Lifestyle Counseling Research Articles

Impact of a pharmacist-led weight management service in a cardiology clinic

BackgroundGlucagon-like peptide-1 receptor agonists (GLP-1 RAs) for weight management require frequent dose titration, patient education, and insurance coverage navigation, which pharmacists are well equipped to manage. Data are lacking regarding the benefit of a pharmacist-managed service using GLP-1 RAs for weight loss in a high-risk cardiac population. ObjectiveThis study aimed to evaluate the impact of a pharmacist-led weight loss service within a cardiology clinic using GLP-1 RAs and lifestyle counseling in patients with overweight and obesity. Practice descriptionAn outpatient cardiology clinic employs clinical pharmacists who use collaborative practice agreements to provide cardiovascular risk reduction services that did not include weight management at baseline. Practice innovationThis is the first description of a pharmacist-led weight management clinic using solely GLP-1 RAs in a cardiology practice. Patients were referred to the clinical pharmacist, who initiated and titrated GLP-1 RA and provided lifestyle counseling. Evaluation methodsThis was a single-center, prospective, pre-post analysis of adults with a body mass index of at least 30 kg/m2 or 27 kg/m2 with a weight-related comorbidity, with a preceding failed dietary effort and insurance coverage for semaglutide (Wegovy, Novo Nordisk) or liraglutide (Saxenda, Novo Nordisk) and managed by a pharmacist. The primary outcome was patients achieving ≥ 5% weight loss at 6 months, assessed via descriptive statistics. ResultsBetween March 2022 and March 2023, 204 patients were referred by their cardiologist, and 59 patients started treatment with semaglutide (Wegovy, Novo Nordisk) or liraglutide (Saxenda, Novo Nordisk). A total of 31 patients completed 6 months of treatment at time of study completion, and all achieved ≥ 5% weight loss at 6 months, with a mean weight loss of 12.6%. Glycated hemoglobin improved by 0.6%, low-density lipoprotein by 18 mg/dL, triglycerides by 29 mg/dL, systolic blood pressure by 9 mm Hg, and diastolic blood pressure by 2 mm Hg. ConclusionPharmacist-led management of GLP-1 RA in patients with obesity or overweight led to clinically meaningful weight loss and improvements in weight-related comorbidities.

Abstract 16624: Patients’ Perspectives on the Impact and Management of Angina - Preliminary Results of the PACT-ANGINA International Survey

Introduction: PACT-ANGINA is a quality improvement initiative aimed to improve the understanding of challenges in the management of angina and chronic coronary syndromes. Hypothesis: An international patient survey is conducted to assess how angina and its management affect patients’ lives and what patients want in terms of the management of their angina. Methods: A working group that included 9 cardiologists and 7 patient representatives developed an online, anonymous questionnaire. Patients with angina were invited to take part in the survey by patient organizations and treating physicians. Results: Between January and June 2023, the survey was completed by 891 patients in 21 countries. The proportion of female patients was 46%. Among participants, 57% had been diagnosed with angina for 2 years or less, and 54% had never undergone a percutaneous coronary intervention. The proportion of patients with no history of smoking was 65% and the most common self-reported concomitant diseases were hypertension (49%), diabetes (38%) and dyslipidemia (23%). Pain, tightness, pressure or discomfort in the chest (89%), shortness of breath (44%), and fatigue (39%) were the most frequently reported symptoms, and 34% of participants felt that their physical activities were very or extremely limited by angina symptoms. The proportion of respondents who felt that angina was having a great or extreme impact on their quality of life was 37%. When asked to rate the relative importance of 9 treatment objectives, respondents assigned the highest priority to 1) reducing angina attacks and symptoms, 2) avoiding hospitalizations, and 3) prolonging their life as much as possible. Among different aspects of care, those considered the most important by respondents to improve the management of their angina were 1) a better follow-up of their symptoms, 2) practical and easy-to-understand information, and 3) lifestyle changes counseling. Conclusions: This study demonstrates that patients with angina are often limited by their symptoms, which impact their quality of life. Patient-centered management of angina is necessary to improve clinical care of such a common cardiac condition.

