Lifestyle Intervention For People Research Articles

National health and economic impact of a lifestyle program to prevent type 2 diabetes mellitus in Germany: a simulation study

IntroductionTo examine the long-term health and economic impact of a lifestyle diabetes prevention program in people with high risk of developing type 2 diabetes in Germany.Research design and methodsWe assessed...

Metabolomic Profile Alterations Associated with the SLC16A11 Risk Haplotype Following a Lifestyle Intervention in People With Prediabetes

BackgroundA risk haplotype in SLC16A11 characterized by alterations in fatty acid metabolism emerged as a genetic risk factor associated with increased susceptibility to type 2 diabetes (T2D) in Mexican population. Its role on treatment responses is not well understood. ObjectivesWe aimed to determine the impact of the risk haplotype on the metabolomic profile during a lifestyle intervention (LSI). MethodsWe recruited Mexican-mestizo individuals with ≥1 prediabetes criteria according to the American Diabetes Association with a body mass index between 25 and 45 kg/m2. We conducted a 24-wk quasiexperimental LSI study for diabetes prevention. Here, we compared longitudinal plasma liquid chromatography/mass spectrometry metabolomic changes between carriers and noncarriers. We analyzed the association of risk haplotype with metabolites leveraging repeated assessments using multivariable-adjusted linear mixed models. ResultsBefore the intervention, carriers (N = 21) showed higher concentrations of hippurate, C16 carnitine, glycine, and cinnamoylglycine. After 24 wk of LSI, carriers exhibited a deleterious metabolomic profile. This profile was characterized by increased concentrations of hippurate, cinnamoglycine, xanthosine, N-acetylputrescine, L-acetylcarnitine, ceramide (d18:1/24:1), and decreased concentrations of citrulline and phosphatidylethanolamine. These metabolites were associated with higher concentrations of total cholesterol, triglycerides, and low density lipoprotein cholesterol. The effect of LSI on the risk haplotype was notably more pronounced in its impact on 2 metabolites: methylmalonylcarnitine (β: −0.56; P-interaction = 0.014) and betaine (β: −0.64; P-interaction = 0.017). Interestingly, lower consumption across visits of polyunsaturated (β: −0.038; P = 0.017) fatty acids were associated with higher concentrations of methylmalonylcarnitine. Covariates for adjustment across models included age, sex, genetic ancestry principal components, and body mass index. ConclusionsOur study highlights the persistence of deleterious metabolomic patterns associated with the risk haplotype before and during a 24-wk LSI. We also emphasize the potential regulatory role of polyunsaturated fatty acids on methylmalonylcarnitine concentrations suggesting a route for improving interventions for individuals with high-genetic risk.

Obesity medications: A narrative review of current and emerging agents

The aim of this narrative review is to synthesize the available data describing the efficacy and safety of medications approved for obesity management and to provide an overview of upcoming agents in development.A literature search of PubMed, Medline, and Embase databases identified relevant articles describing medications approved in the U.S., Australia, U.K., and/or Europe. Papers were selected based on relevance and originality, with phase 3 clinical trials and meta-analyses preferentially included.Six medications are widely approved for long-term weight management in conjunction with lifestyle interventions in people with body mass index (BMI) ≥30 ​kg/m2 or BMI ≥27 ​kg/m2 and at least one medical condition related to excess weight. Compared with lifestyle interventions alone, all medications approved for obesity management are more effective for long-term weight loss and improvements in cardiometabolic risk factors. Older obesity medications are associated with mean weight losses in the range of 5–10%. The new generation of agents, including the injectable incretin analogues semaglutide and tirzepatide are associated with sustained mean weight reductions of 15–20%, along with substantial benefits on a range of health outcomes. Several novel agents are under development, with multi-hormone receptor agonists and oral formulations likely to become available in the coming years.As effective treatment options expand, cost and availability will need to be addressed to enable equitable access to treatment. Other important challenges for clinical practice and research include the need for long-term strategies to prevent and manage weight regain and loss of lean muscle and bone mineral density.

