Changes in blood lipid levels after a digitally-enabled, cardiometabolic preventive health program: a pre-post study in an adult, Dutch general population cohort (Preprint)

Opportunities and challenges of lifestyle intervention-based digital therapeutics in LDL-C management: a scoping review

Background

In recent decades, the prevalence of dyslipidemia, especially high low-density lipoprotein cholesterol (LDL-C), has risen sharply in China. Although lifestyle interventions are important, traditional face-to-face approaches have limitations. Digital Therapeutics (DTx) can provide an effective solution by delivering remote medical interventions to patients via software and hardware, thereby optimizing existing clinical treatment methods with enhanced convenience and accessibility.

Objectives

This study aims to explore the current evidence on the effect of lifestyle intervention-based Digital Therapeutics (LI-DTx) on high LDL-C, and to analyze their advantages and disadvantages.

Eligibility criteria

This scoping review examines clinical studies assessing the effects of DTx on LDL-C levels. Papers were included in the final analysis if there was evidence that DTx had effects on lowering LDL-C levels.

Sources of evidence

Papers that were published between January 2014 and December 2023 were included in the PubMed database.

Charting methods

Data extracted from the publications included country, year, study type, study population, sample size, study duration, intervention, and changes in LDL-C level.

Results

A total of 23 target literature were identified. Twenty-one studies confirmed that LI-DTx could optimize the LDL-C level through remote lifestyle interventions such as diet, exercise, medication, and health education, of which 14 studies reported a significant reduction in LDL-C level (p < 0.05). In the future, the development and design of DTx will need to improve intelligence, personalization, applicability, real-time performance, and data security; integrate with traditional healthcare systems; facilitate multidisciplinary collaboration in dyslipidemia management; and enhance long-term patient engagement with DTx platforms.

Conclusion

LI-DTx may offer a more effective and sustainable solution for LDL-C management, although several challenges remain. Further randomized controlled clinical trials are needed to provide scientific support for its efficacy and safety.

Acute and sub-acute toxicity of ethanol extracts of Hagenia abyssinica and Rumex abyssinicus flowers in Swiss albino mice

BACKGROUND

Hagenia abyssinica (Bruce) J.F. Gmel (Family: Rosaceae) and Rumex abyssinicus Jacq (Family: Polygonaceae) are valuable medicinal plants traditionally used in Ethiopia to treat various diseases. Recent studies have also demonstrated that solvent extracts of these plants exhibit molluscicidal activities under laboratory conditions, highlighting their potential for snail control. However, limited information is available regarding their safety profiles.

OBJECTIVE

This study aimed to evaluate acute, and sub-acute toxicity of 70% ethanol extracts of H. abyssinica and R. abyssinicus flowers in Swiss albino mice, following the Organization for Economic Co-operation and Development guidelines 423 and 407.

METHODS

In the acute toxicity study, both extracts were administered orally to experimental groups at varying concentrations (mg/kg bodyweight): 5, 50, 300, and 2000. For the sub-acute toxicity study, both extracts were given to the experimental groups at doses (mg/kg) of 125, 250, and 500 daily for 28 days. Blood samples were collected from each mouse and analyzed for hematological and biochemical parameters. Additionally, the heart, liver, and kidneys were excised, stained, and examined for potential histopathological effects.

RESULTS

The acute toxicity study revealed no noticeable changes in behavior at the highest oral dosage of 2000 mg/kg. In the sub-acute toxicity study, no statistically significant changes were observed in hematological and biochemical parameters compared to the control group. Similarly, no abnormal histological findings were noted in the examined organs in comparison to the control group.

CONCLUSION

These findings indicate that flower extracts of both plants did not show significant toxicity to laboratory mammals at an oral dosage of 2000 mg/kg.

A Digitally Enabled Combined Lifestyle Intervention for Weight Loss: Pilot Study in a Dutch General Population Cohort

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.