Lifestyle Intervention Research Articles

Associations Between Deficit Accumulation Frailty and Baseline Markers of Lifestyle in the US POINTER Trial.

Multidomain lifestyle interventions may have the potential to slow biological aging as captured by deficit accumulation frailty indices. We describe the distribution and composition of the 49-component frailty index (FI) developed by the U.S. POINTER clinical trial team of investigators and assess its cross-sectional associations with sociodemographic factors and markers chosen to be representative of behaviors targeted by the trial's multidomain interventions. We draw baseline data from the 2111 volunteers enrolled in U.S. POINTER who were ages 60-79 years and at increased risk for cognitive decline. Frailty components were grouped into nine domains. Associations that FI scores and their domains had with behavioral markers were described with correlations and canonical correlation. The 25th, 50th, and 75th percentiles of the frailty index score distribution were 0.153, 0.189, and 0.235. Higher frailty scores tended to occur among individuals who were older, male, and living in areas of greater deprivation (all p<0.001). They were also associated with poorer self-reported diet, less physical activity, and higher Framingham risk scores (all p<0.001). Associations were diffusely distributed among the frailty component domains, indicating that no individual domain was dominating associations. The U.S. POINTER deficit accumulation frailty index had expected relationships with sociodemographic factors and sensitivity to the behaviors targeted by the trial's interventions. Our analysis supports its use as a secondary outcome to assess whether the multidomain interventions differentially impact an established marker of biological aging.

Physical Activity Component of the Greek Interventional Geriatric Study to Prevent Cognitive Impairment and Disability (GINGER): Protocol Development and Feasibility Study

Background/Objectives: Individuals with subjective cognitive decline (SCD) have an increased risk of developing dementia, while non-pharmacological multicomponent lifestyle interventions are recommended for prevention/management. The Greek Interventional Geriatric Initiative to Prevent Cognitive Impairment and Disability (GINGER) is such a multicomponent approach, encompassing simultaneous interventions (cognitive training, depression and sleep management, etc.). Exercise/Physical activity (PA) is suggested as one such intervention. This study (i) presents the exercise protocol developed for GINGER and (ii) explores its feasibility (acceptability, applicability, adherence, users’ satisfaction and reliability). Methods: Exercise/PA protocol development, targeting SCD individuals aged &gt; 55 years, utilized relevant guidelines/literature followed by focus group involving exercise specialists. Data were synthesized through consensus to design optimal exercise interventions prescribed on participant’s physical capacity (heart rate, exertion, etc.), comprising 6-month combined aerobic, strengthening, balance and dual-task exercises, delivered 3 times/weekly in two group-based supervised sessions (in-person and online) and one home-based session. Physical outcomes include balance, aerobic capacity [2-Minute Walk Test (2 MWT), IPAQ-7], strength [Hand Grip Strength (HGS), Sit-to-Stand], fear of falling. Eligibility for entering intervention is low IPAQ-7, 2 MWT or HGS scoring. Feasibility was explored with adherence (exercise diaries and Exercise Adherence Rating Scale) and satisfaction (Patient Satisfaction Questionnaire) Results: Intervention was easily delivered with good reliability across testers’ assessments on 13 SCD participants (ICCs = 0.62–0.99), and improved physical outcomes, whereas users’ adherence and satisfaction scored highly. Conclusions: The exercise protocol for SCD was feasible, acceptable, applicable, reliable, demonstrating adherence and satisfaction, while improving physical parameters. It is thus integrated in the GINGER study, where multiple simultaneous interventions will take place to prevent/enhance cognitive function.

Role of metabolic syndrome and lifestyle factors in endometrial cancer risk and prevention

Introduction: The incidence of endometrial cancer, the sixth most common cancer among women, has been rising, especially in developed countries, possibly due to the obesity and diabetes pandemic. The aim of this review is to investigate the connection between metabolic syndrome, its individual components and endometrial cancer risk and to explore the role of lifestyle factors in endometrial cancer prevention. Materials and methods: For this review, we included studies regarding endometrial cancer and metabolic syndrome, obesity, diabetes and hyperglycemia, hypertension, dyslipidemia and several lifestyle factors, from 1994 to 2024. State of knowledge: This paper reviews existing literature on the relationship between metabolic syndrome and endometrial cancer, highlighting the significant role of central obesity, hyperglycemia and diabetes, dyslipidemia, and hypertension as risk factors. Evidence consistently demonstrates that individuals with metabolic syndrome, and its components individually, are at a heightened risk of developing endometrial cancer compared to those without metabolic abnormalities. Biological mechanisms linking metabolic syndrome’s components to endometrial cancer involve complex interplays between metabolic, hormonal or inflammatory factors and signalling pathways. Lifestyle interventions focusing on weight management, physical activity, and eating habits play an important role in reducing endometrial cancer risk and improving overall health outcomes. Conclusion: An understanding of the relationship between metabolic syndrome and endometrial cancer is crucial for improving risk stratification, early detection, and prevention strategies. Addressing metabolic abnormalities and promoting healthy lifestyle behaviours are essential actions against the rising incidence and burden of endometrial cancer.

