Lifestyle Intervention Research Articles

Cognitive Behavioral Therapy for Paroxysmal Atrial Fibrillation: Heart Rate Variability, Physical Activity, and Sleep

BackgroundCognitive behavioral therapy for symptom preoccupation in paroxysmal atrial fibrillation (AF-CBT) significantly improved AF-specific quality of life in a recent trial. To what extent this may this may be associated with changes in physiological parameters is yet to be determined. ObjectivesThe purpose of this study was to assess the effects of AF-CBT on heart rate variability (HRV), physical activity, and sleep. MethodsPatients with symptomatic paroxysmal AF on optimal medical therapy (mean ± standard deviation 65.4 ± 8.3 years, 58% females, 61% on beta-blockers) were randomized to a 10-week online AF-CBT (n = 65) or AF education (n = 62). AF-CBT was therapist-led and focused on social and physical avoidance. A 5-day Patch-Holter with an integrated accelerometer was applied at baseline, post-treatment, and at 3-month follow-up to assess AF burden, HRV, physical activity, and sleep duration. Subjective assessments were made by the International Physical Activity (IPAQ) and Insomnia Severity Index questionnaires. ResultsAt baseline, participants walked on average 8040 ± 2600 steps/day and slept 8.0 ± 1.1 hours. Objective and subjective physical activity and sleep duration remained unchanged after treatment, with no significant difference between the groups. The Insomnia Severity Index score went from subclinical insomnia (12.2 ± 6.7) to near normal values (8.1 ± 5.6), a significant change compared to controls (P = 0.032). No changes were found in AF burden or HRV indices at rest during the day or at night. ConclusionsIn this select cohort, AF-CBT decreased insomnia severity but had no impact on HRV or physical activity. Thus, AF-CBT may operate through psychological and behavioral factors that are not targeted by current medical and lifestyle interventions.

Gestational diabetes mellitus, body mass index, and cardiometabolic multimorbidity: a prospective cohort study

PurposeGestational diabetes mellitus (GDM) could increase the risks of type 2 diabetes mellitus (T2DM) and cardiovascular disease. However, evidence on its association with cardiometabolic multimorbidity (CMM) was limited. This study aimed to evaluate the association between GDM and the prevalence, incidence, patterns, and progression of CMM; and the role of body mass index (BMI) in such association. MethodsThis study included 203,372 women who have given birth in UK Biobank. The diagnoses of GDM and cardiometabolic diseases (including stroke, coronary heart disease [CHD], and T2DM) were reported by participants or obtained through linkage to inpatient hospital data until 31st December 2020. BMI was assessed at the baseline assessment. CMM was defined as having two or more of included cardiometabolic diseases. Logistic regression models and Cox proportional hazard models were used to assess the association between GDM and CMM, and the modifications on both additive and multiplicative scales were assessed to evaluate the effect of BMI on such association. ResultsA total of 1,217 women had a history of GDM, 2,351 participants had CMM at the end of follow-up and 1,601 was newly diagnosed during follow-up. GDM was associated with higher prevalence (odds ratio [OR]=4.64, 95% confidence interval [95% CI]=3.54-6.08) and incidence (hazard ratio [HR]=3.62, 95% CI=2.62-5.00) of CMM. In particular, GDM was associated with higher odds of T2DM, coexisting T2DM and vascular disease, and T2DM followed by vascular disease. Formal testing for effect modification suggested multiplicative modification by BMI for the association between GDM and incident CMM. ConclusionsGDM was associated with CMM in women’s late life, with multiplicative modification effects of BMI. Our results suggest that maternal and lifestyle interventions (e.g., weight management) are warranted for the primary and secondary prevention of CMM, particularly in women with a history of GDM.

Nutrition for Mental Health: Guidance for Clinical Practice

Nutritional psychiatry is an emerging field that explores the relationship between diet and mental health. Research focuses on dietary patterns, gut microbiome health, and the impact of individual nutrients on mental health. Nutritional and lifestyle interventions can complement psychopharmacology and psychotherapy in clinical practice. This clinical feature article reviews evidence supporting nutritional interventions for mental health and provides clinical guidance.

