Efficacy Of Lifestyle Interventions Research Articles

Enhancing cognitive resilience: a narrative review of lifestyle interventions in cognitive decline prevention among older adults

Background: The increasing prevalence of cognitive decline and neurodegenerative disorders among ageing populations necessitates effective preventive strategies. Lifestyle interventions, including dietary modifications, cognitive training, and physical exercise, have emerged as promising avenues for enhancing cognitive resilience. This narrative review synthesizes current evidence on the efficacy of lifestyle interventions in preventing or delaying cognitive decline among older adults. Methods and Materials: A systematic search was conducted across databases, including PubMed and Google Scholar, using the PICO framework to formulate a precise research question. Inclusion criteria encompassed diverse study designs, focusing on older adults aged 65 years and above, diagnosed with mild cognitive impairment (MCI) or early-stage Alzheimer's disease (AD). Lifestyle interventions targeting cognitive health were compared against standard care or alternative non-pharmacological approaches, with primary outcomes including changes in cognitive function and activities of daily living (ADLs). Objectives: The review aimed to evaluate the effectiveness of lifestyle interventions, such as cognitive training, dietary modifications, and physical exercise, in preserving cognitive function and delaying cognitive decline among older adults. Results: The synthesis of evidence revealed significant benefits associated with lifestyle interventions. Dietary patterns rich in antioxidants, anti-inflammatory compounds, and essential fatty acids demonstrated neuroprotective effects and reduced cognitive decline risk. Physical exercise programs and cognitive stimulation interventions also showed promise in maintaining cognitive function. Multimodal approaches, personalized interventions, and long-term follow-ups emerged as key considerations for optimizing outcomes.

Efficacy of Lifestyle Interventions on Body Weight and Elevated Liver Enzymes among Patients with Non-Alcoholic Fatty-Liver Disease

Efficacy of Lifestyle Interventions on Body Weight and Elevated Liver Enzymes among Patients with Non-Alcoholic Fatty-Liver Disease

Efficacy of Lifestyle Interventions on Body Weight and Elevated Liver Enzymes among Patients with Non-Alcoholic Fatty-Liver Disease

Efficacy of Lifestyle Interventions on Body Weight and Elevated Liver Enzymes among Patients with Non-Alcoholic Fatty-Liver Disease

Cognitive reserve and dementia risk management in people with an intellectual disability.

This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Implementation of Antenatal Lifestyle Interventions Into Routine Care

Lifestyle interventions in pregnancy optimize gestational weight gain and improve pregnancy outcomes, with implementation recommended by the US Preventive Services Task Force. Yet, implementation research taking these efficacy trials into pragmatic translation remains limited. To evaluate success factors for implementing pregnancy lifestyle interventions into antenatal care settings in a meta-analysis, using the penetration, implementation, participation, and effectiveness (PIPE) impact metric. Data from a previous systematic review that searched across 9 databases, including MEDLINE, Embase, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, Cochrane Central Register of Controlled Trials, and Health Technology Assessment Database, were obtained, in 2 stages, up to May 6, 2020. Randomized clinical trials reporting gestational weight gain in singleton pregnancies. The association of penetration, implementation, and participation with effectiveness of antenatal lifestyle interventions in optimizing gestational weight gain was estimated using random-effects meta-analyses. The Cochrane risk of bias tool, version 1.0, was used to assess risk of bias. Penetration (reach), implementation (fidelity), participation, and effectiveness of randomized clinical trials of lifestyle interventions in pregnancy. Ninety-nine studies with 34 546 participants were included. Only 14 studies reported penetration of target populations. Overall, 38 studies (38.4%) had moderate fidelity, 25 (25.2%) had high fidelity, and 36 (36.4%) had unclear fidelity. Participation was reported in 84 studies (84.8%). Lifestyle interventions were associated with reducing gestational weight gain by 1.15 kg (95% CI, -1.40 to -0.91 kg). The findings of this systematic review and meta-analysis suggest that, despite the large body of evidence on efficacy of lifestyle interventions during pregnancy in optimizing gestational weight gain, little guidance is available to inform implementation of this evidence into practice. There is a need to better elucidate implementation outcomes in trial design alongside pragmatic implementation research to improve the health of women who are pregnant and the next generation.