The 10-Year Effects of Intensive Lifestyle Intervention on Kidney Outcomes

Limited data exist on longitudinal kidney outcomes after nonsurgical obesity treatments. We investigated the effects of intensive lifestyle intervention on kidney function over 10 years. Post hoc analysis of Action for Health in Diabetes (Look AHEAD) randomized controlled trial. We studied 4,901 individuals with type 2 diabetes and body mass index of≥25kg/m2 enrolled in Look AHEAD (2001-2015). The original Look AHEAD trial excluded individuals with 4+urine dipstick protein, serum creatinine level of>1.4mg/dL (women), 1.5mg/dL (men), or dialysis dependence. Intensive lifestyle intervention versus diabetes support and education (ie, usual care). Primary outcome was estimated glomerular filtration rate (eGFR, mL/min/1.73m2) slope. Secondary outcomes were mean eGFR, slope, and mean urine albumin to creatinine ratio (UACR, mg/mg). Linear mixed-effects models with random slopes and intercepts to evaluate the association between randomization arms and within-individual repeated measures of eGFR and UACR. We tested for effect modification by baseline eGFR. At baseline, mean eGFR was 89, and 83% had a normal UACR. Over 10 years, there was no difference in eGFR slope (+0.064 per year; 95% CI: -0.036 to 0.16; P=0.21) between arms. Slope or mean UACR did not differ between arms. Baseline eGFR, categorized as eGFR of<80, 80-100, or>100, did not modify the intervention's effect on eGFR slope or mean. Loss of muscle may confound creatinine-based eGFR. In patients with type 2 diabetes and preserved kidney function, intensive lifestyle intervention did not change eGFR slope over 10 years. Among participants with baseline eGFR<80, lifestyle intervention had a slightly higher longitudinal mean eGFR than usual care. Further studies evaluating the effects of intensive lifestyle intervention in people with kidney disease are needed.

High-Intensity Interval Versus Moderate-Intensity Continuous Exercise Training on Glycemic Control, Beta Cell Function, and Aerobic Fitness in Women with Type 2 Diabetes.

Objective: This study aimed to compare the effects of High-Intensity Interval Training (HIIT) and Moderate-Intensity Continuous Training (MICT) on glycemic control, beta-cell function, and aerobic fitness in women with Type 2 Diabetes Mellitus (T2DM). Methods: Thirty-six women with T2DM were assigned equally to HIIT, MICT, and control (CON) groups. Participants in the exercise cohorts underwent a 12-week training regimen (three sessions per week), while the CON group maintained an inactive lifestyle. Glycaemia variables, beta-cell function, maximal oxygen uptake (VO2max), lipid profiles, and body composition were assessed at baseline and post-intervention. Results: Both HIIT and MICT interventions led to significant improvements in glucose, insulin, HbA1c, and insulin resistance index. Moreover, visceral adiposity index (VAI), lipid accumulation product (LAP), total cholesterol (TC), and low-density lipoprotein (LDL) levels significantly decreased in the HIIT and MICT groups after 12 weeks. Triglyceride (TG) levels decreased only after MICT, while high-density lipoprotein (HDL) levels increased after both interventions. Maximal oxygen uptake (VO2max), body mass, body mass index (BMI), and waist circumference (WC) significantly improved in all exercise groups. Notably, the HIIT group showed greater reductions in body mass compared to MICT. Nevertheless, beta-cell function remained unaltered after these two exercise regimens. Conclusion: Both HIIT and MICT interventions effectively managed T2DM in women, regardless of exercise intensity. The HIIT regimen can be considered for time-efficient lifestyle interventions in people with T2DM.

Factors influencing engagement in in-person and remotely delivered lifestyle interventions for young adults with serious mental illness: A qualitative study.