Self-awareness Regarding Obesity and Specific Therapy in Patients with Overweight or Obesity and Cardiovascular Diseases from Moscow Region

Objective: Despite the proven effectiveness of lifestyle interventions and specific medications in the treatment of obesity, little is known about their use in real-world practice. . Aims: To study the awareness of patients about the problem of overweight/obesity, as well as the clinical practice of non-drug and drug therapy according to the survey Material and Methods: Eligible patients were recruited from the prospective outpatient registry of patients with cardiovascular diseases. The design of the study was a cross-sectional cohort singlecentre. All of the included patients completed a specifically designed questionnaire. The study included 295 patients (mean age 66.8 ± 11.8 years) with a body mass index (BMI) of ≥ 25 kg/m2. One hundred eight (36.6%) individuals were overweight, 124 (42.2%) had first-class obesity, 42 (14.2%) had second-class obesity, and 21 (7.1%) patients had third-class obesity. Results: 252 patients (85.4%) were informed of being overweight/obese, and all of them received non-drug recommendations for the treatment of obesity. Anti-obesity medications (AOM) were recommended only to 25 (8.5%) patients: 3 – overweight, 11 – obesity class I, 6 obesity class II, and 5 – obesity class III. Twenty-one (7.1%) patients took the prescribed medications (84% adherence). The drugs were more often taken by patients with class II and III disease (40.5% and 57.1% of patients, respectively). Overweight (8.5%) and class I obesity (18.0%) patients took these drugs less often (p < 0.0001). Conclusion: The results of the survey have demonstrated good awareness of patients about their obesity/overweight and quite frequent use of non-drug obesity therapy. However, the rate of AOM prescription was extremely low.

The role of preventive medicine in reducing chronic disease Burden in the USA: A Systematic Review

Chronic diseases, including cardiovascular disease, diabetes, cancer, and respiratory illnesses, are the leading causes of morbidity and mortality in the United States, placing a significant burden on individuals, healthcare systems, and the economy. Preventive medicine, encompassing primary, secondary, and tertiary strategies, plays a crucial role in mitigating this burden by focusing on disease prevention and health promotion. This systematic review aims to evaluate the effectiveness of preventive medicine in reducing the chronic disease burden in the USA. Through a comprehensive search of peer-reviewed studies, we explore the impact of screening programs, early detection, lifestyle interventions, and health policies designed to prevent chronic diseases. The review highlights the success of preventive measures in decreasing disease incidence, improving health outcomes, and reducing healthcare costs. However, challenges such as disparities in access to care, patient adherence, and the integration of preventive services into the broader healthcare system remain significant barriers. The review concludes by discussing policy implications, recommending strategies to overcome implementation challenges, and outlining future research directions to enhance the role of preventive medicine in combating chronic diseases in the USA.

Associations of periconception dietary glycemic index and load with fertility in women and men: a study among couples in the general population

BackgroundThe dietary glycemic index (GI) and load (GL) reflect carbohydrate quality and quantity, potentially impacting fertility through modulation of insulin sensitivity and generation of oxidative stress. While fertility is influenced by both women and men, reproductive research often emphasizes maternal factors. We first examined periconception dietary intake in both women and male partners, and subsequent associations of dietary GI and GL with fecundability and subfertility.MethodsAmong 830 women and 651 male partners, participating in a population-based prospective cohort study from preconception onwards, we assessed periconception dietary intake and calculated GI and GL, using a food frequency questionnaire (FFQ) at median 12.4 weeks gestation (95% range 10.9, 18.4). Information on time to pregnancy was obtained through questionnaires, with subfertility defined as a time to pregnancy ≥ 12 months or use of assisted reproductive technology.ResultsIn the periconception period, mean energy intake in women was 1870 kcal (SD: 500; 46% carbohydrates, 16% protein, 33% fat; dietary GI 56.2 (SD: 3.5) and GL 141.4 (SD: 67.4)). Mean energy intake in men was 2350 kcal (SD: 591; 43% carbohydrates, 16% protein, 33% fat; dietary GI 56.8 (SD: 3.2) and GL 156.7 (SD: 75.4)). Median time to pregnancy was 4.8 months (IQR: 1.2, 16.4), with 30.6% of 830 women experiencing subfertility. Dietary GI and GL were not associated with fertility outcomes in women. In men, higher dietary GI and GL across the full range were associated with decreased fecundability, after adjusting for socio-demographic and lifestyle factors, as well as dietary GI or GL of female partners [FR: 0.91, 95% CI 0.83, 0.99; FR: 0.90, 95% CI 0.81, 0.99, per SDS increase in dietary GI and GL, respectively]. When assessing the combined influence of dietary GI clinical categories in women and men, both partners adhering to a low GI diet tended to be associated with increased fecundability, but not with subfertility risk.ConclusionsSuboptimal periconception carbohydrate intake may be negatively associated with male fertility, but not with fertility outcomes in women. Further studies are needed to assess whether a lower GI and GL diet is a feasible lifestyle intervention to improve couples fertility.

