Group-Based Lifestyle Intervention Strategies for Metabolic Syndrome: A Scoping Review and Strategic Framework for Future Research

Effects of nutrition education, physical activity and motivational interviewing interventions on metabolic syndrome among females of reproductive age in Wakiso district, central Uganda: a randomised parallel-group trial

BACKGROUND

The prevalence of metabolic syndrome (MetS) has increased significantly in sub-Saharan African countries, including Uganda. Females are disproportionately affected by MetS compared to males. This study evaluated the effects of 12 weeks of community-based nutrition education (NE), physical activity (PA), and motivational interviewing (MI) interventions on MetS and its components among females of reproductive age in central Uganda.

METHODS

We conducted a randomised parallel-group trial involving 120 females aged 15-49 years with MetS in Wakiso district, central Uganda. Participants were recruited between April and May 2023 and were randomly assigned to either the intervention (n = 60) or the control (n = 60) group. The 12-week intervention included NE, PA, and MI. The outcomes included changes in MetS and its components. Data were collected at baseline and endline using a modified STEPS questionnaire to assess sociodemographic factors, blood pressure (BP), waist circumference (WC), fasting blood glucose (FBG), triglycerides, HDL cholesterol (HDLC), and other variables. A generalised linear model was used to evaluate the impact of time and study groups on metabolic outcomes. Analyses were conducted using intention-to-treat in Stata (SE/14.0), at a p-value of < 0.05.

RESULTS

The group x time interaction showed significant positive effects on MetS and its components at the endline. The intervention group had significantly lower odds of MetS compared to the control group [OR = 0.588, 95% CI (0.501, 0.690), p-value < 0.0001)]. The intervention showed reduced mean diastolic BP (coeff=-4.556, 95% CI (-9.035, -0.077), p-value = 0.046), reduced mean FBG (coeff=-1.012, 95% CI (-1.553, -0.470), p < 0.001), and increased mean HDLC (coeff = 0.139, 95% CI (0.015, 0.262), p-value = 0.028). Additionally, the intervention group had significantly higher odds of daily fruit and vegetable intake compared to the control group (OR = 6.31, 95% CI: 1.18-33.64,p = 0.031), increased moderate-intensity recreational activity (Coeff = + 155.65 min/week, 95% CI:19.11-292.22, p = 0.025) and reduced sedentary time by 43.94 min per day (Coeff= -43.94, 95% CI: -87.75 to- 0.13, p = 0.049).

CONCLUSIONS

The community-based interventions significantly improved MetS outcomes among females of reproductive age in Uganda. Scaling up this package of interventions should be explored.

TRIAL REGISTRATION

ISRCTN, ISRCTN17445597. Registered 06 June 2024 - Retrospectively registered, https://www.isrctn.com/ISRCTN17445597 .

The effect of a lifestyle intervention program using a mobile application versus the effect of a program using a booklet for adults with metabolic syndrome: A three-arm randomized controlled trial

PURPOSE

The research aimed to examine the effect of a lifestyle intervention program using mobile application versus booklet for adults with metabolic syndrome in Hong Kong. The outcomes comprised body weight (primary outcome), exercise amount, improvement of cardiometabolic risk factors, cardiovascular endurance, perceived stress scale, and exercise self-efficacy.

DESIGN

A three-arm randomized controlled trial namely App group, Booklet group, and control group was adopted.

METHODS

Two hundred sixty-four adults with metabolic syndrome were recruited from community centers from 2019 to December 2021. Inclusion criteria are those adults with metabolic syndrome, able to use a smart phone. All participants received a 30-min health talk. App group additionally received a mobile application, while Booklet group received a booklet, and the control group received a placebo booklet. Data were collected at baseline, Weeks 4, 12, and 24. SPSS and generalized estimating equations (GEE) model were employed for data analysis.

FINDINGS

Attrition rates were minimal, ranged from 2.65% to 6.44%. Both app and booklet group showed significant improvement in outcomes (exercise amount, waist circumference) when compared to control group. However, statistically significant and superior results were observed in app group, including body weight, exercise amount, waist circumference, body mass index, and systolic blood pressure when compared to booklet group.

CONCLUSION

The lifestyle intervention supported with app was found to be superior to the booklet support for reducing body weight and maintaining exercise.

CLINICAL RELEVANCE

The lifestyle intervention program using mobile application support could be used widely for adults with metabolic syndrome in the community. Suggest nurses may incorporate this program in their health promotion strategies focusing on a healthy lifestyle to reduce the risk of progression to metabolic syndrome.

Efficacy of a multidimensional self-management intervention on low-education women with metabolic syndrome: a cluster randomized controlled trial

Low-education women, a substantially older population, are subject to increased risks of metabolic syndrome and consequent cardiometabolic diseases; early detection and effective management were urgently needed. Ninety-nine women with metabolic syndrome, age 61 and education ≤ 6 years, from four community units were randomly assigned to either a self-management intervention (n = 51) or a control arm (n = 48). The intervention consisted of five dimensions, physical activity and diet modifications (daily exercise classes and two nutrition courses), goal setting, coaching and peer support, problem-solving, and self-monitoring. The control arm received an education leaflet. Assessments were performed at baseline, six months, and 18 months. Compared with the control, the intervention participants improved the overall rate of meeting the recommended servings for six health foods, including vegetables, dairy products, and nuts (except whole grains, fruits, and protein); the rate of meeting regular leisure-time physical activity; and criteria biomarkers-waist circumference, fasting blood glucose, high-density lipoprotein cholesterol (except blood pressure and triglycerides); as well as body weight and body mass index; consequently decreased the number of risk factors and rate of metabolic syndrome. In conclusion, the multidimensional self-management intervention improved physical activity, healthy eating, and metabolic syndrome risks among low-education women with metabolic syndrome.