Abstract 17055: Underweight and Obesity Among Asian Children at Age 3 to 5 Years: Implications for Counseling to Promote Cardiometabolic Health Across the Lifecourse

Background: Body mass index (BMI) is an important pediatric measurement that supports nutrition/weight counseling in children, especially for obesity. However, children with low BMI (<5 th percentile or “underweight”) should be considered, as Asian children are at risk for adverse cardiometabolic health at lower BMI as adults. Mehods: Using electronic record data from well-child visits from 5361 Chinese, 6215 Filipino, 5775 South Asian, and 48,666 Non-Hispanic White (NHW) children with BMI at age 3 and 5 years in a US healthcare system, we examined BMI distribution, underweight (<5th percentile), obesity (≥95th percentile), and changes in BMI from age 3 to 5 years. Results: Underweight was higher in Asian vs NHW (highest for South Asian, 15.0%, age 3, p<0.01). Obesity was highest for Filipino (11.3%, age 5) and lowest for Chinese (3.6%) vs NHW (p<0.01). At age 3, trends in greater proportion with underweight vs obesity for Chinese (6.3% vs 3.0%) and South Asian (15.0% vs 6.5%) children were seen, but not Filipino (5.0% vs 9.7%) and NHW (4.0 vs 7.8%) children (Table), similar to age 5. Most children with underweight had height <25th percentile. By age 5, large proportions shifted out of underweight, with modest obesity increases (Table). Obesity transition was greatest for South Asian children. Conclusions: Among major Asian groups and NHW children, underweight was most prevalent in South Asian (1 in 7, age 3) and obesity most prevalent in Filipino (1 in 10, age 5) children. High obesity prevalence in Filipino children and greater BMI transition in South Asian children highlight ethnic differences in BMI that support targeted lifestyle counseling to improve future cardiometabolic health.

Postpartum Lifestyle Behaviors among Women with Hypertensive Disorders of Pregnancy: Data from the HUNT Study.

Hypertensive disorders of pregnancy (HDP) are associated with an increased risk of cardiovascular disease later in life. Clinical guidelines for postpartum follow-up after HDP often recommend lifestyle counseling to reduce this risk. However, knowledge about lifestyle behaviors and perceptions among women with a history of HDP is limited. We linked data from the fourth survey of the population-based Trøndelag Health Study (HUNT4) with data from the Medical Birth Registry of Norway. The associations between HDP and postpartum lifestyle behaviors and perceptions were examined using multivariable logistic regression. In a secondary analysis, HUNT4 participants with a recent history of pre-eclampsia were compared with women with a recent history of pre-eclampsia participating in a postpartum pilot intervention study. Lifestyle behaviors and perceptions were self-reported and included diet (intake frequency of fruits, vegetables, meat, fish, and sugar-sweetened beverages), alcohol intake, physical activity, sleep, smoking, lifestyle satisfaction, and the importance of a healthy lifestyle. Among 7551 parous HUNT4 participants, 610 had a history of HDP. We found no differences in lifestyle behaviors between women with and without a history of HDP. However, women with HDP had higher odds of being unsatisfied with their lifestyle. Women with pre-eclampsia participating in a postpartum lifestyle intervention study tended to have a healthier lifestyle at baseline than women participating in HUNT4. Future studies should explore how lifestyle intervention programs could be adapted to the needs of women who have experienced HDP or other pregnancy complications that are associated with an increased risk of CVD.

Bone Mineral Density in Transgender Adolescents Treated With Puberty Suppression and Subsequent Gender-Affirming Hormones

Bone mineral density (BMD) z scores in transgender adolescents decrease during puberty suppression with a gonadotropin-releasing hormone (GnRH) agonist. Previous research found that after short-term use of gender-affirming hormones (GAH), pretreatment z scores were not restored. Long-term follow-up studies are lacking. To assess BMD after long-term GAH treatment in transgender adults who used puberty suppression in adolescence. This single-center cohort study with follow-up duration of 15 years selected participants from a database containing all people visiting a gender identity clinic at an academic hospital in the Netherlands between 1972 and December 31, 2018. Recruitment occurred from March 1, 2020, to August 31, 2021. A total of 75 participants diagnosed with gender dysphoria who had used puberty suppression before age 18 years prior to receiving at least 9 years of long-term GAH were included. Puberty suppression with a GnRH agonist followed by GAH treatment. Lumbar spine, total hip, and femoral neck BMD and z scores before the start of puberty suppression, at start of GAH, and at short- and long-term follow-up. Among 75 participants, 25 were assigned male at birth, and 50 were assigned female at birth. At long-term follow-up, the median (IQR) age was 28.2 (27.0-30.8) years in participants assigned male at birth and 28.2 (26.6-30.6) years in participants assigned female at birth. The median (IQR) duration of GAH treatment was 11.6 (10.1-14.7) years among those assigned male at birth and 11.9 (10.2-13.8) years among those assigned female at birth. The z scores decreased during puberty suppression. In individuals assigned male at birth, the mean (SD) z score after long-term GAH use was -1.34 (1.16; change from start of GnRH agonist: -0.87; 95% CI, -1.15 to -0.59) at the lumbar spine, -0.66 (0.75; change from start of GnRH agonist: -0.12; 95% CI, -0.31 to 0.07) at the total hip, and -0.54 (0.84; change from start of GnRH agonist: 0.01; 95% CI, -0.20 to 0.22) at the femoral neck. In individuals assigned female at birth, after long-term GAH use, the mean (SD) z score was 0.20 (1.05; change from start of GnRH agonist: 0.09; 95% CI, -0.09 to 0.27) at the lumbar spine, 0.07 (0.91; change from start of GnRH agonist: 0.10; 95% CI, -0.06 to 0.26) at the total hip, and -0.19 (0.94; change from start of GnRH agonist: -0.20; 95% CI, -0.26 to 0.06) at the femoral neck. In this cohort study, after long-term use of GAH, z scores in individuals treated with puberty suppression caught up with pretreatment levels, except for the lumbar spine in participants assigned male at birth, which might have been due to low estradiol concentrations. These findings suggest that treatment with GnRH agonists followed by long-term GAH is safe with regard to bone health in transgender persons receiving testosterone, but bone health in transgender persons receiving estrogen requires extra attention and further study. Estrogen treatment should be optimized and lifestyle counseling provided to maximize bone development in individuals assigned male at birth.