Weight Changes Are Linked to Adipose Tissue Genes in Overweight Women with Polycystic Ovary Syndrome

Women with polycystic ovary syndrome (PCOS) have varying difficulties in achieving weight loss by lifestyle intervention, which may depend on adipose tissue metabolism. The objective was to study baseline subcutaneous adipose tissue gene expression as a prediction of weight loss by lifestyle intervention in obese/overweight women with PCOS. This is a secondary analysis of a randomized controlled trial where women with PCOS, aged 18–40 and body mass index (BMI) ≥ 27 were initially randomized to either a 4-month behavioral modification program or minimal intervention according to standard care. Baseline subcutaneous adipose tissue gene expression was related to weight change after the lifestyle intervention. A total of 55 obese/overweight women provided subcutaneous adipose samples at study entry. Weight loss was significant after behavioral modification (−2.2%, p = 0.0014), while there was no significant weight loss in the control group (−1.1%, p = 0.12). In microarray analysis of adipose samples, expression of 40 genes differed significantly between subgroups of those with the greatest weight loss or weight gain. 10 genes were involved in metabolic pathways including glutathione metabolism, gluconeogenesis, and pyruvate metabolism. Results were confirmed by real-time polymerase chain reaction (RT-PCR) in all 55 subjects. Expressions of GSTM5, ANLN, and H3C2 correlated with weight change (R = −0.41, p = 0.002; R = −0.31, p = 0.023 and R = −0.32, p = 0.016, respectively). GSTM5, involved in glutathione metabolism, was the strongest predictor of weight loss, and together with baseline waist-hip ratio (WHR) explained 31% of the variation in body weight change. This study shows that baseline subcutaneous adipose tissue genes play a role for body weight outcome in response to lifestyle intervention in overweight/obese women with PCOS.

Primary prevention of type 2 diabetes in the EU: A systematic review of interventional studies

Abstract Background The GBD 2019 study revealed that type 2 diabetes caused over 109.000 deaths and accounted for 5.3 million Disability Adjusted Life Years in the EU, with an estimated annual cost of EUR 300 billion in 2014. Interventions for primary prevention are pivotal in preventing diabetes, providing a structured approach to implementing lifestyle modifications or community-based programs. The objective of this study was to demonstrate the effectiveness of primary prevention interventions to prevent or delay the onset of type 2 diabetes in the EU member states. Methods A systematic review on six databases was conducted for relevant interventional studies carried out in the EU-28. The main outcome of the studies was determined by changes in the incidence of type 2 diabetes. Results The search yielded 18.885 records, of which 18 met the eligibility criteria. The following studies reported significant incidence reduction in the intervention groups: The Finnish Diabetes Prevention Study by individualised lifestyle intervention (HR: 0.614, 95%CI: 0.478-0.789), the Spanish CORDIOPREV Study through increased plant protein intake (HR: 0.64, 95%CI: 0.43-0.96), the Spanish PreDE trial by promoting healthy diet and physical exercise (RR: 0.68, 95%CI: 0.47-0.99), the Norfolk Diabetes Prevention Study with intensive diet-exercise counselling (OR: 0.57, 95%CI: 0.38-0.87), the Spanish PREDIMED and PREDIMED-Reus trials by mediterranean diet supplemented with extra virgin olive oil or mixed nuts (HR: 0.60, 95%CI: 0.43-0.85; HR: 0.49, 95%CI: 0.25-0.97; HR: 0.48, 95%CI: 0.24-0.96), and the Dutch SLIM Study with advices on diet and physical activity (RR: 0.53, 95%CI: 0.29-0.97). Conclusions Significantly decreasing the incidence of diabetes is feasible within primary healthcare settings through intensive lifestyle interventions targeting individuals at high risk. Therefore, it would be beneficial to incorporate these findings into the European guidelines for preventing type 2 diabetes. Key messages • Primary care plays an important role in the prevention of type 2 diabetes. • Well-defined primary lifestyle interventions are capable of slowing the progression from prediabetes to diabetes.

Cognitive behavioral therapy for symptomatic paroxysmal atrial fibrillation: effects on physical activity, sleep and heart rate variability

Abstract Background We have devised a novel psychological intervention, cognitive behavioral therapy for paroxysmal atrial fibrillation (AF-CBT), that targets symptom preoccupation and avoidance behaviour. AF-CBT significantly improved cardiac anxiety and quality of life (QoL) in a randomized trial. To what extent this may be attributed to changes in physiological parameters is yet to be determined. Purpose A) to assess changes in objective and subjective measures of physical activity and sleep. B) to evaluate potential treatment effects on heart rate variability (HRV). Methods Patients with paroxysmal AF on optimal medical therapy (65.4±8.3 years, 58% women) and European Heart Rhythm Association Symptom Score ≥2b were randomized to a 10-week therapist-led online AF-CBT (n=65) or a control group (n=62), with the primary outcome of Atrial Fibrillation Effect on Quality-of-life (AFEQT). A Patch-Holter with an integrated accelerometer was applied for five days at baseline, post-treatment, and at three months follow-up. Each recording was divided into day and night (sleep time) based on posture, heart rate, and activity. HRV was analysed in both time and frequency domains, excluding AF episodes and aberrant beats. Results AFEQT increased from 62.4±14.3 to 83.7± 13.8 points in the AF-CBT group at the 3-month follow-up with a relative difference of 15.0 points. At baseline, the participants walked 8040±2600 steps/day and slept 8.0 ± 1.1 hours. AF-CBT did not increase physical activity, and there were no significant changes in objective sleep duration. The Insomnia Severity Score went from subclinical (12.2±6.7) to near normal values (8.1±5.6), which was significant as compared to controls (p=0.032). AF burden increased from 5.3% to 7.3% in the AF-CBT group and 5.0% to 9.2% in the control group, with no difference between the groups (p=0.59). We did not observe any change in heart rate or HRV indices at rest during the day or at night. Conclusion AF-CBT did not mediate its effects on QoL by improving objective physiological variables. Thus, our findings underline the importance of subjective, psychological, and behavioural aspects and indicate that AF-CBT might fill a void beyond medical and lifestyle interventions in comprehensive AF care.

