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Gannamani R, Castela Forte J, Folkertsma P, Hermans S, Kumaraswamy S, van Dam S, Chavannes N, van Os H, Pijl H, Wolffenbuttel BHR. A Digitally Enabled Combined Lifestyle Intervention for Weight Loss: Pilot Study in a Dutch General Population Cohort. JMIR Form Res 2024; 8:e38891. [PMID: 38329792 PMCID: PMC10884913 DOI: 10.2196/38891] [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: 09/26/2022] [Revised: 05/04/2023] [Accepted: 09/25/2023] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND Overweight and obesity rates among the general population of the Netherlands keep increasing. Combined lifestyle interventions (CLIs) focused on physical activity, nutrition, sleep, and stress management can be effective in reducing weight and improving health behaviors. Currently available CLIs for weight loss (CLI-WLs) in the Netherlands consist of face-to-face and community-based sessions, which face scalability challenges. A digitally enabled CLI-WL with digital and human components may provide a solution for this challenge; however, the feasibility of such an intervention has not yet been assessed in the Netherlands. OBJECTIVE The aim of this study was two-fold: (1) to determine how weight and other secondary cardiometabolic outcomes (lipids and blood pressure) change over time in a Dutch population with overweight or obesity and cardiometabolic risk participating in a pilot digitally enabled CLI-WL and (2) to collect feedback from participants to guide the further development of future iterations of the intervention. METHODS Participants followed a 16-week digitally enabled lifestyle coaching program rooted in the Fogg Behavior Model, focused on nutrition, physical activity, and other health behaviors, from January 2020 to December 2021. Participants could access the digital app to register and track health behaviors, weight, and anthropometrics data at any time. We retrospectively analyzed changes in weight, blood pressure, and lipids for remeasured users. Surveys and semistructured interviews were conducted to assess critical positive and improvement points reported by participants and health care professionals. RESULTS Of the 420 participants evaluated at baseline, 53 participated in the pilot. Of these, 37 (70%) were classified as overweight and 16 (30%) had obesity. Mean weight loss of 4.2% occurred at a median of 10 months postintervention. The subpopulation with obesity (n=16) showed a 5.6% weight loss on average. Total cholesterol decreased by 10.2% and low-density lipoprotein cholesterol decreased by 12.9% on average. Systolic and diastolic blood pressure decreased by 3.5% and 7.5%, respectively. Participants identified the possibility of setting clear action plans to work toward and the multiple weekly touch points with coaches as two of the most positive and distinctive components of the digitally enabled intervention. Surveys and interviews demonstrated that the digital implementation of a CLI-WL is feasible and well-received by both participants and health care professionals. CONCLUSIONS Albeit preliminary, these findings suggest that a behavioral lifestyle program with a digital component can achieve greater weight loss than reported for currently available offline CLI-WLs. Thus, a digitally enabled CLI-WL is feasible and may be a scalable alternative to offline CLI-WL programs. Evidence from future studies in a Dutch population may help elucidate the mechanisms behind the effectiveness of a digitally enabled CLI-WL.
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Affiliation(s)
- Rahul Gannamani
- Ancora Health BV, Groningen, Netherlands
- Department of Neurology, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands
| | - José Castela Forte
- Ancora Health BV, Groningen, Netherlands
- Department of Clinical Pharmacy and Pharmacology, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands
| | - Pytrik Folkertsma
- Ancora Health BV, Groningen, Netherlands
- Department of Endocrinology, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands
| | | | | | - Sipko van Dam
- Ancora Health BV, Groningen, Netherlands
- Department of Endocrinology, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands
| | - Niels Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden University, Leiden, Netherlands
- National eHealth Living Lab, Leiden, Netherlands
| | - Hendrikus van Os
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden University, Leiden, Netherlands
- National eHealth Living Lab, Leiden, Netherlands
| | - Hanno Pijl
- Department of Endocrinology, Leiden University Medical Center, Leiden University, Leiden, Netherlands
| | - Bruce H R Wolffenbuttel
- Department of Endocrinology, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands
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Janssen E, Philippens N, Kremers S, Crutzen R. Outcomes of the combined lifestyle intervention CooL during COVID-19: a descriptive case series study. BMC Public Health 2024; 24:40. [PMID: 38166961 PMCID: PMC10762946 DOI: 10.1186/s12889-023-17501-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 12/15/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND The main objective of this nationwide study was to investigate changes in outcomes between baseline and eight months of participation regarding anthropometrics, control and support, physical activity, diet attentiveness, perceived fitness, sleep, and stress of participants in Coaching on Lifestyle (CooL), a Combined Lifestyle Intervention (CLI). Since the study took place when the COVID-19 pandemic emerged, we defined a subobjective, i.e., to address changes in intervention outcomes over time while participants were exposed to pandemic-related restrictions and uncertainties. METHODS Data were collected from November 2018 until October 2021 at different locations across the Netherlands from 1824 participating adults, meeting the CLI inclusion criteria. We collected a broad set of data on anthropometrics (weight, body mass index (BMI), waist circumference), control and support (self-mastery, social support), physical activity (sedentary time on least/most active days, physical active minutes), diet attentiveness (attentiveness to meal composition, awareness to amounts of food and attentiveness to consuming), alcohol consumption, smoking, perceived fitness (perceived health, fitness when waking, fitness during daytime, impact daily stress), sleep and stress. RESULTS All outcomes showed improvements after eight months compared to baseline except for social support and smoking. Large effect sizes were found on weight (0.57), waist circumference (0.50) and perceived health (0.50). Behaviour patterns showed small to large effect sizes, with the largest effect sizes on diet attentiveness (i.e., attentiveness to meal composition (0.43), awareness to amounts of food (0.58) and attentiveness to consuming (0.39)). The outcomes of participants pre COVID-19 versus during COVID-19 showed differences on self-mastery (p = 0.01), sedentary time (all underlying constructs p < 0.02), perceived fitness (all underlying constructs p < 0.02) and stress (p < 0.01). CONCLUSION The results show that small changes in multiple behaviours go along with a large positive change in perceived health and health-related outcomes in line with the lifestyle coaching principles. In addition, participating in CooL may have protected against engaging in unhealthier behaviour during the pandemic. TRIAL REGISTRATION As the CLI is considered usual health care that does not fall within the scope of the Dutch Medical Research Involving Human Subjects Act, this study was exempt from trial registration.
