Comprehensive Lifestyle Modification Research Articles

Comprehensive Lifestyle Modification Influences Medium-Term and Artificially Induced Stress in Ulcerative Colitis-A Sub-Study within a Randomized Controlled Trial Using the Trier Social Stress Test.

Objective: The present study presents long-term results of stress-related outcomes of a prospective RCT that evaluated effects of a ten-week comprehensive lifestyle-modification program (LSM) in patients with inactive ulcerative colitis (UC). In addition, exploratory results of a sub-study applying a laboratory stress protocol (Trier Social Stress Test; TSST) conducted within the RCT are reported. Methods: Ninety-seven patients with inactive UC were randomized to LSM (n = 47; 50.28 ± 11.90 years; 72.3% female) or self-care (n = 50; 45.54 ± 12.49 years; 70% female). Patients’ perceived stress, anxiety, flourishing and depression were assessed at week 0, 12, 24 and 48. After the respective intervention, 16 female patients (LSM: n = 8; 44.6 ± 14.3 years; Self-care: n = 8; 49.25 ± 4.30 years) additionally underwent the TSST. State anxiety, blood pressure, pulse, complete blood counts, adrenocorticotropic hormone (ACTH), cortisol, adrenalin and noradrenalin were measured at baseline (−15 min), stress (+10 min), recovery1 (+20 min) and recovery2 (+55 min). Statistical significance was set at p < 0.05; for the exploratory sub-study using the TSST, p-values < 0.10 were considered significant. Results: Patients’ perceived stress declined significantly after the LSM (p < 0.001) compared with control. This lasted until week 24 (p = 0.023) but did not persist until week 48 (p = 0.060). After 48 weeks, patients’ flourishing was significantly increased compared with control (p = 0.006). In response to the TSST, significant group differences were evident for pulse (p = 0.015), adrenaline (p = 0.037) and anxiety (p = 0.066). After 55 min, group differences were found for ACTH (p = 0.067) and systolic blood pressure (p = 0.050). Conclusions: LSM has a medium-term positive effect on perceived stress. First indications show that it is promising to investigate these effects further under laboratory conditions. It is also desirable to find out how the effects of LSM can be maintained in the long term.

Maternal sleep duration and neonatal birth weight: the Japan Environment and Children\u2019s Study

BackgroundThe adequate maternal sleep duration required for favorable obstetric outcomes is unknown. We evaluated the association between maternal sleep duration and low birth weight infants, small for gestational age infants, and macrosomia.MethodsParticipants enrolled in the Japan Environment and Children’s Study, a nationwide birth cohort study, with singleton pregnancies after 22 weeks, who gave birth between 2011 and 2014 were enrolled and categorized into five groups according to maternal sleep duration during pregnancy: < 6.0 h, 6.0–7.9 h, 8.0–8.9 h, 9.0–9.9 h, and 10.0–12.0 h. We evaluated the association between maternal sleep duration and the incidence of low birth weight infants (< 2500 g), very low birth weight infants (< 1500 g), small for gestational age infants, and macrosomia (> 4000 g), with women with maternal sleep duration of 6.0–7.9 h as the reference, using a multiple logistic regression model.ResultsIn total, 82,171 participants were analyzed. The adjusted odds ratios (95% confidence intervals) for low birth weight infants in women with maternal sleep duration of 9.0–9.9 h and 10.0–12.0 h and for small for gestational age infants in women with maternal sleep duration of 9.0–9.9 h were 0.90 (0.83–0.99), 0.86 (0.76–0.99), and 0.91 (0.82–0.99), respectively, before adjusting for excessive gestational weight gain. No significant association was observed between maternal sleep duration and these outcomes after adjusting for excessive gestational weight gain. Among women with appropriate gestational weight gain, the adjusted odds ratios (95% confidence intervals) for low birth weight infants and for small for gestational age infants with sleep duration of 9.0–9.9 h were 0.88 (0.80–0.97) and 0.87 (0.78–0.97), respectively.ConclusionsMaternal sleep duration of 9.0–9.9 h was significantly associated with the decreased incidence of low birth weight infants and small for gestational age infants in pregnant women with appropriate gestational weight gain, compared with that of 6.0–7.9 h. Care providers should provide proper counseling regarding the association between maternal sleep duration and neonatal birth weight and suggest comprehensive maternal lifestyle modifications to prevent low birth weight and small for gestational age infants.