A community health worker-led program to improve access to gestational diabetes screening in urban slums of Pune, India: Results from a mixed methods study.

The World Health Organization recommends all pregnant women receive screening for gestational diabetes (GDM) with a fasting oral glucose tolerance test (OGTT). However, very few women receive recommended screening in resource-limited countries like India. We implemented a community health worker (CHW)-delivered program to evaluate if home-based, CHW-delivered OGTT would increase GDM screening in a low-resource setting. We conducted a mixed methods study in two urban slum communities in Pune, India. CHWs were trained to deliver home-based, point-of-care fasting OGTT to women in their third trimester of pregnancy. The primary outcome was uptake of CHW-delivered OGTT. Secondary outcomes included GDM prevalence and linkage to GDM care. Individual interviews were conducted with purposively sampled pregnant women, CHWs, and local clinicians to assess barriers and facilitators of this approach. From October 2021-June 2022, 248 eligible pregnant women were identified. Of these, 223 (90%) accepted CHW-delivered OGTT and 31 (14%) were diagnosed with GDM. Thirty (97%) women diagnosed with GDM subsequently sought GDM care; only 10 (33%) received lifestyle counseling or pharmacologic therapy. Qualitative interviews indicated that CHW-delivered testing was considered highly acceptable as home-based testing saved time and was more convenient than clinic-based testing. Inconsistent clinical management of GDM was attributed to providers' lack of time to deliver counseling, and perceptions that low-income populations are not at risk for GDM. Convenience and trust in a CHW-delivered GDM screening program resulted in high access to gold-standard OGTT screening and identification of a high GDM prevalence among pregnant women in two urban slum communities. Appropriate linkage to care was limited by clinician time constraints and misperceptions of GDM risk. CHW-delivered GDM screening and counseling may improve health education and access to preventive healthcare, offloading busy public clinics in high-need, low-resource settings.

Digital physical therapy intervention to treat female urinary incontinence: a semi-experimental study

Background: Urinary incontinence affects 15-40% Brazilians in rural areas, indicating the necessity of treatment for people in remote regions. Digital technology could be an option, but the evidence-based digital health intervention remains untapped. Objective: To assess whether a group intervention by synchronous video call reduces the severity of female urinary incontinence symptoms and to assess woman’s perception on this modality. Methods: Incontinent women who had digital access were invited to this semi-experimental study. An 8-week protocol was conducted through video calls once a week. Lifestyle counseling and exercises were performed. Pre- and post-evaluations were done exclusively by phone call. Results: 48 women were enrolled in the study and 40 concluded the protocol. They were 56.5 years (±12.0) and most of them had mixed urinary incontinence. The impact on quality of life and the severity of urinary incontinence symptoms was significantly improved and most of the participants were completely satisfied with the intervention. A large effect size was observed (Glass’s delta = 0.83) Conclusion: Our findings support a digital group approach for the treatment of female urinary incontinence as an alternative to be further explored. Combining digital service with group assistance brought satisfaction and clinical results for the participants and it can be promising for public health services.

Community-based type 2 diabetes care by lay village health workers in rural Lesotho: protocol for a cluster-randomized trial within the ComBaCaL cohort study (ComBaCaL T2D TwiC)

