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Sabatini S, Nolan JJ, O'Donoghue G, Kennedy A, Petrie J, Walker M, O'Gorman DJ, Gastaldelli A. Baseline phenotypes with preserved β-cell function and high insulin concentrations have the best improvements in glucose tolerance after weight loss: results from the prospective DEXLIFE and EGIR-RISC studies. Metabolism 2024; 155:155910. [PMID: 38599278 DOI: 10.1016/j.metabol.2024.155910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 04/04/2024] [Accepted: 04/04/2024] [Indexed: 04/12/2024]
Abstract
BACKGROUND Weight loss and lifestyle intervention improve glucose tolerance delaying the onset of type 2 diabetes (T2D), but individual responses are highly variable. Determining the predictive factors linked to the beneficial effects of weight loss on glucose tolerance could provide tools for individualized prevention plans. Thus, the aim was to investigate the relationship between pre-intervention values of insulin sensitivity and secretion and the improvement in glucose metabolism after weight loss. METHODS In the DEXLIFE cohort (373 individuals at high risk of T2D, assigned 3:1 to a 12-week lifestyle intervention or a control arm, Trial Registration: ISRCTN66987085), K-means clustering and logistic regression analysis were performed based on pre-intervention indices of insulin sensitivity, insulin secretion (AUC-I), and glucose-stimulated insulin response (ratio of incremental areas of insulin and glucose, iAUC I/G). The response to the intervention was evaluated in terms of reduction of OGTT-glucose concentration. Clusters' validation was done in the prospective EGIR-RISC cohort (n = 1538). RESULTS Four replicable clusters with different glycemic and metabolomic profiles were identified. Individuals had similar weight loss, but improvement in glycemic profile and β-cell function was different among clusters, highly depending on pre-intervention insulin response to OGTT. Pre-intervention high insulin response was associated with the best improvement in AUC-G, while clusters with low AUC-I and iAUC I/G showed no beneficial effect of weight loss on glucose control, as also confirmed by the logistic regression model. CONCLUSIONS Individuals with preserved β-cell function and high insulin concentrations at baseline have the best improvement in glucose tolerance after weight loss.
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Affiliation(s)
- Silvia Sabatini
- Institute of Clinical Physiology, National Research Council, CNR, Pisa, Italy
| | - John J Nolan
- Department of Clinical Medicine, Trinity College Dublin, Ireland
| | - Grainne O'Donoghue
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Aileen Kennedy
- School of Biological, Health and Sports Sciences, Technological University Dublin, Dublin, Ireland
| | - John Petrie
- School of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Mark Walker
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Donal J O'Gorman
- School of Health and Human Performance, Dublin City University, Glasnevin, Dublin, Ireland
| | - Amalia Gastaldelli
- Institute of Clinical Physiology, National Research Council, CNR, Pisa, Italy.; Diabetes Division, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.
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Sprague BN, Tu W, Unverzagt FW, Moser LR, Adams M, Carter A, Dawkins E, Keith NR, Reinoso DR, Clark DO. Food resources and kitchen skills plus aerobic training (FoRKS+) for black adults with hypertension: A pilot trial protocol. Contemp Clin Trials 2024; 141:107533. [PMID: 38621517 DOI: 10.1016/j.cct.2024.107533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 03/21/2024] [Accepted: 04/10/2024] [Indexed: 04/17/2024]
Abstract
BACKGROUND Midlife hypertension is associated with cognitive decline and Alzheimer's disease and related dementia (ADRD), suggesting that blood pressure control may be a therapeutic target for dementia prevention. Given excess hypertension in non-Hispanic Black (NHB) adults, blood pressure control may also reduce ADRD disparities. We describe a pilot randomized controlled trial (RCT) to evaluate the feasibility and preliminary efficacy of a multicomponent lifestyle-based intervention versus enhanced usual care on cognition among middle-aged NHB adults. METHODS AND STUDY DESIGN The Food Resources and Kitchen Skills plus Aerobic Training (FoRKS+) study is a 2-arm, single-blinded trial that compares those receiving the FoRKS+ program (target N = 64) versus those receiving enhanced usual care (target N = 64) in local federally-qualified health centers. Key eligibility criteria include self-identified NHB adults between ages 35-75 with a mean systolic blood pressure ≥ 130 mm/Hg obtained from 24-h ambulatory blood pressure monitoring. The FoRKS+ program includes 5 weeks of hypertension self-management courses, 11 weeks of nutrition courses, and 12 weeks of aerobic training in dietitian and health coach-led virtual groups. We will collect data on primary cognitive outcomes, feasibility, hypothesized intervention mediators and moderators, and demographic and health covariates at baseline, near intervention weeks 16-, and 28 (primary outcome assessment), and week 52 follow-up. We will use mixed-effects modeling to examine intervention effects on cognition. DISCUSSION This pilot RCT will examine the feasibility and preliminary effects of a multicomponent lifestyle intervention on cognitive function in NHB adults, which may have implications for reducing health disparities in ADRD.
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Affiliation(s)
- Briana N Sprague
- Department of Medicine, Division of General Internal Medicine and Geriatrics, Indiana University School of Medicine, Indianapolis, IN, USA; Indiana University Center for Aging Research, Regenstrief Institute, Inc, Indianapolis, IN, USA.
| | - Wanzhu Tu
- Indiana University Center for Aging Research, Regenstrief Institute, Inc, Indianapolis, IN, USA; Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Frederick W Unverzagt
- Indiana University Center for Aging Research, Regenstrief Institute, Inc, Indianapolis, IN, USA; Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Lyndsi R Moser
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Mariah Adams
- Department of Kinesiology, Indiana University Bloomington, Bloomington, IN, USA
| | - Amy Carter
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Emily Dawkins
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN, USA
| | - NiCole R Keith
- Indiana University Center for Aging Research, Regenstrief Institute, Inc, Indianapolis, IN, USA; Department of Kinesiology, Indiana University Bloomington, Bloomington, IN, USA
| | - Deanna R Reinoso
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN, USA; Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Daniel O Clark
- Department of Medicine, Division of General Internal Medicine and Geriatrics, Indiana University School of Medicine, Indianapolis, IN, USA; Indiana University Center for Aging Research, Regenstrief Institute, Inc, Indianapolis, IN, USA
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Jakobsen DD, Järvholm K, Brader L, Bruun JM. Long-term changes in eating-related problems and quality of life in children with overweight and obesity attending a 10-week lifestyle camp. Obes Res Clin Pract 2024:S1871-403X(24)00041-3. [PMID: 38705820 DOI: 10.1016/j.orcp.2024.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 04/09/2024] [Accepted: 04/23/2024] [Indexed: 05/07/2024]
Abstract
BACKGROUND Eating-related problems (e.g., binge eating (BE)) and impaired quality of life (QoL) is more prevalent in children with overweight and obesity. This study aimed to investigate changes in self-reported overeating (OE), BE, and QoL in children with overweight or obesity attending multicomponent 10-week lifestyle camps with a 52-weeks follow-up. Additionally, the study sought to investigate whether self-reported OE/BE before camp was associated with changes in QoL. METHODS Children aged 7 to 14-years could attend camp if they had overweight/obesity, were lonely, unhappy, or had social or family-related problems. In this study only children with overweight and obesity were included (n:185). OE, BE, and QoL were measured using self-reported questionnaires. RESULTS In total, 38 % of the children reported regular BE at baseline. Regular OE, occasional BE, and occasional OE was reported by 14 %, 13 %, and 11 %, respectively, while 24 % reported no eating-related problems. The relative risk of experiencing eating-related problems decreased at 10-weeks compared to baseline. Additionally, the probability of regular OE (RR 0.12 (95 % CI 0.04;0.38) (X2 = 8.44, p = 0.004)) and regular BE (RR 0.01 (95 % CI 0.00;0.11) (X2 = 9.91, p = 0.002)) remained lower at 52-weeks relative to baseline. All QoL dimensions improved after camp, and the presence of self-reported OE and regular BE at baseline was significantly associated with lower QoL at baseline, 10 and 52-weeks. CONCLUSION Children self-reporting OE and BE may be a particular vulnerable group that needs more support from camp staff and healthcare professionals to improve QoL. CLINICAL TRIAL REGISTRATION clinicaltrials.gov with ID: NCT04522921.
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Affiliation(s)
- Dorthe Dalstrup Jakobsen
- Steno Diabetes Center Aarhus, Aarhus University Hospital, 8200 Aarhus N., Denmark; Department of Clinical Medicine, Aarhus University, 8200 Aarhus N., Denmark; Danish National Center for Obesity, 8200 Aarhus N., Denmark.
| | - Kajsa Järvholm
- Department of Psychology, Lund University, 223 62 Lund, Sweden
| | - Lea Brader
- Global Nutrition, Arla Foods amba, 8200 Aarhus N., Denmark
| | - Jens Meldgaard Bruun
- Steno Diabetes Center Aarhus, Aarhus University Hospital, 8200 Aarhus N., Denmark; Department of Clinical Medicine, Aarhus University, 8200 Aarhus N., Denmark; Danish National Center for Obesity, 8200 Aarhus N., Denmark
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Khokhar S, Holden J, Toomer C, Del Parigi A. Weight Loss with an AI-Powered Digital Platform for Lifestyle Intervention. Obes Surg 2024; 34:1810-1818. [PMID: 38573389 DOI: 10.1007/s11695-024-07209-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 03/28/2024] [Accepted: 03/28/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND Lifestyle intervention remains the cornerstone of weight loss programs in addition to pharmacological or surgical therapies. Artificial intelligence (AI) and other digital technologies can offer individualized approaches to lifestyle intervention to enable people with obesity to reach successful weight loss. METHODS SureMediks, a digital lifestyle intervention platform using AI, was tested by 391 participants (58% women) with a broad range of BMI (20-78 kg/m2), with the aim of losing weight over 24 weeks in a multinational field trial. SureMediks consists of a mobile app, an Internet-connected scale, and a discipline of artificial intelligence called Expert system to provide individualized guidance and weight-loss management. RESULTS All participants lost body weight (average 14%, range 4-22%). Almost all (98.7%) participants lost at least 5% of body weight, 75% lost at least 10%, 43% at least 15%, and 9% at least 20%, suggesting that this AI-powered lifestyle intervention was also effective in reducing the burden of obesity co-morbidities. Weight loss was partially positively correlated with female sex, accountability circle size, and participation in challenges, while it was negatively correlated with sub-goal reassignment. The latter three variables are specific features of the SureMediks weight loss program. CONCLUSION An AI-assisted lifestyle intervention allowed people with different body sizes to lose 14% body weight on average, with 99% of them losing more than 5%, over 24 weeks. These results show that digital technologies and AI might provide a successful means to lose weight, before, during, and after pharmacological or surgical therapies.
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Affiliation(s)
| | - John Holden
- Rockford-College of Medicine, University of Illinois, Rockford, IL, 6110, USA
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Wagenaar CA, Toonstra A, Walrabenstein W, van Schaardenburg D, van Nassau F. How the Plants for Joints multidisciplinary lifestyle intervention achieved its effects: a mixed methods process evaluation. BMC Public Health 2024; 24:1034. [PMID: 38615001 PMCID: PMC11016213 DOI: 10.1186/s12889-024-18554-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 04/08/2024] [Indexed: 04/15/2024] Open
Abstract
BACKGROUND Plants for Joints (PFJ) is a multidisciplinary intervention centered around a whole-food plant-based diet, physical activity, and sleep and stress management. The PFJ intervention successfully improved disease activity and symptoms in people with rheumatoid arthritis (RA) or osteoarthritis (OA), respectively, and metabolic health. To investigate how these effects were achieved a mixed methods process evaluation was conducted to understand the context, implementation, and mechanism of impact of the PFJ intervention. Also, the relationship between degree of implementation and lifestyle changes was explored. METHODS Quantitative and qualitative data were collected across the evaluation domains context (i.e. reach), implementation (i.e. recruitment and delivery), and mechanism of impact (i.e. responsiveness) of both the participants and coaches (incl. dietitians, sport coaches) according to the UK MRC guidelines for process evaluations. Data was collected from the participants via focus groups and questionnaires after the intervention, and interviews with coaches. Qualitative data were analyzed thematically, and quantitative data were assessed with descriptive statistics and linear regression analyses. Degree of implementation was quantified using a theory-driven implementation index score composed of different process evaluation constructs. RESULTS Of the 155 participants who participated in the PFJ intervention, 106 (68%) took part in the questionnaire and 34 (22%) attended a focus group. Participants felt the intervention was complete, coherent, and would recommend the intervention to others (mean score 9.2 (SD 1.4) out of 10). Participants felt heard and empowered to take control of their lifestyle and health outcomes. Components perceived as most useful were self-monitoring, social support, practical and theoretical information, and (individual) guidance by the multidisciplinary team. Participants perceived the intervention as feasible, and many indicated it effectively improved their health outcomes. In an explorative analysis there was no significant difference in healthy lifestyle changes across implementation index score groups. CONCLUSION This process evaluation offers important insights into why the PFJ intervention works and how the intervention can be optimized for future implementation. Results indicating the intervention's high satisfaction, feasibility, and perceived effectiveness, further support the use of plant-based lifestyle interventions as an additional treatment option for patients with RA, OA, or other chronic diseases. TRIAL REGISTRATION International Clinical Trial Registry Platform numbers: NL7800, NL7801, and NL7802, all registered 17-06-2019.
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Affiliation(s)
- Carlijn A Wagenaar
- Reade Center for Rheumtology and Rehabilitation, Amsterdam, The Netherlands.
- Department of Clinical Immunology and Rheumatology, Amsterdam University Medical Centers, Universiteit van Amsterdam, Amsterdam, The Netherlands.
- Amsterdam Rheumatology and Immunology Center, Amsterdam, The Netherlands.
| | - Alie Toonstra
- Reade Center for Rheumtology and Rehabilitation, Amsterdam, The Netherlands
| | | | - Dirkjan van Schaardenburg
- Reade Center for Rheumtology and Rehabilitation, Amsterdam, The Netherlands
- Department of Clinical Immunology and Rheumatology, Amsterdam University Medical Centers, Universiteit van Amsterdam, Amsterdam, The Netherlands
- Amsterdam Rheumatology and Immunology Center, Amsterdam, The Netherlands
| | - Femke van Nassau
- Department of Public and Occupational Health, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
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McNaught E, Reale S, Bourke L, Brown JE, Collinson M, Day F, Hewison J, Farrin AJ, Ibeggazene S, Innes AQ, Mason E, Meads D, Scope A, Taylor C, Taylor SJ, Turner RR, Rosario DJ. Supported exercise TrAining for Men wIth prostate caNcer on Androgen deprivation therapy (STAMINA): study protocol for a randomised controlled trial of the clinical and cost-effectiveness of the STAMINA lifestyle intervention compared with optimised usual care, including internal pilot and parallel process evaluation. Trials 2024; 25:257. [PMID: 38610058 PMCID: PMC11010375 DOI: 10.1186/s13063-024-07989-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 02/05/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND UK national clinical guidance recommends that men with prostate cancer on androgen deprivation therapy are offered twice weekly supervised aerobic and resistance exercise to address iatrogenic harm caused by treatment. Very few NHS trusts have established adequate provision of such services. Furthermore, interventions fail to demonstrate sustained behaviour change. The STAMINA lifestyle intervention offers a system-level change to clinical care delivery addressing barriers to long-term behaviour change and implementation of new prostate cancer care pathways. This trial aims to establish whether STAMINA is clinically and cost-effective in improving cancer-specific quality of life and/or reducing fatigue compared to optimised usual care. The process evaluation aims to inform the interpretation of results and, if the intervention is shown to benefit patients, to inform the implementation of the intervention into the NHS. METHODS Men with prostate cancer on androgen deprivation therapy (n = 697) will be identified from a minimum of 12 UK NHS trusts to participate in a multi-centre, two-arm, individually randomised controlled trial. Consenting men will have a 'safety to exercise' check and be randomly allocated (5:4) to the STAMINA lifestyle intervention (n = 384) or optimised usual care (n = 313). Outcomes will be collected at baseline, 3-, 6- and 12-month post-randomisation. The two primary outcomes are cancer-specific quality of life and fatigue. The parallel process evaluation will follow a mixed-methods approach to explore recruitment and aspects of the intervention including, reach, fidelity, acceptability, and implementation. An economic evaluation will estimate the cost-effectiveness of the STAMINA lifestyle intervention versus optimised usual care and a discrete choice experiment will explore patient preferences. DISCUSSION The STAMINA lifestyle intervention has the potential to improve quality of life and reduce fatigue in men on androgen deprivation therapy for prostate cancer. Embedding supervised exercise into prostate cancer care may also support long-term positive behaviour change and reduce adverse events caused by treatment. Findings will inform future clinical care and could provide a blueprint for the integration of supervised exercise and behavioural support into other cancer and/or clinical services. TRIAL REGISTRATION ISRCTN 46385239, registered on 30/07/2020. Cancer Research UK 17002, retrospectively registered on 24/08/2022.
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Affiliation(s)
- Emma McNaught
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS2 9JT, UK
| | - Sophie Reale
- Department of Allied Health Professions, Sheffield Hallam University, Sheffield, S10 2BP, UK
| | - Liam Bourke
- Department of Allied Health Professions, Sheffield Hallam University, Sheffield, S10 2BP, UK
| | - Janet E Brown
- Division of Clinical Medicine, University of Sheffield, Sheffield, S10 2RX, UK
| | - Michelle Collinson
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS2 9JT, UK
| | - Florence Day
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS2 9JT, UK
| | - Jenny Hewison
- Division of Health Services Research, Leeds Institute of Health Sciences, University of Leeds, Leeds, LS2 9JT, UK
| | - Amanda J Farrin
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS2 9JT, UK
| | - Saïd Ibeggazene
- Department of Allied Health Professions, Sheffield Hallam University, Sheffield, S10 2BP, UK
| | - Aidan Q Innes
- Nuffield Health, 2 Ashley Avenue, Epsom, Surrey, KT18 5AL, UK
| | - Ellen Mason
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS2 9JT, UK
| | - David Meads
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, LS2 9JT, UK
| | - Alison Scope
- Department of Allied Health Professions, Sheffield Hallam University, Sheffield, S10 2BP, UK
| | - Chris Taylor
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS2 9JT, UK
| | - Steph Jc Taylor
- Wolfson Institute of Population Health, Queen Mary University of London, Yvonne Carter Building, 58 Turner Street, London, E1 2AB, UK
| | - Rebecca R Turner
- Division of Psychology and Mental Health in the School of Health Sciences, The University of Manchester, Manchester, M13 9PL, UK
| | - Derek J Rosario
- Department of Urology, Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Glossop Road, Sheffield, S10 2JF, UK.
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Snigdha A, Majumdar V, Manjunath NK, Jose A. Yoga-based lifestyle intervention for healthy ageing in older adults: a two-armed, waitlist randomized controlled trial with multiple primary outcomes. GeroScience 2024:10.1007/s11357-024-01149-5. [PMID: 38583114 DOI: 10.1007/s11357-024-01149-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 03/22/2024] [Indexed: 04/08/2024] Open
Abstract
Yoga-based clinical research has shown considerable promise in varied ageing-related health outcomes in older adults. However, robust frameworks have yet to be used in intervention research to endorse yoga as a healthy ageing intervention to test the multidimensional construct of healthy ageing. This was an assessor-masked, randomized controlled trial conducted among 258 sedentary, community-dwelling older adults aged 60-80 years, randomly allocated to 26-week yoga-based intervention (YBI) (n = 132) or waitlist control (WLC) (n = 126). The effectiveness of YBI was assessed through two separate global statistical tests, generalized estimating equations and rank sum-based test, against a comprehensive healthy aging panel comprised of ten markers representing the domains of physiological and metabolic, cognitive, physical capability, psychological, and social well-being. The secondary outcomes were individual primary marker scores, Klotho, inflammatory markers, and auxiliary blood markers. We could establish the healthy aging effect of the 26-week YBI over WLC using two models of global statistical test (GEE, β = 0.29; 95% CI = 0.20 to 0.38, p < 0.001), and rank sum-based test (β = 0.28, 95% CI = 0.19 to 0.36, p < 0.001). There were also significant improvements in direction of benefit at individual levels of all the aging markers. Exploratory evaluation with adopted indices from contemporary clinical trials also validated the potential of YBI for healthy aging; HATICE adapted composite score (mean difference = - 0.18; 95% CI = - 0.26 to - 0.09, p < 0.001) and healthy ageing index (mean difference = - 0.33; 95% CI = - 0.63 to - 0.02, p = 0.03). The global effect of YBI across multiple ageing-related outcomes provides a proof of concept for further large-scale validation. The findings hold a great translational value given the accelerated pace of population aging across the globe. Trial registration: CTRI/2021/02/031373.
