'Red Ruby': an interactive web-based intervention for lifestyle modification on metabolic syndrome: a study protocol for a randomized controlled trial

Development and Evaluation of a Blended Self-Management Program for Metabolic Syndrome in Patients With Rheumatic Diseases

Rheumatic diseases are known to be associated with the development of metabolic syndrome, which increases mortality rates due to cardiovascular complications. Although a variety of self-management programs for rheumatic diseases have been developed, few have concentrated on metabolic syndrome. This study aimed to develop and verify a blended (a mixture of telephone and online interventions) metabolic syndrome self-management program. The program was developed in four stages: analysis to identify program contents, website design, website development, and validity testing. A quasi-experimental nonequivalent control group, pretest-posttest design was adopted to verify the program effectiveness in 54 patients with rheumatic disease. The program was initially implemented via telephone for 4 weeks and then self-administered via a web-based platform for 20 weeks. Indices of metabolic syndrome and self-management and quality of life scores were measured as outcome variables. Data were collected three times: before intervention, after 4 weeks of telephone interventions, and after 20 weeks of online self-interventions. The devised program had a significant overall effect on metabolic syndrome indices, metabolic syndrome-related self-management behaviors, and quality of life. Detailed analysis showed the program effectively reduced body mass index, waist circumference, systolic blood pressure, and blood glucose levels and improved metabolic syndrome self-management behaviors. Based on our findings, it can be expected that the use of this program may retard or prevent the progression of metabolic syndrome by improving some metabolic syndrome indices and metabolic syndrome-related self-management behaviors, which are key components of care in rheumatic disease patients with metabolic syndrome. This web-based program appears to be beneficial in public health care settings because it is cost-effective, readily available, and may provide long-term support.

Framingham risk scores for determination the 10-year risk of cardiovascular disease in participants with and without the metabolic syndrome: results of the Fasa Persian cohort study

BACKGROUND

Metabolic syndrome (MetS) is a cluster of risk factors and the Framingham risk score (FRS) is a useful metric for measuring the 10-year cardiovascular disease (CVD) risk of the population. The present study aimed to determine the 10-year risk of cardiovascular disease using the Framingham risk score in people with and without MetS in a large Iranian cohort study.

METHODS

This cross-sectional study was done using the Fasa cohort. Participants aged ≥ 35 years old were recruited to the study from 2015 to 2016. The FRS was calculated using age, sex, current smoking, diabetes, systolic blood pressure (SBP), total cholesterol, and high-density lipoprotein (HDL) cholesterol. MetS was defined as the presence of three or more of the MetS risk factors including triglyceride (TG) level ≥ 150 mg dl- 1, HDL level < 40 mg dl- 1 in men and < 50 mg dl- 1 in women, systolic/diastolic blood pressure ≥ 130/≥85 mmHg or using medicine for hypertension, fasting blood sugar (FBS) level ≥ 100 mg dl- 1 or using diabetes medication and abdominal obesity considered as waist circumference (WC) ≥ 88 cm for women and ≥ 102 cm for men. Multiple logistic regressions were applied to estimate the 10- year CVD risk among people with and without MetS.

RESULTS

Of 8949 participants, 1928 people (21.6%) had MetS. The mean age of the participants with and without Mets was 50.4 ± 9.2 years and 46.9 ± 9.1 years respectively. In total 15.3% of participants with MetS and 8.0% of participants without MetS were in the high-risk category of 10-year CVD risk. Among participants with MetS gender, TG, SBP, FBS and in people without MetS gender, TG, SBP, FBS, and HDL showed strong associations with the predicted 10-year CVD risk.

CONCLUSION

Male sex and increased SBP, TG, and FBS parameters were strongly associated with increased 10-year risk of CVD in people with and without MetS. In people without MetS, reduced HDL-cholestrol was strongly associated with increased 10-year risk of CVD. The recognition of participant's TG, blood pressure (BP), FBS and planning appropriate lifestyle interventions related to these characteristics is an important step towards prevention of CVD.

