Impact Of Lifestyle Intervention Research Articles

Impact of Lifestyle Interventions on Gynecologic Cancers: Beyond Diet and Exercise

A Lifestyle Medicine approach to compliment cancer care is less commonly researched or implemented for women with gynecologic cancers as compared to better funded malignancies such as breast, prostate, and colorectal. Yet, several gynecologic malignancies are linked to obesity, estrogen/metabolic signaling pathways, and altered tumor microenvironment which could benefit greatly from a lifestyle medicine program. Lifestyle medicine, an evidenced-based branch of science, has expanded to the prevention and treatment of disorders caused by lifestyle factors (including cancer). Modifiable lifestyle factors such as obesity, lack of physical activity/nutrient density, microbial dysbiosis, sleep disturbance, and chronic stressors contribute greatly to cancer morbidity and mortality worldwide. This overarching area of research is evolving with some subtopics in their infancy requiring further investigation. Modern tools have allowed for better understanding of mechanisms by which adiposity and inactivity affect tumor promoting signaling pathways as well as the local tumor environment. Through the evolving use of these sophisticated techniques, novel prognostic biomarkers have emerged to explore efficacy of pharmacologic and lifestyle interventions in cancer. This state-of-the-art review article appraises recent evidence for a lifestyle medicine approach, beyond diet and exercise, to optimize survivorship and quality of life for patients with gynecologic cancers and introduces the 8-week web-based comprehensive HEAL-GYN program.

Effects of a lifestyle intervention on depression and anxiety among adults at risk for diabetes in India: A secondary analysis of the Kerala Diabetes Prevention Program

The impact of lifestyle interventions on diabetes and mental health conditions have been documented among people with diabetes. However, the mental health benefits of lifestyle interventions designed for diabetes prevention have not been systematically investigated among people at high risk of diabetes, particularly in low- and middle-income countries. We examined the effects of a 12-month peer support lifestyle intervention designed for diabetes prevention on depression and anxiety symptomology in the sample population of the Kerala Diabetes Prevention Program. Mixed-effects linear regression models were used to examine the effect of the intervention on depression and anxiety scores at 12 and 24 months in the total sample of 1007 adults at risk for diabetes and among those with mild-severe depressive or anxiety symptoms at baseline (n = 326 for depression; n = 203 for anxiety). Among all participants, the intervention group had a significantly higher reduction of depressive symptoms as compared to the control group at 12 months (mean diff score = −0.51; 95% CI: −0.95, −0.07; P = 0.02). This effect was not sustained at 24 months. There were no significant intervention effects for anxiety. Among those with mild-severe symptoms at baseline, the intervention group had a significantly higher reduction of depressive symptoms (mean diff score = −1.55; 95% CI -2.50, −0.6; P = 0.001) and anxiety symptoms (mean diff score = −1.64; 95% CI -2.76, −0.52; P = 0.004) at 12 months. The effect was sustained at 24 months for depression, but not anxiety. Lifestyle interventions designed for prevention of diabetes might improve depressive and anxiety symptoms in the short-term, particularly among those with mild-severe symptoms.

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.

The impact of lifestyle intervention on left atrial function in type 2 diabetes: results from the DIASTOLIC study

Aerobic exercise training and low energy diets have been shown to improve left ventricular remodelling and diastolic function in adults with type 2 diabetes (T2D), albeit with differential effects. The impact of these lifestyle interventions on left atrial (LA) function, however, has not previously been reported. The DIASTOLIC study was a prospective, randomised, open-label, blind endpoint trial, in which 90 people with obesity and T2D and no prevalent cardiovascular disease were randomised to a 12-week intervention of: (i) routine care, (ii) aerobic exercise training, or (iii) low energy (≈ 810 kcal/day) meal replacement plan (MRP). Cardiac magnetic resonance (CMR) imaging was performed pre- and post-intervention. Image analysis included LA volumes (LAV), emptying fraction (LAEF), and LA strain (LAS) corresponding to LA reservoir (LAS-r), conduit (LAS-cd), and booster pump (LAS-bp) function. 73 participants with T2D (mean age 50 ± 6 years, 62% male, body mass index (BMI) 36.1 ± 5.3 kg/m2) completed the trial and had analysable LA images. There was no significant change in CMR measured LA volumetric function (LAV/LAEF) in any group. The routine care group showed no significant change in BMI or LAS. In the MRP group, there were significant reductions in BMI (4.5 kg/m2) and a significant increase in LAS-r and LAS-bp (29.9 ± 7.0 to 32.3 ± 7.0%, p = 0.036 and 14.6 ± 5.3 to 17.2 ± 3.7%, p = 0.034). The exercise group showed a small reduction in BMI (0.49 kg/m2), with no significant change in LAS. Compared to routine care, weight loss via a 12-week MRP, led to improvements in LA filling and contractile function in adults with T2D and obesity. However, these within-group changes were not statistically significant on between-group comparison.ClinicalTrials.gov Identifier: NCT02590822.

