Abstract
Lifestyle interventions can effectively reduce chronic disease risk factors. This study examined the effectiveness of an established lifestyle intervention contextualized for low-literacy communities in Fiji. Ninety-six adults from four villages, with waist circumference (WC) indicative of risk of chronic disease, were randomly selected to an intervention or control group. Process evaluation indicated one intervention and one control village fulfilled the study protocol. There were no differences between intervention and control for body mass index BMI (P = 0.696), WC (P = 0.662), total cholesterol (TC) (P = 0.386), and TC:high-density lipoprotein (HDL) ratio (P = 0.485). The intervention village achieved greater reductions than the control village at 30 and 90 days for systolic blood pressure (30 days: −11.1% vs. −2.5%, P = 0.006; 90 days: −14.5% vs. −6.7%, P = 0.019); pulse rate (30 days: −7.0% vs. −1.1%, P = 0.866; 90 days: −7.1% vs. 4.3%, P = 0.027), and HDL (30 days: −13.9% vs. 1.7%, P = 0.206; 90 days: −18.9% vs. 2.2%, P = 0.001); at 90 days only for diastolic blood pressure (−14.4% vs. −0.2%, P = 0.010); at 30 days only for low-density lipoprotein (−11.6% vs. 8.0%, P = 0.009); and fasting plasma glucose (−10.2% vs. 4.3%, P = 0.032). However, for triglycerides, the control achieved greater reductions than the intervention village at 30 days (35.4% vs. −12.3%, P = 0.008; marginal at 90 days 16.4% vs. −23.5%, P = 0.054). This study provides preliminary evidence of the feasibility and potential effectiveness of the intervention to lower several risk factors for chronic disease over 30 days in rural settings in Fiji and supports consideration of larger studies.
Highlights
Cardiovascular diseases (CVDs), cancer, chronic respiratory diseases, and diabetes constitute the four main noncommunicable diseases (NCDs)
The intervention village achieved greater reductions than the control village at 30 and 90 days for systolic blood pressure (30 days: −11.1% vs. −2.5%, P = 0.006; 90 days: −14.5% vs. −6.7%, P = 0.019); pulse rate (30 days: −7.0% vs. −1.1%, P = 0.866; 90 days: −7.1% vs. 4.3%, P = 0.027), and high-density lipoprotein (HDL) (30 days: −13.9% vs. 1.7%, P = 0.206; 90 days: −18.9% vs. 2.2%, P = 0.001); at 90 days only for diastolic blood pressure (−14.4% vs. −0.2%, P = 0.010); at 30 days only for low-density lipoprotein (−11.6% vs. 8.0%, P = 0.009); and fasting plasma glucose (−10.2% vs. 4.3%, P = 0.032)
Diabetes is increasing rapidly, with 422 million people in the world living with the condition in 2014.[1]. While NCDs are responsible for 41 million deaths each year, equivalent to 71% of all global deaths,[2] these four groups of conditions account for 80% of premature deaths for individuals between 30 and 69 years.[3]
Summary
Cardiovascular diseases (CVDs), cancer, chronic respiratory diseases, and diabetes constitute the four main noncommunicable diseases (NCDs). Overweight and obesity, CVD, and diabetes have increased substantially in low-middle-income countries (LMICs),[4] which bare 85% of the global burden of premature deaths from NCDs.[3] 80% of people with diabetes live in LMICs, with the greatest proportion of these (37%) in the Western Pacific, which includes the South Pacific.[5] Seven of the top 10 countries in the world with the highest prevalence of diabetes are South Pacific Islands.[5] LMIC countries face a double burden of disease from communicable and NCDs,[2] which has resulted in significant social disadvantage and economic burden on individuals, families, and society at large,[4] with economic losses of US$7 trillion projected by 2030, resulting in millions of people trapped in poverty.[6]
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