Lifestyle Intervention Strategy to Treat Diabetes in Older Adults: A Randomized Controlled Trial.

Lifestyle intervention is recommended as first-line treatment of diabetes at all ages; however, little is known about the efficacy of lifestyle intervention in older adults with diabetes. We aimed to determine whether lifestyle intervention would improve glycemic control and age-relevant outcomes in older adults with diabetes and comorbidities. A total of 100 older adults with diabetes were randomly assigned to 1-year intensive lifestyle intervention (ILI) (diet and exercise at a facility transitioned into community-fitness centers and homes) or healthy lifestyle (HL) group. The primary outcome was change in HbA1c. Secondary outcomes included glucoregulation, body composition, physical function, and quality of life. Changes between groups were analyzed with mixed-model repeated-measures ANCOVA following the intention-to-treat principle. HbA1c improved more in the ILI than the HL group (mean ± SE -0.8 ± 0.1 vs. 0.1 ± 0.1%), associated with improved insulin sensitivity (1.2 ± 0.2 vs. -0.4 ± 0.2) and disposition (26.0 ± 8.9 vs. -13.0 ± 8.4 109 min-1) indices (between-group P < 0.001 to 0.04). Body weight and visceral fat decreased more in the ILI than HL group (-8.4 ± 0.6 vs. -0.3 ± 0.6 kg, P < 0.001, and -261 ± 29 vs. -30 ± 27 cm3, P < 0.001, respectively). Physical Performance Test score increased more in the ILI than HL group (2.9 ± 0.6 vs. -0.1 ± 0.4, P < 0.001) as did VO2peak (2.2 ± 0.3 vs. -1.2 ± 0.2 mL/kg/min, P < 0.001). Strength, gait, and 36-Item Short Form Survey (SF-36) Physical Component Summary score also improved more in the ILI group (all P < 0.001). Total insulin dose decreased in the ILI group by 19.8 ± 4.4 units/day. Adverse events included increased episodes of mild hypoglycemia in the ILI group. A lifestyle intervention strategy is highly successful in improving metabolic and functional health of older adults with diabetes.

1170-P: Long-Term Effects of Lifestyle Changes in Subjects with Prediabetes and Type 2 Diabetes on Cardiovascular and All-Cause Mortality: A Systematic Review with Meta-analysis of Randomized Clinical Trials

Long-term RCTs have shown that lifestyle interventions (LI) can prevent T2DM in individuals with prediabetes, improve glycemic control in individuals with T2DM, as well as improve lipid profile and lower blood pressure in both. However, the impact of these interventions on cardiovascular (CV) and total mortality is still not clear. Therefore, we conducted a systematic review with meta-analysis to determine the long-term efficacy of LI on CV and all-cause mortality in subjects with prediabetes and T2DM. We searched PubMed, Cochrane CENTRAL, Embase, Web of Science, protocol records, and reference lists of relevant publications until December 2021. We selected RCTs including adults with prediabetes and T2DM that evaluated LI with at least 2 years of duration, with or without post-trial follow-up. The main outcomes consisted of CV and all-cause mortality. We used the RoB 2.0 tool to evaluate the risk of bias and the GRADE approach for the overall certainty of evidence. Meta-analysis was conducted using a random effects method. We identified 22,900 records, of which studies registred all-cause mortality events (16,554 participants, mean age 55.5 years, mean BMI 30.5 Kg/m2, 9.9 years of follow-up) , and 5 reported CV mortality events (11,017 participants, mean age 54.5 years, and mean BMI 31.8 Kg/m2, 14.8 years of follow-up) . LI did not reduce the risk of CV mortality (RR 0.95; 95% CI 0.74 to 1.21; I2=38%; moderate certainty of the evidence) and all-cause mortality (RR 0.94; 95% CI 0.85 to 1.03; I2=15%; high certainty of the evidence) compared with usual care. This meta-analysis of RCTs demonstrated that intensive LI was not superior to usual care in reducing CV and all-cause mortality for subjects with prediabetes and T2DM. However, there is still insufficient evidence demonstrating the effect of long-term cardioprotective LI on mortality in this specific population. Disclosure K.P.Zucatti: None. N.Fonseca: None. P.Correia: None. E.Brietzke: Speaker's Bureau; Daiichi Sankyo, Janssen Pharmaceuticals, Inc. B.Halpern: None. V.Colpani: None. F.Gerchman: None. P.P.Teixeira: None. L.F.Wayerbacher: None. A.D.Frankenberg: None. B.A.Guerra: None. G.F.Piccoli: None. K.S.Moresco: None. L.Farenzena: None. M.G.Madure: None.