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Affiliation(s)
- Atmakur Snigdha
- Division of Life Science, Swami Vivekananda Yoga Anusandhana Samsthana, 560105, Bengaluru, Karnataka, India
| | - Vijaya Majumdar
- Division of Life Science, Swami Vivekananda Yoga Anusandhana Samsthana, 560105, Bengaluru, Karnataka, India.
| | - N K Manjunath
- Division of Life Science, Swami Vivekananda Yoga Anusandhana Samsthana, 560105, Bengaluru, Karnataka, India
| | - Amrutha Jose
- ICMR-National Institute of Immunohematology, 400012, Mumbai, India
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Wells RG, Neilson LE, McHill AW, Hiller AL. Dietary fasting and time-restricted eating in Huntington's disease: therapeutic potential and underlying mechanisms. Transl Neurodegener 2024; 13:17. [PMID: 38561866 PMCID: PMC10986006 DOI: 10.1186/s40035-024-00406-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 02/23/2024] [Indexed: 04/04/2024] Open
Abstract
Huntington's disease (HD) is a devastating neurodegenerative disorder caused by aggregation of the mutant huntingtin (mHTT) protein, resulting from a CAG repeat expansion in the huntingtin gene HTT. HD is characterized by a variety of debilitating symptoms including involuntary movements, cognitive impairment, and psychiatric disturbances. Despite considerable efforts, effective disease-modifying treatments for HD remain elusive, necessitating exploration of novel therapeutic approaches, including lifestyle modifications that could delay symptom onset and disease progression. Recent studies suggest that time-restricted eating (TRE), a form of intermittent fasting involving daily caloric intake within a limited time window, may hold promise in the treatment of neurodegenerative diseases, including HD. TRE has been shown to improve mitochondrial function, upregulate autophagy, reduce oxidative stress, regulate the sleep-wake cycle, and enhance cognitive function. In this review, we explore the potential therapeutic role of TRE in HD, focusing on its underlying physiological mechanisms. We discuss how TRE might enhance the clearance of mHTT, recover striatal brain-derived neurotrophic factor levels, improve mitochondrial function and stress-response pathways, and synchronize circadian rhythm activity. Understanding these mechanisms is critical for the development of targeted lifestyle interventions to mitigate HD pathology and improve patient outcomes. While the potential benefits of TRE in HD animal models are encouraging, future comprehensive clinical trials will be necessary to evaluate its safety, feasibility, and efficacy in persons with HD.
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Affiliation(s)
- Russell G Wells
- Department of Neurology, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA.
| | - Lee E Neilson
- Department of Neurology, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA
- Neurology and PADRECC VA Portland Health Care System, Portland, OR, 97239, USA
| | - Andrew W McHill
- Sleep, Chronobiology and Health Laboratory, School of Nursing, Oregon Health & Science University, Portland, OR, 97239, USA
- Oregon Institute of Occupational Health Sciences, Oregon Health & Sciences University, Portland, OR, 97239, USA
| | - Amie L Hiller
- Department of Neurology, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA
- Neurology and PADRECC VA Portland Health Care System, Portland, OR, 97239, USA
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Leske M, Koczwara B, Blunt J, Morris J, Eakin E, Short CE, Daly A, Degner J, Beatty L. Co-designing Healthy Living after Cancer Online: an online nutrition, physical activity, and psychosocial intervention for post-treatment cancer survivors. J Cancer Surviv 2024; 18:606-616. [PMID: 36374435 PMCID: PMC9660094 DOI: 10.1007/s11764-022-01284-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 10/20/2022] [Indexed: 11/16/2022]
Abstract
PURPOSE The aim of the present study was to co-design Healthy Living after Cancer Online (HLaC Online), an online intervention supporting cancer survivors to set and meet their healthy living goals. METHODS Adapted from an initial telephone-delivered Healthy Living after Cancer program, wireframes (PDF black and white mock-ups) of the proposed online program were presented in a series of focus groups and interviews to our stakeholder group, which consisted of cancer survivors, oncology healthcare professionals, and representatives from cancer support organisations. Stakeholders were prompted for feedback on the wireframe and given end-user scenarios to encourage deeper engagement with the co-design process. Transcriptions underwent thematic analysis to determine which features of the program needed change or expansion. RESULTS 27 participants took part in one of 8 focus groups or 10 interviews. Five themes were identified relating to (a) website design elements, (b) promoting and maintaining long-term engagement, (c) relatability and relevance, (d) navigating professional support, and (e) family and peer support. Recommended changes, such as simple activities and guidance videos, were integrated into the HLaC Online prototype. CONCLUSIONS Involving end-users in the co-design process ensured the intervention's relevance and specificity to the needs of cancer survivors. Next steps include feasibility testing the prototype, prior to commencing a national randomised control trial of HLaC Online. IMPLICATIONS FOR CANCER SURVIVORS HLaC Online aims to support cancer survivors to improve their quality of life by making healthy lifestyle changes in their physical activity, healthy eating, weight management, mental health, and fatigue management.
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Affiliation(s)
- Morgan Leske
- College of Education, Psychology, and Social Work, Flinders University, Adelaide, SA, Australia.
| | - Bogda Koczwara
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
- Department of Medical Oncology, Southern Adelaide Local Health Network, Adelaide, SA, Australia
| | | | | | - Elizabeth Eakin
- School of Public Health, Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Camille E Short
- Melbourne Centre for Behaviour Change, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | | | - Jon Degner
- Cancer Voices South Australia, Kensington Park, SA, Australia
| | - Lisa Beatty
- College of Education, Psychology, and Social Work, Flinders University, Adelaide, SA, Australia
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Minschart C, Myngheer N, Maes T, De Block C, Van Pottelbergh I, Abrams P, Vinck W, Leuridan L, Driessens S, Mathieu C, Billen J, Matthys C, Laenen A, Bogaerts A, Benhalima K. Effectiveness of a blended mobile-based lifestyle intervention in women with glucose intolerance after a recent history of gestational diabetes (MELINDA): a 1-year, prospective, multicentre, randomised controlled trial. EClinicalMedicine 2024; 70:102523. [PMID: 38495521 PMCID: PMC10940944 DOI: 10.1016/j.eclinm.2024.102523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 02/02/2024] [Accepted: 02/20/2024] [Indexed: 03/19/2024] Open
Abstract
Background Women with glucose intolerance after gestational diabetes mellitus (GDM) are at high risk to develop type 2 diabetes. Traditional lifestyle interventions in early postpartum have limited impact. We investigated the efficacy of a blended mobile-based lifestyle intervention in women with glucose intolerance after a recent history of GDM. Methods Prospective, double-arm, non-masked, multicentre randomised controlled trial (RCT) in which women with glucose intolerance, diagnosed 6-16 weeks after a GDM-complicated pregnancy, were assigned 1:1 to a one-year blended-care, telephone- and mobile-based lifestyle program (intervention) or usual care (control). Primary endpoint was the proportion of women able to achieve their weight goal (≥5% weight loss if prepregnancy BMI ≥ 25 kg/m2 or return to prepregnancy weight if prepregnancy BMI < 25 kg/m2) in the intention-to-treat sample. Key secondary outcomes were frequency of glucose intolerance, diabetes and metabolic syndrome, and lifestyle-related outcomes assessed with self-administered questionnaires. The study was registered in ClinicalTrials.gov (NCT03559621). Findings Between April 10th 2019 and May 13th 2022, 240 participants were assigned to the intervention (n = 121) or control group (n = 119), of which 167 (n = 82 in intervention and n = 85 in control group) completed the study. Primary outcome was achieved by 46.3% (56) of intervention participants compared to 43.3% (52) in the control group [odds ratio (OR) 1.13, 95% confidence interval (CI) 0.63-2.03, p = 0.680; risk ratio 1.07, 95% CI (0.78-1.48)]. Women in the intervention group developed significantly less often metabolic syndrome compared to the control group [7.3% (6) vs. 16.5% (14), OR 0.40, CI (0.22-0.72), p = 0.002], reported less sedentary behaviour and higher motivation for continuing healthy behaviours. In the intervention group, 84.1% (69) attended at least eight telephone sessions and 70.7% (58) used the app at least once weekly. Interpretation A blended, mobile-based lifestyle intervention was not effective in achieving weight goals, but reduced the risk to develop metabolic syndrome. Funding Research fund of University Hospitals Leuven, Novo Nordisk, Sanofi, AstraZeneca, Boehringer-Ingelheim, Lilly.
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Affiliation(s)
- Caro Minschart
- Department of Endocrinology, University Hospitals Leuven, Leuven 3000, Belgium
| | - Nele Myngheer
- Department of Endocrinology, General Hospital Groeninge, Kortrijk 8500, Belgium
| | - Toon Maes
- Department of Endocrinology, Imelda Hospital, Bonheiden 2820, Belgium
| | - Christophe De Block
- Department of Endocrinology-Diabetology-Metabolism, Antwerp University Hospital, Edegem 2650, Belgium
| | | | - Pascale Abrams
- Department of Endocrinology, ZAS Sint-Vincentius, Antwerp 2018, Belgium
- Department of Endocrinology, ZAS Sint-Augustinus, Wilrijk 2610, Belgium
| | - Wouter Vinck
- Department of Endocrinology, ZAS Sint-Augustinus, Wilrijk 2610, Belgium
| | - Liesbeth Leuridan
- Department of Endocrinology, General Hospital Klina, Brasschaat 2930, Belgium
| | - Sabien Driessens
- Department of Endocrinology, General Hospital Klina, Brasschaat 2930, Belgium
| | - Chantal Mathieu
- Department of Endocrinology, University Hospitals Leuven, Leuven 3000, Belgium
- Clinical and Experimental Endocrinology, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven 3000, Belgium
| | - Jaak Billen
- Department of Laboratory Medicine, University Hospitals Leuven, Leuven 3000, Belgium
| | - Christophe Matthys
- Department of Endocrinology, University Hospitals Leuven, Leuven 3000, Belgium
- Clinical and Experimental Endocrinology, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven 3000, Belgium
| | - Annouschka Laenen
- Centre of Biostatics and Statistical Bioinformatics, KU Leuven, Leuven 3000, Belgium
| | - Annick Bogaerts
- Department of Development and Regeneration, KU Leuven, Leuven 3000, Belgium
- Faculty of Health, University of Plymouth, Devon PL4 8AA, United Kingdom
| | - Katrien Benhalima
- Department of Endocrinology, University Hospitals Leuven, Leuven 3000, Belgium
- Clinical and Experimental Endocrinology, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven 3000, Belgium
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11
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DiStefano JK, Piras IS, Wu X, Sharma R, Garcia-Mansfield K, Willey M, Lovell B, Pirrotte P, Olson ML, Shaibi GQ. Changes in proteomic cargo of circulating extracellular vesicles in response to lifestyle intervention in adolescents with hepatic steatosis. Clin Nutr ESPEN 2024; 60:333-342. [PMID: 38479932 PMCID: PMC10937812 DOI: 10.1016/j.clnesp.2024.02.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 02/21/2024] [Accepted: 02/22/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND Recent studies suggest that proteomic cargo of extracellular vesicles (EVs) may play a role in metabolic improvements following lifestyle interventions. However, the relationship between changes in liver fat and circulating EV-derived protein cargo following intervention remains unexplored. METHODS The study cohort comprised 18 Latino adolescents with obesity and hepatic steatosis (12 males/6 females; average age 13.3 ± 1.2 y) who underwent a six-month lifestyle intervention. EV size distribution and concentration were determined by light scattering intensity; EV protein composition was characterized by liquid chromatography tandem-mass spectrometry. RESULTS Average hepatic fat fraction (HFF) decreased 23% by the end of the intervention (12.5% [5.5] to 9.6% [4.9]; P = 0.0077). Mean EV size was smaller post-intervention compared to baseline (120.2 ± 16.4 nm to 128.4 ± 16.5 nm; P = 0.031), although the difference in mean EV concentration (1.1E+09 ± 4.1E+08 particles/mL to 1.1E+09 ± 1.8E+08 particles/mL; P = 0.656)) remained unchanged. A total of 462 proteins were identified by proteomic analysis of plasma-derived EVs from participants pre- and post-intervention, with 113 proteins showing differential abundance (56 higher and 57 lower) between the two timepoints (adj-p <0.05). Pathway analysis revealed enrichment in complement cascade, initial triggering of complement, creation of C4 and C2 activators, and regulation of complement cascade. Hepatocyte-specific EV affinity purification identified 40 proteins with suggestive (p < 0.05) differential abundance between pre- and post-intervention samples. CONCLUSIONS Circulating EV-derived proteins, particularly those associated with the complement cascade, may contribute to improvements in liver fat in response to lifestyle intervention.
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Affiliation(s)
- Johanna K DiStefano
- Diabetes and Metabolic Disease Research Unit, Translational Genomics Research Institute, Phoenix, AZ, USA.
| | - Ignazio S Piras
- Neurogenomics Division, Translational Genomics Research Institute, Phoenix, AZ, USA
| | - Xiumei Wu
- Diabetes and Metabolic Disease Research Unit, Translational Genomics Research Institute, Phoenix, AZ, USA
| | - Ritin Sharma
- Integrated Mass Spectrometry Shared Resource, City of Hope Comprehensive Cancer Center, Duarte, CA, USA; Cancer & Cell Biology Division, Translational Genomics Research Institute, Phoenix, AZ, USA
| | - Krystine Garcia-Mansfield
- Integrated Mass Spectrometry Shared Resource, City of Hope Comprehensive Cancer Center, Duarte, CA, USA; Cancer & Cell Biology Division, Translational Genomics Research Institute, Phoenix, AZ, USA
| | - Maya Willey
- Integrated Mass Spectrometry Shared Resource, City of Hope Comprehensive Cancer Center, Duarte, CA, USA; Cancer & Cell Biology Division, Translational Genomics Research Institute, Phoenix, AZ, USA
| | - Brooke Lovell
- Integrated Mass Spectrometry Shared Resource, City of Hope Comprehensive Cancer Center, Duarte, CA, USA; Cancer & Cell Biology Division, Translational Genomics Research Institute, Phoenix, AZ, USA
| | - Patrick Pirrotte
- Integrated Mass Spectrometry Shared Resource, City of Hope Comprehensive Cancer Center, Duarte, CA, USA; Cancer & Cell Biology Division, Translational Genomics Research Institute, Phoenix, AZ, USA
| | - Micah L Olson
- Division of Endocrinology and Diabetes, Phoenix Children's, Phoenix, AZ, USA; Center for Health Promotion and Disease Prevention, Edson College of Nursing, Arizona State University, Phoenix, AZ, USA
| | - Gabriel Q Shaibi
- Division of Endocrinology and Diabetes, Phoenix Children's, Phoenix, AZ, USA; Center for Health Promotion and Disease Prevention, Edson College of Nursing, Arizona State University, Phoenix, AZ, USA
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12
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Zhang PP, Wang YX, Shen FJ, Xing YF, Gu JY, Li XY, Jin H, Jin SF, Xu M, Wang HJ, Wang H, Li L. Lifestyle intervention in children with obesity and nonalcoholic fatty liver disease (NAFLD): study protocol for a randomized controlled trial in Ningbo city (the SCIENT study). Trials 2024; 25:196. [PMID: 38504343 PMCID: PMC10953067 DOI: 10.1186/s13063-024-08046-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 03/08/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND The increasing prevalence of childhood obesity has become an urgent public health problem, evidence showed that intervention for childhood obesity bring enormous health benefits. However, an effective individualized intervention strategy remains to be developed, and the accompanying remission of related complications, such as nonalcoholic fatty liver disease (NAFLD), needs to be assessed. This study aimed to develop an m-Health-assisted lifestyle intervention program targeting overweight/obese children and assess its effectiveness on indicators of adiposity and NAFLD. METHODS This is a cluster-randomized controlled trial that conducted in children with overweight/obesity in Ningbo city, Zhejiang Province, China. Students in Grade 3 (8-10 years old) were recruited from six primary schools, with three be randomized to intervention group and three to usual practice group. The intervention program will last for one academic year and consists of health education, dietary guidance, and physical activity reinforcement. This program is characterized by encouraging four stakeholders, including School, Clinic, famIly, and studENT (SCIENT), to participate in controlling childhood obesity, assisted by m-Health technology. Assessments will be conducted at baseline and 3 months, 9 months, 24 months, and 36 months after baseline. The primary outcome will be the differences between the two groups in students' body mass index and fatty liver index at the end of the intervention (9 months after baseline). During the implementation process, quality control methods will be adopted. DISCUSSION The program will test the effectiveness of the m-Health-assisted lifestyle intervention on children with obesity and NAFLD. The results of this study will provide evidence for establishing effective lifestyle intervention strategy aimed at childhood obesity and NAFLD and may help develop guidelines for the treatment of obesity and NAFLD in Chinese children. TRIAL REGISTRATION Clinicaltrials.gov NCT05482191. Registered on July 2022.
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Affiliation(s)
- Ping-Ping Zhang
- Ningbo Center for Healthy Lifestyle Research, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang Province, 315000, China
| | - You-Xin Wang
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, 100191, China
| | - Fang-Jing Shen
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang Province, 315000, China
| | - Yun-Fei Xing
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, 100191, China
| | - Jia-Ying Gu
- Ningbo Center for Healthy Lifestyle Research, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang Province, 315000, China
| | - Xue-Ying Li
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, 100191, China
| | - Han Jin
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang Province, 315000, China
| | - Shi-Feng Jin
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, 100191, China
| | - Miao Xu
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang Province, 315000, China
| | - Hai-Jun Wang
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, 100191, China
| | - Hui Wang
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, 100191, China.
| | - Li Li
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang Province, 315000, China.
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Ojeda-Rodriguez A, Rangel-Zuñiga OA, Arenas-de Larriva AP, Gutierrez-Mariscal FM, Torres-Peña JD, Romero-Cabrera JL, Podadera-Herreros A, García-Fernandez H, Porras-Pérez E, Luque RM, Kales SN, Perez-Martinez P, Delgado-Lista J, Yubero-Serrano EM, Lopez-Miranda J. Telomere length as biomarker of nutritional therapy for prevention of type 2 diabetes mellitus development in patients with coronary heart disease: CORDIOPREV randomised controlled trial. Cardiovasc Diabetol 2024; 23:98. [PMID: 38493287 PMCID: PMC10944592 DOI: 10.1186/s12933-024-02175-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 02/20/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND Telomere Length (TL), a marker of cellular aging, holds promise as a biomarker to elucidate the molecular mechanism of diabetes. This study aimed to investigate whether shorter telomeres are associated with a higher risk of type 2 diabetes mellitus (T2DM) incidence in patients with coronary heart disease; and to determine whether the most suitable dietary patterns, particularly a Mediterranean diet or a low-fat diet, can mitigate the development of diabetes in these patients after a follow-up period of five years. METHODS The CORonary Diet Intervention with Olive oil and cardiovascular PREVention study (CORDIOPREV study) was a single-centre, randomised clinical trial done at the Reina Sofia University Hospital in Córdoba, Spain. Patients with established coronary heart disease (aged 20-75 years) were randomly assigned in a 1:1 ratio by the Andalusian School of Public Health to receive two healthy diets. Clinical investigators were masked to treatment assignment; participants were not. Quantitative-PCR was used to assess TL measurements. FINDINGS 1002 patients (59.5 ± 8.7 years and 82.5% men) were enrolled into Mediterranean diet (n = 502) or a low-fat diet (n = 500) groups. In this analysis, we included all 462 patients who did not have T2DM at baseline. Among them, 107 patients developed T2DM after a median of 60 months. Cox regression analyses showed that patients at risk of short telomeres (TL < percentile 20th) are more likely to experience T2DM than those at no risk of short telomeres (HR 1.65, p-value 0.023). In terms of diet, patients at high risk of short telomeres had a higher risk of T2DM incidence after consuming a low-fat diet compared to patients at no risk of short telomeres (HR 2.43, 95CI% 1.26 to 4.69, p-value 0.008), while no differences were observed in the Mediterranean diet group. CONCLUSION Patients with shorter TL presented a higher risk of developing T2DM. This association could be mitigated with a specific dietary pattern, in our case a Mediterranean diet, to prevent T2DM in patients with coronary heart disease. TRIAL REGISTRATION Clinicaltrials.gov number NCT00924937.