Ischemic Heart Disease in Nigeria: Exploring the Challenges, Current Status, and Impact of Lifestyle Interventions on Its Primary Healthcare System.

The burden of ischemic heart disease in Nigeria calls for an evidence-based, innovative, and interdisciplinary approach towards decreasing health inequalities resulting from individual lifestyle and poor socioeconomic status in order to uphold the holistic health of individuals to achieve global sustainability and health equity. The poor diagnosis and management of ischemic heart disease in Nigeria contributes to the inadequate knowledge of its prognosis among individuals, which often results in a decreased ability to seek help and self-care. Hence, current policies aimed at altering lifestyle behaviour to minimize exposure to cardiovascular risk factors may be less suitable for Nigeria’s diverse culture. Mitigating the burden of ischemic heart disease through the equitable access to health services and respect for the autonomy and beliefs of individuals in view of achieving Universal Health Coverage (UHC) requires comprehensive measures to accommodate, as much as possible, every individual, notwithstanding their values and socioeconomic status.

The Impact of Lifestyle Interventions in High-Risk Early Breast Cancer Patients: A Modeling Approach from a Single Institution Experience.

Simple SummaryHigh body mass index (BMI) is correlated with an increased production of hormones (estrogens, insulin, testosterone, leptin), and pro-inflammatory cytokines, which have been associated with breast cancer (BC) risk and recurrence. Regular physical activity (PA) decreases BMI and blood concentrations of testosterone, estrogens, insulin and pro-inflammatory cytokines. Moreover, the Mediterranean diet (MD) reduces obesity, metabolic syndrome (MS) and insulin resistance, which are all associated with increased risk of BC onset and recurrence. Despite the accumulating evidence of the detrimental effect of physical inactivity and overweight on BC recurrence, weight control and PA counseling are not yet current practice. The principal aim of the lifestyle intervention is to promote weight loss through diet and physical activity in overweight and/or high-risk breast cancer survivors. Moreover, implementing a “lifestyle interventions program” in clinical practice can lead to improvements in psychophysical well-being and favor the correction of cardiovascular risk factors and compliance with endocrine therapy, potentially translating into a prognostic advantage.A healthy lifestyle plays a strategic role in the prevention of BC. The aim of our prospective study is to evaluate the effects of a lifestyle interventions program based on special exercise and nutrition education on weight, psycho-physical well-being, blood lipid and hormonal profile among BC patients who underwent primary surgery. From January 2014 to March 2017, a multidisciplinary group of oncologists, dieticians, physiatrists and an exercise specialist evaluated 98 adult BC female patients at baseline and at different time points. The patients had at least one of the following risk factors: BMI ≥ 25 kg/m2, high testosterone levels, high serum insulin levels or diagnosis of MS. Statistically significant differences are shown in terms of BMI variation with the lifestyle interventions program, as well as in waist circumference and blood glucose, insulin and testosterone levels. Moreover, a statistically significant difference was reported in variations of total Hospital Anxiety and Depression Scale (HADS) score, in the anxiety HADS score and improvement in joint pain. Our results suggested that promoting a healthy lifestyle in clinical practice reduces risk factors involved in BC recurrence and ensures psycho-physical well-being.

