Lifestyle Group Research Articles

Does Lifestyle Intervention After Gastric Bypass Surgery Prevent Weight Regain? A Randomized Clinical Trial.

Weight regain after bariatric surgery often starts after 1-2y, but studies evaluating strategies to prevent weight regain are lacking. The aim of this intervention was to evaluate the efficacy of a 2-y-group-based lifestyle intervention starting approximately 2y after Roux-en-Y gastric bypass (RYGB) compared with usual care on weight regain and related metabolic risk factors. A total of 165 patients with a mean of 21months (range 14-32) after RYGB were randomized to a lifestyle intervention group (LIG) or a usual care group (UCG). Of the 165 participants 86% completed the study. The LIG was offered 16 group meetings over 2y with focus on healthy diet, physical activity, and behavioural strategies to prevent weight regain, in addition to usual care. Mean (SD) total weight loss at study start was 30.1 ± 8.2%, while weight regain during the intervention was 4.9 ± 7.4 and 4.6 ± 9.2% in the LIG and UCG, respectively (P = 0.84). There were no differences in metabolic risk factors between the groups. The LIG participants attended 8 ± 4 group meetings, with no difference in weight regain between participants with high compared to lower participation. In all the participants, a positive association between weight increase from nadir to study start and weight regain during the intervention was found. Participants who reported physical activity ≥ 150min/wk had smaller % weight regain compared with less active participants (β = - 5.2 [SE 2.0, 95% CI - 9.1 to - 1.4]). We found no difference in weight regain between LIG and UCG.

Associations of Perfluoroalkyl and Polyfluoroalkyl Substances With Incident Diabetes and Microvascular Disease.

Perfluoroalkyl and polyfluoroalkyl substances (PFASs) are suspected endocrine disruptors widely detected across populations. We examine the extent to which PFASs are associated with diabetes incidence and microvascular disease. Secondarily, we tested whether a lifestyle intervention modifies associations and decreases concentrations. We analyzed data from a prospective cohort of 957 participants from the Diabetes Prevention Program (DPP) trial and Diabetes Prevention Program Outcomes Study (DPPOS). At baseline, participants were randomized to an intensive lifestyle intervention of diet, physical activity, and behavior modification or a placebo medication. We quantified plasma concentrations of six PFASs at baseline and 2 years after randomization. Participants were monitored for ∼15 years, repeatedly tested for diabetes, and evaluated for microvascular disease at the end of the follow-up. A doubling in baseline branched perfluorooctanoic acid concentration was associated with a 14% increase in diabetes risk for the placebo (hazard ratio [HR] 1.14, 95% CI 1.04, 1.25) but not in the lifestyle intervention group (HR 1.01, 95% CI 0.92, 1.11, P interaction = 0.11). Mean change in plasma baseline branched perfluorooctanoic acid concentration was greater for the placebo (0.96 ng/mL; 95% CI 0.71, 1.22) compared with the lifestyle intervention group (0.31 ng/mL; 95% CI 0.14, 0.48) 2 years after randomization. Each doubling in N-ethyl-perfluorooctane sulfonamido acetic acid was associated with 17% greater odds of prevalent microvascular disease (OR 1.17, 95% CI 1.05, 1.31), and a similar association was observed for perfluorodimethylhexane sulfonic acid (OR 1.18, 95% CI 1.04, 1.35), regardless of treatment. Some plasma PFASs were associated with diabetes and microvascular disease. Our results suggest that exercise and diet may attenuate the diabetogenic association of PFASs.

Effect of Pelvic Floor Muscle Training on Improving Prolapse-related Symptoms After Surgery

The aim of this study was to explore the effect of pelvic floor muscle training as an adjunct for prolapse surgery. Participants were randomly allocated into 2 groups receiving lifestyle advice (n = 48) and lifestyle advice + pelvic floor muscle training (n = 49). This study compared the total score (Pelvic Floor Distress Inventory-20) and the scores of the Urinary Distress Inventory-6/Colorectal Anal Distress Inventory-8/Pelvic Organ Prolapse Distress Inventory-6 at admission, discharge, and 42 and 60 days after surgery. The UDI-6 score in the lifestyle advice + pelvic floor muscle training group was lower than that in the lifestyle advice group 42 and 60 days after surgery. Pelvic floor muscle training can improve the bladder-related symptoms to have positive significance for pelvic floor rehabilitation after pelvic organ prolapse surgery.