Screen time and the risk of metabolic syndrome among children and adolescents: A systematic review and dose-response meta-analysis

AIMS

The metabolic syndrome (MetS) and its consequences are one of the main public health challenges worldwide. We conducted a systematic review and dose-response meta-analysis of studies that examined the association between screen time and the MetS among children and adolescents.

DATA SYNTHESIS

A systematic search was conducted using electronic databases, including PubMed, Scopus, ProQuest, and Cochrane Library, for studies published from 1963 up to 2 May 2022. In this systematic review and meta-analysis, observational studies with cross-sectional, case-control, and cohort design evaluating the association between screen time and MetS were included. Random effects models and linear and nonlinear dose-response meta-analyses were used to pool study results.

RESULTS

Seven studies were included in the meta-analysis. The summary OR of MetS among children and adolescents for the highest vs. lowest time of screen time was 1.64 (95% CI: 1.32-2.03, with little evidence of heterogeneity, I² = 9.3%, P-_{heterogeneity} = 0.35, n = 7 studies) and 1.64 (95% CI: 1.27-2.12, I² = 27.7%, n = 6) for cross-sectional studies. Results persisted across several additional subgroup analyses. There was a linear positive association between screen time and the risk of MetS (P dose-response <0.0001; P nonlinearity = 0.64) with an OR of 1.29 (95% CI: 1.12-1.46) per 2 h/day increment in screen time.

CONCLUSION

The current dose-response meta-analysis suggested that increased screen time is associated with an increased risk of MetS among children and adolescents. Public health strategies may target unhealthy screen-based related behaviors to halt the development of MetS among children and adolescents.

Obesity paradigm and web-based weight loss programs: an updated systematic review and meta-analysis of randomized controlled trials

BACKGROUNDS

Web-based therapeutic approaches are new and attractive tools for primary health care systems due to their time and cost-saving nature and their accessibility for different populations. The aim of the current systematic review and meta-analysis is to summarize the results of studies evaluating the effect of web-based interventional programs on weight loss among overweight and obese individuals.

METHODS

A literature review from 2000 to 2016 was conducted. Studies were included in the study if they had adult participants with body mass index (BMI) ≥ 25 kg/m², a web-user intervention arm, and a non-web user control arm, with the primary aim of weight loss. Weight change in the interventional group versus control group was pooled with the random-effect model. Data were extracted on sample characteristics, drop-outs, weight loss, intervention duration, and the amount of weight loss. The mean weighted difference and 95% confidence intervals (CI) were calculated.

RESULTS

Eight studies met the inclusion criteria and included in the final model. Overall, using the web-based interventions had a weak non-significant effect on weight loss in overweight and obese individuals (WMD 0.56 kg, CI - 3.474, 4.592; P = 0.786). The most important reason was the unadjusted baseline weight of experimental and control groups in included studies, although the stratified analysis showed that, low study quality score and not using feedback and goal-setting in the study were the main factors diminishing the effectiveness of web-based intervention treatment group.

CONCLUSION

The results of the current meta-analysis indicated no effectiveness of web-based interventional programs in the weight loss of overweight and obese individuals. Although the great between-study heterogeneity and a small number of included studies further highlight the need for additional researches in this field.

The effect of a community-based e-health program to promote the role of physical activity among healthy adults in Hungary

Background

Physically active lifestyle can prolong the years spent without chronic diseases and is strongly associated with good mental and physical health. The goal of the study was to examine the physical activity patterns of the healthy adults and the effectiveness of a community-based e-health program.

Methods

The study sample comprised of 633 participants. Analyses were based on the E-Harmony health program that was conducted in Hungary in 2014–2015. The longitudinal study measured the physical activity patterns of the healthy adult population, and a 12-month community-based internet and media program was evaluated for the target group to improve the physical activity level and related knowledge. We examined the effectiveness of the program by the International Physical Activity Questionnaire – Hungarian validated long version adjusting for socio-demographic parameters, also across multivariate linear regression analysis using SPSS 24.0 software. Confidence interval of 95% was used and the level of significance was p < 0.05.