Comprehensive Lifestyle Improvement Program for Prostate Cancer (CLIPP) is associated with improvement in weight and components of metabolic syndrome in men exposed to androgen deprivation therapy for prostate cancer.

Androgen deprivation therapy (ADT) for prostate cancer is associated with adverse effects, such as obesity and metabolic syndrome, which increase cardiovascular risk, the most common cause of non-cancer mortality in men diagnosed with prostate cancer. The Comprehensive Lifestyle Improvement Program for Prostate Cancer (CLIPP) was created to determine the feasibility of conducing a comprehensive lifestyle modification intervention in men on ADT for prostate cancer and determine its early efficacy in reducing obesity and metabolic syndrome. A single-arm, open-label clinical trial was conducted by recruiting 31 men diagnosed with prostate cancer and exposed to ADT within the last 5 years. A multicomponent lifestyle modification program was delivered weekly for 16 weeks by a trained health coach. This was followed by 8 weeks of passive follow-up resulting in a total trial duration of 24 weeks. Feasibility was determined by calculating study recruitment, retention, and adherence rates. Weight and components of metabolic syndrome (waist circumference, triglycerides (TG), high-density lipoprotein (HDL), serum glucose, and blood pressure (BP)) were measured at baseline, 12, and 24 weeks. Recruitment, retention, and adherence rates were 47.1%, 90.3%, and 100%, respectively. Statistically significant improvements were noted between baseline and end of study measurements for weight (206.3 vs. 191.3 lbs, p < 0.001), waist (41.3 vs. 38.8 inches, p < 0.001), systolic BP (144.1 vs. 133.4 mm of Hg, p = 0.014), diastolic BP (83.3 vs. 76.2 mm of Hg, p = 0.0056), TG (146.0 vs. 113.8 mg/dl, p = 0.022), HDL (51.1 vs. 55.0 mg/dl, p = 0.012), and serum glucose (114.0 vs. 103.2 mg/dl, p = 0.013). CLIPP demonstrates feasibility and early efficacy of a multicomponent lifestyle modification intervention toward addressing obesity as well as components of metabolic syndrome in men on ADT for prostate cancer. This study provides strong preliminary data to develop future clinical trials in this population.

Design and rationale of the randomized trial of comprehensive lifestyle modification, optimal pharmacological treatment and utilizing PET imaging for quantifying and managing stable coronary artery disease (the CENTURY study)

The literature reports no randomized trial in chronic coronary artery disease (CAD) of a comprehensive management strategy integrating intense lifestyle management, maximal medical treatment to specific goals and high precision quantitative cardiac positron emission tomography (PET) for identifying high mortality risk patients needing essential invasive procedures. We hypothesize that this comprehensive strategy achieves greater risk factor reduction, lower major adverse cardiovascular events and fewer invasive procedures than standard practice. The CENTURY Study (NCT00756379) is a randomized-controlled-trial study in patients with stable or at high risk for CAD. Patients are randomized to standard of care (Standard group) or intense comprehensive lifestyle-medical treatment to targets and PET guided interventions (Comprehensive group). Comprehensive Group patients are regularly consulted by the CENTURY team implementing diet/lifestyle/exercise program and medical treatment to target risk modification. Cardiac PET at baseline, 24-, and 60-months quantify the physiologic severity of CAD and guide interventions in the Comprehensive group while patients and referring physicians of the Standard group are blinded to PET results. The primary end-point is the CENTURY risk score reduction during 5 years follow-up. The secondary endpoint is a composite of death, non-fatal myocardial infarction, stroke, and coronary revascularization. The CENTURY Study is the first study in stable CAD to test the incremental benefit of a comprehensive strategy integrating intense lifestyle modification, medical treatment to specific goals, and high-precision quantitative myocardial perfusion imaging to guide revascularization. A total of 1028 patients have been randomized, and the 5 years follow-up will conclude in 2022.