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Affiliation(s)
- Ester Janssen
- Department of Health Promotion, NUTRIM, School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands.
| | - Nicole Philippens
- Department of Health Promotion, NUTRIM, School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - Stef Kremers
- Department of Health Promotion, NUTRIM, School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - Rik Crutzen
- Department of Health Promotion, CAPHRI, Care & Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
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Nieuwenhuijse EA, Vos RC, van den Hout WB, Struijs JN, Verkleij SM, Busch K, Numans ME, Bonten TN. The Effect and Cost-Effectiveness of Offering a Combined Lifestyle Intervention for the Prevention of Cardiovascular Disease in Primary Care: Results of the Healthy Heart Stepped-Wedge Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5040. [PMID: 36981949 PMCID: PMC10048996 DOI: 10.3390/ijerph20065040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 03/04/2023] [Accepted: 03/05/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVE To evaluate the effectiveness and cost-effectiveness of offering the combined lifestyle programme "Healthy Heart", addressing overweight, diet, physical activity, smoking and alcohol, to improve lifestyle behaviour and reduce cardiovascular risk. DESIGN A practice-based non-randomised stepped-wedge cluster trial with two-year follow-up. Outcomes were obtained via questionnaires and routine care data. A cost-utility analysis was performed. During the intervention period, "Healthy Heart" was offered during regular cardiovascular risk management consultations in primary care in The Hague, The Netherlands. The period prior to the intervention period served as the control period. RESULTS In total, 511 participants (control) and 276 (intervention) with a high cardiovascular risk were included (overall mean ± SD age 65.0 ± 9.6; women: 56%). During the intervention period, 40 persons (15%) participated in the Healthy Heart programme. Adjusted outcomes did not differ between the control and intervention period after 3-6 months and 12-24 months. Intervention versus control (95% CI) 3-6 months: weight: β -0.5 (-1.08-0.05); SBP β 0.15 (-2.70-2.99); LDL-cholesterol β 0.07 (-0.22-0.35); HDL-cholesterol β -0.03 (-0.10-0.05); physical activity β 38 (-97-171); diet β 0.95 (-0.93-2.83); alcohol OR 0.81 (0.44-1.49); quit smoking OR 2.54 (0.45-14.24). Results were similar for 12-24 months. Mean QALYs and mean costs of cardiovascular care were comparable over the full study period (mean difference (95% CI) QALYs: -0.10 (-0.20; 0.002); costs: EUR 106 (-80; 293)). CONCLUSIONS For both the shorter (3-6 months) and longer term (12-24 months), offering the Healthy Heart programme to high-cardiovascular-risk patients did not improve their lifestyle behaviour nor cardiovascular risk and was not cost-effective on a population level.
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Affiliation(s)
- Emma A. Nieuwenhuijse
- Health Campus the Hague, Leiden University Medical Center, 2511 DP The Hague, The Netherlands
| | - Rimke C. Vos
- Health Campus the Hague, Leiden University Medical Center, 2511 DP The Hague, The Netherlands
| | - Wilbert B. van den Hout
- Department of Medical Decision Making, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Jeroen N. Struijs
- Health Campus the Hague, Leiden University Medical Center, 2511 DP The Hague, The Netherlands
- Department of Quality of Care and Health Economics, National Institute for Public Health and the Environment, 3720 MA Bilthoven, The Netherlands
| | - Sanne M. Verkleij
- Health Campus the Hague, Leiden University Medical Center, 2511 DP The Hague, The Netherlands
| | - Karin Busch
- Hadoks Chronische Zorg BV, 2517 JK The Hague, The Netherlands
| | - Mattijs E. Numans
- Health Campus the Hague, Leiden University Medical Center, 2511 DP The Hague, The Netherlands
- Department of Public Health and Primary Care, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Tobias N. Bonten
- Department of Public Health and Primary Care, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
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Yiga P, Van der Schueren B, Seghers J, Kiyimba T, Ogwok P, Tafiire H, Muluta SN, Matthys C. Effect of a complex lifestyle intervention to optimize metabolic health among females of reproductive age in urban Uganda, a randomized controlled trial. Am J Clin Nutr 2023; 117:436-443. [PMID: 36811566 DOI: 10.1016/j.ajcnut.2022.12.005] [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: 09/19/2022] [Revised: 12/13/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The metabolic health of urban Ugandans, mostly females, is increasingly becoming sub-optimal. OBJECTIVES We assessed the effect of a complex lifestyle intervention, based on a small change approach, on metabolic health among females of reproductive age in urban Uganda. METHODS A cluster randomized controlled two-arm trial with a 1:1 allocation involving church communities in Kampala (Uganda) was undertaken. The intervention arm received infographics and face-to-face group sessions, whereas the comparison arm received infographics only. Eligible participants were aged 18 to 45 years with a waist circumference of ≥80 cm and without cardiometabolic diseases. The study included a 3-month intervention and a 3-month postintervention follow-up. The primary outcome was a reduction in waist circumference. Secondary outcomes included optimization of cardiometabolic health, physical activity, and fruit and vegetable intake. Intention to treat analyses were performed using linear mixed models. This trial was registered at clinicaltrials.gov as NCT04635332. RESULTS The study was conducted between 21 November 2020 and 8 May 2021. Six church communities were randomly selected, 3 (n = 66) per study arm. At 3 months and postintervention follow-up, 118 and 100 participants were analyzed, respectively. At 3 months, waist circumference tended to be lower in the intervention arm (-1.48 cm (95% CI: -3.05, 0.10) P = 0.06). The intervention showed an effect on fasting blood glucose concentrations (-6.95 mg/dL (95% CI: -13.37, -0.53) P = 0.034). Participants in the intervention arm consumed more fruits (62.6 g (95% CI: 1.9, 123.3) P = 0.046) and vegetables (66.2 g (95% CI: 25.5, 106.8) P = 0.002), whereas physical activity increased with no notable differences across the study arms. At 6 months, we found an intervention effect on waist circumference (-1.87 cm (95% CI: -3.32, -0.44) P = 0.011), fasting blood glucose concentration (-6.48 mg/dL (95% CI: -12.76, -0.21) P = 0.043), fruit consumption (29.7 g (95% CI: 5.8, 53.7) P = 0.015), and physical activity (2675.1 MET-mins/wk (95% CI: 1045.7, 4304.4) P = 0.001). CONCLUSIONS The intervention improved and sustained physical activity and fruit and vegetable intake, but these changes were accompanied by minimal cardiometabolic health improvements. If maintained over time, the attained lifestyle improvements may result in substantial cardiometabolic health improvements.
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Affiliation(s)
- Peter Yiga
- Department of Food Science and Technology, Kyambogo University, Kampala, Uganda; Clinical and Experimental Endocrinology, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium; Mildmay Research Centre Uganda, Kampala, Uganda
| | - Bart Van der Schueren
- Clinical and Experimental Endocrinology, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium; Department of Endocrinology, University Hospitals Leuven, Leuven, Belgium
| | - Jan Seghers
- Department of Movement Sciences, KU Leuven, Leuven, Belgium
| | - Tonny Kiyimba
- Department of Food Science and Technology, Kyambogo University, Kampala, Uganda; Clinical and Experimental Endocrinology, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
| | - Patrick Ogwok
- Department of Food Science and Technology, Kyambogo University, Kampala, Uganda
| | - Henry Tafiire
- Department of Food Science and Technology, Kyambogo University, Kampala, Uganda; Laboratory of Food Technology, Department of Microbial and Molecular Systems, KU Leuven, Leuven, Belgium
| | | | - Christophe Matthys
- Clinical and Experimental Endocrinology, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium; Department of Endocrinology, University Hospitals Leuven, Leuven, Belgium.