Type 2 diabetes remission 1 year after an intensive lifestyle intervention: A secondary analysis of a randomized clinical trial.

AimTo investigate whether an intensive lifestyle intervention induces partial or complete type 2 diabetes (T2D) remission.Materials and methodsIn a secondary analysis of a randomized, assessor‐blinded, single‐centre trial, people with non‐insulin‐dependent T2D (duration <10 years), were randomly assigned (2:1, stratified by sex, from April 2015 to August 2016) to a lifestyle intervention group (n = 64) or a standard care group (n = 34). The primary outcome was partial or complete T2D remission, defined as non‐diabetic glycaemia with no glucose‐lowering medication at the outcome assessments at both 12 and 24 months from baseline. All participants received standard care, with standardized, blinded, target‐driven medical therapy during the initial 12 months. The lifestyle intervention included 5‐ to 6‐weekly aerobic and combined aerobic and strength training sessions (30‐60 minutes) and individual dietary plans aiming for body mass index ≤25 kg/m2. No intervention was provided during the 12‐month follow‐up period.ResultsOf the 98 randomized participants, 93 completed follow‐up (mean [SD] age 54.6 [8.9] years; 46 women [43%], mean [SD] baseline glycated haemoglobin 49.3 [9.3] mmol/mol). At follow‐up, 23% of participants (n = 14) in the intervention and 7% (n = 2) in the standard care group met the criteria for any T2D remission (odds ratio [OR] 4.4, 95% confidence interval [CI] 0.8‐21.4]; P = 0.08). Assuming participants lost to follow‐up (n = 5) had relapsed, the OR for T2D remission was 4.4 (95% CI 1.0–19.8; P = 0.048).ConclusionsThe statistically nonsignificant threefold increased remission rate of T2D in the lifestyle intervention group calls for further large‐scale studies to understand how to implement sustainable lifestyle interventions among people with T2D.

Exercise Recommendations for Women with Polycystic Ovary Syndrome: Is the Evidence Enough?

In this opinion piece, we summarize, discuss implications of implementation, and critically evaluate our 2018 evidence-based guideline recommendations for exercise and physical activity in women with polycystic ovary syndrome (PCOS). We developed recommendations as part of a larger international guideline development project. The overall guideline scope and priorities were informed by extensive health professional and consumer engagement. The lifestyle guideline development group responsible for the exercise recommendations included experts in endocrinology, exercise physiology, gynecology, dietetics, and obstetrics, alongside consumers. Extensive online communications and two face-to-face meetings addressed five prioritized clinical questions related to lifestyle, including the role of exercise as therapy for women with PCOS. The guideline recommendations were formulated based on one narrative and two evidence-based reviews, before consensus voting within the guideline panel. The development process was in accordance with the Appraisal of Guidelines for Research and Evaluation (AGREE) II, and used the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework to assess evidence quality, desirable and undesirable consequences, feasibility, acceptability, cost, implementation, and recommendation strength. Given the evidence for exercise as therapy in PCOS being of low quality, a consensus recommendation was made based on current exercise guidelines for the general population. Women with PCOS and clinicians are forced to adopt generic approaches when recommending exercise therapy that perpetuates clinical management with pharmacological solutions. The current status of evidence highlights the need for greater international co-operation between researchers and funding agencies to address key clinical knowledge gaps around exercise therapy in PCOS to generate evidence for appropriate, scalable, and sustainable best practice approaches.

327-OR: Prediabetes Conversion to Normoglycemia Is Superior Adding a Low-Carbohydrate Formula Diet to Lifestyle Intervention—A 12-Month Subanalysis of the ACCORH Study