Composite Score of Healthy Lifestyle Factors and Risk of Hepatocellular Carcinoma: Findings from a Prospective Cohort Study.

While the associations between individual lifestyle factors and risk of hepatocellular carcinoma (HCC) have been described previously, their combined impact on HCC risk is unknown. The association of a composite score of healthy lifestyle factors, including body mass index, alcohol consumption, cigarette smoking, alternative Mediterranean diet, and sleep duration, and HCC risk was examined in the Singapore Chinese Health Study, an ongoing prospective cohort study of 63,257 Chinese men and women. Cox proportional hazard regression method was used to estimate HR and its 95% confidence interval (CI). Conditional logistic regression method was used to evaluate this composite lifestyle score-HCC risk association among a subset of individuals who tested negative for hepatitis B surface antigen (HBsAg) and anti-hepatitis C antibody. After a mean follow-up of 17.7 years, 561 participants developed HCC. Individuals with higher composite scores representing healthier lifestyles (range 0-8) were at significantly lower risk of HCC. Compared with the lowest composite score category (0-4), the HRs (95% CIs) for the composite scores of 5, 6, 7, and 8 were 0.67 (0.62-0.85), 0.61 (0.48-0.77), 0.49 (0.37-0.65), and 0.13 (0.06-0.30), respectively (P trend < 0.0001). A similar inverse association was observed in participants with negative HBsAg and anti-hepatitis C virus (HCV)-negative serology (HR, 0.38; 95% CI, 0.19-0.79; for the highest vs. the lowest category of the composite scores; P trend = 0.001). Healthy lifestyles protect against HCC development, especially for individuals without hepatitis B virus and HCV infections. This study highlights the importance of a comprehensive lifestyle modification strategy for HCC primary prevention.

Comprehensive lifestyle modification as complementary therapy to prevent and manage post-transplant diabetes mellitus*

Summary Post-transplant diabetes mellitus (PTDM) is one from the most common metabolic complications after kidney transplantation. PTDM develops in the early period after transplantation. The risk factors of PTDM are carbohydrate imbalances occurring in the patient prior to transplantation, surgery and the inclusion of immunosuppressive treatment. Kidney transplant patients tend to gain weight, which is associated with an increased risk of post-transplant diabetes, cardiovascular diseases and abnormal transplanted kidney function. Patients after kidney transplantation should be advised to adopt a lifestyle based on a proper diet, exercise, weight control and smoking cessation. The strategy to reduce the risk factors for PTDM development should start before transplantation and continue after kidney transplantation. A targeted, non-pharmacological approach to patients already during the dialysis period may have a significant impact on reducing post-transplantation diabetes. Lifestyle interventions can effectively reduce the risk of development and inhibit the progression of post-transplantation diabetes. The article describes elements of comprehensive non-pharmacological management based on available knowledge of rehabilitation, dietetics and psychology.

Logistic Regression Analysis on Hypertension and Lifestyle Risk Factors in Rural India

Background: Hypertension is the most important risk factor for chronic disease burden in India. The numbers of peoples affected and the prevalence of hypertension in rural India are expected to increase over the next decade. Aim and Objectives: To determine the prevalence and associated lifestyle risk factors of hypertension in rural India. Materials & methods: A community based cross sectional study was done among age group 40 years & above in rural area of eastern UP, India. Multistage and probability proportional to size sampling procedure was used. Statistical analysis: Data of 1856 individuals for prevalence of hypertension and associated risk factors were analysed and 2 value for each of the risk factors were calculated. Logistic regression analysis was used to predict hypertensive population associated with different risk factors also Adjusted Odd Ratio and corresponding Forest plot were also discussed in detail for each lifestyle risk factors. Results: The overall prevalence of hypertension was found to be 29.1%. Obesity and diabetes were strongly associated with hypertension. Compared to age group (40-49) years, others groups (50-59), (60-69), (70& above) were 2.44, 3.67, 5.33 times (AOR=2.44, 3.67, 5.33) more likely to have hypertensive population. Hypertension occurs nearly equal in both male and female (AOR=1.007; 95%CI: 0.77-1.32). In this study smokers, obese and diabetic person are more likely to have hypertension. Smokers have 1.38 times more chance to become hypertensive (AOR=1.380; 95%CI: 1.01-1.88) than non-smokers while in alcoholic and non-alcoholic population have equal chance (AOR=1.009; 95%CI=0.74-1.37) to become hypertensive. Conclusion: There is need to implement comprehensive lifestyle modification program such as promotion of healthy dietary habits, physical activity, tobacco cessation, avoidance of excessive intake of alcohol and stress, which may play major role in prevention of new hypertensive cases.