Lifestyle Interventions for Prevention and Management of Diet-Linked Non-Communicable Diseases among Adults in Arab Countries

The increased incidences of diet-related non-communicable diseases (NCDs) such as diabetes, obesity, and cardiovascular diseases among adults are becoming the chief public health concern in most Arab countries. Economic expansion has contributed to a nutrition shift from a traditional seasonal diet to Westernized eating habits coupled with a sedentary lifestyle. Despite the rising concern for NCD mortality, public health policies are inadequately addressed. This narrative review aims to discuss the effectiveness of nutritional interventions focusing on diet and physical activity in the management of NCDs among Arab adults. A comprehensive literature search was performed using different database platforms such as Cochrane reviews, Scopus, and PubMed for articles published between 1 December 2012 and 31 December 2021. Fifteen recent research articles addressing NCDs, mainly diabetes and obesity, from different Arab countries were included in this review. Structured lifestyle interventions involving behavioral therapy approaches and personalized goals for diet and physical activity were found to improve specific health outcomes in most studies. Significant improvements in health outcomes were reported for longer-duration interventions with follow-ups. A combination of both online and face-to-face sessions was found to be effective. It is important to identify barriers to physical activity for a culturally acceptable lifestyle intervention and conduct further studies to evaluate interventions for the long-term maintenance of health outcomes.

Factors Associated with Undertaking Health-Promoting Activities by Older Women at High Risk of Metabolic Syndrome

BACKGROUND

The complexity of health problems concerning women aged ≥60 years makes it necessary to develop effective, low-cost strategies involving biopsychosocial interventions. The aim of this study is to identify the factors associated with undertaking health-promoting activities by older women at high risk of metabolic syndrome (MetS) with or without depressive symptoms.

METHODS

The study group consisted of 70 older women (62-84 years old) undertaking regular physical activity. A self-developed questionnaire (used to determine the living situation, selected lifestyle components and health problems), the Perceived Stress Questionnaire (PSQ) and the Geriatric Depression Scale (GDS) were used.

RESULTS

In the study group undertaking regular physical activity, 40% had increased symptoms of depression (D group), and 60% were classified as non-depressed (ND group). The D group had a higher general stress level (t = -6.18, p = 0.001). Improving and/or maintaining physical fitness was identified as the greatest motivation in both groups. Willingness to spend time with other people significantly differed between the two groups (χ² = 4.148, p = 0.042). The sole factor significantly differentiating between both groups was lack of time (χ² = 8.777, p = 0.003).

CONCLUSIONS

Motivations and barriers to undertaking health-promoting activities and levels of perceived stress were significantly different between the depressed and non-depressed groups. It is important to encourage primary care physicians to perform screening tests for late-life depression and to provide information on where therapeutic interventions are available for patients with symptoms of MetS and coexisting depressive symptoms.

Comprehending Nutrition and Lifestyle Behaviors of People with Metabolic Syndrome: A Focus Group Study

Demographically and socio-culturally appropriate care is critical for empowering people with metabolic syndrome (MetS) to self-manage their condition. This focus group study aimed to explore the understanding of nutrition and lifestyle behaviors (NLBs) of Malaysians with MetS. Adults with MetS (N = 21) participated in four focus groups at a university's research clinic in Malaysia. A thematic framework analysis approach was applied to the focus group data using an initial coding framework developed from the Health Belief Model. Six main themes were identified on perceived motivations, barriers, and threats toward healthy NLBs. Motivations to adopt healthy NLBs were body image, personal experience of adverse complications, and family and social support. The perception that healthcare is a business model, the idea that changes in NLBs are difficult and expensive, and cultural influence on food intake were identified as barriers to healthy NLBs. Inadequate knowledge of MetS was identified as a subtheme in this study. Health education and health promotion activities that aim to modify the NLBs of people with MetS should consider the community's perception of motivation and barriers to change. Addressing these aspects in the development of programs can potentially increase program adoption and adherence, ensuring the success of community-based lifestyle interventions.

The Impact of Nutrition-Based Interventions on Nutritional Status and Metabolic Health in Small Island Developing States: A Systematic Review and Narrative Synthesis

Small island developing states (SIDS) have a high burden of nutrition-related disease associated with nutrient-poor, energy-dense diets. In response to these issues, we assessed the effectiveness of nutrition-based interventions on nutritional status (under-nutrition) and metabolic health (over-nutrition) among persons in SIDS. We included SIDS-based nutrition studies with change in nutrition status (e.g., markers of anaemia) or metabolic status (e.g., markers of glycaemia) as outcomes. The PRISMA framework was applied and MEDLINE, Embase, CINAHL, OARE library, Web of Science, Scopus, ASSIA, EconLit, AGORA, AGRICOLA, AGRIS, WHO-EMRO, and LILACS were searched (2000−2020). Cochrane risk of bias (ROB) and Cochrane ROBINS-I tools assessed ROB for randomised and non-randomised studies, respectively. PROSPERO registration (CRD42021236396) was undertaken. We included 50 eligible interventions, involving 37,591 participants: 14 trials reported on nutritional status, 36 on metabolic health. Effective interventions, evaluated at the individual level, took a multifaceted approach for metabolic outcomes; while nutrition outcomes utilised supplements. Most intervention types were suitable for issues related to ‘over’ nutrition versus ‘under’ nutrition. Twenty-six studies (nutrition status (six); metabolic health (twenty)) were effective (p < 0.05). With the current rise of nutrition-related public health challenges, there is a need for further development and evaluation of these and related interventions at the population level.