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Affiliation(s)
- Ana Ojeda-Rodriguez
- Lipids and Atherosclerosis Unit, Internal Medicine Unit, Reina Sofia University Hospital, Cordoba, 14004, Spain
- Department of Medical and Surgical Science, University of Cordoba, Cordoba, 14004, Spain
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Av. Menendez Pidal, s/n, Cordoba, 14004, Spain
- CIBER Fisiopatologia de la Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III, Madrid, 28029, Spain
| | - Oriol A Rangel-Zuñiga
- Lipids and Atherosclerosis Unit, Internal Medicine Unit, Reina Sofia University Hospital, Cordoba, 14004, Spain
- Department of Medical and Surgical Science, University of Cordoba, Cordoba, 14004, Spain
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Av. Menendez Pidal, s/n, Cordoba, 14004, Spain
- CIBER Fisiopatologia de la Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III, Madrid, 28029, Spain
| | - Antonio P Arenas-de Larriva
- Lipids and Atherosclerosis Unit, Internal Medicine Unit, Reina Sofia University Hospital, Cordoba, 14004, Spain
- Department of Medical and Surgical Science, University of Cordoba, Cordoba, 14004, Spain
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Av. Menendez Pidal, s/n, Cordoba, 14004, Spain
- CIBER Fisiopatologia de la Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III, Madrid, 28029, Spain
| | - Francisco M Gutierrez-Mariscal
- Lipids and Atherosclerosis Unit, Internal Medicine Unit, Reina Sofia University Hospital, Cordoba, 14004, Spain
- Department of Medical and Surgical Science, University of Cordoba, Cordoba, 14004, Spain
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Av. Menendez Pidal, s/n, Cordoba, 14004, Spain
- CIBER Fisiopatologia de la Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III, Madrid, 28029, Spain
| | - Jose D Torres-Peña
- Lipids and Atherosclerosis Unit, Internal Medicine Unit, Reina Sofia University Hospital, Cordoba, 14004, Spain
- Department of Medical and Surgical Science, University of Cordoba, Cordoba, 14004, Spain
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Av. Menendez Pidal, s/n, Cordoba, 14004, Spain
- CIBER Fisiopatologia de la Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III, Madrid, 28029, Spain
| | - Juan L Romero-Cabrera
- Lipids and Atherosclerosis Unit, Internal Medicine Unit, Reina Sofia University Hospital, Cordoba, 14004, Spain
- Department of Medical and Surgical Science, University of Cordoba, Cordoba, 14004, Spain
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Av. Menendez Pidal, s/n, Cordoba, 14004, Spain
- CIBER Fisiopatologia de la Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III, Madrid, 28029, Spain
| | - Alicia Podadera-Herreros
- Lipids and Atherosclerosis Unit, Internal Medicine Unit, Reina Sofia University Hospital, Cordoba, 14004, Spain
- Department of Medical and Surgical Science, University of Cordoba, Cordoba, 14004, Spain
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Av. Menendez Pidal, s/n, Cordoba, 14004, Spain
- CIBER Fisiopatologia de la Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III, Madrid, 28029, Spain
| | - Helena García-Fernandez
- Lipids and Atherosclerosis Unit, Internal Medicine Unit, Reina Sofia University Hospital, Cordoba, 14004, Spain
- Department of Medical and Surgical Science, University of Cordoba, Cordoba, 14004, Spain
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Av. Menendez Pidal, s/n, Cordoba, 14004, Spain
- CIBER Fisiopatologia de la Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III, Madrid, 28029, Spain
| | - Esther Porras-Pérez
- Lipids and Atherosclerosis Unit, Internal Medicine Unit, Reina Sofia University Hospital, Cordoba, 14004, Spain
- Department of Medical and Surgical Science, University of Cordoba, Cordoba, 14004, Spain
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Av. Menendez Pidal, s/n, Cordoba, 14004, Spain
- CIBER Fisiopatologia de la Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III, Madrid, 28029, Spain
| | - Raul M Luque
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Av. Menendez Pidal, s/n, Cordoba, 14004, Spain
- CIBER Fisiopatologia de la Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III, Madrid, 28029, Spain
- Department of Cell Biology, Physiology and Immunology, University of Cordoba, Cordoba, 14004, Spain
| | - Stefanos N Kales
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Occupational Medicine, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, USA
| | - Pablo Perez-Martinez
- Lipids and Atherosclerosis Unit, Internal Medicine Unit, Reina Sofia University Hospital, Cordoba, 14004, Spain
- Department of Medical and Surgical Science, University of Cordoba, Cordoba, 14004, Spain
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Av. Menendez Pidal, s/n, Cordoba, 14004, Spain
- CIBER Fisiopatologia de la Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III, Madrid, 28029, Spain
| | - Javier Delgado-Lista
- Lipids and Atherosclerosis Unit, Internal Medicine Unit, Reina Sofia University Hospital, Cordoba, 14004, Spain
- Department of Medical and Surgical Science, University of Cordoba, Cordoba, 14004, Spain
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Av. Menendez Pidal, s/n, Cordoba, 14004, Spain
- CIBER Fisiopatologia de la Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III, Madrid, 28029, Spain
| | - Elena M Yubero-Serrano
- Lipids and Atherosclerosis Unit, Internal Medicine Unit, Reina Sofia University Hospital, Cordoba, 14004, Spain
- Department of Medical and Surgical Science, University of Cordoba, Cordoba, 14004, Spain
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Av. Menendez Pidal, s/n, Cordoba, 14004, Spain
- CIBER Fisiopatologia de la Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III, Madrid, 28029, Spain
| | - Jose Lopez-Miranda
- Lipids and Atherosclerosis Unit, Internal Medicine Unit, Reina Sofia University Hospital, Cordoba, 14004, Spain.
- Department of Medical and Surgical Science, University of Cordoba, Cordoba, 14004, Spain.
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Av. Menendez Pidal, s/n, Cordoba, 14004, Spain.
- CIBER Fisiopatologia de la Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III, Madrid, 28029, Spain.
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Zeng MH, Shi QY, Xu L, Mi YQ. Establishment and validation of an adherence prediction system for lifestyle interventions in non-alcoholic fatty liver disease. World J Gastroenterol 2024; 30:1393-1404. [PMID: 38596499 PMCID: PMC11000086 DOI: 10.3748/wjg.v30.i10.1393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Revised: 01/16/2024] [Accepted: 02/18/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Non-alcoholic fatty liver disease (NAFLD) is the most common liver disease worldwide, affecting about 1/4th of the global population and causing a huge global economic burden. To date, no drugs have been approved for the treatment of NAFLD, making the correction of unhealthy lifestyles the principle method of treatment. Identifying patients with poor adherence to lifestyle correction and attempting to improve their adherence are therefore very important. AIM To develop and validate a scale that can rapidly assess the adherence of patients with NAFLD to lifestyle interventions. METHODS The Exercise and Diet Adherence Scale (EDAS) was designed based on compilation using the Delphi method, and its reliability was subsequently evaluated. Demographic and laboratory indicators were measured, and patients completed the EDAS questionnaire at baseline and after 6 months. The efficacy of the EDAS was evaluated in the initial cohort. Subsequently, the efficacy of the EDAS was internally verified in a validation cohort. RESULTS The EDAS consisted of 33 items in six dimensions, with a total of 165 points. Total EDAS score correlated significantly with daily number of exercise and daily reduction in calorie intake (P < 0.05 each), but not with overall weight loss. A total score of 116 was excellent in predicting adherence to daily reduction in calorie intake (> 500 kacl/d), (sensitivity/specificity was 100.0%/75.8%), while patients score below 97 could nearly rule out the possibility of daily exercise (sensitivity/specificity was 89.5%/44.4%). Total EDAS scores ≥ 116, 97-115, and < 97 points were indicative of good, average, and poor adherence, respectively, to diet and exercise recommendations. CONCLUSION The EDAS can reliably assess the adherence of patients with NAFLD to lifestyle interventions and have clinical application in this population.
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Affiliation(s)
- Ming-Hui Zeng
- Clinical School of the Second People’s Hospital, Tianjin Medical University, Tianjin 300192, China
| | - Qi-Yu Shi
- Department of Gastroenterology, Cangzhou People’s Hospital, Cangzhou 061000, Hebei Province, China
| | - Liang Xu
- Clinical School of the Second People’s Hospital, Tianjin Medical University, Tianjin 300192, China
- Department of Hepatology, Tianjin Second People’s Hospital, Tianjin 300192, China
- Tianjin Research Institute of Liver Diseases, Tianjin 300192, China
| | - Yu-Qiang Mi
- Clinical School of the Second People’s Hospital, Tianjin Medical University, Tianjin 300192, China
- Department of Hepatology, Tianjin Second People’s Hospital, Tianjin 300192, China
- Tianjin Research Institute of Liver Diseases, Tianjin 300192, China
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15
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Lim GP, Appalasamy JR, Ahmad B, Quek KF, Ramadas A. Peer-led lifestyle interventions for the primary prevention of cardiovascular disease in community: a systematic review of randomised controlled trials. BMC Public Health 2024; 24:812. [PMID: 38486215 PMCID: PMC10941612 DOI: 10.1186/s12889-024-18328-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 03/11/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Peer-led lifestyle interventions have gained recognition as effective approaches for managing and preventing chronic diseases. However, there remains a critical knowledge gap regarding the impact and effectiveness of peer-led interventions specifically in the primary prevention of cardiovascular disease (CVD). Our systematic review aims to synthesise the available evidence and evaluate the impact of peer-led lifestyle interventions, providing invaluable insights that can guide the development of peer-led strategies for preventing CVD. METHODS Systematic database searches were conducted on Ovid Medline, Embase, Cochrane Centre for Controlled Trials, PubMed and Scopus to source peer-reviewed articles published between 2013 and 2023. Reference lists of the included publications were also manually searched. RESULTS Fourteen unique randomised controlled trials were identified, of which three were pilot studies. Most of the interventions were conducted among individuals at moderate to high risk of CVD and lasted for a year. There is a variety of components in intervention delivery, including group discussions and individual counselling. Peer leader training mostly covered intervention delivery, communication, and research-specific skills. Systolic blood pressure showed the most promising CVD-related improvement, while mixed results were found for several other dietary and lifestyle behavioural outcomes. CONCLUSION Peer-led lifestyle interventions have shown varying effectiveness in cardiovascular health outcomes. The competencies and roles of peer leaders were identified to guide future intervention development with a more comprehensive approach to the primary prevention of CVD.
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Affiliation(s)
- Geok Pei Lim
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
| | | | - Badariah Ahmad
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
| | - Kia Fatt Quek
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
| | - Amutha Ramadas
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia.
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Gregg EW, Chen H, Bancks MP, Manalac R, Maruthur N, Munshi M, Wing R. Impact of remission from type 2 diabetes on long-term health outcomes: findings from the Look AHEAD study. Diabetologia 2024; 67:459-469. [PMID: 38233592 PMCID: PMC10844408 DOI: 10.1007/s00125-023-06048-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 09/28/2023] [Indexed: 01/19/2024]
Abstract
AIMS/HYPOTHESIS We examined the association of attainment of diabetes remission in the context of a 12 year intensive lifestyle intervention with subsequent incidence of chronic kidney disease (CKD) and CVD. METHODS The Look AHEAD study was a multi-centre RCT comparing the effect of a 12 year intensive lifestyle intervention with that of diabetes support and education on CVD and other long-term health conditions. We compared the incidence of CVD and CKD among 4402 and 4132 participants, respectively, based on achievement and duration of diabetes remission. Participants were 58% female, and had a mean age of 59 years, a duration of diabetes of 6 year and BMI of 35.8 kg/m2. We applied an epidemiological definition of remission: taking no diabetes medications and having HbA1c <48 mmol/mol (6.5%) at a single point in time. We defined high-risk or very high-risk CKD based on the Kidney Disease Improving Global Outcomes (KDIGO) criteria, and CVD incidence as any occurrence of non-fatal acute myocardial infarction, stroke, admission for angina or CVD death. RESULTS Participants with evidence of any remission during follow-up had a 33% lower rate of CKD (HR 0.67; 95% CI 0.52, 0.87) and a 40% lower rate of the composite CVD measure (HR 0.60; 95% CI 0.47, 0.79) in multivariate analyses adjusting for HbA1c, BP, lipid levels, CVD history, diabetes duration and intervention arm, compared with participants without remission. The magnitude of risk reduction was greatest for participants with evidence of longer-term remission. CONCLUSIONS/INTERPRETATION Participants with type 2 diabetes with evidence of remission had a substantially lower incidence of CKD and CVD, respectively, compared with participants who did not achieve remission. This association may be affected by post-baseline improvements in weight, fitness, HbA1c and LDL-cholesterol. TRIAL REGISTRATION ClinicalTrials.gov NCT00017953 DATA AVAILABILITY: https://repository.niddk.nih.gov/studies/look-ahead/.
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Affiliation(s)
- Edward W Gregg
- School of Population Health, Royal College of Surgeons of Ireland, Dublin, Ireland.
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK.
| | - Haiying Chen
- Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Michael P Bancks
- Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Raoul Manalac
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Nisa Maruthur
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Medha Munshi
- Joslin Diabetes Center, Division of Gerontology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Rena Wing
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
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Hadley TS, Wild CEK, Maessen SE, Hofman PL, Derraik JGB, Anderson YC. Changes in weight status of caregivers of children and adolescents enrolled in a community-based healthy lifestyle programme: Five-year follow-up. Obes Res Clin Pract 2024; 18:154-158. [PMID: 38631969 DOI: 10.1016/j.orcp.2024.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 03/14/2024] [Accepted: 03/24/2024] [Indexed: 04/19/2024]
Abstract
Whānau Pakari is a family-centred healthy lifestyle programme for children/adolescents with overweight/obesity in New Zealand. This secondary analysis from our randomised trial within the clinical service assessed 5-year BMI changes in accompanying caregivers (n = 23), mostly mothers. Overall, baseline and 5-year caregivers' BMI were similar (32.50 vs 31.42 kg/m2, respectively; p = 0.31) but two-thirds (65%) experienced BMI reductions. Five-year BMI change was similar in High-intensity and Low-intensity randomisation groups [-1.37 kg/m2 (-4.95, 2.21); p = 0.44]. Caregiver's BMI change was not associated with child's BMI change. Despite no overall BMI reduction, our findings contrast with upward BMI trajectories predicted for NZ adults with overweight/obesity.
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Affiliation(s)
- Thomas S Hadley
- Department of Paediatrics, Health New Zealand | Te Whatu Ora Taranaki, New Plymouth, New Zealand
| | - Cervantée E K Wild
- Department of Paediatrics: Child and Youth Health, Faculty of Medicine and Health Sciences, University of Auckland, New Zealand; Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Sarah E Maessen
- Department of Paediatrics: Child and Youth Health, Faculty of Medicine and Health Sciences, University of Auckland, New Zealand
| | - Paul L Hofman
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - José G B Derraik
- Department of Paediatrics: Child and Youth Health, Faculty of Medicine and Health Sciences, University of Auckland, New Zealand; Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Yvonne C Anderson
- Department of Paediatrics: Child and Youth Health, Faculty of Medicine and Health Sciences, University of Auckland, New Zealand; Curtin Medical School, Faculty of Health Sciences, Curtin University, WA, Australia; Telethon Kids Institute, Perth Children's Hospital, Nedlands, WA, Australia; Child and Adolescent Community Health, Child and Adolescent Health Service, Perth, WA, Australia.
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Hurtado MD, Saadedine M, Kapoor E, Shufelt CL, Faubion SS. Weight Gain in Midlife Women. Curr Obes Rep 2024:10.1007/s13679-024-00555-2. [PMID: 38416337 DOI: 10.1007/s13679-024-00555-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/11/2024] [Indexed: 02/29/2024]
Abstract
PURPOSE OF REVIEW To summarize the evidence and clinical implications of weight and body composition changes during midlife in women and provide an overview of weight gain prevention and management in this population. RECENT FINDINGS Aging-related changes such as decreased energy expenditure and physical activity are important culprits for weight gain in midlife women. The hormonal changes of menopause also influence body adiposity distribution and increase central adiposity. These body changes can have health consequences including the development of cardiometabolic diseases, osteoarthritis, cancer, worsening in cognition, mental health, and menopause symptoms. Midlife women experience changes related to aging, menopause, and lifestyle which favor weight gain. Clinical practice should focus on early counseling and anticipatory guidance on the importance of dietary changes and physical activity to attenuate this phenomenon. Future research should focus on the longitudinal relationship between weight trends in midlife and health consequences and mortality.
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Affiliation(s)
- Maria D Hurtado
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Medicine, Mayo Clinic, Jacksonville, FL, USA
- Precision Medicine for Obesity Program, Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Mariam Saadedine
- Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Jacksonville, FL, USA
- Mayo Clinic Center for Women's Health, Rochester, MN, USA
| | - Ekta Kapoor
- Mayo Clinic Center for Women's Health, Rochester, MN, USA
- Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN, USA
- Women's Health Research Center, Mayo Clinic, Rochester, MN, USA
| | - Chrisandra L Shufelt
- Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Jacksonville, FL, USA
- Mayo Clinic Center for Women's Health, Rochester, MN, USA
| | - Stephanie S Faubion
- Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Jacksonville, FL, USA.
- Mayo Clinic Center for Women's Health, Rochester, MN, USA.
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Sultan MI, Ibrahim SA, Youssef RF. Impact of a Mediterranean diet on prevention and management of urologic diseases. BMC Urol 2024; 24:48. [PMID: 38408996 PMCID: PMC10898175 DOI: 10.1186/s12894-024-01432-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 02/16/2024] [Indexed: 02/28/2024] Open
Abstract
Compared to a Western diet, the Mediterranean diet moves away from red meat and processed foods. Universally regarded as a healthier dietary alternative, the Mediterranean diet has garnered scientific endorsement for its ability to confer an array of compelling benefits. These health benefits encompass not only a lowered incidence of Type 2 diabetes with a reduction in obesity, but also a robust protective effect on cardiovascular health. Extensive literature exists to corroborate these health benefits; however, the impact of a Mediterranean diet on urologic diseases, specifically sexual dysfunction, lower urinary tract symptoms, stone disease, and urologic cancers are not well studied. Understanding how dietary habits may impact these urologic conditions can contribute to improved prevention and treatment strategies.A total of 955 papers from PubMed and Embase were systematically reviewed and screened. After exclusion of disqualified and duplicated studies, 58 studies consisting of randomized controlled trials, cohort studies, cross sectional studies, reviews and other meta-analyses were included in this review. 11 primary studies were related to the impact of a Mediterranean diet on sexual dysfunction, 9 primary studies regarding urinary symptoms, 8 primary studies regarding stone disease, and 9 primary studies regarding urologic cancers. All primary studies included were considered of good quality based on a New-Castle Ottawa scale. The results demonstrate a Mediterranean diet as an effective means to prevent as well as improve erectile dysfunction, nephrolithiasis, lower urinary tract symptoms, and urinary incontinence. The review highlights the need for additional research to study the impact of diet on urologic cancers and other urologic conditions such as premature ejaculation, loss of libido, female sexual dysfunction, and overactive bladder.
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Affiliation(s)
- Mark I Sultan
- Department of Urology, University of California, 3800 Chapman Ave, Suite 7200, Irvine: Orange, CA, 92868, USA
| | - Shady A Ibrahim
- Department of Urology, University of California, 3800 Chapman Ave, Suite 7200, Irvine: Orange, CA, 92868, USA
| | - Ramy F Youssef
- Department of Urology, University of California, 3800 Chapman Ave, Suite 7200, Irvine: Orange, CA, 92868, USA.