Lifestyle interventions have shown to reverse hyperglycemia to normoglycemia. However, most interventions are cost-intensive. Formula diets have shown to improve glycemic control and be cost-effective. We, therefore, hypothesized that adding a low-carbohydrate formula diet to a low-intense lifestyle intervention is superior in reversing prediabetes than lifestyle intervention alone. In this predefined subanalysis of a multicenter RCT (ACOORH study (no. NIHR CRN 3571)) including a total of n=463 obese subjects, overweight persons (n=141, BMI: &amp;gt;27 kg/m²) with prediabetes (defined as HbA1c: 5.7-6.4%) were randomized (1:2) into either a lifestyle intervention control group (CON, n=45) or a formula diet-based lifestyle intervention group (INT, n=96). Both groups were equipped with telemonitoring devices, received information on healthy diet and were instructed to increase physical activity. Additionally, INT received a low-carbohydrate, soy-protein-rich product (Almased®) substituting three meals/day (~1200 kcal) within the first week. During weeks 2-4, participants replaced two meals/day and during weeks 5-26 only one meal/day was substituted (1300-1500 kcal/day). Follow-up was performed after 52 weeks. Intention-to-treat analyses were performed. Nine and 8 persons of CON and INT (20% vs. 8%; P&amp;lt;0.05) dropped out after 12 weeks and 17 and 31 (38% vs. 32%, P=0.567) after 52 weeks. Compared to CON significantly more subjects in INT converted to normoglycemia after 52 weeks (51% vs. 32%; P&amp;lt;0.05). The risk reduction led to a number-needed-to-treat of 5.3 for INT. Concomitantly, INT reduced weight more significantly (-5.9 kg with 95% CI [-6.9; -4.9] vs. -2.4 kg [-4.0; -0.9]; P&amp;lt;0.001) after 12 weeks, while there was no difference after 52 weeks between groups. A low-intense lifestyle intervention with a low-carbohydrate formula diet reduces prediabetes prevalence stronger than a lifestyle intervention alone. Disclosure S. Martin: Consultant; Self; Almased Wellness GmbH, AstraZeneca, Lilly Diabetes. W. Banzer: None. A. Berg: Research Support; Self; Almased Wellness GmbH. K. Braumann: None. D. Fuhrer: Research Support; Self; Almased Wellness GmbH. M. Halle: Advisory Panel; Self; Merck Sharp &amp; Dohme Corp. Research Support; Self; Novartis AG. Speaker's Bureau; Self; Amgen Inc., AstraZeneca, Berlin-Chemie AG, Daiichi Sankyo Company, Limited, Merck Sharp &amp; Dohme Corp., Novartis AG, Pfizer Inc., Sanofi. D. McCarthy: None. M. Pinget: None. G. Predel: None. H. Toplak: Advisory Panel; Self; Amgen Inc., Boehringer Ingelheim Pharmaceuticals, Inc., Merck Sharp &amp; Dohme Corp., Mylan, Novartis AG, Novo Nordisk A/S, Sanofi. Research Support; Self; Amgen Inc., Boehringer Ingelheim Pharmaceuticals, Inc., Novartis AG, Novo Nordisk A/S, Sanofi. Speaker's Bureau; Self; Amgen Inc., Amgen Inc., AstraZeneca, Bayer AG, Boehringer Ingelheim Pharmaceuticals, Inc., Eli Lilly and Company, Merck Sharp &amp; Dohme Corp., Mylan, Novo Nordisk Inc., Sanofi. Funding Almased Wellness GmbH

Pre-employment health lifestyle profiles and actual turnover among newly graduated nurses: A descriptive and prospective longitudinal study