Annals for Educators - 3 November 2020.

Annals for Educators - 3 November 2020.

The effectiveness of intensive and traditional cardiac rehabilitation programs for improving cardiometabolic outcomes in patients with cardiovascular disease

Abstract Background Cardiac rehabilitation (CR) is integral to the optimal medical management of patients with cardiovascular disease (CVD). Purpose This study aims at evaluating the effectiveness of traditional (TCR) and intensive (ICR) CR programs for improving cardiometabolic outcomes of patients with CVD. Methods The study is based on retro-prospective review of hospital medical data of patients enrolled in TCR or ICR programs. TCR involved 36 supervised exercise and educational sessions (1 hr) 3 days/week over 12 weeks. ICR included a structured class model (4 hrs) twice a week over 9 weeks (a total of 18 sessions, 72 hrs). The ICR sessions were provided by a multidisciplinary team and consisted of supervised exercise, plant-based diet, nutrition education, stress management, and social support. The comparative analyses of numerous biomarkers and hemodynamic parameters before and after CR program for both groups were performed. The occurrence of major cardiac adverse events (MACE) in the long-term follow-up was assessed. Results In total, 314 patients (213 in TCR and 101 in ICR) were enrolled. Mean treatment adherence was 78% (97% in ICR vs 68% in TCR, p=0.000). Mean follow-up for MACE was 12.6 months (13.2 in ICR vs 12 in TCR, p=0.038). No differences were observed between TCR and ICR in patient age (66 years on average) and gender (68–73% of males). Coronary heart disease, hypertension, and heart failure (HF) were the most frequent CVDs in both TCR and ICR groups (88% vs 95%, p=0.044, 75% vs 66%, p=0.104, 48% vs 25%, p=0.000, respectively). There was no significant difference in incidence of diabetes and chronic kidney disease, and pharmacotherapy between groups. TCR program resulted in significant improvements in body and visceral fat, waist circumference, and exercise capacity whereas no significant changes were observed in weight, body mass index (BMI), blood pressure (BP), heart rate (HR), and lipids levels. ICR resulted in significant improvements in most metabolic biomarkers (weight, BMI, body and visceral fat, waist circumference), hemodynamic parameters (exercise capacity, BP) and lipid biomarkers levels (total cholesterol, low-density and non-high-density-lipoprotein cholesterol). Compared with TCR, ICR resulted in more significant improvements of metabolic biomarkers such as weight (p&amp;lt;0.001), BMI (p&amp;lt;0.001), body fat (p&amp;lt;0.05) and waist circumference (p=0.002), and hemodynamic parameters such as diastolic BP (p&amp;lt;001) and HR (p=0.05). A trend towards lower incidence of MACE (all-cause death, non-fatal myocardial infarction, unstable angina, and revascularisation) with significantly lower rates of hospitalisation for HF (2 vs 24, p=0.005) in the long-term follow-up was observed in ICR compared with TCR group. Conclusion Intense and more comprehensive lifestyle modification provided by the ICR program had greater impact on improving cardiometabolic outcomes including long-term MACE compared to the TCR program. Funding Acknowledgement Type of funding source: None

Nonpharmacologic Interventions for Reducing Blood Pressure in Adults With Prehypertension to Established Hypertension.