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20
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Caldwell AE, Gorczyca AM, Bradford AP, Nicklas JM, Montgomery RN, Smyth H, Pretzel S, Nguyen T, DeSanto K, Ernstrom C, Santoro N. Effectiveness of preconception weight loss interventions on fertility in women: a systematic review and meta-analysis. Fertil Steril 2024:S0015-0282(24)00126-2. [PMID: 38408693 DOI: 10.1016/j.fertnstert.2024.02.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 02/09/2024] [Accepted: 02/19/2024] [Indexed: 02/28/2024]
Abstract
IMPORTANCE Weight loss before conception is recommended for women with overweight or obesity to improve fertility outcomes, but evidence supporting this recommendation is mixed. OBJECTIVE To examine the effectiveness of weight loss interventions using lifestyle modification and/or medication in women with overweight or obesity on pregnancy, live birth, and miscarriage. DATA SOURCES An electronic search of MEDLINE, Embase, Cochrane Library, including Cochrane Database of Systematic Reviews and Cochrane Central Register of Controlled Trials, and Cumulative Index to Nursing and Allied Health Literature was conducted through July 6, 2022, via Wiley. STUDY SELECTION AND SYNTHESIS Randomized controlled trials examining weight loss interventions through lifestyle and/or medication in women with overweight or obesity planning pregnancy were included. Random-effects meta-analysis was conducted, reporting the risk ratio (RR) for each outcome. Subgroup analyses were conducted by intervention type, type of control group, fertility treatment, intervention length, and body mass index (BMI). MAIN OUTCOME(S) Clinical pregnancy, live birth, and miscarriage events. RESULT(S) A narrative review and meta-analysis were possible for 16 studies for pregnancy (n = 3,588), 13 for live birth (n = 3,329), and 11 for miscarriage (n = 3,248). Women randomized and exposed to a weight loss intervention were more likely to become pregnant (RR = 1.24, 95% CI 1.07-1.44; I2 = 59%) but not to have live birth (RR = 1.19, 95% CI 0.97-1.45; I2 = 69%) or miscarriage (RR = 1.17, 95% CI 0.79-1.74; I2 = 31%) compared with women in control groups. Subgroup analyses revealed women randomized to weight loss interventions lasting 12 weeks or fewer (n = 9, RR = 1.43; 95% CI 1.13-1.83) and women with a BMI ≥ 35 kg/m2 (n = 7, RR = 1.54; 95% CI, 1.18-2.02) were more likely to become pregnant compared with women in the control groups. Miscarriage was higher in intervention groups who underwent fertility treatment (n = 8, RR 1.45; 95% CI 1.07-1.96). CONCLUSION(S) Pregnancy rates were higher in women undergoing preconception weight loss interventions with no impact on live birth or miscarriage rates. Findings do not support one-size-fits-all recommendation for weight loss through lifestyle modification and/or medication in women with overweight or obesity immediately before conception to improve live birth or miscarriage outcomes.
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Affiliation(s)
- Ann E Caldwell
- Division of Endocrinology Metabolism and Diabetes, University of Colorado School of Medicine, Aurora, Colorado.
| | - Anna M Gorczyca
- Division of Physical Activity and Weight Management, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Andrew P Bradford
- Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, Colorado
| | - Jacinda M Nicklas
- Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Robert N Montgomery
- Department of Biostatistics & Data Science, University of Kansas Medical Center, Kansas City, Kansas
| | - Heather Smyth
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado-Denver, Colorado
| | | | - Thy Nguyen
- University of Colorado School of Medicine, Aurora, Colorado
| | - Kristen DeSanto
- Strauss Health Sciences Library, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Celia Ernstrom
- University of Colorado School of Medicine, Aurora, Colorado
| | - Nanette Santoro
- Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, Colorado
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21
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Misserian M, Wheelington A, King R, Francis J, Mathew MS, Allicock MA, Cartwright BR, Adewunmi A, Chandrasekhar A, Polavarapu D, Qureshi FG, Barlow SE, Messiah SE. Adaptation of a standardized lifestyle intervention to maximize health outcomes in adolescent metabolic and bariatric surgery patients. J Transl Med 2024; 22:197. [PMID: 38395836 PMCID: PMC10893696 DOI: 10.1186/s12967-024-04953-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 02/03/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Metabolic and bariatric surgery (MBS) is safe and efficacious in treating adolescents with severe obesity. Behavioral/lifestyle programs can support successful preparation for surgery and post-MBS weight loss, but no standardized lifestyle intervention exists for adolescents. Here we describe the process of developing and adapting the Diabetes Prevention Program Group Lifestyle Balance (DPP/GLB) curriculum to support adolescents pre- and post-MBS. METHODS We collected both qualitative and quantitative data from a diverse group of adolescents (N = 19, mean age 15.2 years, range 13-17, 76% female, 42% non-Hispanic Black, 41% Hispanic, 17% other). Additionally, we included data from 13 parents, all of whom were mothers. These participants were recruited from an adolescent MBS program at Children's Health System of Texas. In an online survey, we asked participants to rank their preferences and interests in DPP/GLB content topics. We complemented these results with in-depth interviews from a subset of 10 participants. This qualitative data triangulation informed the development of the TeenLYFT lifestyle intervention program, designed to support adolescents who were completing MBS and described here. This program was adapted from adolescent and parent DPP/GLB content preferences, incorporating the social cognitive model (SCM) and the socioecological model (SEM) constructs to better cater to the needs of adolescent MBS patients. RESULTS Adolescents' top 3 ranked areas of content were: (1) steps to adopt better eating habits and healthier foods; (2) healthy ways to cope with stress; and (3) steps to stay motivated and manage self-defeating thoughts. Nearly all adolescent participants preferred online delivery of content (versus in-person). Mothers chose similar topics with the addition of information on eating healthy outside the home. Key themes from the adolescent qualitative interviews included familial support, body image and self-confidence, and comorbidities as key motivating factors in moving forward with MBS. CONCLUSIONS The feedback provided by both adolescents and parents informed the development of TeenLYFT, an online support intervention for adolescent MBS candidates. The adapted program may reinforce healthy behaviors and by involving parents, help create a supportive environment, increasing the likelihood of sustained behavior change. Understanding adolescent/parent needs to support weight management may also help healthcare providers improve long-term health outcomes for this patient population.
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Affiliation(s)
- Maral Misserian
- School of Health Professions, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Rashon King
- Center for Pediatric Population Health, University of Texas Health Science Center at Houston (UTHealth) School of Public Health, 2777 North Stemmons Freeway, Suite 8400, Dallas, TX, 75390, USA
- UTHealth School of Public Health at Houston, Dallas Campus, Dallas, TX, USA
| | - Jackson Francis
- Center for Pediatric Population Health, University of Texas Health Science Center at Houston (UTHealth) School of Public Health, 2777 North Stemmons Freeway, Suite 8400, Dallas, TX, 75390, USA
- UTHealth School of Public Health at Houston, Dallas Campus, Dallas, TX, USA
| | - M Sunil Mathew
- Center for Pediatric Population Health, University of Texas Health Science Center at Houston (UTHealth) School of Public Health, 2777 North Stemmons Freeway, Suite 8400, Dallas, TX, 75390, USA
- UTHealth School of Public Health at Houston, Dallas Campus, Dallas, TX, USA
| | - Marlyn A Allicock
- UTHealth School of Public Health at Houston, Dallas Campus, Dallas, TX, USA
| | - Bethany R Cartwright
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Touchstone Diabetes Center, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Adejumoke Adewunmi
- Center for Pediatric Population Health, University of Texas Health Science Center at Houston (UTHealth) School of Public Health, 2777 North Stemmons Freeway, Suite 8400, Dallas, TX, 75390, USA
- UTHealth School of Public Health at Houston, Dallas Campus, Dallas, TX, USA
| | - Aparajita Chandrasekhar
- Center for Pediatric Population Health, University of Texas Health Science Center at Houston (UTHealth) School of Public Health, 2777 North Stemmons Freeway, Suite 8400, Dallas, TX, 75390, USA
- UTHealth School of Public Health at Houston, Dallas Campus, Dallas, TX, USA
| | - Dhatri Polavarapu
- Center for Pediatric Population Health, University of Texas Health Science Center at Houston (UTHealth) School of Public Health, 2777 North Stemmons Freeway, Suite 8400, Dallas, TX, 75390, USA
- UTHealth School of Public Health at Houston, Dallas Campus, Dallas, TX, USA
| | - Faisal G Qureshi
- Children's Health System of Texas, Dallas, TX, USA
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Sarah E Barlow
- Children's Health System of Texas, Dallas, TX, USA
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Sarah E Messiah
- Center for Pediatric Population Health, University of Texas Health Science Center at Houston (UTHealth) School of Public Health, 2777 North Stemmons Freeway, Suite 8400, Dallas, TX, 75390, USA.
- UTHealth School of Public Health at Houston, Dallas Campus, Dallas, TX, USA.
- Department of Pediatrics, UTHealth McGovern Medical School, Houston, TX, USA.
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22
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Barbera M, Lehtisalo J, Perera D, Aspö M, Cross M, De Jager Loots CA, Falaschetti E, Friel N, Luchsinger JA, Gavelin HM, Peltonen M, Price G, Neely AS, Thunborg C, Tuomilehto J, Mangialasche F, Middleton L, Ngandu T, Solomon A, Kivipelto M. A multimodal precision-prevention approach combining lifestyle intervention with metformin repurposing to prevent cognitive impairment and disability: the MET-FINGER randomised controlled trial protocol. Alzheimers Res Ther 2024; 16:23. [PMID: 38297399 PMCID: PMC10829308 DOI: 10.1186/s13195-023-01355-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 11/17/2023] [Indexed: 02/02/2024]
Abstract
BACKGROUND Combining multimodal lifestyle interventions and disease-modifying drugs (novel or repurposed) could provide novel precision approaches to prevent cognitive impairment. Metformin is a promising candidate in view of the well-established link between type 2 diabetes (T2D) and Alzheimer's Disease and emerging evidence of its potential neuro-protective effects (e.g. vascular, metabolic, anti-senescence). MET-FINGER aims to test a FINGER 2.0 multimodal intervention, combining an updated FINGER multidomain lifestyle intervention with metformin, where appropriate, in an APOE ε4-enriched population of older adults (60-79 years) at increased risk of dementia. METHODS MET-FINGER is an international randomised, controlled, parallel-group, phase-IIb proof-of-concept clinical trial, where metformin is included through a trial-within-trial design. 600 participants will be recruited at three sites (UK, Finland, Sweden). Participants at increased risk of dementia based on vascular risk factors and cognitive screening, will be first randomised to the FINGER 2.0 intervention (lifestyle + metformin if eligible; active arm) or to receive regular health advice (control arm). Participants allocated to the FINGER 2.0 intervention group at risk indicators of T2D will be additionally randomised to receive metformin (2000 mg/day or 1000 mg/day) or placebo. The study duration is 2 years. The changes in global cognition (primary outcome, using a Neuropsychological Test Battery), memory, executive function, and processing speed cognitive domains; functional status; lifestyle, vascular, metabolic, and other dementia-related risk factors (secondary outcomes), will be compared between the FINGER 2.0 intervention and the control arm. The feasibility, potential interaction (between-groups differences in healthy lifestyle changes), and disease-modifying effects of the lifestyle-metformin combination will be exploratory outcomes. The lifestyle intervention is adapted from the original FINGER trial (diet, physical activity, cognitive training, monitoring of cardiovascular/metabolic risk factors, social interaction) to be consistently delivered in three countries. Metformin is administered as Glucophage®XR/SR 500, (500 mg oral tablets). The metformin/placebo treatment will be double blinded. CONCLUSION MET-FINGER is the first trial combining a multimodal lifestyle intervention with a putative repurposed disease-modifying drug for cognitive impairment prevention. Although preliminary, its findings will provide crucial information for innovative precision prevention strategies and form the basis for a larger phase-III trial design and future research in this field. TRIAL REGISTRATION ClinicalTrials.gov (NCT05109169).
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Affiliation(s)
- Mariagnese Barbera
- Department of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Yliopistonranta 1C, 70211, Kuopio, Finland.
- The Ageing Epidemiology Research Unit, School of Public Health, Imperial College London, Charing Cross Hospital, St Dunstan's Road, LondonLondon, W6 8RP, UK.
| | - Jenni Lehtisalo
- Department of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Yliopistonranta 1C, 70211, Kuopio, Finland
- Population Health Unit, Finnish Institute for Health and Welfare, Mannerheimintie 166, P.O. Box 30, Helsinki, Finland
| | - Dinithi Perera
- The Ageing Epidemiology Research Unit, School of Public Health, Imperial College London, Charing Cross Hospital, St Dunstan's Road, LondonLondon, W6 8RP, UK
- FINGERS Brain Health Institute, C/O Stockholms Sjukhem, Box 122 30, SE-102 26, Stockholm, Sweden
| | - Malin Aspö
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Karolinska Vägen 37A, 171 64, Solna, Sweden
- Theme Inflammation and Aging, Medical Unit Aging, Karolinska University Hospital, Karolinska Vägen 37A, 171 76, Solna, Sweden
| | - Mary Cross
- Imperial Clinical Trials Unit, School of Public Health, Faculty of Medicine, Imperial College London, Imperial College London, Stadium House, 68 Wood Lane, London, W12 7RH, UK
| | - Celeste A De Jager Loots
- The Ageing Epidemiology Research Unit, School of Public Health, Imperial College London, Charing Cross Hospital, St Dunstan's Road, LondonLondon, W6 8RP, UK
| | - Emanuela Falaschetti
- Imperial Clinical Trials Unit, School of Public Health, Faculty of Medicine, Imperial College London, Imperial College London, Stadium House, 68 Wood Lane, London, W12 7RH, UK
| | - Naomi Friel
- The Ageing Epidemiology Research Unit, School of Public Health, Imperial College London, Charing Cross Hospital, St Dunstan's Road, LondonLondon, W6 8RP, UK
| | - José A Luchsinger
- Departments of Medicine and Epidemiology, Columbia University Irving Medical Center, 622 W 168Th St, New York, NY, USA
| | | | - Markku Peltonen
- Population Health Unit, Finnish Institute for Health and Welfare, Mannerheimintie 166, P.O. Box 30, Helsinki, Finland
- FINGERS Brain Health Institute, C/O Stockholms Sjukhem, Box 122 30, SE-102 26, Stockholm, Sweden
| | - Geraint Price
- The Ageing Epidemiology Research Unit, School of Public Health, Imperial College London, Charing Cross Hospital, St Dunstan's Road, LondonLondon, W6 8RP, UK
| | - Anna Stigsdotter Neely
- Department of Social and Psychological Studies, Karlstad University, 651 88, Karlstad, Sweden
- Department of Health, Education and Technology, Luleå University of Technology, 971 87, Luleå, Sweden
| | - Charlotta Thunborg
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Karolinska Vägen 37A, 171 64, Solna, Sweden
- Theme Inflammation and Aging, Medical Unit Aging, Karolinska University Hospital, Karolinska Vägen 37A, 171 76, Solna, Sweden
| | - Jaakko Tuomilehto
- Population Health Unit, Finnish Institute for Health and Welfare, Mannerheimintie 166, P.O. Box 30, Helsinki, Finland
- Department of Public Health, University of Helsinki, PO BOX 20, 00014, Helsinki, Finland
- Diabetes Research Group, King Abdulaziz University, 21589, Jeddah, Saudi Arabia
| | - Francesca Mangialasche
- FINGERS Brain Health Institute, C/O Stockholms Sjukhem, Box 122 30, SE-102 26, Stockholm, Sweden
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Karolinska Vägen 37A, 171 64, Solna, Sweden
- Theme Inflammation and Aging, Medical Unit Aging, Karolinska University Hospital, Karolinska Vägen 37A, 171 76, Solna, Sweden
| | - Lefkos Middleton
- The Ageing Epidemiology Research Unit, School of Public Health, Imperial College London, Charing Cross Hospital, St Dunstan's Road, LondonLondon, W6 8RP, UK
- Directorate of Public Health, Imperial College NHS Healthcare Trust Hospitals, Praed Street, London, W2 1NY, UK
| | - Tiia Ngandu
- Population Health Unit, Finnish Institute for Health and Welfare, Mannerheimintie 166, P.O. Box 30, Helsinki, Finland
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Karolinska Vägen 37A, 171 64, Solna, Sweden
| | - Alina Solomon
- Department of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Yliopistonranta 1C, 70211, Kuopio, Finland.
- The Ageing Epidemiology Research Unit, School of Public Health, Imperial College London, Charing Cross Hospital, St Dunstan's Road, LondonLondon, W6 8RP, UK.
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Karolinska Vägen 37A, 171 64, Solna, Sweden.
| | - Miia Kivipelto
- The Ageing Epidemiology Research Unit, School of Public Health, Imperial College London, Charing Cross Hospital, St Dunstan's Road, LondonLondon, W6 8RP, UK
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Karolinska Vägen 37A, 171 64, Solna, Sweden
- Theme Inflammation and Aging, Medical Unit Aging, Karolinska University Hospital, Karolinska Vägen 37A, 171 76, Solna, Sweden
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Yliopistonranta 1C, 70211, Kuopio, Finland
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Leske M, Galanis C, Koczwara B, Beatty L. A meta-analysis of healthy lifestyle interventions addressing quality of life of cancer survivors in the post treatment phase. J Cancer Surviv 2024:10.1007/s11764-023-01514-x. [PMID: 38206430 DOI: 10.1007/s11764-023-01514-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 12/13/2023] [Indexed: 01/12/2024]
Abstract
PURPOSE This study's primary aim was to investigate whether including a mental health component to healthy lifestyle interventions are associated with greater effects on quality of life (QoL) for post-treatment cancer survivors than addressing physical activity and/or nutrition alone. METHODS PsycINFO, Scopus, Medline, CINAHL, and Google Scholar were searched to identify randomised control trials of healthy lifestyle interventions for post-treatment cancer survivors, with a usual care or waitlist control, and measured QoL. Meta-analyses quantified the effects of interventions vs controls at post-treatment on total QoL, physical, emotional, and social well-being. Subgroup analyses compared interventions with vs without a mental health component, modes of delivery, and duration. The quality of the included studies was assessed using the Cochrane Risk of Bias 2. RESULTS Eighty-eight papers evaluating 110 interventions were included: 66 effect sizes were extracted for meta-analysis, and 22 papers were narratively synthesised. The pooled effect size demonstrated a small, significant effect of healthy lifestyle interventions in comparison to control for all QoL outcomes (total g = 0.32, p >.001; physical g = 0.19, p = 0.05; emotional g = 0.20, p >.001; social g = 0.18, p = 0.01). There was no significant difference between interventions with vs without a mental health component. Face-to-face delivered interventions were associated with greater total QoL and physical well-being compared to other modalities. Interventions delivered ≤12 weeks were associated with greater physical well-being than those delivered ≥13 weeks. Overall, studies had substantial levels of heterogeneity and 55.9% demonstrated high risk of bias. CONCLUSIONS Participating in a healthy lifestyle intervention following cancer treatment improves QoL. Few trials addressed mental health or evaluated online or telephone modalities; future research should develop and evaluate interventions that utilise these features. IMPLICATIONS FOR CANCER SURVIVORS Brief healthy lifestyle interventions can be recommended for cancer survivors, particularly those interested in improving physical well-being.
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Affiliation(s)
- Morgan Leske
- College of Education, Psychology, and Social Work, Flinders University, Adelaide, SA, Australia.
| | - Christina Galanis
- College of Education, Psychology, and Social Work, Flinders University, Adelaide, SA, Australia
| | - Bogda Koczwara
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
- Department of Medical Oncology, Southern Adelaide Local Health Network, Adelaide, SA, Australia
| | - Lisa Beatty
- College of Education, Psychology, and Social Work, Flinders University, Adelaide, SA, Australia
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24
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Rodriguez-Ayllon M, Verdejo-Roman J, Lesnovskaya A, Mora-Gonzalez J, Solis-Urra P, Catena A, Erickson KI, Ortega FB, Esteban-Cornejo I. The effects of physical activity on white matter microstructure in children with overweight or obesity: The ActiveBrains randomized clinical trial. Int J Clin Health Psychol 2024; 24:100426. [PMID: 38125983 PMCID: PMC10730345 DOI: 10.1016/j.ijchp.2023.100426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 11/23/2023] [Indexed: 12/23/2023] Open
Abstract
Background Emerging research supports the idea that physical activity benefits brain development. However, the body of evidence focused on understanding the effects of physical activity on white matter microstructure during childhood is still in its infancy, and further well-designed randomized clinical trials are needed. Aim This study aimed: (i) to investigate the effects of a 20-week physical activity intervention on global white matter microstructure in children with overweight or obesity, and (ii) to explore whether the effect of physical activity on white matter microstructure is global or restricted to a particular set of white matter bundles. Methods In total, 109 children aged 8 to 11 years with overweight or obesity were randomized and allocated to either the physical activity program or the control group. Data were collected from November 2014 to June 2016, with diffusion tensor imaging (DTI) data processing and analyses conducted between June 2017 and November 2021. Images were pre-processed using the Functional Magnetic Resonance Imaging (MRI) of the Brain´s Software Library (FSL) and white matter properties were explored by probabilistic fiber tractography and tract-based spatial statistics (TBSS). Results Intention-to-treat analyses were performed for all children who completed the pre-test and post-test DTI assessment, with good quality DTI data (N = 89). Of them, 83 children (10.06±1.11 years, 39 % girls, intervention group=44) met the per-protocol criteria (attended at least 70 % of the recommended sessions). Our probabilistic fiber tractography analysis did not show any effects in terms of global and tract-specific fractional anisotropy (FA) and mean diffusivity (MD) in the per-protocol or intention-to-treat analyses. Additionally, we did not observe any effects on the voxel-wise DTI parameters (i.e., FA and MD) using the most restricted TBSS approach (i.e., per protocol analyses and p-corrected image with a statistical threshold of p < 0.05). In the intention-to-treat analysis, we found that our physical activity program had a borderline effect (p-corrected image with a statistical threshold of p < 0.1) on 7 different clusters, including a cluster in the corpus callosum. Conclusion We conclude that a 20-week physical activity intervention was not enough to induce changes in global and tract-specific white matter during childhood. The effects of physical activity on white matter microstructure could be restricted to local changes in several white matter tracts (e.g., the body of the corpus callosum). However, our results were not significant, and more interventions are needed to determine whether and how physical activity affects white matter microstructure during childhood.