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Mulderij LS, Verkooijen KT, Groenewoud S, Koelen MA, Wagemakers A. The positive impact of a care-physical activity initiative for people with a low socioeconomic status on health, quality of life and societal participation: a mixed-methods study. BMC Public Health 2022; 22:1522. [PMID: 35948969 PMCID: PMC9363851 DOI: 10.1186/s12889-022-13936-w] [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: 12/03/2021] [Accepted: 07/12/2022] [Indexed: 11/10/2022] Open
Abstract
Background Overweight and obesity rates are increasing worldwide, particularly among people with a low socioeconomic status (SES). Care–physical activity (care–PA) initiatives may improve participants’ lifestyles and thereby lower overweight and obesity rates. A two-year care–PA initiative specifically developed for citizens with a low SES, X-Fittt 2.0, was offered free of charge to participants, and included 12 weeks of intensive guidance and sports sessions, and 21 months of aftercare. Here, we study the impact of X-Fittt 2.0 on health, quality of life (QoL) and societal participation using a mixed-methods design. Methods Questionnaires and body measurements were taken from 208 participants at the start of X-Fittt 2.0 (t0) and after 12 weeks (t1), one year (t2) and two to three years (t3). We also held 17 group discussions (t1, n = 71) and 68 semi-structured interviews (t2 and t3). Continuous variables were analysed using a linear mixed-model analysis (corrected for gender, age at t0, height, education level and employment status at the different time points), while we used descriptive statistics for the categorical variables. Qualitative data were analysed using a thematic analysis. Results Body weight was significantly lower at all three post-initiative time points compared with the baseline, with a maximum of 3.8 kg difference at t2. Body Mass Index, waist circumference, blood pressure and self-perceived health only significantly improved during the first 12 weeks. A positive trend regarding paid work was observed, while social visits decreased. The latter might be explained by the COVID-19 pandemic, as lockdowns limited social life. Furthermore, participants reported increased PA (including sports) and a few stopped smoking or drinking alcohol. Participants mentioned feeling healthier, fitter and more energetic. Additionally, participants’ self-esteem and stress levels improved, stimulating them to become more socially active. However, the participants also mentioned barriers to being physically active, such as a lack of money or time, or physical or mental health problems. Conclusions X-Fittt 2.0 improved the health, QoL and societal participation of the participants. Future initiatives should take into account the aforementioned barriers, and consider a longer intervention period for more sustainable results. More complete data are needed to confirm the findings. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13936-w.
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Affiliation(s)
- Lisanne Sofie Mulderij
- Health and Society Group, Wageningen University & Research, P.O. Box 8130, 6700, EW, Wageningen, the Netherlands
| | - Kirsten T Verkooijen
- Health and Society Group, Wageningen University & Research, P.O. Box 8130, 6700, EW, Wageningen, the Netherlands.
| | - Stef Groenewoud
- Radboud University Medical Centre, Radboud Institute for Health Sciences, Scientific Centre for Quality of Healthcare, IQ healthcare, P.O. Box 9101, 6500, HB, Nijmegen, the Netherlands
| | - Maria A Koelen
- Health and Society Group, Wageningen University & Research, P.O. Box 8130, 6700, EW, Wageningen, the Netherlands
| | - Annemarie Wagemakers
- Health and Society Group, Wageningen University & Research, P.O. Box 8130, 6700, EW, Wageningen, the Netherlands
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A systematic review and meta-analysis of weight loss in control group participants of lifestyle randomized trials. Sci Rep 2022; 12:12252. [PMID: 35851070 PMCID: PMC9293970 DOI: 10.1038/s41598-022-15770-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 06/29/2022] [Indexed: 12/03/2022] Open
Abstract
Randomized clinical trials (RCTs) of lifestyle modification have reported beneficial effects of interventions, compared to control. Whether participation in the control group has benefits is unknown. To determine whether control group participants experience weight loss during the course of RCTs. After prospective registration (PROSPERO CRD42021233070), we conducted searches in Medline, Scopus, Web of Science, Cochrane library and Clinicaltrials.gov databases from inception to May 2021 without language restriction to capture RCTs on dietary advice or physical activity interventions in adults with overweight, obesity or metabolic syndrome. Data extraction and study quality assessment was performed by two independent reviewers. Weight loss in the control group, i.e., the difference between baseline and post-intervention, was pooled using random effects model generating mean difference and 95% confidence interval (CI). Heterogeneity was assessed using the I2 statistical test. Subgroup meta-analysis was performed stratifying by follow-up period, type of control group protocols and high-quality studies. Among the 22 included studies (4032 participants), the risk of bias was low in 9 (40%) studies. Overall, the controls groups experienced weight loss of − 0.41 kg (95% CI − 0.53 to − 0.28; I2 = 73.5% p < 0.001). To identify a result that is an outlier, we inspected the forest plot for spread of the point estimates and the confidence intervals. The magnitude of the benefit was related to the duration of follow-up (− 0.51 kg, 95% CI − 0.68, − 0.3, for 1–4 months follow-up; − 0.32 kg, 95% CI − 0.58, − 0.07, 5–12 months; − 0.20 kg, 95% CI − 0.49, 0.10, ≥ 12 months). In high-quality studies we found an overall weight loss mean difference of − 0.16 (95% CI − 0.39, 0.09) with a considerable heterogeneity (I2 = 74%; p < 0.000). Among studies including control group in waiting lists and combining standard care, advice and material, no heterogeneity was found (I2 = 0%, p = 0.589) and (I2 = 0%, p = 0.438); and the mean difference was − 0.84 kg (95% CI − 2.47, 0.80) and − 0.65 kg (95% CI − 1.03, − 0.27) respectively. Participation in control groups of RCTs of lifestyle interventions had a benefit in terms of weight loss in meta-analysis with heterogeneity. These results should be used to interpret the benefits observed with respect to intervention effect in trials. That control groups accrue benefits should be included in patient information sheets to encourage participation in future trials among patients with overweight and obesity.
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Kettle VE, Madigan CD, Coombe A, Graham H, Thomas JJC, Chalkley AE, Daley AJ. Effectiveness of physical activity interventions delivered or prompted by health professionals in primary care settings: systematic review and meta-analysis of randomised controlled trials. BMJ 2022; 376:e068465. [PMID: 35197242 PMCID: PMC8864760 DOI: 10.1136/bmj-2021-068465] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/21/2021] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To examine the effectiveness of physical activity interventions delivered or prompted by primary care health professionals for increasing moderate to vigorous intensity physical activity (MVPA) in adult patients. DESIGN Systematic review and meta-analysis of randomised controlled trials. DATA SOURCES Databases (Medline and Medline in progress, Embase, PsycINFO, CINAHL, SPORTDiscus, Sports Medicine and Education Index, ASSIA, PEDro, Bibliomap, Science Citation Index, Conference Proceedings Citation Index), trial registries (Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, TRoPHI), and grey literature (OpenGrey) sources were searched (from inception to September 2020). ELIGIBILITY CRITERIA FOR SELECTING STUDIES Randomised controlled trials of aerobic based physical activity interventions delivered or prompted by health professionals in primary care with a usual care control group or another control group that did not involve physical activity. STUDY SELECTION AND ANALYSIS Two independent reviewers screened the search results, extracted data from eligible trials and assessed the risk of bias using the Cochrane risk of bias tool (version 2). Inverse variance meta-analyses using random effects models examined the primary outcome of difference between the groups in MVPA (min/week) from baseline to final follow-up. The odds of meeting the guidelines for MVPA at follow-up were also analysed. RESULTS 14 566 unique reports were identified and 46 randomised controlled trials with a range of follow-ups (3-60 months) were included in the meta-analysis (n=16 198 participants). Physical activity interventions delivered or prompted by health professionals in primary care increased MVPA by 14 min/week (95% confidence interval 4.2 to 24.6, P=0.006). Heterogeneity was substantial (I2=91%, P<0.001). Limiting analyses to trials that used a device to measure physical activity showed no significant group difference in MVPA (mean difference 4.1 min/week, 95% confidence interval -1.7 to 9.9, P=0.17; I2=56%, P=0.008). Trials that used self-report measures showed that intervention participants achieved 24 min/week more MVPA than controls (95% confidence interval 6.3 to 41.8, P=0.008; I2=72%, P<0.001). Additionally, interventions increased the odds of patients meeting guidelines for MVPA by 33% (95% confidence interval 1.17 to 1.50, P<0.001; I2=25%, P=0.11) versus controls. 14 of 46 studies were at high risk of bias but sensitivity analyses excluding these studies did not alter the results. CONCLUSIONS Physical activity interventions delivered or prompted by health professionals in primary care appear effective at increasing participation in self-reported MVPA. Such interventions should be considered for routine implementation to increase levels of physical activity and improve health outcomes in the population. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42021209484.