The Impact of Lifestyle Intervention on Dietary Quality among Rural Women with Previous Gestational Diabetes Mellitus—A Randomized Controlled Study

Healthy diet is essential to type 2 diabetes mellitus (T2DM) prevention for women with previous gestational diabetes mellitus (GDM). To evaluate the effect of a lifestyle intervention program on diet quality for rural women who were previously diagnosed with GDM, we conducted a randomized controlled study in two counties located in south-central China. A total of 404 eligible women were allocated into an intervention group and control group. Participants in the intervention group received 6-month lifestyle intervention including six group seminars and eight telephone consultations. Dietary data were collected at baseline and 18 months via a 24 h dietary recall, and dietary quality was measured by two indicators, Chinese Healthy Eating Score (CHEI) and Minimum Dietary Diversity for Women (MDD-W). Baseline CHEI scores (54.4 vs. 53.5, p = 0.305) and the proportions of participants who met MDD-W (73.8% vs. 74.5%, p = 0.904) were comparable between the two groups. The intervention group achieved a higher CHEI score (62.2 vs. 58.9, p = 0.001) and higher MDD-W proportion (90.6% vs. 81.2%, p = 0.023) at 18 months. Lifestyle intervention was associated with the change of CHEI (p = 0.049) but not with MDD-W (p = 0.212). In conclusion, compared with usual care, lifestyle intervention resulted in greater improvement of dietary quality among rural women with previous GDM.

Long-term effects (>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.

Impact of lifestyle Intervention on branched-chain amino acid catabolism and insulin sensitivity in adolescents with obesity.

IntroductionInsulin resistance in adolescents with obesity associates with a sex‐dependent metabolic ‘signature’ comprising branched‐chain amino acids (BCAAs), glutamate and C3/C5 acylcarnitines (C3/C5), implicating altered flux through BCAA catabolic pathways. Here, we investigated the effects of lifestyle intervention on BCAA catabolism and insulin sensitivity. We hypothesized (1) weight reduction and improved insulin sensitivity associate with enhanced BCAA catabolism; (2) baseline BCAAs and their metabolic by‐products predict changes in weight and insulin sensitivity during lifestyle intervention.MethodsA 33 adolescents with obesity were studied before and after 6 months of lifestyle intervention. Principal component analysis and multiple linear regression models were used to correlate changes in metabolic factors with changes in weight and insulin sensitivity assessed by HOMA‐IR, adiponectin and ratio of triglyceride (TG) to HDL. Baseline metabolic factors were used as explanatory variables in prediction models.ResultsWeight reduction was associated with reductions in BCAA, glutamate, and C3/C5 (p = .002) and increases in urea cycle AA (p = .029), suggesting an increase in BCAA catabolism. Increases in urea cycle AA during weight reduction were associated with increases in adiponectin, a marker of insulin sensitivity. Markers of insulin resistance (high BCAA, glutamate, and C3/C5 and low urea cycle AA) at baseline predicted increases in metrics of insulin sensitivity (decreased TG/HDL and increased adiponectin) during lifestyle intervention.ConclusionsWeight reduction in adolescents is associated with increases in BCAA catabolism and improvements in insulin sensitivity. Our study underscores the therapeutic potential of manipulating BCAA catabolism to treat obesity‐associated insulin resistance in adolescents and prevent progression to T2D.

The impact of a 6-week community-based physical activity and health education intervention-a pilot study among Irish farmers.

There is a higher prevalence of lifestyle-related diseases among Irish farmers than the general adult population. Lifestyle interventions that increase physical activity and improve dietary patterns have been associated with reduced chronic disease risk and improved quality of life among high-risk populations. The impact of lifestyle interventions among Irish farmers is unknown. To assess the effectiveness of a community-based intervention on farmer health, cardiovascular fitness, lower limb strength endurance, and dietary intake. A 6-week physical activity and lifestyle education intervention involving two 60-min circuit-based exercise training sessions and one 60-min health education workshop per week was implemented. Pre- and post-measurements included total body weight, body fat percentage, lean muscle mass, resting blood pressure, fasting blood glucose, cholesterol, triglycerides, cardiovascular fitness, lower limb strength, perceived physical and mental health, and dietary intake. Thirty farmers completed the intervention giving an adherence rate of 75%. At baseline, mean BMI (32.7 ± 4.1 kg/m2), body fat percent (31.7 ± 6.7), waist circumference (110.2 ± 10.4 cm), systolic (128.7 ± 7.8 mmHg) and diastolic (86.2 ± 6.8 mmHg) blood pressure were higher than recommended levels. Significant improvements (p < 0.05) were found for total body weight, BMI, waist and hip circumferences, cardiovascular fitness, lower limb strength endurance, systolic blood pressure, total energy, total fat, total unsaturated fat, monounsaturated fat, saturated fat, trans fat, total carbohydrate, sodium, cholesterol and percentage energy intakes of total fat, saturated fat, protein, and physical and mental health scores. Irish farmers remain at high risk of developing chronic diseases but respond positively to lifestyle intervention.