Development of a systematic referral model to primary care health interventions for patients with atrial fibrillation. a delphi study

Abstract Background The European Society of Cardiology (ESC) guidelines for the management of atrial fibrillation (AF) recommend integrated care in AF, combining medical treatment with lifestyle modifications and psychosocial management in a multi-disciplinary set-up. Research show that patients with AF can benefit from lifestyle interventions and psychosocial management, like patient education. According to World Health Organization recommendations, these health interventions are moving from hospitals to primary healthcare settings. Therefore, patients with AF should be systematically referred to these interventions. Yet, an evidence-based referral model that can support this transition is lacking. Purpose The purpose is to develop a systematic referral model for primary care health interventions for patients with AF. Methods We used the Delphi-technique with three rounds of questionnaires (figure 1). International and national clinical experts in AF across disciplines and health sectors were invited to participate. In the first round, the expert panel evaluated items that could be part of a referral model on relevance, improvability and self-reporting. In the second round, the expert panel evaluated each item as either an inclusion or exclusion criteria, important knowledge to have, or not relevant. In the third round, the expert panel evaluated the items according to data source and outcome status. A final model was drawn based on items reaching consensus. The study was reported according to the guidance on conducting and reporting Delphi studies (CREDES). Results In total, 69 of 139 invited experts accepted to participate (50%). These were mostly academics or clinicians (90%), stemming from primary sector (16%), secondary sector (35%) and research (32%). Most were medical doctors (36%) and nurses (35%). However physiotherapist, psychologists, dieticians, and other disciplines along with six patients with AF were also represented. The expert panel (60% females) had a mean age of 50 years, and 65% were from Denmark. For the final referral model (figure 2), AF symptom burden and impaired health-related quality of life, anxiety and poor medicine compliance combined with a risk factor profile were the main inclusion criteria. Furthermore, it was important to know about the patients’ mental well-being, self-management abilities and comorbidities. Conclusion Consensus was reached for a generic referral model, which can be further adjusted in the appropriate clinical context. The model includes inclusion criteria which closely correlate with guidelines for AF management focusing on reducing the patients’ symptom and risk factor burden. The referral model is expected to increase the number of patients with AF referred to primary care health interventions, which could lead to better quality of life, fewer hospital admissions and lowered health care costs in AF.

Cardiac Urea Cycle Activation by Time-Restricted Feeding Protects Against Pressure Overload-Induced Heart Failure.

Heart failure is a leading cause of mortality worldwide, necessitating the development of novel therapeutic and lifestyle interventions. Recent studies highlight a potential role of time-restricted feeding (TRF) in the prevention and treatment of cardiac diseases. Here, it is found that TRF protected against heart failure at different stages in mice. Metabolomic profiling revealed that TRF upregulated most circulating amino acids, and amino acid supplementation protected against heart failure. In contrast, TRF showed a mild effect on cardiac amino acid profile, but increased cardiac amino acid utilization and activated the cardiac urea cycle through upregulating argininosuccinate lyase (ASL) expression. Cardiac-specific ASL knockout abolished the cardioprotective effects afforded by TRF. Circulating amino acids also protected against heart failure through activation of the urea cycle. Additionally, TRF upregulated cardiac ASL expression through transcription factor Yin Yang 1, and urea cycle-derived NO contributes to TRF-afforded cardioprotection. Furthermore, arteriovenous gradients of circulating metabolites across the human hearts were measured, and found that amino acid utilization and urea cycle activity were impaired in patients with decreased cardiac function. These results suggest that TRF is a promising intervention for heart failure, and highlight the importance of urea cycle in regulation of cardiac function.