BackgroundType 2 diabetes (T2D) poses a growing public health burden, especially in low- and middle-income countries (LMICs). Task-shifting to lay village health workers (VHWs) and the use of digital clinical decision support systems (CDSS) are promising approaches to tackle the current T2D care gap in LMICs. However, evidence on the effectiveness of lay worker-led T2D care models, in which VHWs initiate and monitor drug treatment in addition to community-based screening and referral services, is lacking.MethodsWe are conducting a cluster-randomized trial nested within the Community-Based Chronic Disease Care Lesotho (ComBaCaL) cohort study (NCT05596773) using the trial within cohort (TwiC) design to assess the effectiveness of a VHW-led, CDSS-assisted T2D care model in rural Lesotho. Participants are non-pregnant members of the ComBaCaL cohort study with T2D. The ComBaCaL cohort study is conducted in approximately 100 villages in two rural districts in Lesotho and is managed by trained and supervised VHWs. In intervention villages, VHWs offer a community-based T2D care package including lifestyle counselling, first-line oral antidiabetic, lipid-lowering, and antiplatelet treatment guided by a tablet-based CDSS to participants who are clinically eligible, as well as treatment support to participants who prefer or clinically require facility-based T2D care. In control clusters, all participants will be referred to a health facility for T2D management. The primary endpoint is the mean glycosylated haemoglobin (HbA1c) 12 months after enrolment. Secondary endpoints include the 10-year risk for cardiovascular events estimated using the World Health Organization risk prediction tool.DiscussionThe trial was launched on May 13, 2023, and has enrolled 226 participants at the date of submission (October 6, 2023). To our knowledge, the trial is the first to assess task-shifting of T2D care to VHWs at the community level, including the prescription of first-line antidiabetic, lipid-lowering, and antiplatelet medication in sub-Saharan Africa, and will thus provide the missing evidence on the effectiveness of such a T2D care model in this setting. The study is operating within the established Lesotho VHW programme. Similar community health worker programmes which exist across sub-Saharan Africa may benefit from the findings.Trial registrationClinicalTrials.gov NCT05743387. Registered on February 24 2023.

THU270 Efficacy Of Patient Support Program On Management Of Cardiovascular Risk Factors For Adults With Type 2 Diabetes Mellitus

Abstract Disclosure: A. Shah: None. S. Damse: None. P. Thiyagarajah: None. K. Soulat: None. T. Ahadome: None. Efficacy Of Patient Support Program On Management Of Cardiovascular Risk Factors For Adults With Type 2 Diabetes Mellitus. Type 2 diabetes mellitus (T2DM) is a major risk factor for cardiovascular disease. Patients with T2DM have 2 to 3 times the risk of cardiovascular mortality and morbidity.1 This study aimed to assess the efficacy of an intensive intervention strategy in improving cardiovascular risk factors, HbA1C level in high-risk patients with T2DM. Methods: An interventional program with a multi component strategy was delivered by Wellthy therapeutics over a period of 40 weeks. The program had interventions including customized dietary plans, behavioral interventions, including stress management and coping skills training, lifestyle counseling, disease awareness and self-management training of symptoms at home. Interventions were initiated by certified health coaches via chats and calls. A high-risk diabetic cohort whose HbA1C greater than 10% were recruited by convenience sampling method. Intervention Statistical analysis was done using SPSS version 21. Results: The mean age of patients was 48.49±14.46. The mean of HbA1C, Total Cholesterol, LDL, Triglycerides, BMI at baseline was 11.4, 195.42, 125.9, 247.26, 26.77 respectively. The mean of HbA1C, Total Cholesterol, LDL, Triglycerides, BMI at the endline was 9.70, 181.98, 119.82, 195.34, 25.95 respectively. The effect of the Paired Ttest witnessed that intensive intervention strategy had a statistically significant improvement in effect on the cardiovascular risk factors from baseline to follow up p<0.05.(HbA1C p=.001, Total cholesterol p=.019, Triglycerides p=.002, BMI p=.007). Conclusion: This program played a highly significant role in managing cardiovascular risk factors by training patients in self-monitoring, medication adherence, and knowledge on disease awareness. There is increasing evidence that these interventions can support modification of lifestyle risk factors among people with coronary T2DM; however, existing interventions are disparate. These types of interventions play a potential role in meeting the individual needs and preferences to optimize self-management of their disease. Presentation: Thursday, June 15, 2023

FRI405 PCOS Health-related Quality-of-life And Depressive Symptoms Across The Lifespan