Results

The total physical activity of the study sample was 5129.9 (SD = 4488.1) MET min/week. Male participants scored higher in total activity but the results showed no statistical significance. Our participants were sitting 2211.6 (SD = 1592.8) min /week on average (daily average was 315.9 (SD = 227.6) minutes); the results showed no statistically significant difference by gender. We found weak but significant relationship between the active lifestyle and anthropometric data, especially according to leisure time activities and sedentary behaviour (p < 0.001). Based on the multivariate linear regression models the socio-demographic parameters significantly affected the physical activity level of participants. After the 12-month community-based e-health program, 10.34% changes occurred in the total physical activity level (p < 0.001).

Conclusions

To our knowledge, ours was the first community-based e-health program in Hungary to improve the physical activity level of the healthy adult population. Based on our results this web-based e-health program can be an adequate tool to promote healthy lifestyle. The study could provide appropriate information for the further health interventions and policy making. Further research is necessary to determine the special risk groups and to develop an applicable e-health program for such specific subgroups.

Gender difference in the association between Framingham Risk Score with cardio-metabolic risk factors and psychological distress in patients with metabolic syndrome

BACKGROUND

In the current study we aimed to evaluate the gender-specific associations between metabolic and psychological risk factors of cardiovascular disease (CVD) and Framingham Risk Score (FRS) in patients with metabolic syndrome.

METHODS

In a cross-sectional study of 256 patients with metabolic syndrome (157 men, 99 women), the cardiovascular disease risk was evaluated using the FRS scoring system by a pre-defined computerized algorithm. Psychological distress was also assessed by general health questionnaire (GHQ)-12. Evaluation of the biochemical parameters including fasting serum glucose (FSG), lipid profile, liver enzymes and adiponectin concentrations were also performed using the enzymatic methods.

RESULTS

The prevalence of low, intermediate and high risk of CVD in men was significantly higher than women (P < 0.05). Both genders in high risk of CVD had significantly higher age, systolic blood pressure (SBP) and FSG concentrations compared with male and females in intermediate and low risk of CVD (P < 0.05). In multiple logistic regression, being single was in the highest relationship with high psychological distress values compared with married or divorced/separated marital status. Moreover, high SBP and low high density lipoprotein (HDL) concentrations were also potent determinants of high psychological distress (P < 0.05).

CONCLUSIONS

In the current study, the prevalence of CVD risk factors were higher in men compared with women. Moreover, higher age, SBP and FSG were potent determinants of FRS in both genders. Marital status and serum HDL were in relation with psychological distress among patients with metabolic syndrome.

Framingham risk score for estimation of 10-years of cardiovascular diseases risk in patients with metabolic syndrome

BACKGROUND

There are a few studies evaluating the predictive value of Framingham risk score (FRS) for cardiovascular disease (CVD) risk assessment in patients with metabolic syndrome in Iran. Because of the emerging high prevalence of CVD among Iranian population, it is important to predict its risk among populations with potential predictive tools. Therefore, the aim of the current study is to evaluate the FRS and its determinants in patients with metabolic syndrome.

METHODS

In the current cross-sectional study, 160 patients with metabolic syndrome diagnosed according to the National Cholesterol Education Adult Treatment Panel (ATP) III criteria were enrolled. The FRS was calculated using a computer program by a previously suggested algorithm.

RESULTS

Totally, 77.5, 16.3, and 6.3% of patients with metabolic syndrome were at low, intermediate, and high risk of CVD according to FRS categorization. The highest prevalence of all of metabolic syndrome components were in low CVD risk according to the FRS grouping (P < 0.05), while the lowest prevalence of these components was in high CVD risk group (P < 0.05). According to multiple logistic regression analysis, high systolic blood pressure (SBP) and fasting serum glucose (FSG) were potent determinants of intermediate and high risk CVD risk of FRS scoring compared with low risk group (P < 0.05).