Real-world evaluation of a lipid transformation project in primary care settings

Abstract Background The National Health Service England Long-Term Plan (2019) highlights the need to optimise lipid management to reduce cardiovascular disease (CVD) risk. A collaborative project was funded between a local health service and an industry partner to review current practice and improve outcomes in a UK region through introduction of lipid management pathways, primary care education and patient-focused reviews to optimise lipid-lowering therapies among high-risk patient groups. Purpose The project aimed to increase prescribing of CVD risk reduction therapies such as high-intensity statins (HIST), escalation of therapy to achieve lipid-lowering treatment targets, to improve clinician knowledge and confidence in lipid management and provide benefits for local populations in reducing CVD risk. Methods Systematic patient searches across six Primary Care Networks (PCNs) prioritised high-risk patients for review. Community of Practice sessions were held to facilitate shared learning and problem-solving. A pragmatic, real-world evaluation was conducted to explore the impact of the new pathways and tools on prescribing outcomes and optimisation of lipid-lowering therapies. To examine the changes in HIST prescriptions, a statistical analysis of open-source prescribing data was undertaken between baseline (December 2021) and follow-up (December 2022) on over 39,000 eligible patient records. Qualitative interviews with clinicians from all participating PCNs and a thematic analysis of emerging themes was conducted in 2023. Results A paired sample t-test demonstrated a significant increase in the percentage of HIST prescribed, of the total number of statins prescribed, across the six PCNs between baseline and follow-up t(5) = -3.38, p = 0.01. Table 1 illustrates the changes at individual PCN level. Four of the six PCNs reached the National Institute for Health and Care Excellence minimum threshold of 65% target for HIST prescribing in statin prescriptions and three of these PCNs exceeded the optimal target of 75% HIST. An additional 600 patients were prescribed Ezetimibe (as therapy escalation or for statin intolerance). Through qualitative data, clinicians reported development of new skills and knowledge, leading to increased confidence in optimising lipid management with medication and lifestyle interventions. Conclusion The lipid transformation project demonstrated significant improvements in prescribing of lipid-lowering therapies and improved clinician competence in lipid management pathways and guidance. This has enabled sustainable improvements in lipid management and cardiovascular disease reduction in local populations.

Association of insulin resistance with cardiovascular disease and all-cause mortality in type 1 diabetes mellitus: systematic review and meta-analysis

Abstract Background Insulin resistance (IR) is a key factor in the pathogenesis of type 2 diabetes mellitus (T2DM) and is associated with a higher risk of cardiovascular disease (CVD) and mortality. However, the association between IR and these outcomes in type 1 diabetes mellitus (T1DM) is less clear. This systematic review and meta-analysis aimed to investigate the associations between CVD outcomes and IR in T1DM. Methods PubMed, EMBASE, and the Cochrane Library databases were searched from inception to 15 March 2023 and updated on 31 October 2023. Observational studies (cohort studies or post hoc analysis of clinical trials) reporting the associations between IR measured by estimated glucose disposal rate (eGDR) level and the risk of CVD and all-cause mortality in individuals with T1DM were eligible. Data, pooled by random effects models, were presented as hazard ratios (95% confidence intervals, CI). The primary outcomes were the composite CVD outcome and all-cause mortality. Results Eight studies involving 21,930 individuals were included, of which five studies involving 19,960 T1DM individuals reported the risk of CVD. During a median follow-up of 10 years, there were 2,149 cases of incident CVD. The pooled hazard ratio for composite CVD outcome per 1-unit increase in the eGDR index was 0.83 (95% CI 0.78–0.90, I2 = 58.9%). Five studies involving 19,403 T1DM individuals reported the risk of all-cause mortality. During a median follow-up of 10 years, a total of 1,279 deaths were observed. The pooled hazard ratio for all-cause mortality per 1-unit increase in the eGDR index was 0.84 (95% CI 0.81–0.87, I2 = 0%). Conclusions IR as measured by eGDR may be an additional risk factor for cardiovascular disease and all-cause mortality in individuals with T1DM. Modification of IR by lifestyle interventions or pharmacological treatments could be a viable therapeutic target to lower the risk of CVD in T1DM.Figure 1 Literature flowchartFigure2 Forest plot

Improvement in cardiac function but not structure in adults born preterm following a prescribed moderate to high intensity exercise intervention: a randomized clinical trial