Metformin plus lifestyle interventions versus lifestyle interventions alone for the delay or prevention of type 2 diabetes in individuals with prediabetes: a meta-analysis of randomized controlled trials.

We conducted this meta-analysis of randomized controlled trials (RCTs) to compare the efficacy of adding metformin to lifestyle interventions versus lifestyle interventions alone in individuals with prediabetes. We searched four databases from inception until March 20, 2024. Our primary outcomes included the incidence of type 2 diabetes, hemoglobin A1c (HbA1c), and fasting plasma glucose (FPG). Secondary outcomes included blood pressure, plasma lipids, and weight measurements. Dichotomous outcomes were pooled as the risk ratio (RR) and its 95% confidence interval (CI), while continuous outcomes were pooled as the standardized mean difference (SMD) and its 95% CI in the random effect model. All statistical analyses were conducted using the "meta" package of RStudio software. We included 12 RCTs, comprising 2720 patients. Adding metformin to lifestyle interventions significantly reduced HbA1c levels (SMD = -0.10, 95% CI [-0.19, -0.01], P = 0.03) and the incidence of type 2 diabetes (RR = 0.85, 95% CI [0.75, 0.97], P = 0.01). Interestingly, adding metformin to lifestyle interventions was comparable to lifestyle interventions alone in terms of FPG at both 3 and 6 months; however, it significantly reduced FPG at 12 months (SMD = -0.34, 95% CI [-0.59, -0.08], P = 0.01). There were no significant differences between the two groups in terms of all secondary outcomes. Our findings suggest that adding metformin to lifestyle interventions may improve glycemic control in individuals with prediabetes and reduce their risk of progression to diabetes, compared to lifestyle interventions alone. A longer duration of this combined approach may be required to observe the desired effects.

(Cost-)effectiveness and implementation of a combined lifestyle intervention for outpatients with severe mental illness (GOAL!): a hybrid quasi-experimental study protocol.

People with severe mental illness (SMI) face not only impaired mental health, but also a greater risk of physical comorbidities and a shorter life expectancy compared to the general population. A poor lifestyle plays a substantial role in this disparity. Combined Lifestyle Interventions targeting multiple lifestyle behaviors can improve mental and physical health, and quality of life. However, there is currently no appropriate structural support for people with SMI in outpatient care in the Netherlands. The Combined Lifestyle Intervention for Outpatients with SMI (GOAL!) is developed to address this gap. This study examines the (cost-)effectiveness and implementation of GOAL!. In a type 1 hybrid quasi-experimental study with a mixed-method matched design, GOAL! participants (N = 50) are compared to people receiving care as usual (N = 50). The GOAL! program includes group and individual sessions, given by allied health professionals, over a period of two years. The first year starts with a 3-month intensive course on physical activity and nutrition, followed by 9 months of aftercare covering various lifestyle topics tailored to the group's needs. There is close collaboration with local stakeholders to facilitate transfer to the community setting. The second year focuses on maintaining established activities in one's daily living environment. Our primary outcome will be the change in physical activity, comparing GOAL! participants to those receiving care as usual. Secondary outcomes are changes in other lifestyle behaviors, physical health, mental well-being, and healthcare and societal costs. Additionally, achieving lifestyle-related goals, adverse effects, and barriers and facilitators to implementation are examined. Measurements are obtained at start (T0), and after 3 (T1), 12 (T2) and 24 months (T3). This study investigates the effects of GOAL! on lifestyle behaviors, health outcomes, implementation factors and cost-effectiveness after two years, aiming to offer valuable insights into the effectiveness and implementation outcomes of lifestyle interventions for outpatients with SMI. ClinicalTrials.gov (Identifier: NCT05600205). Prospectively registered on October 26, 2022.