Patient-reported outcomes of lifestyle interventions in patients with severe mental illness: a systematic review and meta-analysis

BackgroundLifestyle interventions for severe mental illness (SMI) are known to have small to modest effect on physical health outcomes. Little attention has been given to patient-reported outcomes (PROs).AimTo systematically review the use of PROs and their measures, and quantify the effects of lifestyle interventions in patients with SMI on these PROs.MethodsFive electronic databases were searched (PubMed/Medline, Embase, PsycINFO, CINAHL, and Web of Science) from inception until 12 November 2020 (PROSPERO: CRD42020212135). Randomised controlled trials (RCTs) evaluating the efficacy of lifestyle interventions focusing on healthy diet, physical activity, or both for patients with SMI were included. Outcomes of interest were PROs.ResultsA total of 11.267 unique records were identified from the database search, 66 full-text articles were assessed, and 36 RCTs were included, of which 21 were suitable for meta-analyses. In total, 5.907 participants were included across studies. Lifestyle interventions had no significant effect on quality of life (g = 0.13; 95% CI = − 0.02 to 0.27), with high heterogeneity (I2 = 68.7%). We found a small effect on depression severity (g = 0.30, 95% CI = 0.00 to 0.58, I2 = 65.2%) and a moderate effect on anxiety severity (g = 0.56, 95% CI = 0.16 to 0.95, I2 = 0%).DiscussionThis meta-analysis quantifies the effects of lifestyle interventions on PROs. Lifestyle interventions have no significant effect on quality of life, yet they could improve mental health outcomes such as depression and anxiety symptoms. Further use of patient-reported outcome measures in lifestyle research is recommended to fully capture the impact of lifestyle interventions.

Effectiveness and implementation of a multidisciplinary lifestyle focused approach in the treatment of inpatients with mental illness (MULTI\u2009+): a stepped wedge study protocol

BackgroundPeople with mental illness have a reduced life expectancy compared to the general population. Despite the increasing evidence for the efficacy of lifestyle interventions there is little change in routine clinical care. This discrepancy is often referred to as the implementation gap and has caused a need for effectiveness and implementation research in real-world settings. Our study assesses the effectiveness and implementation of a multidisciplinary lifestyle focused approach in the treatment of inpatients with mental illness (MULTI +).MethodsAn open cohort stepped wedge cluster randomized trial in inpatients psychiatric wards of GGz Centraal, the Netherlands. The wards are divided into three clusters based on geographical region. These clusters are randomly allocated to one of the three pre-defined steps to integrate MULTI + . MULTI + can be tailored to fit individual psychiatric wards and includes 10 core components aimed at improving lifestyle factors. The primary outcome is to investigate the difference in the mean QRISK3 score of patients receiving MULTI + compared to patients receiving TAU. Secondary outcomes include somatic and mental health outcomes, lifestyle factors, and implementation factors. Findings will be analysed using mixed model analyses.DiscussionThe MULTI + study is the first large-scale study evaluating the long-term effects of a multidisciplinary, multicomponent approach aimed at improving lifestyle factors in routine inpatient mental health care. A limitation of this study is the risk of missing data due to the large-scale, real-world setting of this study. Furthermore, implementation monitoring and external events that may influence outcomes could be difficult to account for. Strengths of this study are the focus on effectiveness as well as implementation and the inclusion of both patient and health care professionals’ perspectives. Effectiveness studies in routine clinical care can advance our knowledge on lifestyle interventions in real-world settings.Trial registrationClinicalTrials.gov registration. Identifier: NCT04922749. Retrospectively registered 3th of June 2021.