Abstract Background People born preterm (<37 weeks’ gestation) have a potentially adverse cardiac phenotype that progresses with blood pressure elevation and may explain their increased risk of early heart failure and cardiovascular-related mortality. It remains unknown whether lifestyle or pharmacological interventions lead to beneficial left ventricle (LV) and right ventricle (RV) structural and/or functional changes in preterm-born adults. Purpose To determine whether preterm-born adults with elevated and stage 1 hypertension exhibit similar cardiac remodelling following a 16-week aerobic exercise intervention as their term-born peers with comparable blood pressures. Methods We conducted an open, parallel, two-arm superiority randomised controlled (1:1) trial in n=203 adults aged 18-35 years old with elevated or stage 1 hypertension. Participants were randomised to a 16-week aerobic exercise intervention targeting three, 60-minute supervised sessions per week at 60-80% peak heart rate (exercise intervention) or sign-posted to educational materials (controls). In a pre-specified cardiovascular magnetic resonance imaging (CMR) sub-study in n=100 individuals, CMR was performed before and after the 16-week intervention. Group differences in outcome variables after the intervention were examined using ANCOVA adjusting for baseline outcome variables, sex, and age. Interactions between birth category and intervention effect were investigated by including an interaction term in the intervention ANCOVA analyses. Results One hundred participants completed CMR scans at baseline and after the 16-week intervention, with n=47 in the exercise intervention group (n=26 term-born; n=21 preterm-born) and n=53 controls (n=32 term-born; n=21 preterm-born). Cardiac structural measures in preterm-born adults did not change following the intervention. However, term-born adults in the exercise intervention group decreased LV mass to end-diastolic volume ratio (adjusted mean difference: -0.03, 95% CI: -0.06,-0.01, interaction term p=0.027) and increased RV stroke volume (adjusted mean difference: 5.53mL/m2, 95% CI: 2.60,8.47, interaction term p=0.076) versus controls. Preterm-born adults in the exercise intervention group increased LV basal- and mid-ventricular circumferential strain versus controls (adjusted mean difference: -1.33%, 95% CI: -2.07,-0.60, interaction term p=0.057 and adjusted mean difference: -1.54%, 95% CI: -2.46,-0.63, interaction term p=0.046, respectively), which was not observed in term-born adults. Similarly, preterm-born adults improved RV longitudinal strain versus controls (adjusted mean difference: -0.51%, 95% CI: -1.49,0.46, interaction term p=0.053), which was also not observed in term-born adults. Conclusions Aerobic exercise training improves myocardial function but not cardiac structure in preterm-born adults. Modified exercise protocols or combination with pharmacological intervention may lead to additional cardiac remodelling benefits.

Effect of DASH vs. Mediterranean diet on metabolic syndrome and cardiometabolic profile in adults with high normal blood pressure or grade 1 hypertension: the DASH-MedDiet randomized controlled trial

Abstract Background Lifestyle interventions are recommended as the first-line treatment to control metabolic syndrome components and improve cardiometabolic profile. However, studies directly comparing the effects of the Dietary Approaches to Stop Hypertension (DASH) vs. the Mediterranean diet (MedDiet) on metabolic syndrome prevalence and cardiometabolic risk factors are currently lacking. Purpose We aimed to assess the effects of a 3-month intensive dietary intervention implementing salt restriction either alone or on top of the DASH and MedDiet compared to no/ minimal intervention on metabolic syndrome prevalence and cardiometabolic profile in never drug-treated adults with high normal blood pressure (BP) or grade 1 hypertension. Methods We randomly assigned individuals to the control group (CG, n = 60), salt restriction group (SRG, n = 60), DASH diet with salt restriction group (DDG, n = 60), or MedDiet with salt restriction group (MDG, n = 60). All patients were followed monthly for 3 months in individual sessions coordinated by the clinical dietician. For the patients of all four study groups, the goal was to maintain the initial body weight unchanged. Patients in the CG received general advice on dietary principles for BP control. For the patients in all three intervention groups, the goal was to limit sodium intake to 2,000 mg/ day (equivalent to 5,0g salt/ day). In addition, patients in the DDG and the MDG received an individualized dietary plan with six daily sample menus to facilitate the adoption of the assigned dietary pattern. Anthropometric indices, dietary intake, office BP, and fasting blood samples were evaluated pre- and post-intervention. Results According to the intention-to-treat analysis, at 3 months post-intervention, the DDG and the MDG had lower odds ratio (OR) (95% CI) of metabolic syndrome [0.29 (0.12, 0.72), and 0.15 (0.06, 0.41), respectively] compared to the CG. Moreover, the MDG had lower odds of elevated BP levels compared to both the DDG and the SRG [0.08 (0.03, 0.19), and 0.13 (0.05, 0.34), respectively], and lower odds of metabolic syndrome compared to the SRG [0.25 (0.09, 0.67)]. In addition, the DDG and the MDG had lower odds of elevated fasting glucose compared to both the CG and the SRG, whereas the study groups did not differ regarding the odds of elevated waist circumference, elevated triglycerides, and reduced HDL- cholesterol. Regarding cardiometabolic indices, total and LDL-cholesterol, fasting glucose, HbA1c, and systolic/ diastolic BP were reduced in all three intervention groups compared to the CG. Conclusions On a background of salt restriction, the MedDiet was superior in BP reduction, but the DASH and MedDiet reduced the prevalence of metabolic syndrome to the same extent.