Impact of PNPLA3 in Lean Individuals and in Cryptogenic Steatotic Liver Disease.

Although metabolic dysfunction-associated steatotic liver disease (MASLD) is strongly associated with obesity, around 20% of individuals with hepatic steatosis may nonetheless have normal body mass index, a condition often referred to as lean nonalcoholic fatty liver disease (NAFLD). Under the new nomenclature and definition of MASLD, lean NAFLD can be further divided into lean MASLD (when there is one or more cardiometabolic risk factors) and cryptogenic steatotic liver disease (when there is no cardiometabolic risk factor). Current studies suggest that the at-risk PNPLA3 rs738409 variant is more common among individuals with lean NAFLD than their overweight and obese counterparts. However, even in this group, cardiometabolic risk factors are often required for the development of hepatic steatosis and liver injury. In the general population, PNPLA3 gene polymorphism is associated with an increased risk of MASLD, more severe liver histology (i.e., the presence of steatohepatitis and fibrosis) and future development of hepatocellular carcinoma and cirrhotic complications. Emerging data also suggest that individuals carrying the PNPLA3 GG genotype might have a greater reduction in hepatic steatosis and liver enzymes with lifestyle intervention and metabolic treatments, such as glucagon-like peptide-1 receptor agonists. Studies have not specifically examined the impact of PNPLA3 in lean individuals.

The Effect of Lifestyle Interventions on Anxiety, Depression and Stress: A Systematic Review and Meta-Analysis of Randomized Clinical Trials

Background/Objectives: Depression, anxiety, and stress are common mental health issues that affect individuals worldwide. This systematic review and meta-analysis examined the effectiveness of various lifestyle interventions including physical activity, dietary changes, and sleep hygiene in reducing the symptoms of depression, anxiety, and stress. Using stress as an outcome and conducting detailed subgroup analyses, this study provides novel insights into the differential effects of lifestyle interventions across diverse populations. Methods: Five databases were systematically searched: PubMed, Web of Science, Scopus, Cochrane Library, and Google Scholar, for gray literature searches. Keywords were used to search each database. The search period was from the conception of the databases until August 2023 and was conducted in English. For each analysis, Hedges’ g was reported with a 95% confidence interval (CI) based on the random-effects method. Subgroups were analyzed and heterogeneity and publication bias were examined. Results: Ninety-six randomized clinical trial studies were included in this meta-analysis. Lifestyle interventions reduced depression (Hedges g −0.21, 95% confidence interval −0.26, −0.15; p &lt; 0.001; I2 = 56.57), anxiety (Hedges g −0.24, 95% confidence interval −0.32, −0.15; p &lt; 0.001; I2 = 59.25), and stress (−0.34, −0.11; p &lt; 0.001; I2 = 61.40). Conclusions: Lifestyle interventions offer a more accessible and cost-effective alternative to traditional treatments and provide targeted benefits for different psychological symptoms.

Effect of Different Dietary Patterns on Cardiometabolic Risk Factors: An Umbrella Review of Systematic Reviews and Meta-Analyses

Background/Objectives: Lifestyle interventions such as dietary changes have been proposed to control the cardiometabolic risk factors and thus prevent cardiovascular (CV) disease (CVD). We performed an umbrella review to investigate whether different dietary patterns affect CV risk in individuals with at least one cardiometabolic risk factor (hypertension, dyslipidemia, obesity, diabetes, metabolic syndrome) but not established CVD. Methods: We systematically searched the PubMed and Scopus databases (up to August 2024) for the systematic reviews and meta-analyses of randomized controlled trials (RCTs). Articles should be written in English and refer to a specific dietary pattern (such as Mediterranean diet, etc.). The population studied referred to adults with at least one cardiovascular (CV) risk factor. Results: From 4512 records identified, we finally included 25 meta-analyses with a total of 329 associations. Strong evidence for a benefit was found for LCD with reductions in BW [MD: −4.79 (95% CI −5.85, −3.72) kg, p ≤ 0.001], SBP [MD: −6.38 (95% CI −7.84, −4.93) mmHg, p ≤ 0.001], TG [WMD: −5.81 (95% CI −7.96, −3.66) mg/dL, p ≤ 0.001], and fasting plasma insulin [MD: −15.35 (95% CI −19.58, −11.12) pmol/L, p ≤ 0.001], as well as for low-GI diet for the reduction of BW [SMD: −0.66 (95% CI −0.90, −0.43) kg, p ≤ 0.001]. Conclusions: Across many dietary patterns, LCD showed strong or highly suggestive evidence for a benefit on SBP, BW reduction, and lipid profile improvement. Secondarily, low-GI, DASH, and Portfolio and Nordic diets suggested beneficial effects on controlling CV risk.