CONCLUSION

In the current study, significant associations between components of metabolic syndrome and different FRS categorization among patients with metabolic syndrome were identified. High SBP and FSG were associated with meaningfully increased risk of CVD compared with other parameters.

TRIAL REGISTRATIONS

The study is not a trial; the registration number is not applicable.

Mediterranean dietary pattern and VEGF +405 G/C gene polymorphisms in patients with metabolic syndrome: An aspect of gene-nutrient interaction

Aims

To evaluate the relationship between Mediterranean dietary pattern, anthropometric and metabolic biomarkers and vascular endothelial growth factor (VEGF) +405 G/C gene polymorphism in patient with metabolic syndrome (Mets).

Materials and methods

In this study 150 patients with Mets and 50 healthy subjects were enrolled. Dietary intakes were evaluated with a semi-quantitative food-frequency questionnaire (FFQ) and Mediterranean dietary quality index (Med-DQI) was assessed. Anthropometric assessments and blood pressure measurement were performed. Biochemical assays including fasting serum glucose (FSG), matrix metalloproteinase-3 (MMP-3), liver enzymes and lipid profiles were also assessed. Polymorphism of +405 G/C VEGF gene was determined utilizing polymerase chain reaction-restriction fragments length polymorphism (PCR-RFLP) method.

Results

Serum high density lipoprotein-cholesterol (HDL-C) was significantly lower and low density lipoprotein cholesterol (LDL-C), triglyceride (TG), total cholesterol (TC) concentrations and FSG were significantly higher in metabolic syndrome patients compared with control group (P < 0.05). Metabolic syndrome group with high consumption of “cholesterol” had significantly upper serum TG; also high consumption of “fish” and “vegetables-fruits” was associated with a significantly lower serum LDL concentrations. In metabolic syndrome patients with CC genotype, mean score of “saturated fatty acid” subgroup was significantly higher compared with other genotypes; whereas, in healthy individuals, mean score of “fruit-vegetable” subgroup in individuals of CC and GG genotype was significantly higher (P<0.05).

Conclusion

Our findings indicated a significant relationship between Mediterranean dietary quality index and both anthropometric and metabolic risk factors. We also indicated a higher “saturated fatty acid” intake in CC genotype among metabolic syndrome patients.

An interactive web-based intervention on nutritional status, physical activity and health-related quality of life in patient with metabolic syndrome: a randomized-controlled trial (The Red Ruby Study)

BACKGROUND/OBJECTIVES

Physical inactivity and unhealthy nutritional behaviors are recognized as the key factors in the cause and management of metabolic syndrome (MetS). The effectiveness of interactive web-based interventions on dietary intakes, physical activity and health-related quality of life (HRQOL) among people with MetS is currently unknown.

METHODS

The two-arm randomized-controlled trial was conducted for patients with MetS from June through December 2012 in Tehran, Iran. Participants (n=160) were recruited through online registration on the study website. After free clinical assessments of eligible participants for MetS, they were randomly assigned to intervention and control groups (n=80). All participants received general information about cardiovascular diseases and MetS risk factors via the website. The intervention group logged in to interactive part including My Healthy Heart Profile, received tailored calorie-restricted diet and used all parts of the interactive prevention program. Anthropometric measures, glycemic status, lipid profile, physical activity and food intake were evaluated at the beginning and after 6-month follow-up. HRQOL was assessed at beginning, 3- and 6-month follow-up.

RESULTS

There were no significant differences between the intervention and control groups on age, gender, education and MetS factors. In comparison with control group, the intervention group showed significant changes in moderate physical activity 260.3±473.6 vs 101.6±213.1 MET-min/week, walking 505.2±505.3 vs 321±884 MET-min per week, cholesterol intake -88.4±158.7 vs -8.3±6 mg per day, total calories -430.2±957.5 vs -392.9±34.7 kcal per day and sodium 1336.9±2467 vs 1342±3200.4 mmol per day. With regard to HRQOL, the intervention group showed greater improvement in general health and vitality (P<0.05 for all).