Abstract Disclosure: P.J. Wright: None. C.F. Corbett: None. A.S. Tavakoli: None. Polycystic ovary syndrome (PCOS) is a complex, heterogenous collection of symptoms attributed to hormonal dysregulation. Of women diagnosed with PCOS, approximately 50% have obesity, 70% have dyslipidemia, and 80% have insulin resistance (1). These clinical features increase the risk for cardiovascular disease, diabetes, and reproductive cancers by ≥50% while negatively impacting health-related quality-of-life (HRQoL). To date, most PCOS studies have only examined the cardiometabolic disturbances and HRQoL among women of reproductive age. However, PCOS is a chronic condition that transcends the reproductive years and requires management across a woman’s lifespan. Older women with PCOS continue to cope with multiple risk factors due to persistent hormonal dysregulation and/or because they have developed ≥1 cardiometabolic comorbidities. As such, we hypothesize that HRQoL among peri-postmenopausal women with PCOS remains compromised and depressive symptoms remain common. The purpose of our cross-sectional study was to compare HRQoL and depressive symptoms among peri-postmenopausal women with PCOS aged ≥43 years relative to premenopausal women with PCOS aged 18-42 years. An online survey link comprising questionnaires about demographics, HRQoL, and depressive symptoms was posted on two PCOS-specific Facebook groups. Respondents (n = 1,044) were separated into two age cohorts: women with PCOS aged 18-42 years (n = 935) and women with PCOS aged ≥43 years (n = 109). Data from the online survey were analyzed using descriptive statistics, Pearson correlations, and multiple regression via SAS. Results were interpreted through the lens of life course theory. Life course theory describes a sequence of age-differentiated events and roles embedded in sociocultural context that people enact over time. Sociocultural contexts include stages of life (e.g., parenthood, menopause), social conditions (e.g., age-related norms), and relationships with other people (e.g., family, friends) during periods of human development (adolescence, adulthood, etc). Chronic health conditions impact human development and often alter the sociocultural context for women as they navigate the life course. Age, marital status, and children significantly differed between groups. HRQoL among older women with PCOS was significantly better as compared to those aged 18-42 years. Results indicated significant positive linear associations between the HRQoL psychosocial/emotional subscale and other HRQoL subscales and a significant negative association with age. Fertility and sexual function HRQoL subscales were not significantly associated with the psychosocial/emotional subscale among women aged ≥43 years. Women in both groups had moderate depressive symptoms. Study findings demonstrate the need to tailor PCOS management and PCOS-specific HRQoL assessment instruments to women’s life stage. This knowledge can inform future research about peri-postmenopausal women with PCOS and age appropriate and patient-centered healthcare, including requisite clinical screenings (e.g., depressive symptoms) and lifestyle counseling across the lifespan. Azziz, R. (2020). Epidemiology and pathogenesis of the polycystic ovary syndrome in adults. http://www.uptodate.com/contents/epidemiology-and-pathogenesis-of-the-polycysticovary-syndrome/ Presentation: Friday, June 16, 2023

FRI060 Real World Experience Of Weight Management In Low Socioeconomic Community Clinic

Abstract Disclosure: B.A. West: None. S. Mon: None. Pilot Study: Real-world experience of weight management in low socioeconomic community clinic Introduction: Management of obesity and unhealthy behaviors is an essential step in patients with Prediabetes and T2DM, particularly those with socioeconomic status (SES) in whom obesity is more prevalent. While several behavior interventions targeting obesity exist, a successful adaptation of interventions in routine care is challenging especially in those with low SES. We examined the real word experience of weight loss management in our community clinic. Method: Retrospective chart review of consecutive patients seen in an endocrinology clinic at a hospital-based community clinic. Result: A total of 23 female patients, average age 48.4 ± 10.8 years, with average BMI 37.4 ± 6.9 kg/m2, were provided comprehensive lifestyle counseling focusing on nutrition, exercise, sleep health at each visits along with semaglutide at the highest tolerable dose of 2.4 mg/dl weekly. Within 6 months from the initiation of semaglutide and the weight loss intervention, 11/23 (48%) patients lost weight by >5% from their baseline visit, and 17/20 (85%) patients at the end of 1 year. 12/20 (60%) and 6/20 (30%) lost weight at least by 10% and 15% respectively at the end of 1 year. Compared to the baseline data, weight ( 101.2±18.4) kg, SBP 127.6 ± 13.4 mmHg, HbA1C 6.0 ± 1.1 mg/dL, Total Cholesterol 182.1 ± 40.4 mg/dL, LDL 102.4 ± 35.8 mg/dL, most parameters were improved at the end of 6 and 12 months respectively: weight 91.0± 18.6 vs 88.4± 16.2 kg, SBP 125.2± 16.8 vs. 126.9± 15.6 mmHg, HbA1C 5.8 ± 1.2 vs 6.3 ± 1.4 mg/dl, Total cholesterol 178.9± 33.1 vs 175.0 ± 50.7mg/dl, LDL 100.4± 27.7 vs 101.8± 47.7 mg/dL. Conclusion: This real-world implementation study reported the benefits of weight loss and other clinical parameters after the intervention consisting of a combined health behavior counseling and use of semaglutide at the low-SES community clinic. Presentation: Friday, June 16, 2023

Nutrition and Physical Activity Counseling by General Practitioners in China.