BackgroundNewly graduated nurses’ pre-employment health lifestyles play particularly important roles in their smooth adaptation to and retention in clinical nursing; however, the longitudinal relationship between pre-employment health lifestyles and work outcomes, such as turnover, remains underexamined. To identify the health lifestyle profiles of specific populations of interest, recent studies have employed multifaceted approaches using health behaviors and/or statuses. ObjectivesTo identify the pre-employment health lifestyle profiles of newly graduated nurses, and to examine the longitudinal relationships between health lifestyle profiles and actual turnover. DesignDescriptive and prospective longitudinal study design. SettingsOne tertiary hospital in Seoul, South Korea. ParticipantsA total of 464 newly graduated nurses who started work between September 2014 and December 2015. MethodsThe outcome was actual turnover—whether participants had resigned from the organization and the days they worked up to December 31, 2017. We measured eight health lifestyle variables on the first day of orientation before ward placement (i.e., at baseline): quantity and quality of sleep, eating three meals a day, having a regular diet, alcohol consumption, moderate exercise, depression, and self-rated health. We employed latent class analysis to identify the health lifestyle profiles of new nurses, and used Cox proportional hazards regression to examine the longitudinal relationships between health lifestyle profiles and actual turnover. ResultsWe classified newly graduated nurses’ pre-employment health lifestyle profiles into two groups: unhealthy lifestyle (15.6%) and discordant (84.4%). Compared with the new nurses in the discordant group, those in the unhealthy lifestyle group had significantly higher probabilities of resigning (HR = 2.38, 95% CIs of HR = 1.62–3.50); this relationship remained significant after adjusting for perceived job stress at six weeks of work (HR = 2.26, 95% CIs of HR = 1.50–3.39). ConclusionsThis study identified significant differences in the patterns of newly graduated nurses’ pre-employment health lifestyles; our analysis showed that classification in the unhealthy lifestyle group was a turnover risk factor. Given that new nurses’ health lifestyles affect work outcomes, hospitals should implement organizational and educational initiatives to encourage healthy lifestyles. In considering pre-employment health lifestyle profiles, hospitals should also monitor novice nurses’ adaptation and wellness. Nursing education should include strategies to enhance nursing students’ own health. Further extensive longitudinal studies should seek to identify the health lifestyle profiles of heterogeneous nurse populations.

Per- and polyfluoroalkyl substances and blood lipid levels in pre-diabetic adults—longitudinal analysis of the diabetes prevention program outcomes study

Exposure to per- and polyfluoroalkyl substances (PFASs) may interfere with lipid regulation. However, most previous studies were cross-sectional with the risk of reverse causation, suggesting a need for long-term prospective studies. We examined the relationship of baseline plasma PFAS concentrations with repeated measures of blood lipids. We included 888 prediabetic adults from the Diabetes Prevention Program (DPP) and DPP Outcomes Study, who had measurements of 6 plasma PFAS concentrations at baseline (1996–1999) and repeated measures of blood lipids over 15 years of follow-up, and were initially randomized to placebo or a lifestyle intervention. We used linear regression to examine cross-sectional associations of PFAS concentrations and lipid levels at baseline, and evaluated prospective risks of hypercholesterolemia and hypertriglyceridemia using Cox proportional hazard models, and tested for effect modification by study arm. Participants (65.9% female, 57.0% White, 65.9% aged 40–59 years) had comparable PFAS concentrations [e.g., median (IQR) perfluorooctanoic acid (PFOA) 4.9 ng/mL (3.2)] with the general U.S. population in 1999–2000. We observed higher total cholesterol at baseline per doubling of PFOA (β: 6.1 mg/dL, 95% CI: 3.1, 9.04), perfluorohexane sulfonic acid (PFHxS, β: 2.2 mg/dL, 95% CI: 0.2, 4.3), and perfluorononanoic acid (PFNA, β: 2.9 mg/dL, 95% CI: 0.7, 5.0). Prospectively, baseline concentrations of several PFASs, including PFOA, PFOS, PFHxS and PFNA, predicted higher risks of incident hypercholesterolemia and hypertriglyceridemia, but only in the placebo group and not the lifestyle intervention group. For example, participants in the placebo group with PFOA concentration > median (4.9 ng/mL) were almost twice as likely (HR: 1.90, 95% CI: 1.25, 2.88) to develop hypertriglyceridemia compared to those ≤median. Findings suggest adverse effects of some PFASs on lipid profiles in prediabetic adults. However, the detrimental effect was attenuated with a lifestyle intervention.

Clinico-pathological presentation of gastric carcinoma and its relation to the anatomical site of occurrence among patients in the hilly state of Himachal Pradesh, India

Background: The incidence of gastric cancer varies in different parts of the world and among various ethnic groups. Himachal Pradesh, located in the north of India, has different customs, food habits, life-style and diverse ethnic groups. We undertook this study to analyze the clinical presentations and pathological characteristics of stomach cancer patients in the biggest referral center in the state.Methods: All endoscopic biopsy proven cases of carcinoma stomach attending the OPD or admitted in the general surgery ward between July 2014 to June 2015, went through a thorough clinical examination, routine and diagnostic investigations and endoscopic biopsies for histopathological confirmation.Results: The study included 62 patients of adenocarcinoma stomach with maximum cases between 45 to 65 yrs age, more in males (2:1). Borrmann type II was most common macrocsopic appearance followed by type IV. As per Lauren classification, 36 were of intestinal, 24 diffuse and 2 had mixed type. 10 patients had well differentiated, 28 moderately differentiated and 24 patients had poorly differentiated tumors. Anorexia, abdominal pain, weight loss, nausea and vomiting was the most common symptoms seen in antral lesions (distal) and anemia was the most common sign followed by dehydration, mass abdomen and ascitis.Conclusions: The study has added to the literature of clinical and pathological presentation and relation of signs and symptoms to the site of occurrence of gastric carcinoma from the hilly and rural state of northern India.