Abstract ES7-1: Harnessing Lifestyle Interventions via Diet and Exercise for Cancer Risk Reduction

Abstract A growing body of evidence indicates the importance of maintaining optimal metabolic health to reduce the risk of developing cancer and to improve outcomes after cancer diagnosis. Classical and normal weight obesity are states of metabolic dysfunction, and highly prevalent risk factors for the development and growth of several cancers. Classical obesity (defined as a body mass index (BMI) ≥ 30) is a risk factor for at least 13 different types of cancer. Recent data indicate that up to one third of normal weight individuals have metabolic obesity and, subsequently, increased risk for several cancers including breast and colon. Methods to risk-stratify metabolic health and subsequent cancer risk beyond traditional anthropometric metrics such as BMI could improve the efficacy of lifestyle interventions aimed at reducing cancer risk and improving cancer outcomes. In this educational session, the molecular mechanisms linking classical and normal weight obesity to cancer growth will be presented. Obesity-related dysfunction can contribute to cancer pathogenesis and treatment resistance through various mechanisms, including those mediated by insulin, leptin, adiponectin, pro-inflammatory mediators, and hormone signaling pathways, particularly in women. Furthermore, adiposity-related changes can influence tumor vascularity and inflammation in the tumor microenvironment, which can support tumor development and growth. Building upon these mechanistic findings, several clinical trials testing “precision lifestyle” interventions targeted at specific biologic pathways are ongoing. Several randomized control trials testing diet, exercise, and weight loss interventions in cancer populations have demonstrated the feasibility of such interventions. Here, the next generation of lifestyle interventions, such as digital interventions, that target specific pathway dysregulation will be presented. Additionally, pharmacologic interventions that target host metabolism are under study as adjuncts to standard cancer therapy. As rates of classical and normal weight obesity continue to increase, the development of individualized and biologically rational lifestyle interventions could represent an impactful strategy to reduce the worldwide cancer burden. Citation Format: NM Iyengar. Harnessing Lifestyle Interventions via Diet and Exercise for Cancer Risk Reduction [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr ES7-1.

Efficacy of lifestyle intervention in adults with impaired glucose tolerance with and without impaired fasting plasma glucose: A post hoc analysis of Da Qing Diabetes Prevention Outcome Study.

The extent that pre-diabetic fasting plasma glucose (FPG) levels influence the effectiveness of lifestyle interventions in preventing type 2 diabetes (T2DM) is uncertain. We aimed to determine if the outcome of lifestyle intervention in people with impaired glucose tolerance (IGT) differs in those with normal or impaired FPG levels. Data were used from the Da Qing Diabetes Prevention Outcome Study, which was a 30-year follow-up of a 6-year randomized trial of lifestyle intervention in 576 people with IGT. We then conducted a post-hoc analysis to compare the efficacy of intervention to reduce the incidence of T2DM and its complications in those with baseline FPG <100 mg/dL and FPG ≥100 mg/dL. Lifestyle intervention reduced the cumulative incidence of T2DM by 37%-46% in those with baseline FPG <100 mg/dL and by 47%-51% in those with FPG ≥100 mg/dL. The FPG <100 mg/dL group had a lower cumulative incidence of diabetes and 6.41 years median delay in its onset compared with 2.21 years delay in the FPG ≥100 mg/dL group. In those with FPG <100 mg/dL intervention was associated with at least as great a reduction in cardiovascular disease and all-cause mortality as in the FPG ≥100 mg/dL group. Lifestyle intervention reduced the incidence of T2DM in people with IGT regardless of baseline FPG levels, and in those with FPG <100 mg/dL led to a substantial delay in its onset. All persons with IGT, with normal or impaired FPG levels, may benefit from lifestyle intervention to delay its onset and mitigate the incidence of T2DM.

