Abstract
The initial benefits of lifestyle modification programs such as reduction in chronic and cardiovascular diseases (CVD) risk factors have been well documented. However, such positive effects may deteriorate over time following relapse into inactivity. Timely detection of weight regain leading to the deterioration of the accrued benefits could trigger early resumption of intensive lifestyle intervention. To date, no known cost-effective, noninvasive approach for monitoring long-term outcomes has yet been established. The purpose of this study was to determine if body mass index (BMI) change predicted changes in other CVD biometric markers during an intensive lifestyle modification program. This study was an observational, retrospective review of records of participants from the Complete Health Improvement Program (CHIP). Biomarker changes of participants in this community-based Intensive Therapeutic Lifestyle Modification Program (ITLMP) offered in Athens, Ohio, a rural Appalachian college town, between April 2011 and June 2017 were reviewed retrospectively. BMI, heart rate (Pulse), systolic blood pressure (SBP), diastolic blood pressure (DBP), and fasting blood levels of total cholesterol (TC), low-density lipoprotein (LDL), high-density lipoprotein (HDL), triglycerides (TG), and glucose (FBS) were monitored before and after program completion. Data were analyzed using a multivariate general linear model. The sample analyzed consisted of 620 participants (mean age of 52.3±13.0 years, 74.5% female). Controlling for age and gender, BMI change significantly predicted 5 out of the 8 biomarker changes measured [Wilk's λ = 0.939, F(8,526) = 4.29, p <.0001]. Specifically, a 1-point BMI decrease was associated with 4.4 units decrease in TC, 3.2 units in LDL, 5.3 units in TG, 2 units in SBP, and 1 unit in DBP (all p values < .05). These results suggest that change in BMI may be a useful predictor of change in other CVD biomarkers' outcomes during and after an ITLMP participation. Tracking BMI, therefore, could serve as a proxy measure for identifying regressing biomarker changes following participation in an ITLMP leading to a timelier reassessment and intervention. Future studies evaluating the value of BMI as a surrogate for highlighting overall cardiovascular health are warranted.
Highlights
Cardiovascular disease (CVD) is the leading cause of death in the United States [1]
A 1-point decrease was associated with 4.4 units decrease in total cholesterol (TC), 3.2 units in low-density lipoprotein (LDL), 5.3 units in TG, 2 units in systolic blood pressure (SBP), and 1 unit in diastolic blood pressure (DBP) (Table 3)
The current study demonstrates that a reduction in body mass index (BMI) following an intensive lifestyle change intervention is associated with desired changes in levels of lipids and blood pressure
Summary
Cardiovascular disease (CVD) is the leading cause of death in the United States [1]. Risk factors for CVD include dyslipidemia, hypertension, elevated body mass index (BMI), and diabetes [2,3,4]. Intensive therapeutic lifestyle modification programs (ITLMP) have been effective in improving all of these CVD risk factors [5,6,7]. One well studied ITLMP is the Complete Health Improvement Program (CHIP), which has demonstrated short-term effectiveness in improving many CVD risk factors [8, 9]. Look AHEAD, provided strong evidence in support of the efficacy of intensive lifestyle intervention (ILI), especially in Type 2 diabetes patients. It was observed that the ILI patients compared to a control group (that received standard treatment), across a four-year span of observation, registered desirable results regarding glycemic control, blood pressure reduction, lower triglycerides, and improvements in other CVD related risk factors [10]
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