Preschool children's eating and sleeping habits: late rising and brunch on weekends is related to several physical and mental symptoms

ObjectiveAs the relationships of sleep-wake schedule and mealtime with children's behaviors have not often been studied together, we investigated the relationships of these lifestyles variables with preschool children's well-being. MethodsUsing a network survey, we investigated several lifestyle variables of 1000 families with preschool children. ResultsOur previous articles reported that preschool children's bedtime was delayed by the compulsory nap routine in Japanese nursery schools. The present study revealed similar results. We conducted a cluster analysis with children's meal and sleep time data, which yielded five different lifestyle groups. Cluster 1 was characterized by “extremely late and irregular” meal and sleep times; similar to Cluster 1, Cluster 2 was a “late and irregular” lifestyle group. Cluster 3 was a “mildly late” lifestyle group. Cluster 4 was an “early bird and regular lifestyle” group, and Cluster 5 resembled the “early bird and regular lifestyle” group on weekdays, but was “late and irregular on weekends.” It was found that the later and more irregular the children's meal and sleep times, the worse their physical and mental condition. Even for Cluster 5, the children who had early and regular meal and sleep times on weekdays, getting up and having breakfast late and irregularly on weekends showed worse physical and mental conditions. These problematic symptoms observed in children with late meal and sleep times on weekends might be partly associated with the irregularity of their habits and partly associated with delayed mealtime, especially for breakfast (brunch). ConclusionA stable lifestyle, including a regular sleep and wake schedule and mealtime, is important for preschool children's mental and physical health.

OR11-2 A Lifestyle Program Targeting Women with Obesity and Infertility Improves Their Fertility: A Randomized Controlled Trial

Obesity reduces fertility and the effectiveness of fertility treatments in women, in addition to increasing pregnancy complications and programming of childhood obesity. Since studies have suggested that weight loss and lifestyle management could improve the fertility of women with obesity, obesity management with lifestyle modification is recommended for these women. Objectives: To evaluate the impacts of a lifestyle program in women with obesity and infertility on: 1) fertility outcomes, and 2) anthropometric and lifestyle measures. Methods: Women with obesity and infertility consulting at the fertility clinic of an academic hospital were randomized to the lifestyle program group (LPG) or control group (CG). Women in the CG began usual fertility care directly. Those in the LPG received the lifestyle intervention alone, without fertility treatments, for the first 6 months, and then in association with fertility treatments, if not pregnant. The lifestyle intervention combined individual and group sessions with a nutritionist and a kinesiologist in order to support progressive and sustainable lifestyle modifications. Per-protocol analyses including women who completed at least 6 months of the trial, or became pregnant, are presented. The maximal duration of follow-up, and intervention in the LPG, was 18 months or the end of pregnancy. Proportions were compared using chi-squared tests and means, using Student’s t tests. Results: Among 130 randomized women, 108 completed at least 6 months of the study or became pregnant (83%, 51 LPG and 57 CG). In these women, the lifestyle program increased by 58% the pregnancy rate as compared to controls (60.8% vs 38.6%, p=0.021) and almost tripled the proportion of women who conceived spontaneously, without fertility treatments (33.3% vs 12.3%, p=0.009). The lifestyle program also increased the live birth rate by 39% (51.0% vs 36.8%), although this was not statistically significant (p=0.139). When comparing participants with measures at 6 months of follow-up or at first pregnancy visit if before 6 months (75%, 46 LPG; 51 CG), women in the LPG lost significantly more % of weight (-3.4 ± 4.5% vs -0.89 ± 3.7, p=0.003), waist circumference (-2.9 ± 4.3 cm vs -0.97 ± 4.4, p=0.036) and % of fat mass (-1.3 ± 2.1% vs -0.47 ± 1.3%, p=0.033) compared to the CG. They also improved significantly more their lifestyle habits than the CG (healthy eating index: +18.2 ± 13.7 points vs +5.3 ± 12.4, p<0.001; total leisure activity’s energy expenditure: +0.77 ± 1.63 kcal/kg/day vs +0.17 ± 1.26 kcal/kg/day, p=0.044). Conclusion: A lifestyle program targeting women with obesity seeking fertility treatments improves not only their anthropometry and lifestyle habits, but most importantly, their chances of conceiving, especially spontaneously, in comparison to standard fertility treatments alone. Such impact could significantly reduce the costs associated with fertility treatments. Unless otherwise noted, all abstracts presented at ENDO are embargoed until the date and time of presentation. For oral presentations, the abstracts are embargoed until the session begins. s presented at a news conference are embargoed until the date and time of the news conference. The Endocrine Society reserves the right to lift the embargo on specific abstracts that are selected for promotion prior to or during ENDO.