Impact of lifestyle interventions on reducing dietary sodium intake and blood pressure in patients with hypertension: A randomized controlled trial.

The objective of this study is to determine the impact of applying lifestyle intervention in the form of a continuous care model (CCM) on reducing dietary sodium intake and blood pressure (BP) in patients with hypertension. This randomized controlled trial was conducted in a 2-group design on a total of 50 patients who were hypertensive (experimental and control) as a pre‒post test study. A healthy lifestyle (emphasizing physical activity and heart-healthy diet) in the form of CCM, which considers the patient as an active agent in the health process, was conducted in the experimental group over a period of 4 months. The mean BP value and dietary sodium intake in both groups were measured at the beginning and the end of the study. The mean sodium intake, the mean systolic BP, and the mean diastolic BP decreased to 2.42±0.73 mm Hg (from 3.12±0.79), 128.4±13.04 mm Hg (from 144.20±13.12), and 79.4±8.93 mm Hg (from 89±9.12), respectively, after the intervention in the experimental group (p=0.021, p<0.001, and p=0.011, respectively). Applying lifestyle intervention in the form of CCM may be recommended to reduce dietary sodium intake and mean systolic and diastolic BP in patients who are hypertensive. Considering the fact that lifestyle modifications are quite important regardless of the use of antihypertensive drugs, lifestyle intervention in the form of CCM is recommended to improve patient's adherence to dietary restrictions and consequently, treatment outcomes in patients who are hypertensive.

Body mass index, silent coronary artery disease and the impact of adopting healthy lifestyle and sexual performance on the risk of major adverse cardiovascular events in erectile dysfunction patients

Abstract Background Erectile dysfunction (ED) is associated with a higher prevalence of risk factors such as hypertension and diabetes and it is an independent predictor of major adverse cardiovascular events (MACE). ED is a common problem in men with obesity. Purpose The aim of this study is to investigate the association of overweight and obesity with asymptomatic coronary artery disease and the impact of lifestyle interventions on MACE risk in men suffering from ED. Methods A total of 614 patients (55±9 y/o) with ED and without known cardiovascular disease (CVD) underwent dobutamine stress echocardiography (and coronary angiography in patients with positive stress echocardiography for myocardial ischemia) to reveal occult coronary artery disease (CAD). In all patients C-reactive protein (CRP) and total testosterone (TT) were measured at entry. After this evaluation and management of concomitant traditional risk factors they were advised to adopt the recommended strategies for healthy lifestyle and improvement of sexual activity. Results The whole population was divided into three groups according to body mass index (BMI) at entry (normal: 18–25.5 kg/m2, n=132; overweight:25.5–29.9 kg/m2, n=295; and obesity: &amp;gt;29.9kg/m2, n=187). There were no statistically significant differences in age, blood pressure (BP) level and smoking prevalence between the three groups. Obese ED patients had significantly lower TT and higher CRP compared to overweight and normal BMI patients (overall P&amp;lt;0.001 and P&amp;lt;0.01, respectively). The prevalence of angiographically documented CAD was not different between obese and overweight patients and it was significantly higher compared to that of subjects with normal BMI (13.8% vs 14.5% vs 7.2%, respectively, overall P&amp;lt;0.05). In the whole study population, a total of 43 (7%) MACE occurred during a mean follow-up of 6.7 years after adopting a healthy lifestyle and improvement in sexual life. Interestingly, overweight status at baseline was associated with a higher MACE prevalence and the overall difference between the three BMI groups at entry was statistically significant (Mantel log-rank test: 8.65; P=0.0014) (Figure 1). Furthermore, in a Cox proportional hazard model overweight at entry (3.14, CI: 1.49–7.87, P&amp;lt;0.01), TT level (0.72; CI 0.56–0.97, P&amp;lt;0.01) and the use of phosphodiesterase-5 (PDE-5) inhibitors (0.83; CI 0.67–0.97, P&amp;lt;0.05) were independent predictors of MACE. Conclusion Overweight and obese ED patients have similar prevalence of asymptomatic CAD, however the overweight profile at baseline appears to have a significantly higher MACE risk compared to obesity at follow-up after adopting a healthy lifestyle and improving sexual life with PDE-5 inhibitors. The paradox finding warrants further investigation. Figure 1. BMI categories and MACE risk Funding Acknowledgement Type of funding source: None

Prevalence of non-alcoholic fatty liver disease and factors associated with it in Indian women with a history of gestational diabetes mellitus.