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Affiliation(s)
- Maria Rodriguez-Ayllon
- Department of Physical Education and Sports, Faculty of Sport Sciences, Sport and Health University Research Institute (iMUDS), University of Granada, Granada, Spain
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Juan Verdejo-Roman
- Department of Personality, Assessment, and Psychological Treatment, Mind, Brain and Behavior Research Center (CIMCYC), University of Granada, Granada, Spain
| | - Alina Lesnovskaya
- Department of Psychology, Center for the Neural Basis of Cognition, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jose Mora-Gonzalez
- Department of Physical Education and Sports, Faculty of Sport Sciences, Sport and Health University Research Institute (iMUDS), University of Granada, Granada, Spain
| | - Patricio Solis-Urra
- Department of Physical Education and Sports, Faculty of Sport Sciences, Sport and Health University Research Institute (iMUDS), University of Granada, Granada, Spain
- Faculty of Education and Social Sciences, Universidad Andres Bello, Viña del Mar 2531015, Chile
- Servicio de Medicina Nuclear, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Andrés Catena
- Department of Experimental Psychology, University of Granada, Granada, Spain
| | - Kirk I. Erickson
- Department of Psychology, Center for the Neural Basis of Cognition, University of Pittsburgh, Pittsburgh, PA, USA
- AdventHealth Research Institute, Neuroscience, Orlando, FL, USA
| | - Francisco B Ortega
- Department of Physical Education and Sports, Faculty of Sport Sciences, Sport and Health University Research Institute (iMUDS), University of Granada, Granada, Spain
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
- Physiopathology of Obesity and Nutrition Research Center (CIBERobn), Institute of Health Carlos III (ISCIII), Madrid, Spain
| | - Irene Esteban-Cornejo
- Department of Physical Education and Sports, Faculty of Sport Sciences, Sport and Health University Research Institute (iMUDS), University of Granada, Granada, Spain
- Servicio de Medicina Nuclear, Hospital Universitario Virgen de las Nieves, Granada, Spain
- Physiopathology of Obesity and Nutrition Research Center (CIBERobn), Institute of Health Carlos III (ISCIII), Madrid, Spain
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25
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Zhang MZ, Shi JX, Li H, Chen R, Zheng MB, Yan LJ, Wu NJ, He QQ. The impact of educational lifestyle intervention on body weight and psychological health among overweight/obese patients with severe mental disorders. J Affect Disord 2023; 343:71-76. [PMID: 37741469 DOI: 10.1016/j.jad.2023.09.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 08/29/2023] [Accepted: 09/18/2023] [Indexed: 09/25/2023]
Abstract
BACKGROUND There was a high prevalence of overweight/obesity among patients with severe mental disorders (SMD). However, studies on the lifestyle-based interventions in patients with SMD are limited. OBJECTIVE To examine the effects of an educational lifestyle intervention on body weight and psychological health among Chinese community-dwelling overweight/obese patients with SMD. METHODS Community-dwelling overweight/obese patients with SMD was recruited from Shenzhen, China in October 2020. They were randomly allocated into intervention group (IG) and control group (CG). Participants in IG received a 12-month educational lifestyle intervention, while the CG was exposed to routine care. A generalized estimating equation model was used to assess the effect of the intervention over time. RESULTS A total of 176 subjects (88 in IG and 88 in CG) aged 42.2 ± 10.9 years were included in this study. After adjusting for potential confounders, body weight (p = 0.001), body mass index (BMI, p = 0.001), and waist circumference (p = 0.027) in IG significantly decreased compared with CG after 12 months. Besides, IG had significantly higher life satisfaction than CG after intervention (p = 0.026), whereas significant reductions in depressive symptoms were observed in IG from 26.1 % at baseline to 13.6 % after the intervention (p = 0.027), and the between-group differences were marginally significant (p = 0.086). CONCLUSION An educational lifestyle intervention can effectively reduce body weight parameters and improve psychological health in overweight/obese patients with SMD.
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Affiliation(s)
- Min-Zhe Zhang
- School of Public Health, Wuhan University, Wuhan, PR China
| | - Jun-Xia Shi
- Center of Prevention and Control of Pingshan, Shenzhen, PR China
| | - Hui Li
- Medical Department, Taixing People's Hospital, Jiangsu, PR China
| | - Rui Chen
- School of Public Health, Wuhan University, Wuhan, PR China
| | - Miao-Bing Zheng
- School of Nutrition and Exercise, Deakin University, Melbourne, Australia
| | - Li-Jing Yan
- Global Health Research Center, Duke Kunshan University, Suzhou, PR China
| | - Neng-Jian Wu
- Center of Prevention and Control of Pingshan, Shenzhen, PR China
| | - Qi-Qiang He
- School of Public Health, Wuhan University, Wuhan, PR China; Hubei Biomass-Resource Chemistry and Environmental Biotechnology Key Laboratory, Wuhan University, Wuhan, PR China.
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26
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Al-Mhanna SB, Rocha-Rodriguesc S, Mohamed M, Batrakoulis A, Aldhahi MI, Afolabi HA, Yagin FH, Alhussain MH, Gülü M, Abubakar BD, Ghazali WSW, Alghannam AF, Badicu G. Effects of combined aerobic exercise and diet on cardiometabolic health in patients with obesity and type 2 diabetes: a systematic review and meta-analysis. BMC Sports Sci Med Rehabil 2023; 15:165. [PMID: 38049873 PMCID: PMC10696788 DOI: 10.1186/s13102-023-00766-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 11/06/2023] [Indexed: 12/06/2023]
Abstract
BACKGROUND Lifestyle modifications involving diet and exercise are recommended for patients diagnosed with obesity and type 2 diabetes mellitus (T2DM). The purpose of this review was to systematically evaluate the effects of combined aerobic exercise and diet (AEDT) on various cardiometabolic health-related indicators among individuals with obesity and T2DM. METHODOLOGY A comprehensive search of the PubMed/Medline, Web of Science, Scopus, Science Direct, Cochrane, and Google Scholar databases was conducted for this meta-analysis. The Cochrane risk of bias tool was used to evaluate eligible studies, and the GRADE tool was used to rate the certainty of evidence. A random-effects model for continuous variables was used, and the results were presented as mean differences or standardised mean differences with 95% confidence intervals. RESULTS A total of 16,129 studies were retrieved; 20 studies were included, and data were extracted from 1,192 participants. The findings revealed significant improvements in body mass index, body weight, waist circumference, systolic blood pressure, diastolic blood pressure, total cholesterol, triglycerides, fasting blood glucose, fasting plasma insulin, glycated hemoglobin, leptin, interleukin-6, C-reactive protein, and adiponectin (p < 0.05) compared to the standard treatment (ST) group. No significant differences were observed between the AEDT and ST groups in fat mass, hip circumference, waist-to-hip ratio, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and tumor necrosis factor-alpha. The present findings are based on low- to moderate-quality evidence. CONCLUSIONS AEDT may be a critical behavior for holistic cardiometabolic health-related benefits as a contemporary anti-obesity medication due to its significant positive impact on patients with obesity and T2DM. Nevertheless, further robust evidence is necessary to determine whether AEDT is an effective intervention for lowering cardiovascular and metabolic risk factors among individuals with obesity and T2DM.
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Affiliation(s)
- Sameer Badri Al-Mhanna
- Center for Global Health Research, Saveetha Medical College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, New Delhi, India
- Department of Physiology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, 16150, Malaysia
| | - Sílvia Rocha-Rodriguesc
- Escola Superior Desporto e Lazer, Instituto Politécnico de Viana do Castelo, Viana do Castelo, Portugal
- Tumour & Microenvironment Interactions Group, INEB- Institute of Biomedical Engineering, i3S-Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
| | - Mahaneem Mohamed
- Department of Physiology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, 16150, Malaysia
| | - Alexios Batrakoulis
- Department of Physical Education and Sport Science, School of Physical Education, Sport Science and Dietetics, University of Thessaly, Trikala, Greece
| | - Monira I Aldhahi
- Department of Rehabilitation, College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Hafeez Abiola Afolabi
- Department of General Surgery, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Fatma Hilal Yagin
- Department of Biostatistics and Medical Informatics, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Maha H Alhussain
- Department of Food Science and Nutrition, College of Food and Agricultural Science, King Saud University, Riyadh, Saudi Arabia
| | - Mehmet Gülü
- Department of Sports Management, Faculty of Sport Sciences, Kirikkale University, Kirikkale, Turkey
| | - Bishir Daku Abubakar
- Department of Human Physiology, Federal University Dutse, Dutse, Jigawa State, Nigeria
| | - Wan Syaheedah Wan Ghazali
- Department of Physiology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, 16150, Malaysia.
| | - Abdullah F Alghannam
- Lifestyle and Health Research Center, Health Sciences Research Center, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Georgian Badicu
- Department of Physical Education and Special Motricity, Transilvania University of Brasov, Brasov, Romania
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27
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Pyatak EA, Ali A, Khurana AR, Lee PJ, Sideris J, Fox S, Diaz J, Granados G, Blanchard J, McGuire R, Salazar Plascencia E, Salcedo-Rodriguez E, Flores-Garcia J, Linderman M, Taylor EE, Tapia V, Nnoli N, Sequeira PA, Freeby MJ, Raymond JK. Research design and baseline participant characteristics of the Resilient, Empowered, Active Living with Diabetes - Telehealth (REAL-T) Study: A randomized controlled trial for young adults with type 1 diabetes. Contemp Clin Trials 2023; 135:107386. [PMID: 37931702 PMCID: PMC10846480 DOI: 10.1016/j.cct.2023.107386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 10/16/2023] [Accepted: 11/03/2023] [Indexed: 11/08/2023]
Abstract
BACKGROUND Type 1 diabetes (T1D) is a chronic condition affecting nearly 1.9 million people in the United States. Young adults (YAs) with T1D face unique challenges in managing their condition, experiencing poorer health and well-being than other age groups. The current study is evaluating the Resilient, Empowered, Active Living (REAL) intervention, previously shown to improve glucose levels and quality of life among YAs with diabetes, using telehealth delivery (REAL-T) to expand reach and accessibility. This paper reports on the methodology and baseline participant characteristics of the REAL-T study. METHODS REAL-T is a two-arm randomized controlled trial that recruited 18-30 year olds with T1D via clinics and social media advertising. Data collection, which was adapted to be fully remote due to COVID-19, occurs every three months for one year. Participants receive either usual care or a 6-month telehealth occupational therapy intervention. The primary outcome is glycated hemoglobin (A1c); secondary outcomes include diabetes distress, quality of life, and continuous glucose monitor-derived measures. RESULTS The study enrolled a diverse sample of 209 YAs with T1D. Analysis of baseline data indicates equivalence between the intervention and control groups. Study participants have notably higher diabetes distress and poorer mental well-being than similar populations. CONCLUSION The REAL-T study successfully adapted to remote implementation during the COVID-19 pandemic. By examining long-term outcomes, mediating pathways, and cost-effectiveness, the study will contribute knowledge of the impact of tailored interventions for YAs with T1D, designed to reduce disparities and improve health and well-being in this population.
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Affiliation(s)
- Elizabeth A Pyatak
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, United States of America.
| | - Aina Ali
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, United States of America
| | - Anya R Khurana
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, United States of America
| | - Pey-Jiuan Lee
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, United States of America
| | - John Sideris
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, United States of America
| | - Steven Fox
- Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, United States of America
| | - Jesus Diaz
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, United States of America
| | - Gabrielle Granados
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, United States of America
| | - Jeanine Blanchard
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, United States of America
| | - Riley McGuire
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, United States of America
| | - Elia Salazar Plascencia
- Alpha Clinic, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States of America
| | | | | | - Megan Linderman
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, United States of America
| | - Elinor E Taylor
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, United States of America
| | - Valerie Tapia
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, United States of America
| | - Ngozi Nnoli
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, United States of America
| | - Paola A Sequeira
- Department of Endocrinology, Los Angeles General Medical Center, Los Angeles, CA, United States of America
| | - Matthew J Freeby
- David Geffen UCLA School of Medicine, Los Angeles, CA, United States of America
| | - Jennifer K Raymond
- Alpha Clinic, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States of America; Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States of America
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28
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Wadden TA, Chao AM, Moore M, Tronieri JS, Gilden A, Amaro A, Leonard S, Jakicic JM. The Role of Lifestyle Modification with Second-Generation Anti-obesity Medications: Comparisons, Questions, and Clinical Opportunities. Curr Obes Rep 2023; 12:453-473. [PMID: 38041774 DOI: 10.1007/s13679-023-00534-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/22/2023] [Indexed: 12/03/2023]
Abstract
PURPOSE OF REVIEW This review examines lifestyle modification for obesity management with the goal of identifying treatment components that could support the use of a new generation of anti-obesity medications (AOMs). RECENT FINDINGS Semaglutide reliably reduces baseline body weight by approximately 15% at 68 weeks, in contrast to 5-10% for lifestyle modification. Tirzepatide induces mean losses as great as 20.9%. Both medications reduce energy intake by markedly enhancing satiation and decreasing hunger, and they appear to lessen the need for traditional cognitive and behavioral strategies (e.g., monitoring food intake) to achieve calorie restriction. Little, however, is known about whether patients who lose weight with these AOMs adopt healthy diet and activity patterns needed to optimize body composition, cardiometabolic health, and quality of life. When used with the new AOMs, the focus of lifestyle modification is likely to change from inducing weight loss (through calorie restriction) to facilitating patients' adoption of dietary and activity patterns that will promote optimal changes in body composition and overall health.
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Affiliation(s)
- Thomas A Wadden
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, 3535 Market Street, Suite 3027, Philadelphia, PA, 19104, USA.
| | - Ariana M Chao
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | - Molly Moore
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, 3535 Market Street, Suite 3027, Philadelphia, PA, 19104, USA
| | - Jena S Tronieri
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, 3535 Market Street, Suite 3027, Philadelphia, PA, 19104, USA
| | - Adam Gilden
- Department of Medicine, University of Colorado School of Medicine, Denver, CO, USA
| | - Anastassia Amaro
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Sharon Leonard
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, 3535 Market Street, Suite 3027, Philadelphia, PA, 19104, USA
| | - John M Jakicic
- Department of Medicine, Medical Center, Kansas University, Kansas City, KS, USA
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29
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Donovan LM, McDowell JA, Pannick AP, Pai J, Bais AF, Plumley R, Wai TH, Grunwald GK, Josey K, Sayre GG, Helfrich CD, Zeliadt SB, Hoerster KD, Ma J, Au DH. Protocol for a pragmatic trial testing a self-directed lifestyle program targeting weight loss among patients with obstructive sleep apnea (POWER Trial). Contemp Clin Trials 2023; 135:107378. [PMID: 37935303 DOI: 10.1016/j.cct.2023.107378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 10/23/2023] [Accepted: 11/03/2023] [Indexed: 11/09/2023]
Abstract
BACKGROUND Obesity comprises the single greatest reversible risk factor for obstructive sleep apnea (OSA). Despite the potential of lifestyle-based weight loss services to improve OSA severity and symptoms, these programs have limited reach. POWER is a pragmatic trial of a remote self-directed weight loss care among patients with OSA. METHODS POWER randomizes 696 patients with obesity (BMI 30-45 kg/m2) and recent diagnosis or re-confirmation of OSA 1:1 to either a self-directed weight loss intervention or usual care. POWER tests whether such an intervention improves co-primary outcomes of weight and sleep-related quality of life at 12 months. Secondary outcomes include sleep symptoms, global ratings of change, and cardiovascular risk scores. Finally, consistent with a hybrid type 1 approach, the trial embeds an implementation process evaluation. We will use quantitative and qualitative methods including budget impact analyses and qualitative interviews to assess barriers to implementation. CONCLUSIONS The results of POWER will inform population health approaches to the delivery of weight loss care. A remote self-directed program has the potential to be disseminated widely with limited health system resources and likely low-cost.
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Affiliation(s)
- Lucas M Donovan
- Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA; University of Washington, Seattle, WA, USA.
| | - Jennifer A McDowell
- Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA
| | - Anna P Pannick
- Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA
| | - James Pai
- Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA; Tulane University, New Orleans, LA, USA
| | - Anthony F Bais
- Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA
| | - Robert Plumley
- Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA
| | | | | | | | - George G Sayre
- Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA
| | - Christian D Helfrich
- Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA; University of Washington, Seattle, WA, USA
| | - Steven B Zeliadt
- Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA; University of Washington, Seattle, WA, USA
| | - Katherine D Hoerster
- Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA; University of Washington, Seattle, WA, USA
| | - Jun Ma
- University of Illinois Chicago, Chicago, IL, USA
| | - David H Au
- Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA; University of Washington, Seattle, WA, USA
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30
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Haemer M, Tong S, Bracamontes P, Gritz M, Osborn B, Perez-Jolles M, Shomaker L, Steen E, Studts C, Boles R. Randomized-controlled trial of a whole-family obesity prevention and treatment intervention designed for low-income Hispanic families: HeLP the healthy living program. Contemp Clin Trials 2023; 135:107359. [PMID: 37852530 PMCID: PMC10842075 DOI: 10.1016/j.cct.2023.107359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 10/06/2023] [Accepted: 10/15/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND Low-income Hispanic families face marked disparities in obesity, but interventions for obesity prevention and treatment have rarely been designed with this population as a focus. Hispanic culture is characterized by Familism, a value that prioritizes familial respect, cooperation, and togetherness. We describe the rationale and design of a trial of the Healthy Living Program (HeLP), a bilingual whole-family behavioral obesity prevention and treatment intervention designed around the value Familism and addressing food insecurity. METHODS/DESIGN This two-group randomized comparative effectiveness trial will compare the effects of HeLP versus a primary care counseling intervention (Recommended Treatment of Obesity in Primary Care, or RTOP) on decreasing body mass index (BMI; kg/m2) in Hispanic children 2-16 years of age with obesity and preventing BMI increase among siblings without obesity. 164 families per arm will be recruited from primary care practices. Families randomized to HeLP will participate in 12 two-hour sessions, followed by booster sessions. HeLP sessions include family meals and instruction in parenting skills, nutrition, culinary skills, fitness, and mindfulness delivered at community recreation centers by bilingual health educators and athletic trainers. Families randomized to RTOP will be offered individual visits in primary care every 3 months throughout the 18-month follow-up period. Secondary outcomes include changes to objectively measured child fitness, the home environment related to nutrition, physical activity, and media usage, food insecurity, child eating behaviors, quality of life, parent BMI and waist circumference, and implementation outcomes. DISCUSSION This protocol paper describes the rationale and planned methods for the comparative effectiveness trial. TRIAL REGISTRATION Clinicaltrials.gov Identifier NCT05041855 (6/13/2023).