Attitudes of Voluntary Simplifier University Students in Hungary

The Lifestyle of Voluntary Simplicity (LOVOS) segment is composed of consumers who attempt to achieve sustainable consumption. The segment has been examined by only a few research studies so far, and none of them were conducted among Hungarian consumers. Therefore, the aim of our exploratory research is to examine the occurrence of the LOVOS consumer group among university students from Debrecen, Hungary. To achieve our aim, we first identified the five main value groups of the LOVOS lifestyle with an expert focus group interview. Based on the interview, a questionnaire survey was conducted among university students from Debrecen (N = 500). Based on the results, four value-based segments were identified, of which the Voluntary simplifiers’ cluster (39.6% of respondents) reflected the characteristics of the LOVOS lifestyle to the greatest extent. Based on the literature, it seemed necessary to segment this group further in terms of their commitment to individual values. As a result, three further clusters were created, of which, the Holistic simplifiers’ group (9.8% of respondents) showed the greatest commitment to the values of the LOVOS lifestyle. We concluded that the characteristics of voluntary simplifiers have already appeared among university students from Debrecen, but further research is needed to reveal the value orientation of the whole of Hungarian society.

Setting Kids Up for Success (SKUFS): Outcomes of an Innovation Project for Promoting Healthy Lifestyles in a Pediatric Patient-Centered Medical Home

The greatest increase in childhood obesity prevalence occurs from preschool to school-age (SA). Evidence supports a family-centered approach to promote healthy lifestyle behaviors and weight management among SA children. The purpose of this study was to establish a healthy weight management support group in a pediatric patient-centered medical home. Overweight or obese SA children and their parent participated in four biweekly support meetings consisting of an educational presentation, group exercise, and a healthy snack. Sessions included education about nutrition, exercise, emotions, and health. Anthropometrics, the Healthy Habits screening tool, and Daily Logs, including step counts, were utilized to track outcomes. There was a significant improvement in fruit and vegetable intake and dining out (p = <.05), and a clinical improvement in physical activity and sugar sweetened beverage intake. Setting Kids Up For Success provides a framework for patient-centered medical home's to provide a healthy lifestyle support group for SA children and their families.