Aims/IntroductionThis study aims to evaluate the prevalence of and factors associated with non‐alcoholic fatty liver disease (NAFLD) in Indian women with prior gestational diabetes mellitus (GDM) diagnosed using International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria.Materials and MethodsThis cross‐sectional study (2018–2019) enrolled women with and without prior GDM. Study participants underwent detailed assessments, including relevant medical, obstetric and demographic details; 75‐g oral glucose tolerance test with glucose and insulin estimation at 0, 30 and 120 min; and other relevant biochemical and anthropometric measurements. NAFLD status was defined by ultrasonography.ResultsWe evaluated a total of 309 women (201 and 108 with and without prior GDM, respectively) at a mean age of 31.9 ± 5.0 years and median of 16 months (interquartile range 9–38 months) following the index delivery. The prevalence of NAFLD was significantly higher in women with prior GDM (62.7% vs 50.0%, P = 0.038; grade 2 and 3 disease, 13.9% vs 6.5%). On logistic regression analysis (fully adjusted model), the odds of NAFLD were 2.11‐fold higher in women with prior GDM (95% confidence interval 1.16–3.85, P = 0.014). Overweight/obesity, metabolic syndrome, prediabetes and homeostasis model of assessment of insulin resistance (a measure of insulin resistance) were positively associated with NAFLD, whereas the Matsuda index (a measure of insulin sensitivity) showed a negative association with NAFLD.ConclusionsThe prevalence of NAFLD is high in women with prior GDM. Such women also have a high burden of cardiometabolic risk factors. Future studies should evaluate the intermediate and long‐term hepatic and cardiovascular risk, and the impact of lifestyle interventions in reducing morbidity in such women.

Infant growth during the first year of life following a pregnancy lifestyle intervention in routine care-Findings from the cluster-randomised GeliS trial.

Lifestyle interventions in pregnancy may influence postpartum development and obesity risk in offspring. The impact of lifestyle interventions as health system-based approaches is unclear. To evaluate the effect of an antenatal lifestyle intervention conducted as public health approach on infant development and feeding practices. We followed offspring born to women participating in the cluster-randomised GeliS trial who received usual care (CG) or repeated lifestyle counselling (IG). We collected data on offspring development and complementary feeding until the 12th month postpartum. Of the 1998 mother-child pairs, 1783 completed the follow-up. Mean infant weight at 12 months was comparable between groups (IG: 9497.9 ± 1137.0 g; CG: 9433.4 ± 1055.2 g; P = .177). There was no significant evidence of differences in sex- and age-adjusted z-scores or in the odds of offspring being overweight. More infants in the IG received whole-grain products compared to the CG (95.6% vs. 90.8%; P = .003). Despite small differences in the timing of introducing solid foods, there were no further significant differences in the pattern of complementary feeding. The antenatal lifestyle intervention embedded in routine care did not substantially influence infant anthropometrics and is thus unlikely to impact future development.

Impact of Lifestyle Interventions on Quality and Consumption of Hyper-Palatable Foods Within Gestational Diets: Single-Goal vs Multiple-Goal