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Affiliation(s)
- Victoria E Kettle
- The Centre for Lifestyle Medicine and Behaviour (CLiMB), The School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Claire D Madigan
- The Centre for Lifestyle Medicine and Behaviour (CLiMB), The School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - April Coombe
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Henrietta Graham
- The Centre for Lifestyle Medicine and Behaviour (CLiMB), The School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Jonah J C Thomas
- The Centre for Lifestyle Medicine and Behaviour (CLiMB), The School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Anna E Chalkley
- The Centre for Lifestyle Medicine and Behaviour (CLiMB), The School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Amanda J Daley
- The Centre for Lifestyle Medicine and Behaviour (CLiMB), The School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
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van der Heiden W, Lacroix J, Moll van Charante EP, Beune E. GPs' views on the implementation of combined lifestyle interventions in primary care in the Netherlands: a qualitative study. BMJ Open 2022; 12:e056451. [PMID: 35121605 PMCID: PMC8819797 DOI: 10.1136/bmjopen-2021-056451] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES Prevention and lifestyle support are emerging topics in general practice. Healthcare insurance companies reimburse combined lifestyle interventions (CLIs) in the Netherlands since January 2019. CLIs support people with overweight (body mass index, BMI 25-30) or obesity (BMI >30) to reduce weight in peer groups. General practitioners (GPs) are key in the successful implementation of lifestyle interventions in primary care. This study explored GPs' experiences and views on the implementation of CLIs to identify barriers and facilitators to the successful implementation in primary care. DESIGN Qualitative study using semistructured interviews. Content analysis consisted of thematic coding and mapping a first stage of predefined and second stage of iterative evolving set of themes. SETTING GPs were interviewed in a variety of primary care practices between February and April 2019. PARTICIPANTS Fifteen GPs were purposively recruited for semi-structured interviews through snowballing. RESULTS Experiences with lifestyle support among GPs ranged from referring patients to other healthcare professionals to taking a proactive role in lifestyle support themselves. Whether or not GPs took an active role in lifestyle support was related to their belief in the effect of lifestyle interventions. Overall, GPs had little experience with CLI in every day practice. Perceived barriers were a lack of availability of CLIs in the region and the potential lack of added value of CLIs on top of existing lifestyle support. Perceived facilitators were coordination of care provision by GP cooperatives and monitoring of the CLI implementation and their results. Reimbursement of CLIs without any costs for participants enabled application. CONCLUSION The importance of lifestyle interventions in primary care was acknowledged by all GPs, but they differed in their level of experience with providing lifestyle support and awareness of CLIs. Successful integration of CLIs with primary care requires a solid promotion, a well-coordinated implementation strategy and structural evaluation of long-term effectiveness.
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Affiliation(s)
- W van der Heiden
- Department of Public & Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Department of Digital Engagement, Cognition and Behavior, Philips Research, Eindhoven, The Netherlands
| | - Jpw Lacroix
- Department of Digital Engagement, Cognition and Behavior, Philips Research, Eindhoven, The Netherlands
| | - E P Moll van Charante
- Department of Public & Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Department of General Practice, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Ejaj Beune
- Department of Public & Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
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van Lonkhuijzen RMR, Cremers SS, de Vries JHMJ, Feskens EJME, Wagemakers MAEA. Evaluating ‘Power 4 a Healthy Pregnancy’ (P4HP) – protocol for a cluster randomized controlled trial and process evaluation to empower pregnant women towards improved diet quality. BMC Public Health 2022; 22:148. [PMID: 35062921 PMCID: PMC8780817 DOI: 10.1186/s12889-022-12543-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 01/07/2022] [Indexed: 12/19/2022] Open
Abstract
Background In general during pregnancy, women are aware of the importance of good diet quality, interested in nutrition, and receptive to changing dietary intake. However, adherence to dietary guidelines is sub-optimal. A pregnant woman’s first information source regarding nutrition information is her midwife. Healthy nutrition promotion by midwives may therefore be very promising, but midwives face multiple barriers in providing nutritional support. Empowering pregnant women to improve their diet quality is expected to improve their health. Therefore an empowerment intervention has been developed to improve diet quality among pregnant women. The objective of this study is to evaluate the effectiveness and feasibility of Power 4 a Healthy Pregnancy (P4HP). P4HP aims to empower pregnant women to have a healthier diet quality. Methods/design This study applies a mixed methodology consisting of a non-blinded cluster randomized trial with an intervention (P4HP) group and a control group and a process evaluation. Midwifery practices, the clusters, will be randomly allocated to the intervention arm (n = 7) and control arm (n = 7). Participating women are placed in intervention or control conditions based on their midwifery practice. Each midwifery practice includes 25 pregnant women, making 350 participants in total. Health related outcomes, diet quality, empowerment, Sense of Coherence, Quality of Life, and Self-Rated Health of participants will be assessed before (T0) and after (T1) the intervention. The process evaluation focuses on multidisciplinary collaboration, facilitators, and barriers, and consists of in-depth interviews with midwives, dieticians and pregnant women. Discussion This study is the first to evaluate an empowerment intervention to improve diet quality in this target population. This mixed method evaluation will contribute to knowledge about the effectiveness and feasibility regarding diet quality, empowerment, health-related outcomes, multidisciplinary collaboration, facilitators and barriers of the empowerment intervention P4HP. Results will help inform how to empower pregnant women to achieve improved diet quality by midwives and dieticians. If proven effective, P4HP has the potential to be implemented nationally and scaled up to a long-term trajectory from preconception to the postnatal phase. Trial registration The trial is prospectively registered at the Netherlands Trial Register (NL9551). Date registered: 19/05/2021. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-12543-z.