CONCLUSION

These results indicate the positive impact of a lifestyle intervention by a web-based program on physical activity, dietary intake and several dimension of QoL. The use of web-based approaches is a great interest to manage patients at high cardiovascular risk, especially where the prevalence of obesity, MetS and diabetes is increasing.

Association between dietary patterns and metabolic syndrome in a sample of Tehranian adults

AIM

Metabolic syndrome is one of the most known risk factors of cardiovascular disease. The aim of the current study was to investigate relationships between major dietary patterns and cardio-metabolic risk factors in patients with metabolic syndrome.

METHODS

This cross-sectional study was conducted among patients with metabolic syndrome. All of the participants underwent anthropometric and blood pressure measurements. Biochemical assessments including serum aspartate aminotransferase (AST), alanine amino transferase (ALT), fating serum glucose (FSG), serum lipids, insulin and adiponectin concentrations were performed by enzymatic methods. Dietary patterns were obtained by factor analysis procedure using principal component method. Nutrient intakes were analyzed by a semi-quantitative food frequency questionnaire (FFQ).

RESULTS

Four major dietary patterns including healthy, meats and fats, sweets, potatoes and refined grains were extracted in the current study. Higher healthy pattern score was in relation with higher concentrations of AST and lower systolic blood pressure. Lower diastolic blood pressure and higher serum triglyceride concentrations were also observed in upper quintiles of meat and fats pattern (P<0.05). Upper quintile of sweet pattern was accompanied with higher serum FSG and insulin concentrations (P<0.05).

CONCLUSIONS

The independent associations between dietary patterns and blood pressure and serum lipids further support the protective role of healthy diet with fruits, vegetables and fish as predominant food items and an un-favorable effect of unhealthy diets with meat, fats and sweets as major ingredients.

Health-related Quality of Life Among People Participating in a Metabolic Syndrome E-screening Program: A Web-based Study

BACKGROUND

Cardiovascular diseases remain the leading cause of death worldwide. Metabolic syndrome (MetS) is the clustering of risk factors for developing the disease. Strong evidence exists for the efficacy of screening for MetS. However, the potential of novel web-based studies for MetS and online assessing of the quality of life (QOL) for these high-risk participants have not been explored.

METHODS

This was a web-based, cross-sectional study. Participants were recruited through online registering on the study website. Then, those who met the study criteria (waist circumference [WC] ≥90 and blood pressure [BP] ≥130/85) were contacted and invited for the clinical assessments, if they wish. Baseline measurements were MetS risk factors (weight, WC, body mass index and BP, total cholesterol, low-density lipoprotein-cholesterol, high-density lipoprotein-cholesterol, triglycerides, and fasting blood glucose) and health-related QOL (HRQOL) that was measured using the short form-36 (SF-36).

RESULTS

There were 1436 (male: 928, female: 508) registration data on the study website. Reviewing the data, of 317 eligible participants that were invited to the study, 229 persons were responded to invitation in the screening program. The mean age of participants was 43.8 (standard deviation [SD] = 9.9) years. MetS was more frequent in male and married persons. In addition, participants with MetS had lower mean (SD) scores than participants without MetS for the following subscales of HRQOL as: role-physical (with MetS 51.1±35.2; versus without MetS 65.3 ± SD = 40.1), vitality (with MetS 65± 21; versus without MetS 75.3 ± 21.1), mental health (with MetS 49.5±30.1; versus without MetS 34.1±17.2)(P < 0.05 for all).

CONCLUSIONS

People with MetS experienced lower HRQOL than without MetS. Internet as a powerful medium offers a novel setting for delivery health information. It seems that high BP and abdominal obesity are associated with lower HRQOL in the participants with MetS. A web-based prevention program could make people aware for their vulnerability to MetS and its complications.

Interactive web-based lifestyle intervention and metabolic syndrome: findings from the Red Ruby (a randomized controlled trial)

BACKGROUND

Metabolic syndrome is a growing public health problem worldwide. Several interventions have been proposed to specifically target the problem. This study evaluated the effectiveness of an interactive web-based lifestyle for management of metabolic syndrome.