Lessons learned from a combined, personalized lifestyle intervention in hospitalized patients at risk for sarcopenia: a feasibility study

Purpose To examine the feasibility of a combined, personalized exercise and nutrition intervention in hospitalized patients at risk of sarcopenia. Methods The study is part of the FITFOOD randomized controlled trial. Eligible patients were randomized into two groups: receiving a personalized nutrition and exercise intervention, or receiving usual care. The intervention entailed a high-protein diet with daily protein supplementation combined with functional training with strength and aerobic exercises. Feasibility was assessed using quantitative data, such as recruitment rate, and qualitative data retrieved from focus group and individual semi-structured interviews. Results In total, 14 out of 115 eligible patients participated. The recruitment rate was 12%, and the dropout rate was 50% (7 out of 14 participants). Patients at risk for sarcopenia found it difficult to be involved in a lifestyle intervention, because they were often preoccupied with their recovery, had little interest in changing their diet or level of exercise, and were often unable to participate fully due to health issues and mobility difficulty. Conclusions The evaluated combined, personalized lifestyle intervention had limited feasibility in hospitalized patients at risk for sarcopenia, with low recruitment and high dropout rates. The current lifestyle intervention might be too challenging for this vulnerable population. Trial registration The trial associated with this feasibility study was pre-registered on ClinicalTrials.gov under the registration number NCT05413616 on 07 June 2022.

History of Psychopathology and Therapeutic Interventions, a perspective of Classical Islamic Scholars

The works of Al-Razi, Ibn Sina, and Al-Balkhi on the contributions of classical Islamic scholars to understanding and treatment have been discussed. An analysis is done with a critical approach to provide insight into their holistic approaches that deal with the integration of health dimensions in a physical, psychological, and spiritual aspect. The early classifications made by them about mental disorders, cognitive-behavioral techniques, and lifestyle interventions have also been investigated, showing the similarity in such practices with those of current therapies. This approach emphasizes the cultural and ethical value attached to these historical insights in modern mental health care. The findings suggest that ideas from these thinkers will enhance contemporary mental health care since the thoughts provided a more humane, ethical, and culturally appropriate care.

Chinese expert consensus on the management of hypertension in adults with type 2 diabetes.

Both hypertension and type 2 diabetes are attributable to premature death, cardiovascular and kidney diseases with largely overlapping population. Followed the GRADE approach, this expert consensus aimed to reduce the cardiovascular and kidney death and disability due to hypertension and minimize the treatment burden in adults with type 2 diabetes. Through online survey and discussion, a multidisciplinary team comprehensively prioritized seven key guideline questions. Informed by the evidence synthesis and online discussion, the team developed 12 recommendations under the GRADE Evidence-to-decision (EtD) framework. The recommendations covered the screening of hypertension in adults diagnosed with type 2 diabetes but not hypertension and the monitoring, lifestyle interventions, and medications in those diagnosed with type 2 diabetes and hypertension.

Abstract 4135206: Patterns of Lifestyle Risk Behaviors for Cardiovascular Disease in Family Caregivers: A Latent Class Analysis

Introduction: Lifestyle risk behaviors for cardiovascular disease (CVD) often co-occur. However, little is known about their behavioral patterns among family caregivers, a population at high risk for CVD. Aims: To identify distinct latent classes of caregivers of lifestyle risk behaviors for CVD and to examine the individual characteristics associated with membership in the identified latent classes. Methods: This study included 643 unpaid family caregivers from the 2019 Health Information National Trends Survey 5 Cycle 3. The assessed lifestyle risk behaviors included cigarette use, non-abstinence from alcohol, low physical activity, long sedentary time, and low fruit and vegetable consumption. These behaviors were dichotomized based on established guidelines or cut-off points. Latent class analysis was performed to identify latent classes based on these lifestyle risk behaviors among caregivers. Subsequently, multinomial logistic regression was used to investigate socio-demographic, health-related, and caregiving characteristics associated with the latent class membership. Results: Three distinct classes were identified (mean age = 55±16 years; 59.3% female; 57.1% non-Hispanic white): “overall healthy, but non-abstainer” (Class 1, 17.1%; reference), “overall unhealthy” (Class 2, 64.1%), and “inactive, but healthy eaters” (Class 3, 18.8%). In unadjusted multinomial logistic regression models, caregivers reporting greater financial hardship (relative risk ratio [95% CI] = 2.5 [1.0-5.9]), higher psychological distress (3.7 [1.9-7.3]), poorer sleep quality (3.3 [1.6-6.8]), longer caregiving hours (2.1 [1.1-3.9]), and providing dementia care (2.3 [1.3-4.3]) were more likely to belong to Class 2, relative to Class 1. In the adjusted model including the significant characteristics above and controlling for age and gender, psychological distress (2.7 [1.2-5.9]) remained significant. No characteristics were significantly associated with membership in Class 3, relative to Class 1. Conclusions: Lifestyle risk behaviors for CVD among caregivers may cluster in distinct patterns that vary by individual characteristics. Caregivers experiencing psychological distress may be particularly at risk for engaging in lifestyle risk behaviors. Our novel findings underscore the importance of adaptive lifestyle modification interventions that target caregiver subgroups with different patterns of health behaviors to promote their cardiovascular health.