Young adults (ages 18-35) are underrepresented in lifestyle interventions for people with serious mental illness (SMI), such as schizophrenia, bipolar disorder, and severe depression, and little is known about factors influencing their engagement in these programmes. This qualitative study examined factors affecting engagement amongst young adults with SMI who were enrolled in a lifestyle intervention trial at community mental health centres. Seventeen young adults with SMI participated in this qualitative study. Participants were drawn from a 12-month randomized controlled trial (n = 150) comparing an in-person group lifestyle intervention augmented with mobile health technology (PeerFIT) to one-on-one personalized remote health coaching (BEAT) using purposive sampling. The 17 participants completed semi-structured qualitative interviews at post-intervention to explore their perceived benefits of the intervention and factors impacting engagement. We used a team-based descriptive qualitative approach to code transcripts and identify themes in the data. Participants across both interventions reported experiencing improved ability to engage in health behaviour change. Participants described managing psychosocial stressors and family and other responsibilities that limited their ability to attend in-person PeerFIT sessions. The remote and flexible BEAT remote health coaching intervention appeared to facilitate engagement even in the context of challenging life circumstances. Remotely delivered lifestyle interventions can facilitate engagement amongst young adults with SMI navigating social stressors.

Evidence of lifestyle interventions in a pregnant population with chronic hypertension and/or pre-existing diabetes: A systematic review and narrative synthesis.

Pregnant people with chronic hypertension, pre-existing diabetes or both are at high risk of developing cardiovascular disease. Lifestyle interventions play an important role in disease management in non-pregnant populations. To review the existing evidence of randomised controlled trials (RCTs) that examine lifestyle interventions in pregnant people with chronic hypertension and/or pre-existing diabetes. A systematic review and narrative synthesis was conducted. Five electronic databases were searched from inception to April 2021 for RCTs evaluating antenatal lifestyle interventions in people with chronic hypertension and/or pre-existing diabetes with outcomes to include weight or blood pressure change. Nine randomised controlled trials including 7438 pregnant women were eligible. Eight studies were mixed pregnant populations that included women with chronic hypertension and/or pre-existing diabetes. One study included only pregnant women with pre-existing diabetes. Intervention characteristics and procedures varied and targeted diet, physical activity and/or gestational weight. All studies reported weight and one study reported blood pressure change. Outcome data were frequently unavailable for the subset of women of interest, including subgroup data on important pregnancy and birth complications. Eligibility criteria were often ambiguous and baseline data on chronic hypertension was often omitted. A lack of primary interventional trials examining the effect of lifestyle interventions on weight and blood pressure outcomes in pregnant populations with chronic hypertension and/or pre-existing diabetes was evident. Lifestyle modification has the potential to alter disease progression. Future trials should address the ambiguity and frequent exclusion of these important populations.

Mechanisms of gut microbiota-immune-host interaction on glucose regulation in type 2 diabetes.

Intestinal absorption of food is one of the sources of glucose. Insulin resistance and impaired glucose tolerance caused by lifestyle and diet are the precursors of type 2 diabetes. Patients with type 2 diabetes have trouble controlling their blood sugar levels. For long-term health, strict glycemic management is necessary. Although it is thought to be well correlated with metabolic diseases like obesity, insulin resistance, and diabetes, its molecular mechanism is still not completely understood. Disturbed microbiota triggers the gut immune response to reshape the gut homeostasis. This interaction not only maintains the dynamic changes of intestinal flora, but also preserves the integrity of the intestinal barrier. Meanwhile, the microbiota establishes a systemic multiorgan dialog on the gut-brain and gut-liver axes, intestinal absorption of a high-fat diet affects the host's feeding preference and systemic metabolism. Intervention in the gut microbiota can combat the decreased glucose tolerance and insulin sensitivity linked to metabolic diseases both centrally and peripherally. Moreover, the pharmacokinetics of oral hypoglycemic medications are also influenced by gut microbiota. The accumulation of drugs in the gut microbiota not only affects the drug efficacy, but also changes the composition and function of them, thus may help to explain individual therapeutic variances in pharmacological efficacy. Regulating gut microbiota through healthy dietary patterns or supplementing pro/prebiotics can provide guidance for lifestyle interventions in people with poor glycemic control. Traditional Chinese medicine can also be used as complementary medicine to effectively regulate intestinal homeostasis. Intestinal microbiota is becoming a new target against metabolic diseases, so more evidence is needed to elucidate the intricate microbiota-immune-host relationship, and explore the therapeutic potential of targeting intestinal microbiota.

