed articles to select eligible studies and performed data abstraction. Eight studies representing 1218 patients were included. The participants had a median age of 51, median BMI of 29 kg/m², and were 55% male. Mean weight loss increased with program duration. For combination programs, the mean weight loss was -2.6 kg, -3.7 kg, and -6.5 kg for 3, 6, and 12 months, respectively. The components of the MetS most frequently statistically significantly improved were waist circumference (6/6 studies), blood pressure (4/6 studies), and high-density lipoprotein cholesterol (3/6 studies).

LIMITATIONS

Studies did not include long-term follow-up post program completion to evaluate persistence of benefit. It is unknown whether the same results would be found in an older, more obese population.

CONCLUSION

Supervised exercise programs yield significant resolution of components of the MetS, particularly in reducing waist circumference. Longer program duration and frequent interval sessions appear to have highest benefit and thus may help reduce cardiovascular risk and diabetes associated with the MetS.

Systematization of clinical trials related to treatment of metabolic syndrome, 1980-2015

INTRODUCTION

Despite the clinical, epidemiological, and economic significance of metabolic syndrome, the profile of clinical trials on this disease is unknown.

OBJECTIVE

To characterize the clinical trials related to treatment of metabolic syndrome during the 1980-2015 period.

METHODS

Systematic review of the literature using an ex ante search protocol which followed the phases of the guide Preferred Reporting Items for Systematic Reviews and Meta-Analyses in four multidisciplinary databases with seven search strategies. Reproducibility and methodological quality of the studies were assessed.

RESULTS

One hundred and six trials were included, most from the United States, Italy, and Spain, of which 63.2% evaluated interventions effective for several components of the syndrome such as diet (40.6%) or physical activity (22.6%). Other studies assessed drugs for a single factor such as hypertension (7.5%), hypertriglyceridemia (11.3%), or hyperglycemia (9.4%). Placebo was used as control in 54.7% of trials, and outcome measures included triglycerides (52.8%), HDL (48.1%), glucose (29.2%), BMI (33.0%), blood pressure (27.4%), waist circumference (26.4%), glycated hemoglobin (11.3%), and hip circumference (7.5%).

CONCLUSION

It was shown that studies ob efficacy of treatment for metabolic syndrome are scarce and have mainly been conducted in the last five years and in high-income countries. Trials on interventions that affect three or more factors and assess several outcome measures are few, and lifestyle interventions (diet and physical activity) are highlighted as most important to impact on this multifactorial syndrome.

Web-based interventions for the management of stress in the workplace: Focus, form, and efficacy

OBJECTIVES

This review sought to determine what is currently known about the focus, form, and efficacy of web-based interventions that aim to support the well-being of workers and enable them to manage their work-related stress.

METHOD

A scoping review of the literature as this relates to web-based interventions for the management of work-related stress and supporting the psychological well-being of workers was conducted.

RESULTS

Forty-eight web-based interventions were identified and reviewed, the majority of which (n = 37) were "individual" -focused and utilized cognitive-behavioral techniques, relaxation exercises, mindfulness, or cognitive behavior therapy. Most interventions identified were provided via a website (n = 34) and were atheoretical in nature.

CONCLUSIONS

There is some low-to-moderate quality evidence that "individual" -focused interventions are effective for supporting employee well-being and managing their work-related stress. There are few web-based interventions that target "organizational" or "individual/organization" interface factors, and there is limited support for their efficacy. A clear gap appears to exist between work-stress theory and its application in the design and development of web-based interventions for the management of work-related stress.

mHealth App for Cannabis Users: Satisfaction and Perceived Usefulness

OBJECTIVE

The aim of this study was to describe the characteristics of cannabis users and their levels of satisfaction with Stop-cannabis, an app intended for cannabis users who want to stop or reduce their cannabis use or prevent relapse.

METHODS

A cross-sectional online survey was administered to users of Stop-cannabis, a French-language app for iOS and Android devices. All app users were invited to participate in the survey via a message sent to the app.

RESULTS

For hundred and eighty-two users answered the survey. The app was used daily by 348 of the participants (around 70%). More than 80% of participants (397) considered the app to have helped them "a little" or "a lot" to stop or reduce cannabis consumption. Most of the users' suggestions were related to the number or the quality of the messages sent by, or displayed in, the app.

CONCLUSION

This pilot study supports the feasibility of such an app and its perceived usefulness. A self-selection bias, however, limits the conclusions of the study. The efficacy of the app should be evaluated in a randomized controlled trial.