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Affiliation(s)
- Matthew Haemer
- University of Colorado Anschutz Medical Campus, 13001 E 17th Pl, Aurora, CO 80045, USA.
| | - Suhong Tong
- University of Colorado Anschutz Medical Campus, 13001 E 17th Pl, Aurora, CO 80045, USA
| | - Perla Bracamontes
- University of Colorado Anschutz Medical Campus, 13001 E 17th Pl, Aurora, CO 80045, USA
| | - Mark Gritz
- University of Colorado Anschutz Medical Campus, 13001 E 17th Pl, Aurora, CO 80045, USA; University of Colorado Anschutz Medical Campus, Adult and Child Center for Outcomes Research and Delivery Science, 1890 N Revere Ct, Aurora, CO 80045, USA
| | - Brandon Osborn
- University of Colorado Anschutz Medical Campus, 13001 E 17th Pl, Aurora, CO 80045, USA
| | - Monica Perez-Jolles
- University of Colorado Anschutz Medical Campus, 13001 E 17th Pl, Aurora, CO 80045, USA; University of Colorado Anschutz Medical Campus, Adult and Child Center for Outcomes Research and Delivery Science, 1890 N Revere Ct, Aurora, CO 80045, USA
| | - Lauren Shomaker
- University of Colorado Anschutz Medical Campus, 13001 E 17th Pl, Aurora, CO 80045, USA; Colorado State University, Department of Human Development and Family Studies, 410 Pitkin St., Fort Collins, Co 80523, USA
| | - Emily Steen
- University of Colorado Anschutz Medical Campus, 13001 E 17th Pl, Aurora, CO 80045, USA
| | - Christina Studts
- University of Colorado Anschutz Medical Campus, 13001 E 17th Pl, Aurora, CO 80045, USA; University of Colorado Anschutz Medical Campus, Adult and Child Center for Outcomes Research and Delivery Science, 1890 N Revere Ct, Aurora, CO 80045, USA
| | - Richard Boles
- University of Colorado Anschutz Medical Campus, 13001 E 17th Pl, Aurora, CO 80045, USA
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Abstract
Lifestyle intervention is an alluring concept. Changing behaviors to reduce food intake and increase energy expenditure will reduce body weight and body fat. Large randomized clinical trials in academic settings demonstrate lifestyle intervention can produce weight loss and significant health benefits. However, they also demonstrate the problems-not all participants are able to lose even 5%, and weight regain is common. Studies conducted in real-world settings achieve modest weight loss, but no reimbursement model supports it. Health care providers need to understand the benefits and limitations of lifestyle intervention delivery in the medical office setting.
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Affiliation(s)
- Donna H Ryan
- Pennington Biomedical Research Center, 6400 Perkins Road, Baton Rouge, LA 70808, USA.
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Mushcab H, Al Mutairi A, Al Matroud A, Dossary S, Ghamdi MJ. A lifestyle intervention to prevent hypertension in primary healthcare settings: A Saudi Arabian feasibility study. Prev Med Rep 2023; 36:102487. [PMID: 38021415 PMCID: PMC10661115 DOI: 10.1016/j.pmedr.2023.102487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 10/29/2023] [Accepted: 10/30/2023] [Indexed: 12/01/2023] Open
Abstract
Background Hypertension is a leading cause of morbidity and mortality in Saudi Arabia, causing a significant public health challenge in the kingdom. In this study, we aimed to assess the feasibility of the Blood pressure LifeStyle Management (BLSM) program for preventing hypertension by making a significant changes in lifestyle interventions through controlling some risk factors such as behavior, diet, physical activities, and weight in Primary Care. Aim The aim of this study is to evaluate the effectiveness of the Blood pressure LifeStyle Management (BLSM) program in reducing blood pressure. Methods This is a cohort of three-month period feasibility study in a primary care setting in a before-and-after study design. Results A total of 100 individuals were recruited for the study, and 73 have completed the program. The overall systolic (SBP) and diastolic (DBP) blood pressure showed an increment of 0.75 and 1.67 mmHg, respectively. The subgroup analysis exhibited a decrease in SBP (-6.5 mmHg) for patients with hyperlipidemia, while a DBP average increased (+2 mmHg). Females showed a decrease in SBP (-1.04 mmHg) compared to males, who increased in their SBP (+1.69). Smokers showed a significant improvement in SBP and DBP with p < 0.05. Conclusion Lifestyle intervention can improve and control blood pressure in primary care settings. The program can be tailored to include more participants, the length of the program could be modified, and the frequency of follow-ups could be increased to enable participants to change their habits and incorporate better life choices in their daily routines.
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Affiliation(s)
- Hayat Mushcab
- Research Office, Johns Hopkins Aramco Healthcare, Dhahran, Eastern Province, Saudi Arabia
| | - Abdullah Al Mutairi
- Population Health Department, Johns Hopkins Aramco Healthcare, Dhahran, Eastern Province, Saudi Arabia
| | - Ashwaq Al Matroud
- Population Health Department, Johns Hopkins Aramco Healthcare, Dhahran, Eastern Province, Saudi Arabia
| | - Sheikha Dossary
- Population Health Department, Johns Hopkins Aramco Healthcare, Dhahran, Eastern Province, Saudi Arabia
| | - Mohammed J. Ghamdi
- Population Health Department, Johns Hopkins Aramco Healthcare, Dhahran, Eastern Province, Saudi Arabia
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Hanley SJ, Varley I, Sale C, Elliott-Sale KJ. Experiences of Physical Activity, Healthy Eating and Quality of Life During and Following Pregnancy in Overweight and Obese Postpartum Women. Matern Child Health J 2023; 27:1968-1980. [PMID: 37314671 PMCID: PMC10564817 DOI: 10.1007/s10995-023-03684-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2023] [Indexed: 06/15/2023]
Abstract
OBJECTIVES This retrospective study explored the experiences of women with overweight or obesity regarding physical activity, diet and quality of life leading up to, during, and following pregnancy. METHODS A qualitative descriptive design was adopted, whereby data collected through semi-structured interviews were analysed using thematic analysis. Throughout the interviews, individuals were asked to describe their barriers to a healthy lifestyle during and following pregnancy. RESULTS Ten women (34.5 ± 5.2 years old, BMI 30.4 ± 3.5 kg·m- 2) who were between 12 and 52 weeks postpartum participated. A range of themes were identified when discussing barriers to physical activity and healthy eating during and following pregnancy. For example, tiredness, especially in the third trimester of pregnancy, and a lack of support at home, was often cited as preventing engagement in exercise and healthy eating practices. A lack of convenience when attending exercise classes, medical complications following the birth and the cost of attending pregnancy-specific classes were identified as barriers to exercise engagement. Cravings and nausea were identified as barriers to healthy eating during pregnancy. Quality of life was positively associated with exercise and healthy eating, whilst a lack of sleep, loneliness and a loss of freedom since the baby had arrived negatively influenced quality of life. DISCUSSION Postpartum women with overweight and obesity experience many barriers when attempting to engage in a healthy lifestyle during and following pregnancy. These findings can be used to inform the design and delivery of future lifestyle interventions in this population.
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Affiliation(s)
- Stephanie J Hanley
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Ian Varley
- Sport Health and Performance Enhancement Research Centre, School of Science and Technology, Nottingham Trent University, Clifton Campus, Clifton Lane, NG11 8NS, Nottingham, England
| | - Craig Sale
- Department of Sport and Exercise Sciences , Manchester Metropolitan University Institute of Sport, Manchester, United Kingdom
| | - Kirsty J Elliott-Sale
- Department of Sport and Exercise Sciences , Manchester Metropolitan University Institute of Sport, Manchester, United Kingdom.
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Kutzinski M, Krause N, Riemann-Lorenz K, Meyer B, Heesen C. Acceptability of a digital health application to empower persons with multiple sclerosis with moderate to severe disability: single-arm prospective pilot study. BMC Neurol 2023; 23:382. [PMID: 37872471 PMCID: PMC10591383 DOI: 10.1186/s12883-023-03434-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 10/11/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND Many persons with multiple sclerosis (pwMS) desire to learn how health behaviour changes (e.g., dietary adjustments, physical activity, improvements in stress management) might help them manage their disease. Previous research has shown that certain health behaviour changes can improve quality of life (QoL), fatigue and other MS outcomes. Digital health applications may be well suited to deliver relevant health behavioural interventions because of their accessibility and flexibility. The digital health application "levidex" was designed to facilitate health behaviour change by offering evidence-based patient information and cognitive-behavioural therapy techniques to pwMS. By doing so, levidex aims to improve QoL and MS symptoms such as fatigue and mental health. OBJECTIVES A previous study reported on the development of levidex; this non-randomised pilot study examined the feasibility (practicability and acceptability) of levidex in pwMS with moderate to severe disability. Furthermore, the intervention's impact on empowerment, stress management, and relevant health behaviours (e.g., dietary behaviour, physical activity) was explored. METHODS levidex was originally developed for newly diagnosed pwMS in the first year after diagnosis and eventually modified to offer access to pwMS with moderate to severe disability. Participants (n = 43) with an Expanded Disability Status Scale between 3.5 and 7.5 and a disease duration of more than one year were eligible to participate. The intervention was used over a period of six months with measurement time points at baseline, month 3 and month 6. RESULTS Out of 38 participants who completed the six-month intervention period, 18 (47.4%) completed all 16 modules and 9 (23.7%) reached modules 13-16, the long-term maintenance part of levidex. Participants rated levidex positively in terms of practicability and acceptability and had only few points of criticism such as to include more physical exercise routine suggestions suitable for participants with severe impairment. Data on secondary endpoints showed no significant changes. CONCLUSION This pilot study provided evidence for the practicability and acceptability of levidex, a digital health application designed to facilitate health behaviour change in pwMS with moderate to severe disability. Adequately powered randomised controlled studies with longer follow-up periods are needed to clarify the benefit of levidex in pwMS with moderate to severe disability. TRIAL REGISTRATION German Clinical Trials Register (DRKS) DRKS00032667 (14/09/2023); Retrospectively registered.
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Affiliation(s)
- Max Kutzinski
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - Nicole Krause
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - Karin Riemann-Lorenz
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Björn Meyer
- Research and Development Department, GAIA Group, Hamburg, Germany
| | - Christoph Heesen
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
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Patel ML, Rodriguez Espinosa P, King AC. Moderators of a Diet and Physical Activity Intervention: who Responds Best to Sequential vs. Simultaneous Approaches. Int J Behav Med 2023:10.1007/s12529-023-10223-9. [PMID: 37816943 PMCID: PMC11004089 DOI: 10.1007/s12529-023-10223-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2023] [Indexed: 10/12/2023]
Abstract
BACKGROUND Given that low physical activity levels and poor dietary intake are co-occurring risk factors for chronic disease, there is a need for interventions that target both health behaviors, either sequentially or simultaneously. Little is known about participant characteristics that are associated with better or worse response to sequential and simultaneous interventions. METHOD The 12-month Counseling Advice for Lifestyle Management (CALM) randomized trial (N = 150; Mage = 55.3 years) targeted these two behaviors either via a sequential approach - dietary advice first then exercise advice added ("Diet-First") or exercise advice first then dietary advice added ("Exercise-First") - or via a simultaneous approach. The objective was to examine demographic, clinical, and psychosocial moderators of intervention effects on 12-month change in (1) moderate-to-vigorous physical activity (MVPA), (2) fruit/vegetable intake, (3) caloric intake from saturated fat, and (4) weight. Hierarchical regressions first compared Diet-First to Exercise-First, followed by comparisons of these arms combined ("sequential") to the simultaneous arm. RESULTS Older age, higher baseline BMI, and lower social support were associated with higher MVPA in Exercise-First vs. Diet-First, while lower tangible support was associated with higher fruit/vegetable intake in Exercise-First but not in Diet-First. Poor sleep was associated with higher levels of MVPA in the sequential arm than in the simultaneous arm. Lower vitality was associated with greater weight loss in the sequential arm than in the simultaneous arm, while the opposite was true for those who were not married. CONCLUSION Identifying moderators of treatment response can allow the behavioral medicine field to enhance intervention efficacy by matching participant subgroups to their best-fitting interventions. TRIAL REGISTRATION NCT00131105.
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Affiliation(s)
- Michele L Patel
- Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, CA, USA.
| | | | - Abby C King
- Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, CA, USA
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, USA
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36
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Koschker AC, Warrings B, Morbach C, Seyfried F, Jung P, Dischinger U, Edelmann F, Herrmann MJ, Stier C, Frantz S, Malzahn U, Störk S, Fassnacht M. Effect of bariatric surgery on cardio-psycho-metabolic outcomes in severe obesity: A randomized controlled trial. Metabolism 2023; 147:155655. [PMID: 37393945 DOI: 10.1016/j.metabol.2023.155655] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 06/28/2023] [Accepted: 06/29/2023] [Indexed: 07/04/2023]
Abstract
OBJECTIVE Randomized evidence comparing the cardiovascular effects of surgical and conservative weight management is lacking. PATIENTS & METHODS In this single-center, open-label randomized trial, obese patients with indication for Roux-en-Y gastric bypass (RYGB) and able to perform treadmill cardiopulmonary exercise testing (CPET) were included. After a 6-12 month run-in phase of multimodal anti-obesity treatment, patients were randomized to RYGB or psychotherapy-enhanced lifestyle intervention (PELI) and co-primary endpoints were assessed 12 months later. Thereafter, PELI patients could opt for surgery and patients were reassessed 24 months after randomization. Co-primary endpoints were mean change (95 % confidence intervals) in peak VO2 (ml/min/kg body weight) in CPET and the physical functioning scale (PFS) of the Short Form health survey (SF-36). RESULTS Of 93 patients entering the study, 60 were randomized. Among these (median age 38 years; 88 % women; mean BMI 48·2 kg/m2), 46 (RYGB: 22 and PELI: 24) were evaluated after 12 months. Total weight loss was 34·3 % after RYGB vs. 1·2 % with PELI, while peak VO2 increased by +4·3 ml/min/kg (2·7, 5·9) vs +1·1 ml/min/kg (-0·2, 2·3); p < 0·0001. Respective improvement in PFS score was +40 (30, 49) vs +10 (1, 15); p < 0·0001. 6-minute walking distance also favored the RYGB group: +44 m (17, 72) vs +6 m (-14, 26); p < 0·0001. Left ventricular mass decreased after RYGB, but not with PELI: -32 g (-46, -17) vs 0 g (-13,13); p < 0·0001. In the non-randomized follow-up, 34 patients were assessed. Favorable changes were sustained in the RYGB group and were repeated in the 15 evaluated patients that opted for surgery after PELI. CONCLUSIONS Among adults with severe obesity, RYGB in comparison to PELI resulted in improved cardiopulmonary capacity and quality of life. The observed effect sizes suggest that these changes are clinically relevant.
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Affiliation(s)
- Ann-Cathrin Koschker
- Dept. Internal Medicine I, Division of Endocrinology and Diabetology, University Hospital, University of Würzburg, Würzburg, Germany; Dept. Clinical Research & Epidemiology, Comprehensive Heart Failure Center, University Hospital, University of Würzburg, Würzburg, Germany.
| | - Bodo Warrings
- Dept. Clinical Research & Epidemiology, Comprehensive Heart Failure Center, University Hospital, University of Würzburg, Würzburg, Germany; Dept. Psychiatry, Psychosomatics, and Psychotherapy, Center for Mental Health, University Hospital, University of Würzburg, Würzburg, Germany
| | - Caroline Morbach
- Dept. Clinical Research & Epidemiology, Comprehensive Heart Failure Center, University Hospital, University of Würzburg, Würzburg, Germany; Dept. of Internal Medicine I, Division of Cardiology, University Hospital, University of Würzburg, Würzburg, Germany
| | - Florian Seyfried
- Dept. General, Visceral, Transplant, Vascular, and Pediatric Surgery, University Hospital, University of Würzburg, Würzburg, Germany
| | - Pius Jung
- Dept. Internal Medicine I, Division of Pneumology, University Hospital, University of Würzburg, Würzburg, Germany
| | - Ulrich Dischinger
- Dept. Internal Medicine I, Division of Endocrinology and Diabetology, University Hospital, University of Würzburg, Würzburg, Germany
| | - Frank Edelmann
- Dept. Internal Medicine and Cardiology, Campus Virchow Klinikum, Charité University Medicine Berlin, Berlin, Germany; German Centre for Cardiovascular research (DZHK), Partner Site Berlin, Germany
| | - Martin J Herrmann
- Dept. Clinical Research & Epidemiology, Comprehensive Heart Failure Center, University Hospital, University of Würzburg, Würzburg, Germany; Dept. Psychiatry, Psychosomatics, and Psychotherapy, Center for Mental Health, University Hospital, University of Würzburg, Würzburg, Germany
| | - Christine Stier
- Dept. Internal Medicine I, Division of Endocrinology and Diabetology, University Hospital, University of Würzburg, Würzburg, Germany; Dept. General, Visceral, Transplant, Vascular, and Pediatric Surgery, University Hospital, University of Würzburg, Würzburg, Germany
| | - Stefan Frantz
- Dept. Clinical Research & Epidemiology, Comprehensive Heart Failure Center, University Hospital, University of Würzburg, Würzburg, Germany; Dept. of Internal Medicine I, Division of Cardiology, University Hospital, University of Würzburg, Würzburg, Germany
| | - Uwe Malzahn
- Center for Clinical Trials, University Hospital Würzburg, Würzburg, Germany
| | - Stefan Störk
- Dept. Clinical Research & Epidemiology, Comprehensive Heart Failure Center, University Hospital, University of Würzburg, Würzburg, Germany; Dept. of Internal Medicine I, Division of Cardiology, University Hospital, University of Würzburg, Würzburg, Germany
| | - Martin Fassnacht
- Dept. Internal Medicine I, Division of Endocrinology and Diabetology, University Hospital, University of Würzburg, Würzburg, Germany; Dept. Clinical Research & Epidemiology, Comprehensive Heart Failure Center, University Hospital, University of Würzburg, Würzburg, Germany
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Maurus I, Roell L, Lembeck M, Papazova I, Greska D, Muenz S, Wagner E, Campana M, Schwaiger R, Schneider-Axmann T, Rosenberger K, Hellmich M, Sykorova E, Thieme CE, Vogel BO, Harder C, Mohnke S, Huppertz C, Roeh A, Keller-Varady K, Malchow B, Walter H, Wolfarth B, Wölwer W, Henkel K, Hirjak D, Schmitt A, Hasan A, Meyer-Lindenberg A, Falkai P. Exercise as an add-on treatment in individuals with schizophrenia: Results from a large multicenter randomized controlled trial. Psychiatry Res 2023; 328:115480. [PMID: 37716320 DOI: 10.1016/j.psychres.2023.115480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 09/07/2023] [Accepted: 09/09/2023] [Indexed: 09/18/2023]
Abstract
Current treatment methods do not achieve recovery for most individuals with schizophrenia, and symptoms such as negative symptoms and cognitive deficits often persist. Aerobic endurance training has been suggested as a potential add-on treatment targeting both physical and mental health. We performed a large-scale multicenter, rater-blind, parallel-group randomized controlled clinical trial in individuals with stable schizophrenia. Participants underwent a professionally supervised six-month training comprising either aerobic endurance training (AET) or flexibility, strengthening, and balance training (FSBT, control group), follow-up was another six months. The primary endpoint was all-cause discontinuation (ACD); secondary endpoints included effects on psychopathology, cognition, functioning, and cardiovascular risk. In total, 180 participants were randomized. AET was not superior to FSBT in ACD and most secondary outcomes, with dropout rates of 59.55% and 57.14% in the six-month active phase, respectively. However, both groups showed significant improvements in positive, general, and total symptoms, levels of functioning and in cognitive performance. A higher training frequency additionally promoted further memory domains. Participants with higher baseline cognitive abilities were more likely to respond to the interventions. Our results support integrating exercise into schizophrenia treatment, while future studies should aim to develop personalized training recommendations to maximize exercise-induced benefits.