Abstract Objectives Examine the impact of a multiple-goal (MG) vs single-goal (SG) lifestyle interventions on gestational diet quality and hyper-palatable food consumption. Methods Pregnant women were randomized in two pilot trials to MG (n = 21) or SG (n = 16) vs usual care (UC; combined trials, n = 18). The 18-week MG intervention included lifestyle modifications, and the 12-week SG intervention focused only on increasing fiber (≥30 g/day). Interventions included weekly instruction by a registered dietitian, and primary aims were appropriate weight gain. Diet recalls were performed at baseline and study end. Diet quality was scored with three versions of the alternative healthy eating index, including adaptations for pregnancy (AHEI 2010, AHEI-P, and AHEI-P 2010). Foods were classified as hyper-palatable based on fat, carbohydrate, sugar, and sodium content using previously defined criteria, and reported as percentage of total calories (%HPF). One-way ANOVA, paired t-tests, and Pearson's correlations were performed. Results At baseline, no between group differences for diet quality were found. By the end of the study, all diet quality scores increased for SG (P &amp;lt; 0.009) and two increased for MG (AHEI 2010 &amp; AHEI-P-2010, P &amp;lt; 0.041). UC diet quality remained unchanged (P &amp;gt; 0.05). At baseline, %HPF was different between groups (MG &amp;gt; UC &amp;gt; SG, 82%, 57%, and 26%, respectively; P &amp;lt; 0.001). By study end, UC and SG increased %HPF (P &amp;lt; 0.033), while MG remained unchanged (P &amp;gt; 0.05), leaving MG and SG similar in %HPF (80% &amp; 74%, respectively) and higher than UC (65%, P = 0.024). The %HPF was negatively correlated with all diet quality scores at baseline (r = −0.37 to −0.42; P &amp;lt; 0.005) and two at the end of study (AHEI 2010 &amp; AHEI-P 2010 r = −0.39, −0.30, respectively, P &amp;lt; 0.040). Changes in diet quality and %HPF were not related (P &amp;gt; 0.05). Conclusions Interventions aimed to prevent excessive gestational weight gain showed improvements in diet quality. Hyper-palatable food consumption was negatively related to diet quality, yet neither intervention decreased %HPF. Focusing on increasing dietary fiber may allow for a targeted message with broad implications for diet quality, but more research is needed. Funding Sources NIH Clinical and Translational Science Award and the Kansas City Area Life Science Institute.

Lifestyle interventions reduce exercise ventilatory variability in healthy individuals: a randomized intervention study.

Aim: Variation of exercise ventilation confers poor prognosis in heart failure. Sedentary men have higher exercise ventilatory variability than athletes. However, the impact of lifestyle intervention on exercise ventilatory variability in sedentary people is unknown and this is the aim of this study. Materials & methods: Prospective controlled single-blinded interventional study that randomly assigned healthy sedentary individuals to diet and exercise (intervention group, n = 12) or no intervention (control group, n = 12) for 12weeks. Exercise ventilatory variability was accessed before and after intervention. Results: Despite similar values at baseline, there was a 15% reduction in respiratory rate variability (root mean square of the successive differences/n) in intervention group. Conclusion: Diet and exercise training reduced exercise ventilatory variability.

Impact of lifestyle intervention on dry eye disease in office workers: a randomized controlled trial.

Objectives: To evaluate the effects of a 2-month lifestyle intervention for dry eye disease in office workers. Methods: Prospective interventional study (randomized controlled study). Forty-one middle-aged Japanese office workers (men, 22; women, 19; 39.2±8.0 years) with definite and probable dry eye disease were enrolled and randomized to an intervention group (n = 22) and a control group (n = 19). The intervention aimed at modifying diet, increasing physical activity, and encouraging positive thinking. The primary outcome was change in dry eye disease diagnoses. Secondary outcome was change in disease parameters, including dry eye symptoms, as assessed using the Dry Eye-Related Quality of Life Score, corneal and conjunctival staining scores, tear break-up time, and Schirmer test results. Results: A total of 36 participants (intervention group, 17; control group, 19) completed the study. The number of definite dry eye disease diagnoses decreased from four to none (p =.05), and the dry eye symptom score showed a significant decrease in the intervention group (p =.03). In contrast, the corneal and conjunctival staining scores, tear break-up time, and Schirmer test results did not differ significantly between groups. Conclusions: The 2-month lifestyle intervention employed in this study improved dry eye disease status among office workers, with a considerable decrease in subjective symptoms. Lifestyle intervention may be a promising management option for dry eye disease, although further investigation of long-term effects are required.

The Impact of Lifestyle Intervention on Stage of Change toward Healthy Eating and Development of Diabetes in Prediabetic Individuals in Precontemplation Stage