Long-term effects (&amp;gt;24 months) of multiple lifestyle intervention on major cardiovascular risk factors among high risk subjects: a meta-analysis

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): The Norwegian health department Background The evidence of the long-term effects of multiple lifestyle intervention on cardiovascular risk is uncertain. We aimed to summarize the evidence from randomized clinical trials examining the efficacy of lifestyle intervention on major cardiovascular risk factors in subjects at high cardiovascular risk. Methods Eligible trials investigated the impact of lifestyle intervention versus usual care with minimum 24 months follow-up, reporting more than one major cardiovascular risk factor. A literature search updated April 15, 2020 identified 12 eligible studies. The results from individual trials were combined using fixed and random effect models, using the standardized mean difference (SMD) to estimate effect sizes. Small-study effect was evaluated, and heterogeneity between studies examined by subgroup and meta-regression analyses considering patient- and study-level variables. Results Small-study effect was not identified. Lifestyle intervention reduced systolic blood pressure modestly with an estimated SMD of -0.13, 95% confidence interval (CI): -0.21 to -0.04, with moderate heterogeneity (I² = 59%), corresponding to a mean difference of approximately 2 mmHg (MD = -1.86, 95% CI: -3.14 to -0.57, p = 0.0046). This effect disappeared in the subgroup of trials judged at low risk of bias (SMD = 0.02, 95% CI: -0.08 to 0.11). For the outcome total cholesterol SMD was -0.06, 95% CI: -0.13 to 0.00, with no heterogeneity (I² = 0%), indicating no effect of the intervention. Conclusion Lifestyle intervention resulted in only a modest effect on systolic blood pressure and no effect on total cholesterol after 24 months. Further lifestyle trials should consider the challenge of maintaining larger long-term benefits to ensure impact on cardiovascular outcomes.

Long-term effects (>\u200924\xa0months) of multiple lifestyle intervention on major cardiovascular risk factors among high-risk subjects: a meta-analysis

BackgroundThe evidence of the long-term effects of multiple lifestyle intervention on cardiovascular risk is uncertain. We aimed to summarize the evidence from randomized clinical trials examining the efficacy of lifestyle intervention on major cardiovascular risk factors in subjects at high cardiovascular risk.MethodsEligible trials investigated the impact of lifestyle intervention versus usual care with minimum 24 months follow-up, reporting more than one major cardiovascular risk factor. A literature search updated April 15, 2020 identified 12 eligible studies. The results from individual trials were combined, using fixed and random effect models, using the standardized mean difference (SMD) to estimate effect sizes. Small-study effect was evaluated, and heterogeneity between studies examined, by subgroup and meta-regression analyses, considering patient- and study-level variables.ResultsSmall-study effect was not identified. Lifestyle intervention reduced systolic blood pressure modestly with an estimated SMD of − 0.13, 95% confidence interval (CI): − 0.21 to − 0.04, with moderate heterogeneity (I2 = 59%), corresponding to a mean difference of approximately 2 mmHg (MD = − 1.86, 95% CI − 3.14 to − 0.57, p = 0.0046). This effect disappeared in the subgroup of trials judged at low risk of bias (SMD = 0.02, 95% CI − 0.08 to 0.11). For the outcome total cholesterol SMD was − 0.06, 95% CI − 0.13 to 0.00, with no heterogeneity (I2 = 0%), indicating no effect of the intervention.ConclusionLifestyle intervention resulted in only a modest effect on systolic blood pressure and no effect on total cholesterol after 24 months. Further lifestyle trials should consider the challenge of maintaining larger long-term benefits to ensure impact on cardiovascular outcomes.

Role of Panchatikta Panchaprasutik Niruha Vasti in Prediabetes A case report

Background: Prediabetes is an intermediate state of hyperglycemia with glycaemic parameters above normal but below the diabetes threshold. In Ayurveda, it is correlated with Prameha Poovaroopavastha. The risk of developing diabetes remains high with an annual conversion rate 5-10%. Many other studies have shown that the efficacy of lifestyle intervention in diabetes prevention with a relative risk reduction of 40-70% in prediabetes adults. If we treat this disease in early stage then it checks the further pathogenesis of disease. Aim and objectives: The aim of this study was to observe the efficacy of Panchatikta Panchaprasutik Niruha Vasti enema including Palliative treatment in prediabetes. Methods: It is a single case study of 55 years old male patient who was diagnosed with prediabetes correlated as Prameha Poorvaroopa from 1 year approached to Ayurvedic hospital and was treated Panchatikta Panchaprasutik Niruha Vasti. The treatment was continued for consecutive 15 days. Results: After 15days changes were observed in symptoms as well as reduction was seen in blood and urine sugar level and overall quality of life of patient was improved. Conclusion: Patient got satisfactory relief in symptoms as well as objective parameters after 15 days.