BackgroundNonpharmacologic interventions that modify lifestyle can lower blood pressure (BP) and have been assessed in numerous randomized controlled trials and pairwise meta‐analyses. It is still unclear which intervention would be most efficacious.Methods and ResultsBayesian network meta‐analyses were performed to estimate the comparative effectiveness of different interventions for lowering BP. From 60 166 potentially relevant articles, 120 eligible articles (14 923 participants) with a median follow‐up of 12 weeks, assessing 22 nonpharmacologic interventions, were included. According to the surface under the cumulative ranking probabilities and Grading of Recommendations Assessment, Development and Evaluation (GRADE) quality of evidence, for adults with prehypertension to established hypertension, high‐quality evidence indicated that the Dietary Approach to Stop Hypertension (DASH) was superior to usual care and all other nonpharmacologic interventions in lowering systolic BP (weighted mean difference, 6.97 mm Hg; 95% credible interval, 4.50–9.47) and diastolic BP (weighted mean difference, 3.54 mm Hg; 95% credible interval, 1.80–5.28). Compared with usual care, moderate‐ to high‐quality evidence indicated that aerobic exercise, isometric training, low‐sodium and high‐potassium salt, comprehensive lifestyle modification, breathing‐control, and meditation could lower systolic BP and diastolic BP. For patients with hypertension, moderate‐ to high‐quality evidence suggested that the interventions listed (except comprehensive lifestyle modification) were associated with greater systolic BP and diastolic BP reduction than usual care; salt restriction was also effective in lowering both systolic BP and diastolic BP. Among overweight and obese participants, low‐calorie diet and low‐calorie diet plus exercise could lower more BP than exercise.ConclusionsDASH might be the most effective intervention in lowering BP for adults with prehypertension to established hypertension. Aerobic exercise, isometric training, low‐sodium and high‐potassium salt, comprehensive lifestyle modification, salt restriction, breathing‐control, meditation and low‐calorie diet also have obvious effects on BP reduction.

Comprehensive Lifestyle-Modification in Patients with Ulcerative Colitis–A Randomized Controlled Trial

Patients with ulcerative colitis suffer from impaired health-related quality of life (HrQoL). Comprehensive lifestyle-modification might increase HrQoL and decrease disease activity. Ninety-seven patients in clinical remission with impaired HrQoL were randomly assigned to a 10 week comprehensive lifestyle-modification program (LSM; n = 47; 50.28 ± 11.90 years) or control (n = 50; 45.54 ± 12.49 years) that received a single workshop of intense training in naturopathic self-help strategies. Primary outcome was HrQoL (Inflammatory Bowel Disease Questionnaire; IBDQ) at week 12. Secondary outcomes included IBDQ subscales; generic HrQoL; disease activity and microbiome. Both groups showed improvement in HrQoL from baseline to post-treatment at week 12. The IBDQ sum score showed no significant group difference (p = 0.251). If patients attended more than 50% of the training sessions, a significant group effect (p = 0.034) was evident in favor of LSM. In addition, the SF-36 mental component summary (p = 0.002) was significantly different between the groups in favor of LSM. Disease activity microbiome and adverse events did not differ. Both a single workshop and a 10-week comprehensive lifestyle-modification program can improve HrQoL in patients with ulcerative colitis in remission with no apparent effects on clinical disease activity. A treatment difference was observed when examining a subsample of patients who attended ≥ 50% of sessions.

Abstract 2344: Composite score of healthy lifestyle factors and risk of hepatocellular carcinoma: Findings from a prospective cohort study