Abstract 4137169: Artificial Intelligence-Enabled Electrocardiography For The Prediction of Future Type 2 Diabetes Mellitus

Background: Undiagnosed diabetes and prediabetes present a significant global health challenge. Artificial Intelligence-enabled electrocardiography (AI-ECG) has shown promise in identifying subtle ECG changes in a wide range of subclinical diseases. Opportunistic ECG screening could identify prediabetic patients, enabling early interventions to prevent T2DM and adverse cardiovascular events. Aims: To develop the AI-ECG Risk Estimator to diagnose prevalent T2DM and predict future T2DM (AIRE-DM) Methods: AIRE-DM was trained on a real-world secondary care cohort from Beth Israel Deaconess Medical Center (BIDMC) of 1,163,401 ECGs and externally validated in the UK Biobank (UKB, N = 65,606). AIRE-DM employs a residual neural network architecture with a discrete-time survival loss function. Results: AIRE-DM accurately identifies prevalent T2DM (AUROC: BIDMC – 0.712 (0.705-0.719), UKB - 0.731 (0.725 - 0.741) and predicts future T2DM (C-index: BIDMC - 0.666 (0.658-0.675), UKB 0.689 (0.663-0.715). In subjects without T2DM, the high-risk quartile shows a markedly increased risk of future T2DM (HR: BIDMC - 4.67 (4.01-5.45), UKB - 10.10 (5.87-17.40), adjusted for age and sex. Adding AIRE-DM to clinical risk factors in BIDMC and to the American Diabetes Association (ADA) score in the UKB significantly enhanced predictive accuracy for future T2DM (C-index improvement: BIDMC - 0.0359 (0.0354-0.0363), UKB: 0.0337 (0.0324-0.0350), continuous net reclassification index: BIDMC - 0.407 (0.360-0.445), UKB - 0.391 (0.259-0.503)). Using phenome- and genome-wide association studies, we identified biologically plausible associations for AIRE-DM, including glucose regulation, cardiac morphology, diastolic dysfunction, arterial stiffness and lipid metabolism. We identified variants adjacent to CASQ2 , TBX3 , NOS1AP , TKT , VGLL2 and PRDM6 , which are known regulators of cardiac morphology, arterial stiffness and glucose metabolism. Conclusion: AIRE-DM can predict future T2DM in non-diabetics and enhances T2DM risk prediction when integrated with clinical risk scores. Its application holds promise for early identification of individuals at high risk of T2DM, enabling early lifestyle and pharmacological interventions.

Abstract 4130929: The Effect of Weight loss and Weight Maintenance on Branch Chain Amino Acid Levels