Effect and efficacy of lifestyle interventions as secondary prevention.

IntroductionImprovements in health behaviour are often recommended as part of secondary prevention in patients with stroke and transient ischaemic attack. However, there is a lack of knowledge as to how this is applied in clinical practice.AimIn this systematic review and meta‐analysis, we examined the effect of counselling or educational intervention directed at individual or multiple behavioural risk factors on blood pressure and other reported outcomes.MethodsPubMed, Embase, PsycInfo, CINAHL, Scopus and Web of Science were systematically searched. Meta‐analyses were conducted on all outcome measures if appropriate. A qualitative analysis of the content of the interventions was conducted to review which elements the interventions consisted of.ResultsTwenty‐nine randomized controlled trials were identified. Fourteen reported effects on systolic blood pressure, and pooled results showed a significant beneficial effect (n = 2,222; −3.85 mmHg [95%CI −6.43; −1.28]). The effect was greatest in the four interventions which included supervised training (n = 174; −9.83 mmHg [95%CI −16.56; −3.09]).ConclusionModifying health behaviour in stroke survivors might have a moderate beneficial effect on blood pressure, especially if the intervention includes supervised physical training.

1471-P: Efficacy of Lifestyle Intervention in Preventing Diabetes in People with IGT with and without Impaired Fasting Glucose: A Secondary Analysis of Da Qing Diabetes Prevention Outcomes Study (DQDPOS)

Although major diabetes prevention trials show lifestyle intervention delays the onset of type 2 diabetes in persons with impaired glucose tolerance (IGT), impaired fasting glucose (IFG) is typically used in the real world as a more convenient way to identify eligible persons. Such practice includes many without IGT but excludes many with IGT who could benefit from intervention programs. DQDPOS is a long-term follow-up of the Da Qing Diabetes Prevention study, a randomized clinical trial to assess the efficacy of lifestyle intervention to prevent type 2 diabetes in persons with IGT in Da Qing China. We compared the effect of the intervention in those with baseline fasting plasma glucose (FPG) levels of &amp;lt;100 (“normal”, n=287,49.8%) vs. 100-139mg/dl (IFG, n=289,50.2%). Lifestyle intervention reduced diabetes incidence substantially and to a similar extent in both groups at the end of the 6-year intervention and throughout the 30 years of follow-up (hazard ratios 0.50-0.67) (Table). Our results indicate that although using only IFG to identify candidates for lifestyle intervention programs might achieve similar efficacy, its use alone will exclude large numbers of people with IGT but without IFG, who otherwise would benefit from lifestyle interventions. Disclosure Q. Gong: None. P. Zhang: None. J. Wang: None. Y. Chen: None. Y. An: None. X. Feng: None. Y.J. Cheng: None. J. Ma: None. P.H. Bennett: Advisory Panel; Self; World Health Organization. Stock/Shareholder; Self; Eli Lilly and Company, Pfizer Inc., Unilever, UnitedHealth Group. Other Relationship; Self; American Diabetes Association, European Association for the Study of Diabetes, European Diabetic Nephropathy Study Group, International Diabetes Federation, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health. G. Li: None.