126. Co-Occurrence of Heath Risk Behaviors In Adolescents

Adolescence is associated with increased engagement in many health risk behaviors. Previous research has shown that engaging in more than one health risk behavior is common, however less is known about how risk behaviors cluster together and relate to mental health. The purpose of this study is to gain a better understanding how risk factors co-occur and how those co-occurrences relate to levels of depression and anxiety. Data was collected at 12 pediatric primary care clinics, combined across two studies. A total of 602 participants (ages 13-18) were asked to complete an online survey assessing demographic, mental health, and health risk behaviors. Behaviors screened included: low physical activity, sugary beverage consumption, low fruit/vegetable consumption, inconsistent helmet and seatbelt use, inadequate sleep, and use of marijuana or alcohol. Mental health behaviors screened included depression (PHQ-9) and anxiety (GAD-7). Latent class analysis was used to create mutually exclusive classes of adolescents based upon their health risk behaviors. Goodness of fit indices were used to determine the best fitting model. Demographic differences between classes were assessed using chi square and t-tests and Anova testing was conducted to assess differences in depression and anxiety rates between classes. A three class solution was determined to be the best fit. All three class (groups) indicated low levels of fruit and vegetable consumption. The largest group labeled “low risk” (80% of sample) had low risk for all other behaviors. A second class, labeled “lifestyle risk” (10% of sample), was characterized by sugary beverage consumption, lack of helmet and seatbelt use, and inadequate sleep. The last class, labeled “substance risk” (9% of sample), was characterized by the co-occurrence of marijuana use, alcohol use and inadequate sleep. There were significant differences among the classes for age, but not for gender or race. The low risk group was younger than the two riskier groups (P=.002, P<.001). While the lifestyle risk group was younger than the substance risk group (P=.002). Compared to the low risk group, the lifestyle risk group had higher levels of anxiety (p=.02) and the substance risk group had higher rates of depression (p= .001). No other differences were found. These findings improve our understanding of the relationships among risk behaviors during adolescence. While most of the sample was in the low risk group, almost 20% of the sample belonged to a group with risky health behaviors. Adolescents in these riskier groups were more likely to be older adolescents and there was an association between being in a riskier group and positive mental health screens. These results differed by group with the lifestyle risk group having higher levels of anxiety and the substance using group having higher rates of depression. This study provides new information on how health behaviors cluster during adolescence that providers can use to help to plan for needed counseling resources and supports.

Randomized Controlled Trial of A 12-Week Yoga-Based (Including Diet) Lifestyle vs. Dietary Intervention on Cardio-Metabolic Risk Factors and Continuous Risk Score in Indian Adults with Metabolic Syndrome

Metabolic syndrome, a prediabetic and precardiovascular pathologic condition that begins early in life, tracks into adulthood and magnifies with age. Randomized controlled trials evaluating efficacy of yoga-based lifestyle vs. dietary intervention on metabolic syndrome are lacking. Here, the efficacy of a 12-week yoga-based lifestyle intervention vs. dietary intervention on cardio-metabolic risk factors and metabolic syndrome risk scores have been assessed in Indian adults with metabolic syndrome. In this two-arm, open label, parallel group, randomized controlled trial, 260 adults (20–45 years) diagnosed with metabolic syndrome as per joint interim statement, 2009 were randomized to yoga-based (including diet) lifestyle or dietary intervention alone (n = 130, each) for 12 weeks. Primary endpoints were the 12-week changes in cardio-metabolic risk factors and metabolic risk scores. The secondary endpoints were the 12-week changes in the proportion of subjects recovered from metabolic syndrome, dietary intake, and physical activity. Intent-to-treat analysis was performed including all the subjects with baseline data with imputed missing data. Treatment × time interaction showed yoga-based lifestyle intervention had a greater treatment effect over dietary intervention by significantly reducing waist circumference, continuous metabolic syndrome z-score, and dietary intake/day while significantly increasing physical activity. High-density lipoprotein cholesterol showed a significantly greater reduction following dietary intervention than yoga-based lifestyle intervention. A significantly greater proportion of subjects recovered from metabolic syndrome in yoga-based lifestyle (45.4%) vs. dietary intervention group (32.3%). A 12-week yoga-based lifestyle intervention is more efficacious than usual dietary intervention in improving cardio-metabolic risk factor and metabolic risk score in Indian adults with metabolic syndrome.

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).

Metformin and insulin treatment prevent placental telomere attrition in boys exposed to maternal diabetes.

Shortened leukocyte and placental telomeres associated with gestational diabetes mellitus (GDM) suggest this exposure triggers telomere attrition contributing to adverse outcomes. We applied high resolution Single Telomere Length Analysis (STELA) to placenta from GDM pregnancies with different treatment pathways to determine their effectiveness at preventing telomere attrition. Differences in telomere length between control (N = 69), GDM lifestyle intervention (n = 14) and GDM treated with metformin and/or insulin (n = 17) was tested by Analysis of Covariance (ANCOVA) followed by group comparisons using Fisher’s least significant difference. For male placenta only, there were differences in mean telomere length (F(2,54) = 4.98, P = 0.01) and percentage of telomeres under 5 kb (F(2,54) = 4.65, P = 0.01). Telomeres were shorter in the GDM lifestyle intervention group compared to both controls (P = 0.02) and medically treated pregnancies (P = 0.003). There were more telomeres under 5 kb in the GDM lifestyle intervention group compared to the other two groups (P = 0.03 and P = 0.004). Although further work is necessary, we suggest that early adoption of targeted medical treatment of GDM pregnancies where the fetus is known to be male may be an effective strategy for ameliorating adverse outcomes for children.