To reduce unhealthy lifestyles in China, it is critical to implement effective strategies. Counseling provided by physicians is important for assisting patients in improving their lifestyles, and general practitioners (GPs) are the main providers of lifestyle counseling to patients. However, few studies have focused on the lifestyle counseling practices by GPs in China, particularly in regard to nutrition and physical activity. The aims of this study are: (i) to examine the current practice of Chinese GPs in counseling patients regarding nutrition and physical activity; (ii) to understand the common barriers to such counseling by Chinese GPs; and (iii) to study the association between GPs' personal lifestyle choices and their practices in lifestyle counseling. A cross-sectional, self-reported online questionnaire was conducted among GPs in Hunan province, China. A total of 198 GPs completed the questionnaire. The majority of GPs provide nutrition and physical activity counseling to less than 40% of their patients, spending less than three minutes per counseling session. The main reported barriers to counseling on nutrition and physical activity are inadequate time and a lack of knowledge or experience. GPs primarily acquire knowledge through medical books and journals, followed by science popularization. Furthermore, GPs who maintain healthier lifestyle habits, possess a better understanding of lifestyle guidelines, conduct longer office visits, and exhibit higher self-efficacy are more likely to provide counseling to patients. This study highlights the need for improvement in nutrition and physical activity counseling among Chinese GPs. GPs' personal nutrition and physical activity habits may measurably influence their counseling practice. We recommend that GPs themselves adopt healthier lifestyle habits to potentially improve their counseling practice. Moreover, proactive measures should be taken to assist GPs in overcoming barriers encountered with lifestyle counseling.

Contribution of intestinal triglyceride-rich lipoproteins to residual atherosclerotic cardiovascular disease risk in individuals with type 2 diabetes on statin therapy

Aims/hypothesisThis study explored the hypothesis that significant abnormalities in the metabolism of intestinally derived lipoproteins are present in individuals with type 2 diabetes on statin therapy. These abnormalities may contribute to residual CVD risk.MethodsTo investigate the kinetics of ApoB-48- and ApoB-100-containing lipoproteins, we performed a secondary analysis of 11 overweight/obese individuals with type 2 diabetes who were treated with lifestyle counselling and on a stable dose of metformin who were from an earlier clinical study, and compared these with 11 control participants frequency-matched for age, BMI and sex. Participants in both groups were on a similar statin regimen during the study. Stable isotope tracers were used to determine the kinetics of the following in response to a standard fat-rich meal: (1) apolipoprotein (Apo)B-48 in chylomicrons and VLDL; (2) ApoB-100 in VLDL, intermediate-density lipoprotein (IDL) and LDL; and (3) triglyceride (TG) in VLDL.ResultsThe fasting lipid profile did not differ significantly between the two groups. Compared with control participants, in individuals with type 2 diabetes, chylomicron TG and ApoB-48 levels exhibited an approximately twofold higher response to the fat-rich meal, and a twofold higher increment was observed in ApoB-48 particles in the VLDL1 and VLDL2 density ranges (all p < 0.05). Again comparing control participants with individuals with type 2 diabetes, in the latter, total ApoB-48 production was 25% higher (556 ± 57 vs 446 ± 57 mg/day; p < 0.001), conversion (fractional transfer rate) of chylomicrons to VLDL was around 40% lower (35 ± 25 vs 82 ± 58 pools/day; p=0.034) and direct clearance of chylomicrons was 5.6-fold higher (5.6 ± 2.2 vs 1.0 ± 1.8 pools/day; p < 0.001). During the postprandial period, ApoB-48 particles accounted for a higher proportion of total VLDL in individuals with type 2 diabetes (44%) compared with control participants (25%), and these ApoB-48 VLDL particles exhibited a fivefold longer residence time in the circulation (p < 0.01). No between-group differences were seen in the kinetics of ApoB-100 and TG in VLDL, or in LDL ApoB-100 production, pool size and clearance rate. As compared with control participants, the IDL ApoB-100 pool in individuals with type 2 diabetes was higher due to increased conversion from VLDL2.Conclusions/interpretationAbnormalities in the metabolism of intestinally derived ApoB-48-containing lipoproteins in individuals with type 2 diabetes on statins may help to explain the residual risk of CVD and may be suitable targets for interventions.Trial registrationClinicalTrials.gov NCT02948777.Graphical

HEAD-MIP–(HEAlth Dialogues for patients with Mental Illness in Primary care)—a feasibility study