Introduction: Elevated branch chain amino acid levels (BCAA) have been associated with cardiovascular disease (CVD) and type-2 diabetes. While weight loss has been shown to improve BCAA levels, few studies have evaluated the impact of weight loss and weight maintenance with the OPTIFAST® weight loss program and supervised exercise training. Methods: The present study is a secondary analysis of the PREVAIL-P study. During the weight loss phase, overweight and obese adults (N=30) completed a 10-week OPTIFAST® program with supervised aerobic exercise training with the goal of achieving clinically significant weight loss (≥7%). Participants who met the weight loss goal were randomized to levels of aerobic training consistent with physical activity recommendations (PA-REC) (~550 MET minutes per week) or weight maintenance recommendations (WM-REC) (~970 MET minutes per week) for 18 additional weeks. Valine, leucine, isoleucine and total BCAA levels were measured using nuclear magnetic resonance (NMR) at baseline, after the weight loss phase (10 weeks) and at follow-up (28 Weeks) (LabCorp, Raleigh, NC). Results: Following the weight loss phase, participants had a significant mean reduction in weight (-8.8 kg, p&lt;0.001), total BCAA (-37.4 μmol/L, p&lt;0.001), valine (-15.2 μmol/L, p=0.012), leucine (-20.0 μmol/L, p&lt;0.001), but not isoleucine (-4.1 μmol/L, p=0.214) levels. Improvements in BCAA levels were associated with changes in HDL levels (r=-0.39, p=0.03) and approached significance for visceral fat (r=0.34, p=0.07). Furthermore, changes in BCAA metabolites were not associated with weight, glucose metabolism or other lipid variables for the weight loss phase (p&gt;0.05). In a subset of participants (N=14) who completed the weight maintenance phase (due to COVID pandemic), there were no group differences in the change in total BCAA, valine, leucine between the PA-REC and the WM-REC groups (all ps &gt;0.05). Changes in total BCAA levels (baseline to 28 weeks) were associated with higher mean aerobic exercise training intensity during the intervention (r=-0.64, p=0.013). Conclusion: Weight loss using the OPTIFAST® weight loss program diet combined with aerobic exercise improved BCAA levels, which is associated with decreased CVD risk. Lower BCAA levels during weight maintenance may be influenced by higher exercise intensity exercise. Future studies should evaluate the impact of lifestyle interventions on BCAA levels during long-term weight maintenance.

Smartphone Application Intervention on Obstructive Sleep Apnea Among Overweight and Obese High-Tech Employees: A Randomized Controlled Trial.

The aim of this study was to examine the effectiveness of an adjusting lifestyle intervention with a smartphone application (app) in managing obstructive sleep apnea (OSA) among overweight and obese high-tech employees. A 6-months three-armed randomized controlled trial was employed. A total of 144 eligible participants were randomly allocated into the smartphone app 'MyFitnessPal' plus education (MFPE; n = 48), 'MyFitnessPal'-only (MFP-only; n = 50) and the control group (n = 46) at a 1:1:1 ratio. The data were collected using related questionnaires and portable sleep monitor. Generalized estimating equation was used to analyze data. Results revealed that there was a significant interaction between time and group in BMI (Wald χ2 = 4.47, p = 0.04) in the MFPE after the 12th week of the intervention. Nevertheless, there was no significant interaction between group and time observed in apnea-hypopnea index (AHI) score after 24 weeks of intervention. The adjustment lifestyle integrated with an app may offer a simple and cost-effective approach. The findings of this study may provide precious information for occupational healthcare providers, facilitating health promotion in the workplace for overweight employees with OSA.

Abstract 4141434: Real-World Improvement of Cardiometabolic Risk Factors by Treating Obesity at Scale

Intro: Obesity is a critical risk factor for cardiometabolic disease. A growing body of clinical trial data shows GLP-1 receptor agonist medications (GLP-1s) are not only effective in treating obesity but also demonstrate significant impact on the reduction of cardiovascular risk. Yet current models of care have not been able to reach the &gt;200 million Americans who meet criteria for obesity treatment. To improve access to evidence-based treatment, we established a virtual metabolic health company to provide medically-supervised obesity treatment at scale. Research Question: This real-world evaluation examines the impact of a virtual health program on weight and related cardiometabolic markers. Methods: Data were analyzed for individuals who completed at least 12 months (mos) in the core program and for a subset who continued to 24 mos. Obesity treatment involved GLP-1s combined with a proprietary intensive lifestyle intervention delivered with virtual coaching. Weights were submitted via cellular connected scale. Waist circumference, metabolic labs, and patient-completed surveys were analyzed at baseline and 12 mos. Results: The cohort included 6,766 patients, a subset with structured lab data from a larger population of 16,098 patients who had completed 12 mos in the commercial program. Average weight loss at 12 mos was -16.5% (n=5,932) and -17.8% at 24 os (n=1,171). Improvement was observed for all collected metabolic markers: waist circumference, AST/ALT, lipids, HbA1c, insulin, hs-CRP. Specifically for cardiovascular labs, 12 mos results showed improvement in HDL in 56.3% (n= 3,090), in LDL for 64.8% (n=3,066), in hs-CRP for 82.9% (n=2,446). Of n=825 with abnormal A1c at baseline, 77.1% achieve A1c &lt;5.7%. Average reduction in waist circumference was -5.9 inches (n=3,682). Positive changes were also seen for patient-reported outcomes (PROs). Discussion: In the context of significant obesity and cardiovascular results for GLP-1s in clinical trials, it is important to gather data on the efficacy of approaches to scale treatment in the real world since factors such as medication shortages, gaps in insurance coverage, and challenges with adherence occur with treatment outside of clinical trials. Results from 6,766 patients in a virtual metabolic health program available in 50 states and DC demonstrate clinically significant and sustained weight loss through 24 mos, with improvement in associated key cardiometabolic risk markers, health behaviors, and PROs.