Social prescribers’ referral processes and decision-making about healthy eating and physical activity

Abstract Background Social Prescribing (SP) connects primary care patients with non-medical sources of support within the community. There are various SP models, with different referral routes. Many involve patients being referred to a link practitioner, who considers their needs and then “prescribes” or links them to appropriate local support services or resources, typically provided by the third sector. The present study aimed to explore the SP process and the decision-making of link practitioners, particularly around food and physical activity practices. Methods Sixteen semi-structured interviews were conducted with link practitioners working across Aberdeen City. A pragmatic Thematic Framework analysis was undertaken. Findings Participating link practitioners described their approach with clients as building rapport and trust while maintaining boundaries and managing expectations, and their community role as resource mapping and networking. Three broad categories of factors were considered during referral: 1) practicality (e.g., location, transport, cost, mobility, availability), 2) clients’ engagement (e.g., interest, motivation, readiness for change), and 3) link practitioners’ past experiences with services. Challenges identified included navigating waiting lists and service limitations, clients’ engagement and expectations, under-resourced services, navigating waiting lists with caseloads and the emotional burden of seeing people in very difficult situations. All link practitioners considered diet and exercise to fit within the remit of social prescribing but emphasised that clients should lead this discussion. Dietary support via social prescribing typically revolved around poverty rather than health. Discussion The study provides insight into the practical reality of making social prescribing decisions and has the potential to inform training and evaluation processes and support the development of health-focused social prescribing lifestyle interventions. Key messages • Social prescribing – a personalised approach, with clients supported to identify and achieve their health and wellbeing goals based on their strengths and resources available in the local community. • Social Prescribing - a promising platform for offering healthy eating interventions tailored to individual needs.

Artificial intelligence-enhanced electrocardiography derived body mass index as a predictor of future cardiometabolic disease

Abstract Background Obesity, a key risk factor for cardiometabolic diseases, is poorly evaluated by body mass index (BMI), which doesn't account for visceral fat and fat distribution. Given that obesity-related cardiac changes can manifest in surface ECG changes, we hypothesised that an AI-ECG model could predict BMI, and the discrepancy between AI-predicted and actual BMI (delta-BMI) could indicate cardiometabolic health. We also sought to understand the biological mechanisms contributing to the AI-ECG-derived delta-BMI. Methods The AI-ECG model was developed using a data split of 60/10/30% in a USA secondary care dataset of 512,950 ECGs and externally validated in the UK Biobank (N = 42,386), employing a residual neural network architecture. Model performance was evaluated using Mean Absolute Error (MAE), Pearson correlation coefficient (r), and coefficient of determination (R2). The study aimed at identifying incident cardiometabolic diseases, using Cox regression analyses adjusted for BMI, age, and sex. To assess the underlying biological associations of delta-BMI, phenome-wide, genome-wide, metabolome-wide, and proteome-wide association studies were performed. Results In the test set, the model achieved an MAE of 3.95 (3.93–3.97), r of 0.65 (0.65-0.66), and R2 of 0.43 (0.42-0.43). In the UKB, the model achieved an MAE of 2.94 (2.91–2.96), r of 0.62 (0.62–0.63) and R2 of 0.39 (0.38-0.40). The top tertile of delta-BMI showed an increased risk of future cardiometabolic disease (test set: HR 1.15, p<0.001; UKB: HR 1.58, p<0.001) and diabetes mellitus (test set: HR 1.25, p<0.001; UKB: HR 2.28, p<0.001) after adjusting for covariates including measured BMI. Phenotypic profiling highlighted associations between delta-BMI and cardiometabolic diseases, anthropometric measures of truncal obesity, and pericardial fat mass. Metabolic and proteomic profiling associates delta-BMI positively with valine, lipids in small HDL, syntaxin-3, and carnosine dipeptidase 1, and inversely with glutamine, glycine, colipase, and adiponectin. A genome-wide association study revealed associations with regulators of cardiovascular/metabolic traits. These results highlight delta-BMI's potential as a non-invasive, ECG-based biomarker for cardiometabolic risk stratification. Conclusion Our study demonstrates the effectiveness of an AI-enhanced ECG model in accurately predicting BMI, validated across diverse populations. The introduction of delta-BMI as a predictor of cardiometabolic disease offers valuable additional prognostic insights beyond traditional BMI assessments. Our exploration of biological pathways, spanning phenotypic, genotypic, metabolomic, and proteomic associations, contributes to a comprehensive understanding of the association between delta-BMI and cardiometabolic disease. The clinical implications could extend to enhanced screening strategies, personalised risk assessment, and motivation for lifestyle interventions.