METHODS

This randomized controlled trial was conducted from June through August 2012 in Tehran, Iran. Participants were individuals with metabolic syndrome who had registered on the study website. Interested eligible participants were invited for a free clinic visit and clinical assessment. They were randomly assigned to the intervention (n =80) or control (n = 80) group. The intervention group received an interactive web-based program called the Healthy Heart Profile and were followed for 6 months. The control group received general information on metabolic syndrome. Anthropometric measures, glycemic status, and lipid profile were evaluated at baseline, and at 3- and 6-month follow-up assessments. Metabolic syndrome was defined according to The National Cholesterol Education Program Adult Treatment Panel (ATP) III report except for waist circumference, which was modified to ≥90 cm for both genders for the Iranian population.

RESULTS

In total, 1,437 individuals registered on the study website. The mean age of participants was 44.2 years (SD  = 10.0). There were no significant differences between the intervention and control groups on any baseline variable except that participants in the intervention group recorded higher levels of LDL. The results showed a decrease in metabolic syndrome in both groups. These reductions were significantly greater in the intervention group at the 3- and 6-month follow-ups. The intervention group showed significantly greater decreases (P < 0.05) over the control group for, respectively, systolic blood pressure (3-month: -10 versus -6 mmHg; 6-month: -11 versus -8 mmHg), diastolic blood pressure (3-month: -10 versus -4 mmHg; 6-month: -11 versus -6 mmHg), weight (3-month: -2 versus -1 kg; 6-month: -4 versus -1 kg), body mass index (3-month: -0.5 versus -0.2 kg/m(2); 6-month: -1.1 versus -0.4 kg/m(2)) and improvement in HDL (3-month: 2 versus 0.64 mg/dl; 6-month: 6 versus 4 mg/dl).

CONCLUSION

The findings suggest that the web-based interactive program was beneficial for individuals with metabolic syndrome. Comprehensive interactive web-based prevention programs are promising to help involve patients in improving management of metabolic syndrome and adopting a healthy lifestyle.

TRIAL REGISTRATION

IRCT201111198132N1 . Registered 27 May 2013.

Adherence and Attrition in a Web-Based Lifestyle Intervention for People with Metabolic Syndrome

BACKGROUND

The aim of this study was to determine adherence and attrition rates in a lifestyle intervention for people with metabolic syndrome.

METHODS

Adherence and attrition data from a randomized controlled trial were collected. Participants were classified as adherence group if they completed assessments at 3 and 6 months follow-up and as attrition group if they did not. Physical activity and quality of life was measured using the International Physical Activity Questionnaire (IPAQ) and the Short Form Health Survey (SF-36). Generalized Estimating Equations (GEE) was used to explore predictors of attrition.

RESULTS

The mean age of participants (n=160) was 44.1 years. Attrition rate in the intervention and control groups at first follow-up were the same (20%). However, the control group had significantly higher attrition rate (%33.7) compared to the intervention group (%20) at 6 months follow up. Results showed that low educated participants were more likely to not stay in the study than better educated participants (OR=2.95,CI:1.39-6.33,P=0.05). According with length of the study, attrition was decreased at six month (OR=0.66,CI:0.52-0.83,P<0.001). Also, some aspects of health-related quality of life contributed to the attrition rate. Those who had higher scores on general health (OR=0.66,CI:0.54-0.97,P=0.023), social functioning (OR=0.44,CI:0.40-0.76,P=0.032), role emotional (OR=0.74,CI:0.54-0.98,P=0.18), vitality (OR=0.55,CI:0.38-0.90,P=0.015) and mental health (OR=0.63,CI:0.45-0.85,P=0.033) were more likely to stay in the study.

CONCLUSION

It remains a concern that Web-based lifestyle programs may fail to reach those who need it most. Participant in the study generally had better quality of life than those who were lost to follow up.