Abstract 4128250: Healthier Lifestyle is Associated with Better Arterial Health in People without Prevalent Cardiovascular Disease

Background: Higher arterial stiffness contributes to atherogenesis and arterial calcification, resulting in cardiovascular morbidity and mortality. Research Question: The relations of lifestyle, measured by the AHA Life’s Essential 8 (LE8), with arterial health (AH) and CVD outcomes are incompletely understood. Aims: To examine the association of LE8 with AH and extent to which carotid-femoral pulse wave velocity (PWV) mediates the association of LE8 with outcomes in a sample free of CVD. Methods: In 3 Framingham Heart Study cohorts, we studied the relations of LE8 (total score and components) with AH, assessed by arterial stiffness (PWV, by tonometry) and coronary calcification score (CAC, by computed tomography) using multivariable-adjusted linear regression (p&lt;0.01 considered significant after Bonferroni correction). We evaluated the extent to which PWV mediates the association of LE8 with outcomes using Cox proportional hazards regression models (p&lt;0.05 considered significant). Results: We studied 5222 participants, aged 50±15 years, 56% women. Characteristics of the sample are presented in Table . Higher LE8 score (better cardiovascular health) was associated with more favorable AH measures (PWV inverse transformed, standardized; CAC log(CAC+1); all β±SE, x10 -3 ): β PWV =-14.4±0.7, β CAC= -51.9±7.8, both p&lt;0.01). Of the LE8 components, BMI (β PWV =-1.53±0.31), BP (β PWV =-9.74±0.36), fasting glucose (β PWV =2.03±0.45), lipids (β PWV =-1.54±0.31, β CAC =-16.14±3.30) and smoking (β CAC =-17.9±2.8) were the greater contributors to AH (all p&lt;0.01). PWV mediated modest degrees of the associations between LE8 and CHD, HF, CVD, and CVD mortality [ Figure ]. Conclusions: In people without prevalent CVD, healthier lifestyle was associated with better AH. Arterial stiffness mediates the association between lifestyle measures and CHD, HF, CVD, and CVD-mortality. Our results support studying lifestyle interventions to improve arterial health and their benefits for CVD outcomes.

Abstract 4144573: Cardiac biomarkers, intensive lifestyle intervention, and risk of heart failure subtypes in type 2 diabetes – a post-hoc analysis of the Look AHEAD trial

Background: N-terminal pro-B-type natriuretic peptide (NT-proBNP) and high-sensitivity cardiac troponin T (hs-cTnT) identify subclinical heart failure (HF) in type 2 diabetes (T2D). The contribution of changes in cardiac biomarkers to HF risk, particularly HF subtypes, is unclear. Whether HF risk associated with cardiac biomarkers is modifiable with an intensive lifestyle intervention (ILI) targeting weight loss is unknown. Methods: Adults with T2D and overweight/obesity in the Look Action for Health in Diabetes (AHEAD) trial without prevalent HF were included. NT-proBNP and hs-cTnT were measured at baseline, 1- and 4-years (Roche Diagnostics). Adjusted Cox models were created to evaluate the associations of baseline, 1- and 4-year change in NT-proBNP and hs-cTnT with risk of HF with preserved and reduced ejection fraction (HFpEF and HFrEF, respectively). Interaction testing was performed to evaluate heterogeneous effects of the ILI vs diabetes support and education (DSE) across baseline cardiac biomarkers. Results: Of the 3,959 participants included, 212 had incident HF (108 HFpEF, 84 HFrEF) over 12 years. Higher baseline NT-proBNP and hs-cTnT were each significantly associated with higher risk of HFpEF and HFrEF ( Table) . Increases in NT-proBNP over 1- and 4-years were significantly associated with higher risk of HFpEF and HFrEF with a similar pattern of association for hs-cTnT and HF subtypes. After accounting for risk factor changes, the association of 1- and 4-year changes in NT-proBNP, but not hs-cTnT, with risk of HF subtypes remained significant. There was a significant interaction between NT-proBNP and ILI for risk of HFpEF but not HFrEF (p-int = 0.001). The ILI reduced HFpEF risk among participants with elevated (≥125 pg/mL) but not non-elevated NT-proBNP (&lt;125 pg/mL) (ILI vs DSE HR [95% CI]: 0.48 [0.25-0.93] and 1.67 [0.94-2.94], respectively). No significant treatment group by hs-cTnT interactions were identified. Conclusions: In T2D, longitudinal changes in cardiac biomarkers, particularly NT-proBNP, are significantly associated with HF risk, independent of risk factor changes. In Look AHEAD, elevated NT-proBNP may identify individuals who are more likely to benefit from the ILI for HFpEF prevention.