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10
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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: 3.0] [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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11
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Pot GK, de Jong HBT, Battjes-Fries MCE, Patijn ON, Pijl H, Voshol PJ. Observational study on dietary changes of participants following a multicomponent lifestyle program (Reverse Diabetes2 Now). J Hum Nutr Diet 2021; 35:791-803. [PMID: 34967062 DOI: 10.1111/jhn.12976] [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: 06/28/2021] [Accepted: 11/25/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Lifestyle intervention studies to treat type 2 diabetes (T2D) are on the rise. However, in-depth research is lacking into the dietary changes that participants make. METHODS The present study aimed to observe the dietary intake of participants following the group program 'Reverse Diabetes2 Now' (RD2N) over 12 months. The web-based 24-h dietary recall-tool Compl-eat was used to collect dietary intake data. RESULTS In total, 147 T2D patients were included in a cross-sectional study (n = 37 at baseline, n = 58 at 6 months, n = 52 at 12 months). A lower intake of total energy, carbohydrates and iodine was found for the groups at 6 and 12 months compared to the baseline group. The absolute consumption of total fat and saturated fat did not differ between the groups; only the percentage as total calorie consumption decreased. Consumption of vegetables and full-fat yoghurt was higher in groups at 6 and 12 months compared to the group at baseline. Consumption of bread, cakes and sweet biscuits, pasta/rice/tortillas, artificially sweetened soft drinks, and crisps were lower in the groups at 6 and 12 months compared to the group at baseline. Similar results were observed in a separate prospective study in 22 participants over 12 months following the same lifestyle-intervention. CONCLUSIONS Overall, participants shifted their dietary intake somewhat towards a healthier dietary pattern with overall lower energy and carbohydrates and more vegetables. Moreover, participants largely maintained this healthier pattern over 12 months. There were some concerns regarding iodine intake. These promising results need to be confirmed in a fully-scaled study, as well in a comparison with controls.
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Affiliation(s)
- Gerda K Pot
- Louis Bolk Institute, Bunnik, The Netherlands.,Department of Nutritional Sciences, King's College London, London, UK
| | - Hanne B T de Jong
- Louis Bolk Institute, Bunnik, The Netherlands.,Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands
| | | | | | - Hanno Pijl
- Department of Internal Medicine, Section of Endocrinology, Leiden University Medical Centre, Leiden, The Netherlands
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12
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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: 0] [Impact Index Per Article: 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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13
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Philippens N, Janssen E, Verjans-Janssen S, Kremers S, Crutzen R. HealthyLIFE, a Combined Lifestyle Intervention for Overweight and Obese Adults: A Descriptive Case Series Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182211861. [PMID: 34831617 PMCID: PMC8620604 DOI: 10.3390/ijerph182211861] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 11/05/2021] [Accepted: 11/10/2021] [Indexed: 11/22/2022]
Abstract
(1) Background: The aim of this study is to investigate changes over time in participants of healthyLIFE, a Combined Lifestyle Intervention (CLI) based on the Coaching on Lifestyle (CooL) intervention. This study focuses on changes in behavior, physical fitness, motivation and Positive Health eight months after the start of the intervention. (2) Methods: In total, 602 Dutch adults, meeting the CLI inclusion criteria, were included from January 2018 until October 2020 in this descriptive case series study. We collected a broad set of data regarding weight/BMI, physical fitness, motivation, self-efficacy, social influence, personal barriers and needs towards food and physical activity and perceived personal health by means of the six dimensions of Positive Health. (3) Results: Eight months after baseline, positive effects of the intervention were found on most outcome measures. We found an increase in all measured aspects of physical fitness (stamina, flexibility, mobility, hand grip strength and BMI). Dietary changes were limited during the healthyLIFE intervention, except for fruit consumption (increase with an effect size of 0.42). The largest effect sizes were found for the dimensions of Positive Health ranging from 0.41 to 0.68. (4) Conclusion: The healthyLIFE intervention is successful in improving participants’ BMI, physical fitness, and perceived physical, mental and social health. A broad health perspective, beyond physical measurements, is recommended when studying effects of the CLI.
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Affiliation(s)
- Nicole Philippens
- Department of Health Promotion, Maastricht University, 6211 LK Maastricht, The Netherlands; (N.P.); (S.K.); (R.C.)
| | - Ester Janssen
- Department of Health Promotion, Maastricht University, 6211 LK Maastricht, The Netherlands; (N.P.); (S.K.); (R.C.)
- Correspondence:
| | | | - Stef Kremers
- Department of Health Promotion, Maastricht University, 6211 LK Maastricht, The Netherlands; (N.P.); (S.K.); (R.C.)
| | - Rik Crutzen
- Department of Health Promotion, Maastricht University, 6211 LK Maastricht, The Netherlands; (N.P.); (S.K.); (R.C.)
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14
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Trends in type 2 diabetes mellitus disease burden in European Union countries between 1990 and 2019. Sci Rep 2021; 11:15356. [PMID: 34321515 PMCID: PMC8319179 DOI: 10.1038/s41598-021-94807-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 07/15/2021] [Indexed: 12/26/2022] Open
Abstract
This observational study aimed to assess trends in type 2 diabetes mellitus (T2DM) disease burden in European Union countries for the years 1990–2019. Sex specific T2DM age-standardised prevalence (ASPRs), mortality (ASMRs) and disability-adjusted life-year rates (DALYs) per 100,000 population were extracted from the Global Burden of Disease (GBD) Study online results tool for each EU country (inclusive of the United Kingdom), for the years 1990–2019. Trends were analysed using Joinpoint regression analysis. Between 1990 and 2019, increases in T2DM ASPRs were observed for all EU countries. The highest relative increases in ASPRs were observed in Luxembourg (males + 269.1%, females + 219.2%), Ireland (males + 191.9%, females + 165.7%) and the UK (males + 128.6%, females + 114.6%). Mortality trends were less uniform across EU countries, however a general trend towards reducing T2DM mortality was observed, with ASMRs decreasing over the 30-year period studied in 16/28 countries for males and in 24/28 countries for females. The UK observed the highest relative decrease in ASMRs for males (− 46.9%). For females, the largest relative decrease in ASMRs was in Cyprus (− 67.6%). DALYs increased in 25/28 countries for males and in 17/28 countries for females between 1990 and 2019. DALYs were higher in males than females in all EU countries in 2019. T2DM prevalence rates have increased across EU countries over the last 30 years. Mortality from T2DM has generally decreased in EU countries, however trends were more variable than those observed for prevalence. Primary prevention strategies should continue to be a focus for preventing T2DM in at risk groups in EU countries.
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15
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Mohammad Rahimi GR, Aminzadeh R, Azimkhani A, Saatchian V. The Effect of Exercise Interventions to Improve Psychosocial Aspects and Glycemic Control in Type 2 Diabetic Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Biol Res Nurs 2021; 24:10-23. [PMID: 34235949 DOI: 10.1177/10998004211022849] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) patients have a raised risk of developing depression compared with non-diabetic people. OBJECTIVE The objective of this meta-analysis was to investigate the impacts of exercise training interventions to improve psychosocial aspects and glycemic control in T2DM patients. DATA SOURCES PubMed, CINAHL, Medline, Google Scholar, and Scopus databases and reference lists of included studies were searched. STUDY SELECTION The selection criteria were randomized controlled trials (RCTs) using an exercise intervention with or without dietary advice on psychological aspects and glycemic control in T2DM patients, up to January 2021. Meta-analyses were performed using the random-effects model. The analysis included 17 RCTs with 2,127 participants. RESULTS In the pooled analysis, improvements were seen in depression, standard mean difference (SMD) -0.65 (95% confidence interval (CI) -1.03 to -0.28, p = 0.0006), mental health SMD: 0.53 (95% CI 0.31 to 0.76, p < 0.00001), and HbA1c, weighted mean difference (WMD) -0.51% (95% CI -0.97 to -0.04, p = 0.03). There were no significant differences between the intervention and control groups for bodily pain, social functioning, and fasting glucose (all p > 0.05). CONCLUSION Our systematic review and meta-analysis displayed that exercise training interventions decreased depression and HbA1c and increased mental health in individuals with T2DM. Further longer-term and high-quality clinical trials are required to additional assess and confirm the findings presented here.