Efficacy of therapeutic lifestyle changes on lipid profiles assessed by NMR in children with familial and non-familial hypercholesterolemia

Background and aimsThe first line of therapy in children with hypercholesterolaemia is therapeutic lifestyle changes (TLSC). The efficacy of lifestyle intervention in children with familial hypercholesterolaemia (FH), where LDL-C levels are genetically driven, deserves a focused study. AimsTo evaluate the impact of a lifestyle education program, focused on food patterns and physical activity, on lipid profiles assessed by nuclear magnetic resonance (NMR) in children with FH vs. non-FH. MethodsPhase 1 was a cross-sectional study of baseline characteristics, and phase 2 was a prospective TLSC intervention study. In total, the study included 238 children (4 to 18 years old; 47% girls) attending the lipid unit of our hospital due to high cholesterol levels. Eighty-five were diagnosed with FH (72% genetic positive), and 153 were diagnosed with non-Familial hypercholesterolaemia. A quantitative food frequency questionnaire (FFQ) including 137 items was used. Physical activity (PA) was assessed by the Minnesota questionnaire. The lipid profile was assessed using the 2D-1H-NMR (Liposcale test). A total of 127 children (81 in the FH group) participated in the prospective phase and were re-assessed after 1 year of the TLSC intervention, consisting of education on lifestyle changes delivered by a specialized nutritionist. ResultsThe FH and non-FH groups were similar in anthropometry and clinical data, except that those in the FH were slightly younger than those in the non-FH group. Both the FH and non-FH groups showed a similar diet composition characterized by a high absolute calorie intake and a high percentage of fat, mainly saturated fat. The PA was below the recommended level in both groups. After one year of TLSC, the percentage of total and saturated fats was reduced, and the amount of fiber increased significantly in both groups. The percentage of protein increased slightly. The number of children engaged in at least 1 hour/day of PA increased by 56% in the FH group and by 53% in the non-FH group, and both these increases were significant. The total and small-LDL particle numbers were reduced in both groups, although the absolute change was greater in the FH group than in the non-FH group. ConclusionsEducational strategies to implement TLSC in children lead to empowerment, increased adherence, and overall metabolic improvement in children with high blood cholesterol, including those with FH.

Efficacy of therapeutic lifestyle changes on lipid profiles assessed by NMR in children with familial and non-familial hypercholesterolemia

Background and aimsThe first line of therapy in children with hypercholesterolaemia is therapeutic lifestyle changes (TLSC). The efficacy of lifestyle intervention in children with familial hypercholesterolaemia (FH), where LDL-C levels are genetically driven, deserves a focused study. AimsTo evaluate the impact of a lifestyle education program, focused on food patterns and physical activity, on lipid profiles assessed by nuclear magnetic resonance (NMR) in children with FH vs. non-FH. MethodsPhase 1 was a cross-sectional study of baseline characteristics, and phase 2 was a prospective TLSC intervention study. In total, the study included 238 children (4 to 18 years old; 47% girls) attending the lipid unit of our hospital due to high cholesterol levels. Eighty-five were diagnosed with FH (72% genetic positive), and 153 were diagnosed with non-Familial hypercholesterolaemia. A quantitative food frequency questionnaire (FFQ) including 137 items was used. Physical activity (PA) was assessed by the Minnesota questionnaire. The lipid profile was assessed using the 2D-1H-NMR (Liposcale test). A total of 127 children (81 in the FH group) participated in the prospective phase and were re-assessed after 1 year of the TLSC intervention, consisting of education on lifestyle changes delivered by a specialized nutritionist. ResultsThe FH and non-FH groups were similar in anthropometry and clinical data, except that those in the FH were slightly younger than those in the non-FH group. Both the FH and non-FH groups showed a similar diet composition characterized by a high absolute calorie intake and a high percentage of fat, mainly saturated fat. The PA was below the recommended level in both groups. After one year of TLSC, the percentage of total and saturated fats was reduced, and the amount of fiber increased significantly in both groups. The percentage of protein increased slightly. The number of children engaged in at least 1 hour/day of PA increased by 56% in the FH group and by 53% in the non-FH group, and both these increases were significant. The total and small-LDL particle numbers were reduced in both groups, although the absolute change was greater in the FH group than in the non-FH group. ConclusionsEducational strategies to implement TLSC in children lead to empowerment, increased adherence, and overall metabolic improvement in children with high blood cholesterol, including those with FH.