Lifestyle intervention improves cardiometabolic profiles among children with metabolically healthy and metabolically unhealthy obesity

BackgroundIn recent years, there has been a surge of interest in the metabolic phenotype among children with obesity characterized by the absence of associated cardiometabolic risk factors (CRFs), known as metabolically healthy obesity (MHO), as opposed to those with metabolically unhealthy obesity (MUO). This study investigated the effect of lifestyle intervention on CRFs among children with MHO and MUO.MethodsA total of 102 school-aged children with obesity (54 girls and 48 boys) aged 8–16 years completed a 16-week school-based lifestyle modification intervention program, MyBFF@school Phase I. The intervention consisted of physical activity, healthy eating promotion, and psychological empowerment. MHO and MUO statuses were defined based on the 2018 consensus-based criteria. Fasting venous blood collection, body composition measurement, clinical assessment and physical fitness testing were conducted at baseline and at the end of week 16.ResultsAfter the intervention, the CRFs of the children with MUO improved with significant decreases in systolic (p < 0.001) and diastolic (p = 0.01) blood pressure and a significant increase in high-density lipoprotein cholesterol (HDL-C) (p = 0.005), while the CRFs of the children with MHO had a significant decrease in uric acid (p = 0.04). Additionally, 51.6% of the children with MHO transitioned to the MUO, while 26.8% of the children with MUO crossed over to the MHO at the end of the intervention. Furthermore, the odds of having high systolic blood pressure among children with MUO were 59% lower at week-16 than at baseline (OR = 0.41 (95% CI = 0.18, 0.92), p = 0.03).ConclusionsOur findings demonstrated that CRFs improved more prominently among children with MUO following the intervention. More importantly, our findings indicate that MHO in children is transient, hence, strategies to protect children against MUO are warranted.Trial registration: ClinicalTrials.gov NCT02212873.

The effectiveness of couples' lifestyle interventions on weight change: A systematic review and meta-analysis of Randomised Controlled Trials.

Introduction: Lifestyle interventions aiming to reduce excess body weight have been focusing on individuals living with overweight or obesity. However, many health-related behaviors including eating are concordant in couples indicating they might share an obesity risk or support each other's weight loss efforts. Aim: The aim of this systematic review and meta-analysis of randomized controlled trials was to assess the weight change effects of lifestyle interventions targeting couples in a romantic relationship regardless of marital status or sexual preference compared to individuals or no intervention. Methods: Four databases (MEDLINE Ovid, Scopus, CINHAL, and mySearch: EBSCO-Discovery-Service-Tool) were systematically searched from inception until 26th April 2021 with further email alerts. The risk of bias was assessed using the Critical Appraisal Skills Programme. Meta-analysis was conducted using the random-effect model to estimate the weighted mean difference with 95% confidence interval. Results: Seventeen studies were eligible for this review and 11 of them were included in the meta-analysis for weight change. Significant intervention effects were identified for body weight in couples' intervention vs. individual intervention (-2.25 kg, 95% CI-3.63 to-0.88), and vs. no intervention (-4.5 kg, 95% CI-6.62 to-2.38). Conclusion: This systematic review and meta-analysis was the first to investigate the effectiveness of lifestyle interventions targeting couples on weight loss, compared to interventions focused on individuals or standard care. The findings suggest that interventions aimed at couples lead to greater weight loss, though the results should be interpreted with caution due to the wide heterogeneity among the studies. Further research is needed with evidence-based study designs, targeting younger participants, and incorporating longer intervention durations and follow-up periods.