Objective: The aim of this study was to evaluate the stages of change toward healthier behavior by telephone-delivery intervention in prediabetic individuals. Research Design and Methods: A total of 2607 participants aged 20-65 years with impaired fasting glucose were randomized to a one-year telephone-intervention intervention arm (n=1240) or a self-directed control arm with weighing scale and pedometer (n=1367). Stages of change were assessed using a self-administered questionnaire. Results: At the baseline, 5.9% were in the precontemplation stage, 50.6% were in the contemplation stage, and 25.5% were in the preparation stage in the change to healthy eating. At the baseline, 9.4% were in the precontemplation stage, 50.2% were in the contemplation stage, and 12.0% were in the preparation stage in the change toward adopting exercise habits. For participants who were in the precontemplation stage, the proportions of those progressing to the action/maintenance stage for a healthy eating after 1-year intervention and at the end of the trial were increased (17.5 and 16.1-percentage-point increase, respectively), but there was small increase for exercise habits (5.4 and 2.7-percentage-point increase, respectively). For participants who were in the precontenplation stage, the odds of progressing to the action/maintenance stage for the intervention vs. control arm for healthy eating after 1-year intervention and at the end of the trial were 3.07 (95% CI=1.23, 8.13) and 2.21 (95% CI=1.04, 4.67), respectively. The corresponding odds for excise habits were 1.59 (95% CI=0.70, 3.61) and 1.27 (95% CI=0.55, 2.91). The hazard ratio for the development of diabetes on receiving the intervention in the precontenplation stage of healthy eating at the baseline was 0.51. Conclusions: The intervention advanced the stages of changes toward healthy eating and might be effective for preventing diabetes even in the precontemplation stage. Disclosure N. Sakane: Research Support; Spouse/Partner; Pwc. S. Nirengi: None. K. Takahashi: None. A. Suganuma: None. K. Okazaki: Advisory Panel; Self; Eli Lilly and Company. Research Support; Self; Taisho Pharmaceutical Co., Ltd.. Speaker's Bureau; Self; Ono Pharmaceutical Co., Ltd., Mitsubishi Tanabe Pharma Corporation, Novo Nordisk A/S, Astellas Pharma US, Inc., Takeda Development Center Asia, Pte. Ltd., Terumo Medical Corporation, MSD K.K., Sanwa Kagaku Kenkyusho Co., Ltd.. Other Relationship; Self; Aichi prefecture government and Nagoya city government. K. Izumi: None. M. Noda: None. H. Kuzuya: None.

Clinical Relevance of the Behavioral Stages of Change with the Efficacy of Multifaceted Interventions on the Drop-Out from Regular Medical Care in Patients with Diabetes—The Japan Diabetes Outcome Intervention Trial-2 (J-DOIT2)

Background: To examine the impact of lifestyle intervention by telephone (TSC) and face-to-face (FFA) according to the stages of lifestyle change (SLC) on the drop-out from regular medical care of diabetes Methods: Secondary analysis was performed on data from the Japan Diabetes Outcome Intervention Trial-2 large trial (J-DOIT2-LT), which was a 1-year, prospective, cluster randomized, intervention trial. 11 district medical associations were divided into two subregions (clusters), in which patients were registered, and then were randomized to an intervention group (TSC or FFA) or control group (CG). Lifestyle advisors reminded patients of medical visits to the primary care physician (PCP) and gave lifestyle advice by TSC or FFA. The CG received usual medical care. The outcome of this analysis was the drop-out rate from regular medical care. We estimated the HR and 95% CI of either TSC or FFA relative to CG according to the SLC (stage 1/2/3/4/5: pre-contemplation/contemplation/preparation/action/maintenance). Results: A total of 2,071 participants (mean age: 57 ± 6 years; 38% female) were studied. 1170, 616, and 285 patients were divided into CG, TSC, and FFA. In the stage 1-3 of diet, TSC (HR:0.47; 95% CI:0.27-0.82) and FFA (HR:0.20; 95% CI:0.07-0.55) were significantly associated with a low risk of the drop-out after adjusting for covariates. The similar association was observed in the stage 1-3 of exercise. In contrast, neither TSC nor FFA reduced the risk for drop-out in the stage 4-5 of diet. TSC (HR:0.12; 95% CI:0.02-0.95) but not FFA (HR:0.37; 95% CI:0.09-1.62) was associated with a low risk for the drop-out in the stage 4-5 of exercise. Conclusions: FFA could be more effective than TSC to reduce the risk for drop-out from regular medical care of diabetes at the stage 1-3. In contrast, TSC may be enough to reduce the risk for the drop-out in the stage 4-5. Disclosure R. Bouchi: None. M. Noda: None. Y. Hayashino: None. K. Yamazaki: None. H. Suzuki: None. A. Goto: None. T.A. Furukawa: None. K. Izumi: None. M. Kobayashi: None.