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Affiliation(s)
| | - Reza Aminzadeh
- Department of Sports Sciences, Imam Reza International University, Mashhad, Iran
| | - Amin Azimkhani
- Department of Sports Sciences, Imam Reza International University, Mashhad, Iran
| | - Vahid Saatchian
- Department of Sports Sciences, Imam Reza International University, Mashhad, Iran
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16
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Vinke PC, Navis G, Kromhout D, Corpeleijn E. Associations of Diet Quality and All-Cause Mortality Across Levels of Cardiometabolic Health and Disease: A 7.6-Year Prospective Analysis From the Dutch Lifelines Cohort. Diabetes Care 2021; 44:1228-1235. [PMID: 33963020 DOI: 10.2337/dc20-2709] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 02/12/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To simultaneously investigate the association of diet quality and all-cause mortality in groups with varying cardiometabolic diseases (CMDs) at baseline. RESEARCH DESIGN AND METHODS From the population-based Lifelines cohort, 40,892 non-underweight participants aged ≥50 years with data on diet quality and confounding factors were included (enrollment 2006-2013). From food-frequency questionnaire data, tertiles of the Lifelines Diet Score were calculated (T1 = poorest, T3 = best diet quality). Four CMD categories were defined: 1) CMD free, 2) type 2 diabetes, 3) one cardiovascular disease (CVD), 4) two or more CMDs. Months when deaths occurred were obtained from municipal registries up until November 2019. Multivariable Cox proportional hazards models were applied for the total population and stratified by CMD categories. RESULTS After a median follow-up of 7.6 years, 1,438 participants died. Diet quality and CMD categories were independently associated with all-cause mortality in crude and adjusted models (P < 0.001). A dose-response relationship of diet quality with all-cause mortality was observed in the total population (P trend < 0.001, T2 vs. T3 = 1.22 [1.07-1.41], T1 vs. T3 = 1.57 [1.37-1.80]). In stratified analyses, the association was significant for CMD-free individuals (T1 vs. T3 = 1.63 [1.38-1.93]) and for patients with type 2 diabetes (1.87 [1.17-3.00]) but not for patients with one CVD (1.39 [0.93-2.08]) or multiple CMDs (1.19 [0.80-1.76]). CONCLUSIONS A high-quality diet can potentially lower all-cause mortality risk in the majority of the aging population. Its effect may be greatest for CMD-free individuals and patients with type 2 diabetes. Tailored dietary guidelines may be required for patients with extensive histories of CMDs.
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Affiliation(s)
- Petra C Vinke
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Gerjan Navis
- Department of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Daan Kromhout
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Eva Corpeleijn
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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17
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Sevilla-González MDR, Merino J, Moreno-Macias H, Rojas-Martínez R, Gómez-Velasco DV, Manning AK. Clinical and metabolomic predictors of regression to normoglycemia in a population at intermediate cardiometabolic risk. Cardiovasc Diabetol 2021; 20:56. [PMID: 33639941 PMCID: PMC7916268 DOI: 10.1186/s12933-021-01246-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 02/15/2021] [Indexed: 12/14/2022] Open
Abstract
Background Impaired fasting glucose (IFG) is a prevalent and potentially reversible intermediate stage leading to type 2 diabetes that increases risk for cardiometabolic complications. The identification of clinical and molecular factors associated with the reversal, or regression, from IFG to a normoglycemia state would enable more efficient cardiovascular risk reduction strategies. The aim of this study was to identify clinical and biological predictors of regression to normoglycemia in a non-European population characterized by high rates of type 2 diabetes. Methods We conducted a prospective, population-based study among 9637 Mexican individuals using clinical features and plasma metabolites. Among them, 491 subjects were classified as IFG, defined as fasting glucose between 100 and 125 mg/dL at baseline. Regression to normoglycemia was defined by fasting glucose less than 100 mg/dL in the follow-up visit. Plasma metabolites were profiled by Nuclear Magnetic Resonance. Multivariable cox regression models were used to examine the associations of clinical and metabolomic factors with regression to normoglycemia. We assessed the predictive capability of models that included clinical factors alone and models that included clinical factors and prioritized metabolites. Results During a median follow-up period of 2.5 years, 22.6% of participants (n = 111) regressed to normoglycemia, and 29.5% progressed to type 2 diabetes (n = 145). The multivariate adjusted relative risk of regression to normoglycemia was 1.10 (95% confidence interval [CI] 1.25 to 1.32) per 10 years of age increase, 0.94 (95% CI 0.91–0.98) per 1 SD increase in BMI, and 0.91 (95% CI 0.88–0.95) per 1 SD increase in fasting glucose. A model including information from age, fasting glucose, and BMI showed a good prediction of regression to normoglycemia (AUC = 0.73 (95% CI 0.66–0.78). The improvement after adding information from prioritized metabolites (TG in large HDL, albumin, and citrate) was non-significant (AUC = 0.74 (95% CI 0.68–0.80), p value = 0.485). Conclusion In individuals with IFG, information from three clinical variables easily obtained in the clinical setting showed a good prediction of regression to normoglycemia beyond metabolomic features. Our findings can serve to inform and design future cardiovascular prevention strategies. Supplementary Information The online version contains supplementary material available at 10.1186/s12933-021-01246-1.
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Affiliation(s)
- Magdalena Del Rocío Sevilla-González
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, 100 Cambridge, Boston, MA, USA.,Programs in Metabolism and Medical & Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA.,Doctoral Program in Health Sciences, Universidad Nacional Autonóma de México, Mexico City, Mexico.,Department of Medicine, Harvard Medical School, Boston, MA, USA.,Unidad de Investigacion en Enfermedades Metabolicas, Insituto Nacional de Ciencias Medicas y Nutricion "Salvador Zubiran", Mexico City, Mexico
| | - Jordi Merino
- Programs in Metabolism and Medical & Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA.,Department of Medicine, Harvard Medical School, Boston, MA, USA.,Diabetes Unit and Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
| | | | | | - Donají Verónica Gómez-Velasco
- Unidad de Investigacion en Enfermedades Metabolicas, Insituto Nacional de Ciencias Medicas y Nutricion "Salvador Zubiran", Mexico City, Mexico
| | - Alisa K Manning
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, 100 Cambridge, Boston, MA, USA. .,Programs in Metabolism and Medical & Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA. .,Department of Medicine, Harvard Medical School, Boston, MA, USA.