Abstract Background. While the associations between individual lifestyle factors and risk of hepatocellular carcinoma (HCC) were examined substantially, their combined impact on HCC risk has not been evaluated. Methods. The association of a composite score of healthy lifestyle factors, including body mass index, alcohol consumption, cigarette smoking, alternative Mediterranean Diet (aMED), and sleep duration, with the risk of developing HCC was examined in the Singapore Chinese Health Study (SCHS), an on-going prospective cohort of 63,257 Chinese men and women aged 45-74 at enrollment in 1993-1998 with up to 25 years of follow-up. Cox proportional hazard regression method was used to estimate hazard ratio (HR) and its 95% confidence interval (CI) of HCC with the composite score after adjustment for multiple potential confounders. The unconditional logistic regression method was used to confirm the association between the composite lifestyle score and HCC risk among hepatitis B surface antigen (HBsAg) negative individuals to eliminate its potential confounding effect. Results. After a mean follow-up of 17.7 years, 561 participants of the SCHS developed HCC. Individuals with higher composite scores, which represented for healthier lifestyles, were at significantly lower risk of HCC. Compared with the lowest composite score (i.e., 0-4), the HRs (95% CIs) for 5, 6, 7 and 8 were 0.48 (0.36-0.64), 0.44 (0.34-0.67), 0.37 (0.28-0.48), and 0.26 (0.17-0.39), respectively (Ptrend&amp;lt;0.001). A similar inverse association was observed in participants with negative HBsAg serology; HR was 0.12 (95% CI: 0.04-0.38) for the highest versus the lowest category of the composite scores (Ptrend=0.01). Conclusion. Healthy lifestyles are protective against the development of HCC, especially for individuals without viral infection. This finding highlights the importance of a comprehensive lifestyle modification strategy for primary prevention of HCC. Funding: The Singapore Chinese Health Study was supported by the National Institutes of Health (NIH) of the United States (grants # R01 CA144034 and UM1 CA182876). Citation Format: Hung N. Luu, Renwei Wang, Jaideep Behari, Jennifer Adams-Haduch, Andrew O. Odegaard, George Goh Bee, Aizhen Jin, Woon-Puay Koh, Jian-Min Yuan. Composite score of healthy lifestyle factors and risk of hepatocellular carcinoma: Findings from a prospective cohort study [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 2344.

Effect of Comprehensive Lifestyle Modification and Meditation on Coronary Atherosclerosis and Its Risk Factors

Background: Comprehensive lifestyle modification has an effect on coronary atherosclerosis.&#x0D; Objective: This study was performed to determine the effect of comprehensive lifestyle modification and meditation on coronary atherosclerosis.&#x0D; Methodology: This cohort study was done by Quantum Foundation, Dhaka, Bangladesh during the period of January 2010 to December 2014. Patients who had attended the 2-days long orientation program on comprehensive lifestyle modification, meditation and overview of coronary artery disease were included in the study. Participants who had attended ≥10 monthly and ≤2 monthly follow up &amp; counseling session were defined as compliant and noncompliant group respectively. Patients were follow up for angiogram.&#x0D; Results: A total number of 32 patients were divided into compliant and noncompliant groups. Patient in the compliant group used to take heart healthy diet in 100.0% cases and avoided heart-unhealthy diet in 100.0% cases as well. Patients in the compliant group were also adherent to daily practice of meditation in 100.0% of cases and it was only 26.7% in case of non-compliant (P&lt;0.001). From baseline and repeat angiogram Gensini scoring was done to determine the regression of coronary blockage. Regression of coronary blockage was observed in 61.5% cases of compliant group and 10.5% in non-compliant group (P&lt;0.001).&#x0D; Conclusion: Comprehensive lifestyle modification and meditation can regress coronary atherosclerosis.&#x0D; Journal of Current and Advance Medical Research 2020;7(1): 24-29

Lifestyle modification approaches for the treatment of obesity in adults.

The U.S. Preventive Services Task Force has recommended that primary care clinicians screen all adults for obesity and provide those affected intensive multicomponent behavioral interventions. Approximately 95 million U.S. adults qualify for such care, also referred to as lifestyle modification. Using the Guidelines (2013) for Managing Overweight and Obesity in Adults (hereafter, Obesity Guidelines) as a framework, this article reviews the principal components of comprehensive lifestyle modification, which include diet, physical activity, and behavior therapy. To lose weight, the Obesity Guidelines recommend participation for 6 months in high-intensity programs that provide 14 or more counseling sessions with a trained interventionist. When provided face-to-face individual or group treatment, participants lose up to 8 kg (8% of weight) in 6 months and experience improvements in cardiovascular disease risk factors and quality of life. To prevent weight regain, the Obesity Guidelines recommend participation for 1 year in weight-loss-maintenance programs that provide at least monthly counseling. High levels of physical activity, frequent monitoring of body weight, and consumption of a reduced-calorie diet are associated with long-term weight loss. Investigators currently are seeking to increase the availability of lifestyle modification by delivering it in community-based programs, as well as on digital platforms (e.g., Internet and Smartphone). Digitally delivered programs lower costs and expand treatment reach; their efficacy is likely to improve further with the addition of new technologies for monitoring food intake, activity, and weight. Ultimately, to improve long-term weight management, individual lifestyle counseling must be joined with collective and institutional efforts to improve the nation's eating and activity environments. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Dose-dependent effects of lifestyle interventions on blood lipid levels: Results from the PREMIER trial