BackgroundPatients with mental illness have an increased risk of cardiovascular morbidity and mortality compared to the rest of the population, which is partly related to unhealthy lifestyle habits. To individualise lifestyle counselling in primary care, the Swedish-developed Health Dialogue (HD) can be used as an educative tool at recurrent measurement points with the goal to improve non-healthy lifestyle habits. HD has not been aimed specifically at patients with mental illness, and the effect of a systematic approach with repeated HDs in patients with mental illness in primary care has not been previously studied. The aim of this pilot study was to assess the feasibility of the study design for a larger-scale cohort study using repeated HDs focused on the improvement of lifestyle habits in patients seeking primary care due to anxiety, depression, sleeping problems or stress-related symptoms.MethodsPatients were recruited after a visit to a Primary Health Care Center due to mental illness between October 2019 until November 2021 and received a Health Dialogue, including an assessment of cardiovascular risk factors through a Health Curve. Specific feasibility objectives measured were dropout rate, time to follow-up, and risk improvement rate for different lifestyle changes.ResultsA total of 64 patients were recruited and 29 (45%) attended a second HD, with a mean follow-up time of 15 months. All participants had at least one elevated cardiovascular risk level on the Health Curve for the assessed lifestyles. Risk level improvement rate was good except for tobacco use.ConclusionDespite a higher dropout rate than expected, we suggest that the proposed methodology for a full cohort study within general practice of patients with mental illness in primary care is both acceptable to practice and feasible.Trial registrationNCT05181254. Registered January 6th, 2022. Retrospectively registered.

Healthy lifestyle counseling, and barriers perceived by general practitioners in Poland.

The aim of the study was to determine the influence of the personal factors, such as body mass index (BMI), of general practitioners (GPs), and their counseling on weight management, healthy lifestyle, and their perceived barriers. The cross-sectional study was conducted from January 2020 to December 2021 among 161 GPs in the city of Lodz. Only 3.7% of physicians always advised their patients on diet and physical activity (p < 0.05). Most of the GPs (54%) provide counseling occasionally. GPs gave general advice more often to patients with chronic diseases than to patients who did not. The study showed that the chance of providing advice on eating habits or physical activity was significantly higher for the GPs who practiced physical activity (OR = 2.64; 95%Cl: 1.01-6.91, p < 0.05) and measured patient weight, height, and BMI (OR = 4.86; 95%Cl: 1.86-12.67, p < 0.001). GPs who were overweight (OR = 3.55; 95%Cl: 1.49-8.41, p < 0.01) and measured patient weight, height, and BMI (OR = 3.61; 95%Cl: 1.58-8.25, p < 0.01) were more likely to advise on nutrition or physical activity to "healthy" patients. Doctors who measured patient weight, height, and BMI advised patients with chronic diseases (OR = 6.45; 95%Cl: 2.54-16.34, p < 0.001). Over 40% of GPs believe that they are not effective in counseling. Lack of time turned out to be the main barrier to counseling for 73.3% of GPs, which was associated with heavy workload (>100 visits per week). As many GPs doubt their effectiveness, it is recommended that GPs attend more training activities regarding counseling. In addition, organizational changes are needed to reduce patient numbers, and financial incentives are needed to improve counseling and patient measurement.

Impact of Culinary Medicine Course on Confidence and Competence in Diet and Lifestyle Counseling, Interprofessional Communication, and Health Behaviors and Advocacy.

Most physicians report inadequate training to provide diet and lifestyle counseling to patients despite its importance to chronic disease prevention and management. To fill the nutrition training gap, elective Culinary Medicine (CM) courses have emerged as an alternative to curriculum reform. We evaluated the impact of an interprofessional CM course for medical and health professional students who experienced the hands-on cooking component in person or a in mixed-mode format (in-person and via Zoom) at the University of Utah from 2019-2023 (n = 84). A factorial ANOVA assessed differences between educational environment and changes between pre- and post-course survey responses related to diet and lifestyle counseling, interprofessional communication, and health behaviors and advocacy. Qualitative comments from post-course surveys were analyzed on a thematic level. Students rated themselves as having greater confidence and competence in diet and lifestyle counseling (p < 0.05) and increased ability to prepare eight healthy meals (p < 0.05). Additionally, a Mann-Whitney two-sample rank-sum test was used to compare data from exit survey responses from medical students who took the CM course (n = 48) and did not take the CM course (n = 297). Medical students who took CM were significantly more likely to agree that they could counsel patients about nutrition (p < 0.05) and physical activity (p < 0.05). CM courses may improve students' confidence to provide diet and lifestyle counseling.

The Use of Reframing: Increasing the Importance of Lifestyle Medicine.

Lifestyle behavior modification is an essential component to prevention and treatment of non-communicable diseases worldwide. For the last 40years, studies have recognized that there is suboptimal training of physicians in lifestyle medicine and its implementation in clinical settings. The lack of nutrition and exercise counseling occurring in the medical office does not reflect the high level of evidence supporting its use. Lifestyle behavior counseling is complex; as are the individualized needs of patients. Therefore, we suspect that the lack of knowledge in nutrition and exercise prescriptions are not the only barriers to providing optimal care. Reframing lifestyle medicine interventions like nutrition and exercise from adjunctive to central to treatment and reframing the role of the physician therein may be necessary to address important barriers to overall lifestyle behavioral counseling.