Efficacy of lifestyle interventions in the reversion to normoglycemia in Korean prediabetics: One-year results from a randomised controlled trial

AimThis study aimed to determine the efficacy of personalized lifestyle interventions on the reversion of a prediabetic state to normoglycemia compared with regular blood glucose testing alone in prediabetes. MethodsA randomized, multicenter trial was conducted in prediabetes aged 30–70 with fasting blood glucose level of 5.6–6.9mmol/L (100–125mg/dL) and/or HbA1c level of 39–46mmol/mol (5.7–6.4%) recruited from health checkups at 16 health-promotion centers in Korea. The 799 recruited individuals were randomized to either the personalized lifestyle intervention group (LIG) or the control group (CG) by a computer generated random number list prepared by an independent statistician. The CG was provided with fasting blood glucose and HbA1c tests alone every 3months during the first year. The LIG was provided not only blood glucose test but five sessions of personalized lifestyle counseling by nutritionists every 3months during the first year aimed at improving the diet, alcohol and exercise behaviors. Data from lifestyle assesments and laboratory measurements were analyzed at 1-year after baseline. The primary outcome was the reversion rate from prediabetes to normoglycemia. Additional outcome include the effect of the lifestyle intervention program on lifestyle changes in the LIG to support primary outcome. ResultsThe 799 participants randomly allocated to the LIG (n=398) or the CG (n=401). For the analyses of outcomes, 629 participants (313 men and 316 women; mean age, 53.7±9.4years; mean body mass index (BMI), 24.7kg/m2) were included: 325 in the LIG; 304 in the CG. Diet (7.03, 95% CI=4.56–10.86, P<0.001), alcohol (2.24, 95% CI=1.48–3.41, P<0.001), and exercise behaviors (1.85, 95% CI=1.31–2.63, P<0.001) were improved relative to baseline by the personalized lifestyle intervention in the LIG after adjusting age, sex, and family history of diabetes. In terms of main outcome, the cumulative incidence of reversion from prediabetes to normoglycemia at the first year was 37.9% (123/325) [95% CI=32.6–43.1%] in the LIG and 29.6% (90/304) (95% CI=24.5–34.7%) in the CG. After adjustment for age, sex, family history of diabetes, BMI, blood pressure, and lipids, the hazard ratio for reverting to normoglycemia remained significantly higher in the LIG (1.40, 95% CI=1.06–1.83, P=0.017) than in the CG. ConclusionPersonalized lifestyle intervention could be more effective compared with regular blood glucose testing alone in the reversion of a prediabetic state to normoglycemia in Korean prediabetics. This finding suggests that diabetes prevention care would be benefited by incorporating personalized lifestyle counseling.This study was registered at cris.nih.go.kr (KCT0001580).

Efficacy of lifestyle interventions in patients with type 2 diabetes: A systematic review and meta-analysis

BackgroundThe current meta-analysis evaluated the outcomes of various lifestyle interventions, including diet modifications (DIET), physical activity (PA), and patient education (EDU) in reducing the risk of cardiovascular disease in patients with type 2 diabetes. MethodsRandomized clinical trials comparing lifestyle intervention with “usual care” (control) in type 2 diabetes patients were hand-searched from medical databases by two independent reviewers using the terms “diabetes, cardiovascular risk, lifestyle, health education, dietary, exercise/physical activities, and behavior intervention”. ResultsOf the 235 studies identified, 17 were chosen for the meta-analysis. The average age of patients ranged from 50–67.3years. Results reveal no significant difference between the groups, with respect to BMI, while PA and DIET yielded a greater reduction in HbA1c. Significant reduction in both systolic and diastolic pressures in the DIET group, and diastolic pressure in the PA group, was observed. HDL-c in the DIET group was significantly higher than the control group, while no change in LDL-c levels, was seen in all three intervention subtypes. There was no difference between the EDU vs. the control group in terms of HbA1c, blood pressure or HDL-c and LDL-c. ConclusionDIET intervention showed an improvement in HbA1c, systolic/diastolic blood pressure and HDL-c, with an exception of LDL-c and BMI, suggesting that nutritional intervention had a significant impact on the quality of life by reducing the cardiovascular risk in type 2 diabetes patients.