ObjectiveTo assess the effects of comprehensive lifestyle modification on low-density lipoprotein cholesterol (LDL-C) levels and whether greater participation in counseling sessions was associated with greater LDL-C reductions. MethodsMulticenter trial of Pre- or Stage 1 hypertensive adults randomized to: (1)Advice alone, (2)‘Established’ lifestyle intervention implementing physical activity, sodium reduction, and weight loss, if overweight, or (3)‘Established + DASH’ lifestyle intervention with DASH diet counseling. Both intervention groups received behavioral counseling. We used generalized estimating equations to model the intervention’s effects on lipid outcomes. Analyses of number of sessions and lipids were adjusted for demographics and medical history. ResultsAmong 756 participants (mean age 49.7, 63.2% women, 34.7% black), both lifestyle interventions reduced LDL-C, triglycerides, and total cholesterol (TC) at six months. Compared to the ‘Advice’ arm, net mean lipid changes in the Established group were: LDL-C of -5.6 mg/dL (p=0.001) and TC of -7.3 mg/dL (p<0.001). Similarly, changes in the ‘Established + DASH’ group were: LDL-C of -4.0 mg/dL (p=0.03) and TC of -5.7 mg/dL (p=0.006). In dose-response analyses, for every 10-session increase, LDL-C changed by -6.2 mg/dL (p=0.003). ConclusionsComprehensive lifestyle modification lowers LDL-C with greater benefit among persons who attend more counseling sessions. Practice ImplicationsPatient engagement is a critical aspect of effective lifestyle interventions.

Sa1865 – There is More Than Pharmacology: Comprehensive Lifestylemodification in Patients with Ulcerative Colitis – a Randomized Controlled Trial

Sa1865 – There is More Than Pharmacology: Comprehensive Lifestylemodification in Patients with Ulcerative Colitis – a Randomized Controlled Trial

There is more than pharmacology: Comprehensive lifestyle-modification in patients with ulcerative colitis – A randomized controlled trial

There is more than pharmacology: Comprehensive lifestyle-modification in patients with ulcerative colitis – A randomized controlled trial

Comprehensive lifestyle-modification including multi-modal stress management techniques in patients with ulcerative colitis – Results of the Trier Social Stress Test

Comprehensive lifestyle-modification including multi-modal stress management techniques in patients with ulcerative colitis – Results of the Trier Social Stress Test

Comprehensive Lifestyle Improvement Program for Prostate Cancer (CLIPP): Protocol for a Feasibility and Exploratory Efficacy Study in Men on Androgen Deprivation Therapy.