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Affiliation(s)
- Isabel Maurus
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany.
| | - Lukas Roell
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany; Neuroimaging Core Unit Munich (NICUM), University Hospital, LMU Munich, Munich, Germany
| | - Moritz Lembeck
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Irina Papazova
- Department of Psychiatry, Psychotherapy and Psychosomatics of the University Augsburg, Medical Faculty, University of Augsburg, Bezirkskrankenhaus Augsburg, Augsburg, Germany
| | - David Greska
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Susanne Muenz
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Elias Wagner
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Mattia Campana
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Rebecca Schwaiger
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Thomas Schneider-Axmann
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Kerstin Rosenberger
- Institute of Medical Statistics and Computational Biology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Martin Hellmich
- Institute of Medical Statistics and Computational Biology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Eliska Sykorova
- Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Germany
| | - Cristina E Thieme
- Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Germany
| | - Bob O Vogel
- Department of Psychiatry and Psychotherapy, University Hospital Charité Berlin, Berlin, Germany
| | - Carolin Harder
- Department of Psychiatry and Psychotherapy, University Hospital Charité Berlin, Berlin, Germany
| | - Sebastian Mohnke
- Department of Psychiatry and Psychotherapy, University Hospital Charité Berlin, Berlin, Germany
| | - Charlotte Huppertz
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Germany
| | - Astrid Roeh
- Department of Psychiatry, Psychotherapy and Psychosomatics of the University Augsburg, Medical Faculty, University of Augsburg, Bezirkskrankenhaus Augsburg, Augsburg, Germany
| | | | - Berend Malchow
- Department of Psychiatry and Psychotherapy, University Hospital Göttingen, Göttingen, Germany
| | - Henrik Walter
- Department of Psychiatry and Psychotherapy, University Hospital Charité Berlin, Berlin, Germany
| | - Bernd Wolfarth
- Department of Sports Medicine, University Hospital Charité Berlin, Berlin, Germany
| | - Wolfgang Wölwer
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Duesseldorf, Germany
| | - Karsten Henkel
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Germany
| | - Dusan Hirjak
- Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Germany
| | - Andrea Schmitt
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany; Laboratory of Neuroscience (LIM27), Institute of Psychiatry, University of Sao Paulo, São Paulo, Brazil
| | - Alkomiet Hasan
- Department of Psychiatry, Psychotherapy and Psychosomatics of the University Augsburg, Medical Faculty, University of Augsburg, Bezirkskrankenhaus Augsburg, Augsburg, Germany
| | | | - Peter Falkai
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany; Max Planck Institute of Psychiatry, Munich, Germany
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Sauder KA, Gamalski K, DeRoeck J, Vasquez FP, Dabelea D, Glueck DH, Catenacci VA, Fabbri S, Ritchie ND. A pre-conception clinical trial to reduce intergenerational obesity and diabetes risks: The NDPP-NextGen trial protocol. Contemp Clin Trials 2023; 133:107305. [PMID: 37516162 PMCID: PMC11044980 DOI: 10.1016/j.cct.2023.107305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 06/28/2023] [Accepted: 07/26/2023] [Indexed: 07/31/2023]
Abstract
BACKGROUND Intrauterine exposure to maternal overweight/obesity or diabetes transmits risks to offspring, perpetuating a disease cycle across generations. Prenatal interventions to reduce maternal weight or dysglycemia have limited impact, while postpartum interventions can alter the intrauterine environment only if child-bearing continues. Efficacious preconception interventions are needed, especially for underserved populations, and with the potential to be scaled up sustainably. Research is also needed to assess intervention effects at conception, throughout pregnancy, and among offspring. METHODS This two-arm, parallel randomized clinical trial will include 360 biological females with overweight/obesity and moderate-to-high likelihood of pregnancy within 24 months. Participants will be randomized 1:1 to a yearlong pre-conception lifestyle intervention based on the National Diabetes Prevention Program (NDPP-NextGen) or usual care. Data collection will occur at enrollment (before conception), post-conception (<8 weeks gestation), late pregnancy (28-32 weeks gestation), and delivery (before discharge) for participants who become pregnant within 24 months of enrollment. Main outcomes are post-conception body mass index (<8 weeks gestation; primary outcome), post-conception fasting glucose (<8 weeks gestation; secondary outcome), and neonatal adiposity (<2 days post-birth). Additional clinical, behavioral, perinatal and offspring data will be collected, and biospecimens (blood, urine, stool, cord blood) will be banked for future ancillary studies. CONCLUSION This clinical trial will evaluate an intervention model (NDPP-NextGen) with potential to improve maternal health among the >50% of US females with overweight/obesity or diabetes risks in pregnancy. If successful, it can be scaled among >1800 organizations delivering NDPP in the United States to benefit the health of future generations.
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Affiliation(s)
- Katherine A Sauder
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Anschutz Medical Campus, 1890 N Revere Court F426, Aurora, CO 80045, USA; Department of Pediatrics, University of Colorado School of Medicine, 12348 E Montview Blvd C263, Aurora, CO 80045, USA; Department of Epidemiology, Colorado School of Public Health, 13001 E 17th Pl B119, Aurora, CO 80045, USA.
| | - Katharine Gamalski
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Anschutz Medical Campus, 1890 N Revere Court F426, Aurora, CO 80045, USA.
| | - Jayna DeRoeck
- Office of Research, Denver Health and Hospital Authority, 777 Bannock Street, Denver, CO 80204, USA.
| | - Fatima Pacheco Vasquez
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Anschutz Medical Campus, 1890 N Revere Court F426, Aurora, CO 80045, USA.
| | - Dana Dabelea
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Anschutz Medical Campus, 1890 N Revere Court F426, Aurora, CO 80045, USA; Department of Pediatrics, University of Colorado School of Medicine, 12348 E Montview Blvd C263, Aurora, CO 80045, USA; Department of Epidemiology, Colorado School of Public Health, 13001 E 17th Pl B119, Aurora, CO 80045, USA.
| | - Deborah H Glueck
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Anschutz Medical Campus, 1890 N Revere Court F426, Aurora, CO 80045, USA; Department of Pediatrics, University of Colorado School of Medicine, 12348 E Montview Blvd C263, Aurora, CO 80045, USA.
| | - Victoria A Catenacci
- Department of Medicine, University of Colorado Anschutz Medical Campus, 12348 E Montview Blvd C263, Aurora, CO 80045, USA.
| | - Stefka Fabbri
- Department of Obstetrics and Gynecology, Denver Health and Hospital Authority, 777 Bannock Street, Denver, CO 80204, USA.
| | - Natalie D Ritchie
- Office of Research, Denver Health and Hospital Authority, 777 Bannock Street, Denver, CO 80204, USA.
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Mallorquí A, Oliveira C, Rios J, Isla-Pera MP, Gil-Badenes J, Amoretti S, Bernardo M, Vieta E, Parellada E, Garriga M, García-Rizo C. Nurse-led lifestyle intervention in a cohort of schizophrenia patients treated with clozapine. Arch Psychiatr Nurs 2023; 46:51-57. [PMID: 37813503 DOI: 10.1016/j.apnu.2023.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 06/06/2023] [Accepted: 06/18/2023] [Indexed: 10/17/2023]
Abstract
Patients diagnosed with schizophrenia are characterized by early mortality compared to the general population. The main cause of this premature death reflects medical complications linked to metabolic syndrome (MetS). The use of antipsychotics such as clozapine is associated with weight gain and metabolic disturbances in certain predisposed individuals. Non-pharmacological interventions for weight control have become a key element for secondary prevention in the health of patients diagnosed with schizophrenia. Here, we aim to evaluate the physical health effects of a nurse-led non-pharmacological intervention program in patients with a diagnosis of schizophrenia treated with clozapine. Thirty-one outpatients from the outpatient clinical facility of Hospital Clinic in Barcelona, Spain diagnosed with schizophrenia and other psychotic disorders receiving clozapine treatment were enrolled in a prospective interventional study, comprising an 8-week group program of therapeutic education in a healthy lifestyle. MetS factors, physical activity, diet, and lifestyle were evaluated at baseline, post-intervention (8 weeks), and 3 months after the program. Weight, body mass index, high-density lipoprotein cholesterol, and diet patterns displayed significant differences post-intervention and after 3 months, while only waist, hip perimeter, and lifestyle improved post-intervention. Our results suggest the effectiveness of the lifestyle intervention in patients under clozapine treatment despite its long-time differential effect. Strategies to prevent weight gain and metabolic decline will help prevent premature cardiometabolic disease in this vulnerable population.
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Affiliation(s)
- Andrea Mallorquí
- Neurosciences Institute, Hospital Clinic of Barcelona, Barcelona, Spain; Jaume I University, Castellón, Spain.
| | | | - Jose Rios
- Medical Statistics Core Facility, Hospital Clinic Barcelona, Barcelona, Spain; Biostatistics Unit, Faculty of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Maria Pilar Isla-Pera
- Public Health, Mental Health and Maternal Department, Universitat de Barcelona, Campus de Bellvitge, L'Hospitalet del Llobregat, Barcelona, Spain
| | - Joaquin Gil-Badenes
- Barcelona Clinic Schizophrenia Unit (BCSU), Neurosciences Institute, Hospital Clinic Barcelona, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
| | - Silvia Amoretti
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute (VHIR), Barcelona, Catalonia, Spain; Group of Psychiatry, Mental Health and Addictions, Psychiatric Genetics Unit, Barcelona, Spain; Biomedical Network Research Centre on Mental Health (CIBERSAM), Barcelona, Spain
| | - Miguel Bernardo
- Barcelona Clinic Schizophrenia Unit (BCSU), Neurosciences Institute, Hospital Clinic Barcelona, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
| | - Eduard Vieta
- Bipolar and Depressive Disorders Unit, Neurosciences Institute, Hospital Clinic Barcelona, Barcelona, Spain; University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain
| | - Eduard Parellada
- Barcelona Clinic Schizophrenia Unit (BCSU), Neurosciences Institute, Hospital Clinic Barcelona, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
| | - Marina Garriga
- Bipolar and Depressive Disorders Unit, Neurosciences Institute, Hospital Clinic Barcelona, Barcelona, Spain; University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain.
| | - Clemente García-Rizo
- Barcelona Clinic Schizophrenia Unit (BCSU), Neurosciences Institute, Hospital Clinic Barcelona, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
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Connerton CS, Theuri S. NEWSTART: An 8-Week Faith-Based Health Promotion Program to Reduce Chronic Disease Risk Factors in the US. J Relig Health 2023; 62:3175-3187. [PMID: 37326768 DOI: 10.1007/s10943-023-01849-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/31/2023] [Indexed: 06/17/2023]
Abstract
This single-group experimental study examined the effectiveness of NEWSTART, an 8-week health promotion program among adults in an Adventist Faith Community. Participants had a significant reduction in diastolic blood pressure [Formula: see text] with a moderate effect size (Cohen d = 0.68), reduction of daily sugar-sweetened beverage intake [Formula: see text] with a large effect size (Cohen d = 0.96), and an improvement in weekly moderate intensity exercise [Formula: see text] with a large effect size (Cohen d = .83). Participants met the fruit and vegetable intake recommendations and applying program principles to reduce chronic disease risk factors.
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Affiliation(s)
- Charlotte S Connerton
- Department of Nursing, University of Southern Indiana, 8600 University Blvd, Evansville, IN, 47712, USA.
| | - Serah Theuri
- Department of Food and Nutrition, University of Southern Indiana, 8600 University Blvd, Evansville, IN, 47712, USA
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Coppock JA, McNulty AL, Porter Starr KN, Holt AG, Borack MS, Kosinski AS, Collins AT, Bales CW, DeFrate LE. The effects of a 6-month weight loss intervention on physical function and serum biomarkers in older adults with and without osteoarthritis. Osteoarthr Cartil Open 2023; 5:100376. [PMID: 37719442 PMCID: PMC10499923 DOI: 10.1016/j.ocarto.2023.100376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 05/17/2023] [Indexed: 09/19/2023] Open
Abstract
Objective To examine the effects of a 6-month weight loss intervention on physical function, inflammatory biomarkers, and metabolic biomarkers in both those with and without osteoarthritis (OA). Design 59 individuals ≥60 years old with obesity and a functional impairment were enrolled into this IRB approved clinical trial and randomized into one of two 6-month weight loss arms: a higher protein hypocaloric diet or a standard protein hypocaloric diet. All participants were prescribed individualized 500-kcal daily-deficit diets, with a goal of 10% weight loss. Additionally, participants participated in three, low-intensity, exercise sessions per week. Physical function, serum biomarkers and body composition data were assessed at the baseline and 6-month timepoints. Statistical analyses assessed the relationships between biomarkers, physical function, body composition, and OA status as a result of the intervention. Results No group effects of dietary intervention were detected on any outcome measures (multiple p > 0.05). During the 6-month trial, participants lost 6.2 ± 4.0% of their bodyweight (p < 0.0001) and experienced improved physical function on the Short-Performance-Physical-Battery (p < 0.0001), 8-foot-up-and-go (p < 0.0001), and time to complete 10-chair-stands (p < 0.0001). Adiponectin concentrations (p = 0.0480) were elevated, and cartilage oligomeric matrix protein (COMP) concentrations (p < 0.0001) were reduced; further analysis revealed that reductions in serum COMP concentrations were greater in OA-negative individuals. Conclusions These results suggest that weight loss in older adults with and without OA may provide a protective effect to cartilage and OA. In particular, OA-negative individuals may be able to mitigate changes associated with OA through weight loss.
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Affiliation(s)
- James A. Coppock
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Amy L. McNulty
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA
- Department of Pathology, Duke University School of Medicine, Durham, NC, USA
| | - Kathryn N. Porter Starr
- Department of Medicine, Duke University School of Medicine, and Durham VA Medical Center, Durham, NC, USA
- Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, NC, USA
| | - Abigail G. Holt
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | - Michael S. Borack
- Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, NC, USA
| | - Andrzej S. Kosinski
- Department of Biostatistics & Bioinformatics, Duke University, Durham, NC, USA
| | - Amber T. Collins
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Connie W. Bales
- Department of Medicine, Duke University School of Medicine, and Durham VA Medical Center, Durham, NC, USA
- Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, NC, USA
| | - Louis E. DeFrate
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA
- Department of Mechanical Engineering and Materials Science, Duke University, Durham NC, USA
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Voorwinde V, Moukadem S, van Stralen MM, Janssen IM, Monpellier VM, Steenhuis IH. How to get back on track? Experiences of patients and healthcare professionals regarding weight recurrence and needs for an intervention after bariatric-metabolic surgery. Obes Pillars 2023; 7:100074. [PMID: 37990676 PMCID: PMC10662074 DOI: 10.1016/j.obpill.2023.100074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 06/08/2023] [Accepted: 06/08/2023] [Indexed: 11/23/2023]
Abstract
Background Multidisciplinary lifestyle interventions are recommended as a first step in treating weight recurrence after bariatric-metabolic surgery (BMS). However, little is known about the experience of patients and healthcare professionals (HCP) with these interventions and how they should be tailored to the patients' needs. The aim of this study was to gain more insight into the experiences and needs of patients and HCP regarding weight recurrence after BMS and an intervention to get Back on Track. In addition, attitudes towards integrating e-Health into the care program were explored. Methods A qualitative process evaluation of an intervention for weight recurrence, the Back on Track (BoT), was conducted by means of in-depth interviews and focus groups with 19 stakeholders, including patients and HCP involved in BoT. Interviews were transcribed verbatim. Data were analyzed through thematic analysis. Results Patients and HCP reported a wide array of causes of weight recurrence. Patients found it difficult to decide when weight recurrence is problematic and when they should ask for help. Patients reported feeling like the exception and ashamed, therefore experiencing a high threshold to seek help. E-Health was seen as a promising way to improve tailoring, screening, autonomy for the patient, and accessible contact. Conclusion Patients should be adequately counselled on weight recurrence after BMS and the importance of intervening early. It is important to lower the threshold for seeking help. For example by offering more long-term standard care or by adding e-Health to the intervention.
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Affiliation(s)
- Vera Voorwinde
- Nederlandse Obesitas Kliniek (Dutch Obesity Clinic), Huis ter Heide, the Netherlands
- VU University, Faculty of Science, Department of Health Sciences and Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Sahar Moukadem
- VU University, Faculty of Science, Department of Health Sciences and Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Maartje M. van Stralen
- VU University, Faculty of Science, Department of Health Sciences and Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Ignace M.C. Janssen
- Nederlandse Obesitas Kliniek (Dutch Obesity Clinic), Huis ter Heide, the Netherlands
| | - Valerie M. Monpellier
- Nederlandse Obesitas Kliniek (Dutch Obesity Clinic), Huis ter Heide, the Netherlands
| | - Ingrid H.M. Steenhuis
- VU University, Faculty of Science, Department of Health Sciences and Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
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Kan H, Swindle JP, Bae J, Dunn JP, Buysman EK, Gronroos NN, Bengtson L, Chinthammit C, Ford J, Ahmad N. Weight management treatment modalities in patients with overweight or obesity: A retrospective cohort study of administrative claims data. Obes Pillars 2023; 7:100072. [PMID: 37990675 PMCID: PMC10661997 DOI: 10.1016/j.obpill.2023.100072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 05/22/2023] [Accepted: 05/22/2023] [Indexed: 11/23/2023]
Abstract
Background The purpose of this study was to describe demographic and clinical characteristics among patients who have medical encounters for weight management treatments and to investigate the association of those characteristics with treatment modality. Methods This was a retrospective database study using medical claims, pharmacy claims, and enrollment information from commercial and Medicare Advantage with Part D members in the Optum Research Database from 01/01/2011-2/29/2020. Adult patients with a claim for a weight management treatment from 01/01/2012-2/28/2019 were categorized into cohorts according to the highest intensity intervention received. To examine the association between patient characteristics and treatment modality received, a multinomial logit model was performed. Results Cohorts by increasing intensity included lifestyle intervention (LSI, n = 67,679), weight reduction pharmacotherapy (WRRx) with an anti-obesity medication (AOM, n = 6,905), weight reduction procedure (WRP, n = 1,172), and weight reduction surgery (WRS, n = 18,036). Approximately 32.1% and 16.6% of patients who received WRS or WRP had an LSI during the 12-month baseline, and only 0.6% and 0.4% had treatment with long-term AOMs. In a multinomial logit model, patients with type 2 diabetes (not including WRRx cohort), respiratory disorders, cardiovascular risk factors, pain disorders, and mental health conditions had increased odds of treatment with higher intensity intervention versus LSI. Patients who were male, received an intervention more recently (2016-2019), or had a Charlson comorbidity score of 1 (compared to 0) had decreased odds of treatment with higher intensity interventions. Conclusion In this study, age, sex, body mass index, obesity-related complications, and Charlson comorbidity score appeared to influence the type of weight management treatment modality received. This study improves understanding of weight management treatment utilization and identifies gaps and opportunities to improve obesity care with the appropriate use of different treatment modalities.
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Affiliation(s)
- Hong Kan
- Eli Lilly, 893 Delaware St, Indianapolis, IN, USA
| | - Jason P. Swindle
- Evidera, 500 Totten Pond Rd, Waltham, MA, 02451, USA
- Formerly Optum, 11000 Optum Circle, Eden Prairie, MN, USA
| | - Jay Bae
- Eli Lilly, 893 Delaware St, Indianapolis, IN, USA
| | | | | | | | - Lindsay Bengtson
- Boehringer Ingelheim, 900 Ridgebury Rd, Ridgefield, CT, USA
- Formerly Optum, 11000 Optum Circle, Eden Prairie, MN, USA
| | | | - Janet Ford
- Agios Pharmaceuticals, Inc., Cambridge, MA, USA
- Formally Eli Lilly, 893 Delaware St, Indianapolis, IN, USA
| | - Nadia Ahmad
- Eli Lilly, 893 Delaware St, Indianapolis, IN, USA
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Suzuki Y, Hoshi K, Shiroiwa T, Fukuda T. Cost-effectiveness analysis of lifestyle interventions for preventing kidney disease in patients with type 2 diabetes. Clin Exp Nephrol 2023; 27:728-736. [PMID: 37195388 DOI: 10.1007/s10157-023-02357-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 05/01/2023] [Indexed: 05/18/2023]
Abstract
BACKGROUND Lifestyle interventions in patients with type-2 diabetes contribute to reducing the incidence of chronic kidney disease. The cost-effectiveness of lifestyle interventions to prevent kidney disease in patients with type-2 diabetes remains undetermined. We aimed to develop a Markov model from a Japanese healthcare payer's perspective focusing on the development of kidney disease in patients with type-2 diabetes and examine the cost-effectiveness of lifestyle interventions. METHODS To develop the model, the parameters, including lifestyle intervention effect, were derived from results of the Look AHEAD trial and previously published literature. Incremental cost-effectiveness ratios (ICER) were calculated from the difference in cost and quality-adjusted life years (QALY) between lifestyle intervention and diabetes support education groups. We estimated lifetime costs and effectiveness assuming patient's life span to be 100 years. Costs and effectiveness were discounted by 2% annually. RESULTS ICER for lifestyle intervention compared to diabetes support education was JPY 1,510,838 (USD 13,031) per QALY. Cost-effectiveness acceptability curve showed that the probability that lifestyle intervention is cost-effective at the threshold of JPY 5,000,000 (USD 43,084) per QALY gained, compared to diabetes support education, is 93.6%. CONCLUSIONS Using a newly-developed Markov model, we illustrated that lifestyle interventions for preventing kidney disease in patients with diabetes would be more cost-effective from a Japanese healthcare payer's perspective compared to diabetes support education. The model parameters in the Markov model must be updated to adapt to the Japanese setting.