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18
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Duijzer G, Bukman AJ, Meints-Groenveld A, Haveman-Nies A, Jansen SC, Heinrich J, Hiddink GJ, Feskens EJM, de Wit GA. Cost-effectiveness of the SLIMMER diabetes prevention intervention in Dutch primary health care: economic evaluation from a randomised controlled trial. BMC Health Serv Res 2019; 19:824. [PMID: 31711499 PMCID: PMC6849241 DOI: 10.1186/s12913-019-4529-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 09/11/2019] [Indexed: 11/24/2022] Open
Abstract
Background Although evidence is accumulating that lifestyle modification may be cost-effective in patients with prediabetes, information is limited on the cost-effectiveness of interventions implemented in public health and primary health care settings. Evidence from well-conducted pragmatic trials is needed to gain insight into the realistic cost-effectiveness of diabetes prevention interventions in real-world settings. The aim of this study is to assess the cost-effectiveness of the SLIMMER lifestyle intervention targeted at patients at high risk of developing type 2 diabetes compared with usual health care in a primary care setting in the Netherlands. Methods Three hundred and sixteen high-risk subjects were randomly assigned to the SLIMMER lifestyle intervention or to usual health care. Costs and outcome assessments were performed at the end of the intervention (12 months) and six months thereafter (18 months). Costs were assessed from a societal perspective. Patients completed questionnaires to assess health care utilisation, participant out-of-pocket costs, and productivity losses. Quality Adjusted Life Years (QALY) were calculated based on the SF-36 questionnaire. Cost-effectiveness planes and acceptability curves were generated using bootstrap analyses. Results The cost-effectiveness analysis showed that the incremental costs of the SLIMMER lifestyle intervention were €547 and that the incremental effect was 0.02 QALY, resulting in an incremental cost-effectiveness ratio (ICER) of €28,094/QALY. When cost-effectiveness was calculated from a health care perspective, the ICER decreased to €13,605/QALY, with a moderate probability of being cost-effective (56% at a willingness to pay, WTP, of €20,000/QALY and 81% at a WTP of €80,000/QALY). Conclusions The SLIMMER lifestyle intervention to prevent type 2 diabetes had a low to moderate probability of being cost-effective, depending on the perspective taken. Trial registration The SLIMMER study is retrospectively registered with ClinicalTrials.gov (Identifier NCT02094911) since March 19, 2014.
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Affiliation(s)
- Geerke Duijzer
- Wageningen University, Division of Human Nutrition; Academic Collaborative Centre AGORA, PO Box 17, 6700 AA, Wageningen, the Netherlands. .,GGD Noord- en Oost-Gelderland (Community Health Service), PO Box 3, 7200 AA, Warnsveld, the Netherlands.
| | - Andrea J Bukman
- Wageningen University, Division of Human Nutrition; Academic Collaborative Centre AGORA, PO Box 17, 6700 AA, Wageningen, the Netherlands
| | - Aafke Meints-Groenveld
- Wageningen University, Division of Human Nutrition; Academic Collaborative Centre AGORA, PO Box 17, 6700 AA, Wageningen, the Netherlands
| | - Annemien Haveman-Nies
- Wageningen University, Division of Human Nutrition; Academic Collaborative Centre AGORA, PO Box 17, 6700 AA, Wageningen, the Netherlands.,GGD Noord- en Oost-Gelderland (Community Health Service), PO Box 3, 7200 AA, Warnsveld, the Netherlands.,Wageningen University, Consumption and Healthy Lifestyles, PO Box 8130, 6700 EW, Wageningen, the Netherlands
| | - Sophia C Jansen
- GGD Noord- en Oost-Gelderland (Community Health Service), PO Box 3, 7200 AA, Warnsveld, the Netherlands
| | - Judith Heinrich
- GGD Noord- en Oost-Gelderland (Community Health Service), PO Box 3, 7200 AA, Warnsveld, the Netherlands
| | - Gerrit J Hiddink
- Strategic Communication, Sub-department Communication, Philosophy and Technology: Centre for Integrative Development, Social Sciences, Wageningen University, PO Box 8130, 6700 EW, Wageningen, the Netherlands
| | - Edith J M Feskens
- Wageningen University, Division of Human Nutrition; Academic Collaborative Centre AGORA, PO Box 17, 6700 AA, Wageningen, the Netherlands
| | - G Ardine de Wit
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Julius Centrum, PO Box 85500, STR 6.131, 3508 GA, Utrecht, the Netherlands.,Centre for Nutrition, Prevention and Healthcare, National Institute for Public Health and the Environment (RIVM), PO Box 1, 3720 BA, Bilthoven, the Netherlands
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19
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Pot GK, Battjes-Fries MCE, Patijn ON, Pijl H, Witkamp RF, de Visser M, van der Zijl N, de Vries M, Voshol PJ. Nutrition and lifestyle intervention in type 2 diabetes: pilot study in the Netherlands showing improved glucose control and reduction in glucose lowering medication. BMJ Nutr Prev Health 2019; 2:43-50. [PMID: 33235957 PMCID: PMC7678479 DOI: 10.1136/bmjnph-2018-000012] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 04/02/2019] [Accepted: 04/04/2019] [Indexed: 01/14/2023] Open
Abstract
Introduction Prevalence of type 2 diabetes (T2D) is increasing rapidly and lifestyle interventions to reverse diabetes are seen as a possible solution to stop this trend. New practice-based evidence is needed to gain more insight in the actual, and above all scientific, basis for these claims. Methods This observational study with a pretest post-test design aimed to pilot a 6-month multicomponent outpatient group-based nutrition and lifestyle intervention programme on glycaemic control and use of glucose lowering medication in motivated T2D patients with a body mass index (BMI) >25 kg/m2 in the Netherlands (February 2015–March 2016). Results 74 T2D patients (56% female) aged 57.4±8.0 years with mean BMI 31.2±4.2 kg/m2 and mean waist circumference 105.4±10.2 cm were included in the study. Compared with baseline, mean HbA1c levels at 6 months were 5 mmol/mol lower (SD=10, p<0.001) and the number of participants with HbA1c levels ≤53 mmol/mol after intervention had increased (from 36% (n=26/72) to 60% (n=43/72)). At baseline, 90% of participants were taking at least one type of glucose lowering medication. At 6 months, 49% (n=35/72) of the participants had reduced their medication or eliminated it completely (13%). Secondary outcomes were significantly lower fasting glucose levels (− 1.2±2.6 mmol/L), body weight (−4.9±5.1 kg), BMI (−1.70±1.69 kg/m2) and waist circumference (−9.4±5.0 cm). Plasma lipids remained unchanged except for a decrease in triglyceride levels. Furthermore, self-reported quality of life was significantly higher while experienced fatigue and sleep problems were significantly lower. Conclusion This pilot study showed that a 6-month multicomponent group-based program in a routine care setting could improve glycaemic control and reduce the use of glucose lowering medication in motivated T2D diabetics. A fully scaled study is needed to confirm these results.