BackgroundAndrogen deprivation therapy (ADT) for prostate cancer is associated with adverse cardiometabolic effects such as reduced libido, hot flashes, metabolic syndrome, diabetes, myocardial infarction, and stroke. This reduces quality of life and potentially increases mortality. Several large clinical trials have demonstrated improvements in cardiometabolic risk with comprehensive multimodality lifestyle modification. However, there is a lack of data for such interventions in men on ADT for prostate cancer, and existing studies have used non-standardized interventions or lacked data on metabolic risk factors.ObjectiveThe Comprehensive Lifestyle Improvement Project for Prostate Cancer (CLIPP) is designed to address these gaps by using an intervention modeled on the Diabetes Prevention Program, a standardized multicomponent intervention with demonstrated effectiveness in reducing cardiometabolic risk factors that has been successfully adapted for multiple disease types including breast cancer.MethodsA single-arm unblinded clinical trial will be conducted to determine the feasibility of conducting a 24-week comprehensive lifestyle modification intervention that targets weight loss and increased physical activity modeled on the Diabetes Prevention Program in 30 men on ADT for prostate cancer. Secondary aims are to determine the effect of the intervention on cardiometabolic markers and quality of life. The tertiary aim is to determine the effect of the intervention on markers of inflammation and angiogenesis, important mechanisms for prostate cancer progression. Participants will be recruited from the University of Arizona Cancer Center and the surrounding community. The intervention will be delivered weekly in person and over the phone for 16 weeks. For Weeks 16-24, participants receive weekly phone calls from the study health coach to motivate them to continue their lifestyle modification. Questionnaire and biological data are collected at baseline, 12 weeks, and 24 weeks. Body composition using dual-energy x-ray absorptiometry scans will be performed at baseline and end of study.ResultsBased on a sample size of 30, the two-sided 95% confidence interval will not be wider than 0.373 standard deviations for the adherence rate and will not be wider than 0.374 for the retention rate. In addition, the study will have a power of 80% to detect a change of 0.47 standard deviations from baseline for each of the markers investigated in the secondary and tertiary aims assuming a within-subject correlation of 0.20 at a significance level of 5%. The recruitment period is from October 2018 to April 2019.ConclusionsThe aim of CLIPP is to determine the feasibility of conducting a Diabetes Prevention Program–style comprehensive lifestyle modification intervention in men with ADT for prostate cancer and its effects on cardiometabolic adverse effects, quality of life, as well as markers of inflammation and angiogenesis. Results will inform the development of future clinical trials in this population.International Registered Report Identifier (IRRID)DERR1-10.2196/12579

Comprehensive Lifestyle Modification Intervention to Improve Chronic Disease Risk Factors and Quality of Life in Cancer Survivors.

Healthy lifestyle modifications, including weight management, regular physical activity, prudent diet, and stress relief, have been identified as key components of tertiary cancer prevention. In this study, we evaluate the effectiveness of a comprehensive, lifestyle medicine intervention, Lifestyle 180®, on chronic disease risk factors and quality of life in cancer survivors. Retrospective subgroup analysis of a clinical program. An outpatient medical facility. Lifestyle 180 participants with a diagnosis of past cancer. Sixty-four hours of intensive nutrition, culinary medicine, physical activity, and stress relief practices over a 6-month period, with 9- and 12-month follow-up. Pre-postanalysis (baseline vs. 12 months) included biometrics: weight, body mass index (BMI), waist circumference, and blood pressure; standard laboratory tests: lipids, C-reactive protein, fasting insulin/glucose, and insulin resistance; and empirically validated questionnaires: perceived stress, depression, and quality of life. Fifty-eight cancer survivors participated in Lifestyle 180. Average age was 63 years, roughly 75% of participants were female, and the greatest majority had a diagnosis of breast, prostate, or skin cancer. Diagnosis of hyperlipidemia, hypertension, diabetes, and prediabetes presented in 47%, 57%, 22%, and 50% of patients, respectively. Forty-five percent of patients were obese, 24% were overweight, and 16% were depressed. At 12 months, participants lost an average of 14 pounds (-6.6%, p < 0.001) and 2.6 inches off their waist (-5.9%, p < 0.001). BMI decreased significantly by an average of 2.4 kg/m2 (-6.8%, p < 0.001). Significant decreases from well-managed baseline levels also occurred in most measured biomarkers (average change: high-density lipoprotein +3.3 mg/dL, p < 0.05; triglycerides -23.0 mg/dL, p < 0.01; C-reactive protein -1.3 mg/L, p < 0.01; fasting insulin -4.2 μU/mL, p < 0.05; and homeostasis model assessment-insulin resistance -1.5, p < 0.01; n = 40). Changes in psychosocial variables included significant improvements in perceived stress (-20%, p < 0.01) and quality of life (+54%, p < 0.001). We were unable to detect a difference in depressive symptoms. Cancer survivors participating in a comprehensive intervention could employ the prescribed lifestyle modifications to produce clinically relevant health and quality-of-life benefits. These data support the American Cancer Society (ACS) and American Society of Clinical Oncology (ASCO) recommendations to incorporate healthy lifestyle modifications into long-term cancer survivorship care.