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Affiliation(s)
- Yuta Suzuki
- Center for Outcomes Research and Economic Evaluation for Health, National Institute of Public Health, 2-3-6 Minami, Wako, Saitama, 351-0197, Japan.
| | - Keika Hoshi
- Center for Health Informatics Policy, National Institute of Public Health, Saitama, Japan
- Department of Hygiene, Kitasato University School of Medicine, Kanagawa, Japan
| | - Takeru Shiroiwa
- Center for Outcomes Research and Economic Evaluation for Health, National Institute of Public Health, 2-3-6 Minami, Wako, Saitama, 351-0197, Japan
| | - Takashi Fukuda
- Center for Outcomes Research and Economic Evaluation for Health, National Institute of Public Health, 2-3-6 Minami, Wako, Saitama, 351-0197, Japan
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Chen J, Siliceo SL, Ni Y, Nielsen HB, Xu A, Panagiotou G. Identification of robust and generalizable biomarkers for microbiome-based stratification in lifestyle interventions. Microbiome 2023; 11:178. [PMID: 37553697 PMCID: PMC10408196 DOI: 10.1186/s40168-023-01604-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 06/19/2023] [Indexed: 08/10/2023]
Abstract
BACKGROUND A growing body of evidence suggests that the gut microbiota is strongly linked to general human health. Microbiome-directed interventions, such as diet and exercise, are acknowledged as a viable and achievable strategy for preventing disorders and improving human health. However, due to the significant inter-individual diversity of the gut microbiota between subjects, lifestyle recommendations are expected to have distinct and highly variable impacts to the microbiome structure. RESULTS Here, through a large-scale meta-analysis including 1448 shotgun metagenomics samples obtained longitudinally from 396 individuals during lifestyle studies, we revealed Bacteroides stercoris, Prevotella copri, and Bacteroides vulgatus as biomarkers of microbiota's resistance to structural changes, and aromatic and non-aromatic amino acid biosynthesis as important regulator of microbiome dynamics. We established criteria for distinguishing between significant compositional changes from normal microbiota fluctuation and classified individuals based on their level of response. We further developed a machine learning model for predicting "responders" and "non-responders" independently of the type of intervention with an area under the curve of up to 0.86 in external validation cohorts of different ethnicities. CONCLUSIONS We propose here that microbiome-based stratification is possible for identifying individuals with highly plastic or highly resistant microbial structures. Identifying subjects that will not respond to generalized lifestyle therapeutic interventions targeting the restructuring of gut microbiota is important to ensure that primary end-points of clinical studies are reached. Video Abstract.
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Affiliation(s)
- Jiarui Chen
- Leibniz Institute for Natural Product Research and Infection Biology, Hans Knöll Institute -Microbiome Dynamics, Jena, Germany
- State Key Laboratory of Pharmaceutical Biotechnology, The University of Hong Kong, Hong Kong S.A.R., China
- Department of Medicine, The University of Hong Kong, Hong Kong S.A.R., China
| | - Sara Leal Siliceo
- Leibniz Institute for Natural Product Research and Infection Biology, Hans Knöll Institute -Microbiome Dynamics, Jena, Germany
| | - Yueqiong Ni
- Leibniz Institute for Natural Product Research and Infection Biology, Hans Knöll Institute -Microbiome Dynamics, Jena, Germany
| | - Henrik B Nielsen
- Clinical Microbiomics, Fruebjergvej 3, 2100, Copenhagen, Denmark
| | - Aimin Xu
- State Key Laboratory of Pharmaceutical Biotechnology, The University of Hong Kong, Hong Kong S.A.R., China
- Department of Medicine, The University of Hong Kong, Hong Kong S.A.R., China
- Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong S.A.R., China
| | - Gianni Panagiotou
- Leibniz Institute for Natural Product Research and Infection Biology, Hans Knöll Institute -Microbiome Dynamics, Jena, Germany.
- Department of Medicine, The University of Hong Kong, Hong Kong S.A.R., China.
- Faculty of Biological Sciences, Friedrich Schiller University, Jena, Germany.
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Tam JW, Khurshid K, Sprague B, Clark DO, Xu H, Moser LR, Miller DK, Considine R, Callahan CM, Garringer HJ, Rexroth D, Unverzagt FW. Design and baseline characteristics of the Cognitive and Aerobic Resilience for the Brain (CARB) study. Contemp Clin Trials 2023; 131:107249. [PMID: 37268243 PMCID: PMC10527227 DOI: 10.1016/j.cct.2023.107249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 05/15/2023] [Accepted: 05/27/2023] [Indexed: 06/04/2023]
Abstract
BACKGROUND Treatments that delay progression of cognitive impairment in older adults are of great public health significance. This manuscript outlines the protocol, recruitment, baseline characteristics, and retention for a randomized controlled trial of cognitive and aerobic physical training to improve cognition in individuals with subjective cognitive dysfunction, the "Cognitive and Aerobic Resilience for the Brain" (CARB) study. METHODS Community-dwelling, older adults with self-reported memory loss were randomly assigned to receive either computer-based cognitive training, aerobic physical training, combined cognitive and physical training, or education control. Treatment was delivered 2- to 3-times per week in 45- to 90-min sessions for 12 weeks by trained facilitators videoconferencing into subject's home. Outcome assessments of were taken at the baseline, immediately following training, and 3-months after training. RESULTS 191 subjects were randomized into the trial (mean age, 75.5 years; 68% female; 20% non-white; mean education, 15.1 years; 30% with 1+ APOE e4 allele). The sample was generally obese, hypertensive, and many were diabetic, while cognition, self-reported mood, and activities of daily living were in the normal range. There was excellent retention throughout the trial. Interventions were completed at high rates, participants found the treatments acceptable and enjoyable, and outcome assessments were completed at high rates. CONCLUSIONS This study was designed to determine the feasibility of recruiting, intervening, and documenting response to treatment in a population at risk for progressive cognitive decline. Older adults with self-reported memory loss were enrolled in high numbers and were well engaged with the intervention and outcome assessments.
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Affiliation(s)
- Joyce W Tam
- Department of Psychiatry, Indiana University School of Medicine, United States of America
| | - Kiran Khurshid
- Department of Neurology, Indiana University School of Medicine, United States of America
| | - Briana Sprague
- Department of Medicine, Indiana University School of Medicine, United States of America; Indiana University Center for Aging Research at Regenstrief Institute, United States of America
| | - Daniel O Clark
- Department of Medicine, Indiana University School of Medicine, United States of America; Indiana University Center for Aging Research at Regenstrief Institute, United States of America
| | - Huiping Xu
- Department of Biostatistics, Indiana University School of Medicine, United States of America
| | - Lyndsi R Moser
- Department of Psychiatry, Indiana University School of Medicine, United States of America
| | - Douglas K Miller
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, United States of America
| | - Robert Considine
- Department of Medicine, Indiana University School of Medicine, United States of America
| | | | - Holly J Garringer
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, United States of America
| | - Daniel Rexroth
- Department of Psychiatry, Indiana University School of Medicine, United States of America
| | - Frederick W Unverzagt
- Department of Psychiatry, Indiana University School of Medicine, United States of America.
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Herman WH, Villatoro C, Joiner KL, McEwen LN. Retention and outcomes of National Diabetes Prevention Program enrollees and non-enrollees with prediabetes: The University of Michigan experience. J Diabetes Complications 2023; 37:108527. [PMID: 37459781 PMCID: PMC10928673 DOI: 10.1016/j.jdiacomp.2023.108527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 05/31/2023] [Accepted: 06/01/2023] [Indexed: 08/04/2023]
Abstract
AIMS To evaluate retention and outcomes of insured adults with prediabetes who enrolled or did not enroll in National Diabetes Prevention Programs (NDPPs). METHODS Between 2015 and 2019, 776 University of Michigan employees, dependents, and retirees with prediabetes and overweight or obesity enrolled in one-year NDPPs. RESULTS Enrollees attended a median of 18 sessions. Median retention was 38 weeks. Retention was associated with older age, greater initial weight loss, and physical activity. At both 1- and 2-years, body mass index, triglycerides, and HbA1c were significantly improved among enrollees. After adjusting for age group, sex, and race, the odds of developing diabetes based on HbA1c ≥6.5 % was 40 % lower at 1-year and 20 % lower at 2-years, and the odds of self-reported diabetes was 57 % lower at 1-year and 46 % lower at 2-years in enrollees compared to non-enrollees. Enrollees who disenrolled before completing the core curriculum had higher odds and enrollees who completed the NDPP had lower odds of developing diabetes that non-enrollees. CONCLUSIONS In this population with prediabetes, NDPP retention was generally good, risk factors were improved, and diabetes was delayed or prevented for up to two years.
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Affiliation(s)
- William H Herman
- Department of Internal Medicine, Division of Metabolism, Endocrinology, and Diabetes, University of Michigan, Ann Arbor, MI, USA; Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA.
| | - Claudia Villatoro
- Department of Internal Medicine, Division of Metabolism, Endocrinology, and Diabetes, University of Michigan, Ann Arbor, MI, USA
| | - Kevin L Joiner
- Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, MI, USA
| | - Laura N McEwen
- Department of Internal Medicine, Division of Metabolism, Endocrinology, and Diabetes, University of Michigan, Ann Arbor, MI, USA
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van Tetering EMA, Muskens JB, Deenik J, Pillen S, Cahn W, von Rosenstiel I, Oomen M, Rommelse NN, Staal WG, Klip H. The short and long-term effects of a lifestyle intervention in children with mental illnesses: a randomized controlled trial (Movementss study). BMC Psychiatry 2023; 23:529. [PMID: 37480007 PMCID: PMC10362712 DOI: 10.1186/s12888-023-04884-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 05/17/2023] [Indexed: 07/23/2023] Open
Abstract
BACKGROUND A lifestyle including poor diet, physical inactivity, excessive gaming and inadequate sleep hygiene is frequently seen among Dutch children. These lifestyle behaviors can cause long-term health problems later in life. Unhealthy lifestyle and poor physical health are even more prevalent among children with mental illness (MI) such as autism, attention-deficit/hyperactivity disorder, depression, and anxiety. However, research on lifestyle interventions among children with MI is lacking. As a result, there are currently no guidelines, or treatment programs where children with MI and poor lifestyle can receive effective support. To address these issues and to provide insight into the effectiveness of lifestyle interventions in children with MI and their families, the Movementss study was designed. This paper describes the rationale, study design, and methods of an ongoing randomized controlled trial (RCT) comparing the short-term (12 weeks) and long-term (1 year) effects of a lifestyle intervention with care as usual (CAU) in children with MI and an unhealthy lifestyle. METHODS A total of 80 children (6-12 years) with MI according to DSM-V and an unhealthy lifestyle are randomized to the lifestyle intervention group or CAU at a specialized child and adolescent mental hospital. The primary outcome measure is quality of life measured with the KIDSCREEN. Secondary outcomes include emotional and behavior symptoms, lifestyle parameters regarding diet, physical activity, sleep, and screen time, cognitive assessment (intelligence and executive functions), physical measurements (e.g., BMI), parenting styles, and family functioning, prior beliefs, adherence, satisfaction, and cost-effectiveness. Assessments will take place at the start of the study (T0), after 12 weeks (T1), six months (T2), and 12 months of baseline (T3) to measure long-term effects. DISCUSSION This RCT will likely contribute to the currently lacking knowledge on lifestyle interventions in children with MI. TRIAL REGISTRATION trialsearch.who.int/ NL9822. Registered at November 2nd, 2021.
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Affiliation(s)
- Emilie M A van Tetering
- Karakter Child and Adolescent Psychiatry, Nijmegen, The Netherlands.
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboudumc, Nijmegen, The Netherlands.
- Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands.
| | - Jet B Muskens
- Karakter Child and Adolescent Psychiatry, Nijmegen, The Netherlands
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboudumc, Nijmegen, The Netherlands
- Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Jeroen Deenik
- GGz Centraal, Department of Science, Amersfoort, The Netherlands
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Sigrid Pillen
- Kinderslaapexpert BV (Pediatric Sleep Expert Ltd), Mook, The Netherlands
| | - Wiepke Cahn
- Department of Psychiatry, University Medical Centre Utrecht, Utrecht, The Netherlands
| | | | | | - Nanda N Rommelse
- Karakter Child and Adolescent Psychiatry, Nijmegen, The Netherlands
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboudumc, Nijmegen, The Netherlands
- Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Wouter G Staal
- Karakter Child and Adolescent Psychiatry, Nijmegen, The Netherlands
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboudumc, Nijmegen, The Netherlands
- Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands
- Leiden Institution for Brain and Cognition, Leiden, The Netherlands
| | - Helen Klip
- Karakter Child and Adolescent Psychiatry, Nijmegen, The Netherlands
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Saslow LR, Eslamian A, Moran P, Hartogensis W, Mason AE, Kim S, Bauer DC, Griauzde DH, Goldman V, Liu V, Stephens P, Raymond K, Yeung G, Leung C, Hecht FM. Protocol for a randomized controlled trial comparing a very low-carbohydrate diet or moderate-carbohydrate plate-method diet for type 2 diabetes: the LEGEND (Lifestyle Education about Nutrition for Diabetes) trial. Trials 2023; 24:463. [PMID: 37475033 PMCID: PMC10360267 DOI: 10.1186/s13063-023-07512-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 07/12/2023] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND Optimal carbohydrate intake is an important and controversial area in the nutritional management of type 2 diabetes. Some evidence indicates that reducing overall carbohydrate intake with a low- or very low-carbohydrate eating plan can improve glycemic control compared to following eating plans that involve greater carbohydrate intake. However, critical knowledge gaps currently prevent clear recommendations about carbohydrate intake levels. METHODS The LEGEND (Lifestyle Education about Nutrition for Diabetes) Trial aims to compare a very low-carbohydrate diet to a moderate-carbohydrate plate-method diet for glycemic control in adults with type 2 diabetes. This two-site trial plans to recruit 180 adults with type 2 diabetes. We will randomize participants to either a 20-session group-based diet and lifestyle intervention that teaches either a very low-carbohydrate diet or a moderate-carbohydrate plate-method diet. We will assess participants at study entry and 4 and 12 months later. The primary outcome is HbA1c, and secondary outcomes include inflammation (high sensitivity C-reactive protein), body weight, changes in diabetes medications, lipids (small particle LDL, HDL, triglycerides), skeletal metabolism (bone mineral density from dual-energy x-ray absorptiometry and bone turnover markers serum procollagen type I N propeptide and serum C-terminal telopeptide of type I collagen), and body composition (percent body fat, percent lean body mass). DISCUSSION The LEGEND trial is a randomized controlled trial to assess optimal carbohydrate intake in type 2 diabetes by evaluating the effects of a very low-carbohydrate diet vs. a moderate-carbohydrate plate-method diet over a year-long period. The research addresses important gaps in the evidence base for the nutritional management of type 2 diabetes by providing data on potential benefits and adverse effects of different levels of carbohydrate intake. TRIAL REGISTRATION ClinicalTrials.gov NCT05237128. Registered on February 11, 2022.
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Affiliation(s)
| | | | | | | | | | - Sarah Kim
- University of California, San Francisco, CA, USA
| | | | | | | | - Vivian Liu
- University of California, San Francisco, CA, USA
| | | | | | - George Yeung
- University of California, San Francisco, CA, USA
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50
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Rawal L, Dahal P, Paudel G, Biswas T, Shrestha R, Makaju D, Shrestha A, Yadav U, Sahle BW, Iwashita H, Masuda G, Renzaho A, Shakya P, Shrestha A, Karmacharya B, Sakamoto H, Koju R, Sugishita T. Community-based lifestyle intervention for diabetes (Co-LID study) management rural Nepal: study protocol for a clustered randomized controlled trial. Trials 2023; 24:441. [PMID: 37403179 DOI: 10.1186/s13063-023-07451-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 06/12/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) has increased globally; with a disproportionate burden in South and Southeast Asian countries, including Nepal. There is an urgent need for clinically and cost-effective culturally adapted T2DM management programs. In this study, we aim to assess the effectiveness of community based culturally appropriate lifestyle intervention in improving the management and care of people with T2DM. METHODS We will conduct a cluster randomized control trial to evaluate the effectiveness of community based culturally appropriate lifestyle intervention in improving T2DM outcomes. The trial will be conducted in 30 randomly selected healthcare facilities from two purposively selected districts (Kavrepalanchowk and Nuwakot districts) of Bagmati province, Nepal. The selected healthcare facilities are being randomized into 15 interventions (n = 15) and usual care (n = 15) groups. Those in the intervention will receive group-based 12 an hour-long fortnightly session delivered over 6 months period. The intervention package includes 12 planned modules related to diabetes care, ongoing support, supervision and monitoring, follow-up from the trained community health workers, and educational materials on diabetes self-management. The participants in the usual care groups will receive pictorial brochure on diabetes management and they will continue receiving the usual care available from the local health facilities. The primary outcome is HbA1c level, and the secondary outcomes include quality of life, health care utilization, and practice of self-care behaviour, depression, oral health quality of life, and economic assessment of the intervention. Two points measurements will be collected by the trained research assistants at baseline and at the end of the intervention. DISCUSSION This study will provide tested approaches for culturally adapting T2DM interventions in the Nepalese context. The findings will also have practice and policy implications for T2DM prevention and management in Nepal. TRIAL REGISTRATION Australia and New Zealand Clinical Trial Registry (ACTRN12621000531819). Registered on May 6, 2021.
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Affiliation(s)
- Lal Rawal
- School of Health, Medical and Applied Sciences, Central Queensland University, Sydney Campus, 400 Kent Street, Sydney, NSW, 2000, Australia.
- Appleton Institute, Physical Activity Research Group, Central Queensland University, Rockhampton, Australia.
- Translational Health Research Institute, Western Sydney University, Sydney, Australia.
| | - Padam Dahal
- School of Health, Medical and Applied Sciences, Central Queensland University, Sydney Campus, 400 Kent Street, Sydney, NSW, 2000, Australia
| | - Grish Paudel
- School of Health, Medical and Applied Sciences, Central Queensland University, Sydney Campus, 400 Kent Street, Sydney, NSW, 2000, Australia
| | - Tuhin Biswas
- Science and Math Program, Asian University for Women, Chattogram, Bangladesh
| | - Rabina Shrestha
- Research and Development Division, Dhulikhel Hospital Kathmandu University Hospital, Dhulikhel, Nepal
| | - Deepa Makaju
- Research and Development Division, Dhulikhel Hospital Kathmandu University Hospital, Dhulikhel, Nepal
| | - Abha Shrestha
- Department of public health and community programs, Kathmandu University of Medical Sciences, Dhulikhel, Nepal
| | - Uday Yadav
- National Centre for Aboriginal and Torres Strait Islander Wellbeing Research, The National Centre for Epidemiology and Population Health, ACT, The Australian National University, Canberra, Australia
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia
| | - Berhe W Sahle
- School of Nursing and Midwifery, Faculty of Health, Deakin University, 221 Burwood Highway, Burwood, Melbourne, VIC, 3125, Australia
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Hanako Iwashita
- Section of Global Health, Division of Public Health, Department of Hygiene and Public Health, Tokyo Women's Medical University, Tokyo, Japan
| | - Gaku Masuda
- Section of Global Health, Division of Public Health, Department of Hygiene and Public Health, Tokyo Women's Medical University, Tokyo, Japan
| | - Andre Renzaho
- School of Medicine, Western Sydney University, Sydney, Australia
| | - Prabin Shakya
- Research and Development Division, Dhulikhel Hospital Kathmandu University Hospital, Dhulikhel, Nepal
| | - Archana Shrestha
- Department of public health and community programs, Kathmandu University of Medical Sciences, Dhulikhel, Nepal
| | - Biraj Karmacharya
- Department of public health and community programs, Kathmandu University of Medical Sciences, Dhulikhel, Nepal
| | - Haruka Sakamoto
- Section of Global Health, Division of Public Health, Department of Hygiene and Public Health, Tokyo Women's Medical University, Tokyo, Japan
| | - Rajendra Koju
- Department of Internal Medicine/Cardiology, Kathmandu University of Medical Sciences, Dhulikhel, Nepal
| | - Tomohiko Sugishita
- Section of Global Health, Division of Public Health, Department of Hygiene and Public Health, Tokyo Women's Medical University, Tokyo, Japan
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