A systematic review of the role of community pharmacists in the prevention and control of cardiovascular diseases: the perceptions of patients

BackgroundCardiovascular diseases are a leading cause of mortality globally. The modifiable risk factors can be measured and identified early at primary healthcare facilities. Community pharmacists present an opportunity for improved management of cardiovascular diseases and health outcomes. The systematic review aims to identify the roles of community pharmacists in preventing and controlling cardiovascular diseases and patients’ perceptions towards such functions.MethodsA systematic review of the literature was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The team searched MEDLINE, CINAHL via EBSCOhost, and Web of Science from January 2001 to December 2021 with a focus on studies reporting the role of community pharmacists in preventing and controlling cardiovascular diseases, and patients’ perceptions of such roles. Search terms included were ‘‘interventions,’’ ‘‘community pharmacists,’’ ‘‘patients,’’ ‘‘cardiovascular diseases,’’ ‘‘risk factors,’’ and “perceptions”. The quality of studies was appraised using the Joanne Briggs Institute checklist.ResultsA total of 45 studies met the inclusion criteria: 35 (78%) and 10 (22%) reported community pharmacists’ preventive and control roles, respectively. Generally, drug therapy monitoring, medicine and lifestyle counselling, and health education were most common roles, with pharmacist-initiated prescribing and social support least common. A total of 11 (24%) studies reported patients’ perceptions of community pharmacists’ contribution in preventing (73%, n = 8) and controlling (27%, n = 3) cardiovascular diseases. Patients were satisfied with community pharmacists’ services in 10 of 11 studies.ConclusionsThe findings highlight community pharmacists’ capability of providing primary healthcare services in preventing and controlling cardiovascular diseases and provide evidence for their inclusion in primary healthcare frameworks. Future research should assess the effectiveness of these roles and provide a comprehensive evaluation of clinical, humanistic, and economic outcomes.Systematic review registrationOpen Science Framework (OSF) registration https://doi.org/10.17605/OSF.IO/WGFXT.

Self-enactable techniques to influence basic psychological needs and regulatory styles within self-determination theory: An expert opinion study

While a large body of research on Self-Determination Theory (SDT) has identified characteristics of social environments that are conducive to optimal motivation, research has scarcely considered what individuals might themselves do to optimize motivation. Using the compendium of self-enactable techniques, this expert opinion study aimed to identify conceptual linkages between 123 self-enactable techniques and nine core SDT constructs. International scholars (n = 67) judged a block-randomized subset of 30–40 self-enactable techniques for their likely impacts on SDT constructs. Theoretically plausible linkages between self-enactable techniques and SDT constructs are visualized as a network. Seven techniques (i.e., Brainstorm options, Goal integration, Support others, Find meaning in target behaviour, Associate identity with changed behaviour, Valued self-identity, and Emphasize autonomy) were adjudged as having potential beneficial impacts on five or more SDT constructs. Interventions requiring participant engagement, for example self-management or lifestyle counseling, will benefit from a better understanding of motivation self-management.

Using the Behavior Change Wheel to Identify and Understand Key Facilitators and Barriers for Lifestyle Care for Postmenopausal Breast Cancer Survivors: A Delphi-Study.

Optimal approaches to promote sustained adherence to lifestyle and bodyweight recommendations in postmenopausal breast cancer (PMBC) survivors are lacking. This Delphi-study aims to identify and understand expert-opinion on potential barriers and facilitators for promoting adherence to these lifestyle and bodyweight recommendations in (clinical) care for PMBC survivors, and to determine potential effective intervention strategies. The expert panel consisted of oncology Health Care Professionals (HCPs) (N = 57), patient advocates (N = 5), and PMBC survivors (N = 38). They completed three questionnaires: Q1-idea generation; Q2-validation and prioritization; Q3-ranking. The Behavior Change Wheel was used as theoretical framework for analysis. Thematic analysis was applied to identify key overarching themes based on the top-ranked facilitators and barriers. Potential Behavior Change Techniques (BCTs) and intervention strategies were identified using the Behavior Change Technique Taxonomy version 1 and the Behavior Change Wheel. Eleven core categories of key barriers/facilitators for the promotion of adherence to recommendations for lifestyle and bodyweight among PMBC survivors were identified. For each core category, relevant BCTs and practical potential intervention strategies were selected based on suggestions from the expert panel. These included: increasing knowledge about the link between lifestyle and cancer; enabling self-monitoring of lifestyle behaviors followed by evaluation; offering group lifestyle counseling for PMBC survivors, enhancing social support for favorable lifestyle behaviors; and stimulating multidisciplinary collaboration among HCPs. Findings provide valuable insight for the development of interventions changing behavior of PMBC survivors and HCPs toward increased healthy lifestyle (support) behavior.