Empowerment and interprofessional collaboration in health promotion centre Murska Sobota

Abstract Background Health promotion centres (HPCs) were introduced in Slovenian primary health care centres to provide interventions against risk factors for noncommunicable diseases (NCDs). HPCs integrate a multidisciplinary and community-based primary care approach to the prevention of NCDs and provide free lifestyle intervention programmes. This study aims to explore the perspectives of health care professionals on promoting health of local community members, as well as their perceptions of interprofessional collaboration in HPCs. Methods Two group discussions were conducted with a total of 11 health care professionals at the HPC Murska Sobota. Data collection was accompanied by a dual role interpreter in accordance with the principles of cross-language qualitative research. The data was transcribed, semantically translated and thematically analysed. Results Health care professionals emphasize the importance of health-related empowerment of individuals for the success of health promotion activities and therefore for the improvement of individuals’ quality of life. This is based on shared decision-making, self-management and educational measures in a combination of population- and individual-based approaches. The need for efficient interprofessional communication, characterized by a flat hierarchy, is stressed. Structured cooperation with other health care facilities, as well as close collaboration with communities and local media, are described as crucial for reaching all individuals and promoting health equity. Conclusions Interprofessional collaboration, health-related empowerment of individuals and collaboration with local communities are fundamental for the success of health promotion activities, achieving health equity and preventing NCDs. Understanding how these activities are implemented from the health care professionals’ perspective can help other health facilities developing and improving local health promotion strategies. Key messages • Slovenian health care professionals see interprofessional collaboration as fundamental for the implementation of health-promotion strategies. • Health-related empowerment of individuals and collaboration with local communities play an important role in achieving health equity in health promotion activities.

A transnational movement to support the sustainable transition towards a healthy and Eco-friendly Agri-Food System through the promotion of MEDIET and its lifestyle in modern society: MEDIET4ALL

Abstract The Mediterranean diet is considered the world’s most evidence-based low processed eating pattern for promoting health and longevity while saving water/energy and conserving land. Unfortunately, due to the modern societal trends, adherence to the Mediterranean diet model is decreasing, while the consumption of takeout and ultra-processed foods and drinks (UPFDs) is exponentially growing, with alarming levels in many European-Mediterranean (EUR-MED) regions. The overall objective of “MEDIET4ALL” is to support the transition from UPFs culture to modern and sustainable Mediterranean diet through the creation of transnational movement aiming at implementing best practices and innovative solutions to enhance the convenience, modernity, competitivity, and shelf life of Mediterranean diet. To achieve this overall objective, different multidisciplinary tailored approaches are proposed. Specifically, multicenter databases of ingredients/food and their providers will be created to promote the accessibility. Additionally, a variety of highly nutritional and antioxidant-rich “Quick & Easy” recipes that respond to modern trends while following the Mediterranean diet and considering sustainability aspects will be developed. To preserve the eco-friendly and food safety characteristics and extend the shelf life of the Mediterranean diet products, active bio-packaging will also be designed. A strategic “MEDIET4ALL” platform and m-app integrating the abovementioned MEDIET4ALL products and combined Mediterranean lifestyle interventions tailored to each user profile will be developed. Traditional and technology-based awareness and motivational campaigns with extensive marketing and advertising actions to promote MEDIET4ALL movement are also programmed. Working under the concept of a multidisciplinary approach consortium, multiple impacts, particularly supporting the transition towards a healthy and sustainable MED diet and lifestyle, are expected.

Acupuncture-assisted lifestyle intervention improve the metabolic status and spontaneous brain activity of type 2 diabetes Mellitus patients: a randomized, clinical trial

BackgroundAggressive weight management in patients with type 2 diabetes mellitus has demonstrated numerous metabolic advantages, however, existing therapies for weight control have not reached satisfactory results. This study aimed to evaluate the efficacy and safety of acupuncture in the weight management of type 2 diabetes mellitus (T2DM) patients by using a randomized, sham-controlled clinical trial design.MethodsIn this single-blind randomized clinical trial, 102 overweight adult T2DM patients were randomized into two groups. The control group receives diet, exercise, and sham acupuncture intervention, whereas the acupuncture group receives diet and exercise and acupuncture intervention, both for 1 month. Body weight and other anthropometric and laboratory indices were assessed at baseline and endpoint, meanwhile, the body fat content and spontaneous brain activity were measured by functional magnetic resonance imaging(fMRI)as the exploratory outcomes.ResultsNo significant difference was observed between the studied parameters at the baseline. The body weight and BMI were significantly reduced both in the control and acupuncture groups after intervention, without statistical difference between the two groups. What’s interesting is that compared to the control, the acupuncture group displayed a greater improvement in central fat tissue. It notes that the acupuncture group achieved significant liver fat content reduction than the sham acupuncture group. At the same time, the spontaneous brain activity in the occipital lobe and parietal lobe significantly increased in the acupuncture group.ConclusionOne month of acupuncture treatment preferentially improved ectopic fat deposition and was accompanied by changes in brain activity compared with the control group, even before significant changes in total body weight had occurred. further studies of longer duration are necessary for validation.Trial registration: The protocol of this clinical trial is registered at the Acupuncture-Moxibustion Clinical Trial Registry (AMCTR, http://www.acmctr.org/, No. AMCTR-IOR-20000341).