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Affiliation(s)
- Gerda K Pot
- Department of Nutrition and Health, Louis Bolk Instituut, Bunnik, The Netherlands
- King's College London, Division of Diabetes and Nutritional Sciences, London, UK
| | | | - Olga N Patijn
- Department of Nutrition and Health, Louis Bolk Instituut, Bunnik, The Netherlands
| | - Hanno Pijl
- Division of Internal Medicine, Leids Universitair Medisch Centrum, Leiden, The Netherlands
| | - Renger F Witkamp
- Division of Human Nutrition and Health, Wageningen Universiteit, Wageningen, The Netherlands
| | | | - Nynke van der Zijl
- General Practitioner, Medical Centre te Cleeff, Haarlem, The Netherlands
| | | | - Peter J Voshol
- Department of Nutrition and Health, Louis Bolk Instituut, Bunnik, The Netherlands
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20
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Hoogendoorn SW, Rutten GE, Hart HE, de Wolf C, Vos RC. A simple to implement and low-cost supervised walking programme in highly motivated individuals with or at risk for type 2 diabetes: An observational study with a pre-post design. Prev Med Rep 2018; 13:30-36. [PMID: 30510891 PMCID: PMC6260274 DOI: 10.1016/j.pmedr.2018.11.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 09/05/2018] [Accepted: 11/05/2018] [Indexed: 12/30/2022] Open
Abstract
This observational study with a pre-post design, conducted in two Dutch primary healthcare centres, aimed to evaluate the effect of a supervised walking programme in highly motivated individuals with or at risk for type 2 diabetes mellitus (T2DM). Those able and willing to walk at least 6 km, were invited for a 28-week walking programme (February to August 2017), in which participants walked in groups, once weekly under supervision of volunteer healthcare professionals. Changes in bodyweight, BMI, waist circumference, HbA1c, blood pressure, well-being, health status and patient activation were analysed using paired t-tests and the Wilcoxon signed-rank test. Fifty-six people were included (30 T2DM; 26 at risk), of whom 60.7% were female. Mean age was 60.6 years, median BMI 30.8 kg/m2 and mean systolic blood pressure 146.9 mm Hg. Participants with T2DM had median HbA1c of 50.0 mmol/mol. Post-challenge, BMI had decreased to 29.7 kg/m2, and waist circumference decreased 3.4 cm (95% CI 2.1-4.8), both p < 0.01. Systolic and diastolic blood pressure decreased significantly (mean difference 6.5 mm Hg (95% CI 1.6-11.3, p = 0.01) and 3.5 mm Hg (95% CI 1.0-6.0, p < 0.01), respectively). Participants with HbA1c >53 mmol/mol at baseline (n = 8), had median decrease in HbA1c of 6.5 mmol/mol (p = 0.03). Well-being, but not health status and patient activation, improved significantly. In conclusion, in highly motivated individuals with or at risk for T2DM, this simple to implement and low-cost, but intensive, volunteer-based supervised walking programme is favourable, and therefore, can be seen as an option for clinical programs to implement to support highly motivated patients.
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Key Words
- BMI, body mass index
- DBP, diastolic blood pressure
- EMR, electronic medical record
- EQ-VAS, EuroQol-visual analogue scale
- HbA1c, glycosylated haemoglobin A1c
- Lifestyle intervention
- NC, Nijkerk Challenge
- PAM-13, 13-item patient activation measure
- Physical activity
- Prevention
- RCTs, randomised controlled trials
- Real-life setting
- SBP, systolic blood pressure
- T2DM, type 2 diabetes mellitus
- Type 2 diabetes mellitus
- WHO-5, World Health Organization five well-being index
- Walking
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Affiliation(s)
- Sonja W. Hoogendoorn
- Julius Center of Health Sciences and Primary Care, Department of General Practice, University Medical Center Utrecht, Utrecht University, the Netherlands
| | - Guy E.H.M. Rutten
- Julius Center of Health Sciences and Primary Care, Department of General Practice, University Medical Center Utrecht, Utrecht University, the Netherlands
| | - Huberta E. Hart
- Julius Center of Health Sciences and Primary Care, Department of General Practice, University Medical Center Utrecht, Utrecht University, the Netherlands
| | - Cees de Wolf
- Collaborating Health Centers Nijkerk, Nijkerk, the Netherlands
| | - Rimke C. Vos
- Julius Center of Health Sciences and Primary Care, Department of General Practice, University Medical Center Utrecht, Utrecht University, the Netherlands
- Leiden University Medical Center, Dept Public Health and Primary Care/LUMC-Campus The Hague, the Netherlands
- Corresponding author at: UMC Utrecht, div. Julius Centrum, Huispost Str. 6.131, PO Box 85500, 3508, GA, Utrecht, the Netherlands.
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21
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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: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 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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22
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den Braver NR, de Vet E, Duijzer G, Ter Beek J, Jansen SC, Hiddink GJ, Feskens EJM, Haveman-Nies A. Determinants of lifestyle behavior change to prevent type 2 diabetes in high-risk individuals. Int J Behav Nutr Phys Act 2017; 14:78. [PMID: 28606146 PMCID: PMC5468963 DOI: 10.1186/s12966-017-0532-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 05/26/2017] [Indexed: 01/01/2023] Open
Abstract
Background Although there are many effective lifestyle interventions for type 2 diabetes (T2DM) prevention, insight into effective intervention pathways, especially of long-term interventions, is often lacking. This study aims to provide insight into the effective intervention pathways of the SLIMMER diabetes prevention intervention using mediation analyses. Methods In total, 240 participants at increased risk of T2DM were included in the analyses over 18 months. The intervention was a combined lifestyle intervention with a dietary and a physical activity (PA) component. The primary and secondary outcomes were change in fasting insulin (pmol/L) and change in body weight (kg) after 18 months, respectively. Firstly, in a multiple mediator model, we investigated whether significant changes in these outcomes were mediated by changes in dietary and PA behavior. Secondly, in multiple single mediator models, we investigated whether changes in dietary and PA behavior were mediated by changes in behavioral determinants and the participants’ psychological profile. The mediation analyses used linear regression models, where significance of indirect effects was calculated with bootstrapping. Results The effect of the intervention on decreased fasting insulin was 40% mediated by change in dietary and PA behavior, where dietary behavior was an independent mediator of the association (34%). The effect of the intervention on decreased body weight was 20% mediated by change in dietary and PA behavior, where PA behavior was an independent mediator (17%). The intervention significantly changed intake of fruit, fat from bread spread, and fiber from bread. Change in fruit intake was mediated by change in action control (combination of consciousness, self-control, and effort), motivation, self-efficacy, intention, and skills. Change in fat intake was mediated by change in action control and psychological profile. No mediators could be identified for change in fiber intake. The change in PA behavior was mediated by change in action control, motivation, and psychological profile. Conclusion The effect of the SLIMMER intervention on fasting insulin and body weight was mediated by changes in dietary and PA behavior, in distinct ways. These results indicate that changing dietary as well as PA behavior is important in T2DM prevention. Electronic supplementary material The online version of this article (doi:10.1186/s12966-017-0532-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- N R den Braver
- Division of Human Nutrition, Wageningen University & Research, Wageningen, The Netherlands. .,Department of Epidemiology and Biostatistics, VU Medical Center, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.
| | - E de Vet
- Strategic Communication Chair group, Wageningen University & Research, Wageningen, The Netherlands
| | - G Duijzer
- Division of Human Nutrition, Wageningen University & Research, Wageningen, The Netherlands.,GGD Noord- en Oost-Gelderland, Warnsveld, The Netherlands
| | - J Ter Beek
- GGD Noord- en Oost-Gelderland, Warnsveld, The Netherlands
| | - S C Jansen
- GGD Noord- en Oost-Gelderland, Warnsveld, The Netherlands
| | - G J Hiddink
- Strategic Communication Chair group, Wageningen University & Research, Wageningen, The Netherlands
| | - E J M Feskens
- Division of Human Nutrition, Wageningen University & Research, Wageningen, The Netherlands
| | - A Haveman-Nies
- Division of Human Nutrition, Wageningen University & Research, Wageningen, The Netherlands.,GGD Noord- en Oost-Gelderland, Warnsveld, The Netherlands
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