Impacto del estilo de vida en el descontrol glucémico en pacientes con diabetes mellitus tipo 2

&lt;p&gt;&lt;strong&gt;Objetivo:&lt;/strong&gt; determinar el impacto del estilo de vida y de sus diferentes componentes en el control glucémico de los pacientes con diabetes mellitus tipo 2 (dm2). &lt;strong&gt;Métodos:&lt;/strong&gt; diseño transversal analítico, se llevó a cabo en una unidad de medicina familiar en la Ciudad de México, de agosto a octubre de 2015. Se incluyó a 330 participantes con dm2, de 20 a 60 años bajo tratamiento farmacológico. Se utilizó el Instrumento para Medir el Estilo de Vida en Diabéticos (Imevid). Para medir el control glucémico se utilizó hemoglobina glucosilada (HbA1c), se consideró control glucémico un nivel de Hb1Ac &amp;lt;7%. Para conocer los factores de riesgo asociados a descontrol glucémico se realizó un modelo de regresión logística múltiple, el cual se ajustó por estilo de vida, comorbilidades, tiempo de evolución de la dm2 e índice de masa corporal (imc). &lt;strong&gt;Resultados:&lt;/strong&gt; 70.3% (232) de los participantes se encontró en el grupo de edad de 51-60 años, 90.6% (299) presentó alguna comorbilidad, la hipertensión arterial sistémica fue la más frecuente. 48.8% (161) presentó sobrepeso y 14.8% (49) obesidad. 35.8% (118) de los participantes presentaron buen estilo de vida, 43.9% (145) se encontraba en control glucémico. La mediana de Hb1Ac en pacientes con mal estilo de vida fue de 9% en comparación con el grupo que tenía buen estilo de vida con 6.4%, (p&amp;lt;0.001). El buen estilo de vida es un factor protector para control glucémico con un odds ratio (or) de 0.026. &lt;strong&gt;Conclusiones:&lt;/strong&gt; el estilo de vida no saludable es un factor de riesgo para el descontrol glucémico. El estilo de vida, comorbilidades, tiempo de evolución de dm2 e imc explican 85.3% del descontrol glucémico.&lt;/p&gt;

Use of Lifestyle Segmentation for Assessing Consumers’ Attitudes and Behavioral Outcomes towards Mobile Advertising

Purpose – Mobile communication has become an integral part of people’s lives in recent times. Consumers’ purchasing behaviors have been found to be influenced by their attitudes towards mobile advertising. This study explored the usability of lifestyle segmentation to find differences among consumers and assessed the relationship between consumers’ attitudes toward mobile advertising. Design/Methodology/Approach – The study is based on primary data collected through a survey questionnaire on a consumer sample in Pakistan. The study surveyed 166 respondents and categorized them into three different lifestyle groups: self-indulgents, experiencers, and traditionalists. Factor analysis and cluster analysis techniques were applied on the data to identify lifestyle segments, whereas a one-way ANOVA test was used to find significant lifestyle differences among mobile device users as regards their attitudes and behaviors towards mobile advertising. Findings and implications – Significant statistical differences were found among lifestyle segments in terms of attitudes and behavioral outcomes towards mobile advertising. The demographic variables were found to be insignificant for finding attitudinal and behavioral differences among consumers. The relationship between attitudes and behaviors was also found to be positive. Marketers can design their promotional campaigns more effectively by using a lifestyle segmentation approach. Limitations – The scope of the study is limited, as it is a single-market investigation, and its explanatory power is low because of the sample size. Originality – The applicability of lifestyle segmentation in comparison to demographic variables to find attitudinal and behavioral differences towards mobile advertising had not been done before.

Patterns of multiple lifestyle risk factors and their link to mental health in the German adult population: a cross-sectional study

ObjectivesLifestyle risk factors, such as drinking or unhealthy diet, can expotentiate detrimental health effects. Therefore, it is important to investigate multiple lifestyle risk factors instead of single ones. The study...