Effectiveness of (Active) Lifestyle Interventions in People With a Lower Limb Amputation: A Systematic Review

To explore the effectiveness of (active) lifestyle interventions for the health of people with a lower limb amputation in order to offer effective interventions during rehabilitation that may improve physical and psychosocial functioning of people with lower limb amputation. PubMed, CINAHL and Embase were searched from inception to February 2021. Inclusion criteria were (1) (quasi-)randomized controlled trial; (2) minimum of 10 participants with a lower limb amputation; (3) lifestyle intervention focusing on physical activity, smoking habits, alcohol use, nutrition, and/or stress management; (4) focus on health outcomes; (5) participants older than 18 years; (6) studies in Dutch, German, or English; and (7) primary research. Title, abstract, and full-text screening and quality assessment were performed by 2 independent assessors. Of 2460 studies identified, 13 studies were included in this review. Two studies were of moderate methodological quality, 2 studies were of medium quality, and 9 studies were of poor quality. Lifestyle interventions in the included studies focused on physical activity and stress management. These interventions seemed effective for improving physical fitness, walking capacity, changes in body mass, quality of life, and intensity of physical activity. Lifestyle interventions focusing on physical activity and stress management seem effective for improving physical and psychosocial functioning of people with a lower limb amputation. However, the findings should be interpreted with caution given the limited methodological quality of the included studies. Future research should evaluate the effectiveness of interventions on nutrition, smoking habits, and alcohol use and the effectiveness of combined interventions in people with a lower limb amputation.

Effective elements of a combined lifestyle intervention for people with low socioeconomic status. A concept mapping case study

AbstractHealth inequalities still exist between people with a low socioeconomic status (SES) and people with a high SES. Combined lifestyle interventions (CLIs) could benefit the health of people with a low SES. However, it is unclear which CLI elements are effective for this group. Therefore, this study aimed to determine the effective elements X‑Fittt 2.0, a CLI for people with a low SES. Nine professionals and one participant of X‑Fittt 2.0 participated in a concept mapping (CM) process to develop an overview of the effective elements of X‑Fittt 2.0. CM consists of six steps: preparing, brainstorming, clustering, scoring, analysing, and discussing and interpreting. This process resulted in 72 effective elements, grouped in nine clusters, focused on monitoring (12), internal (7) and external (4) collaborations, structure and guidance (10), agreements with participants (5), sports options in the first 12 weeks (10), the sports environment (10), recruitment strategies (5) and the preconditions for X‑Fittt 2.0 (9). These results provide a valuable first overview of effective elements of CLIs for people with a low SES.

PATIENTS' PERCEPTION OF RECOVERY AFTER CARDIOVASCULAR INTERVENTIONS: AN IMPORTANT INDICATOR OF LIFESTYLE CHANGE

Cardiovascular disease (CVD) is one of the leading causes of premature death in the world.1 Recent advances in medical technology have led to lower mortality and better relative recovery in CVD patients. Today, various invasive procedures are used in cardiovascular interventions such as percutaneous coronary interventions (PCIs), which have led to improvements in the outcomes of CVD patients. However, despite the benefits of cardiovascular interventions, patients need to change their lifestyles. Therefore, patients with CVD need rehabilitation after cardiovascular interventions for complete recovery, which is often overlooked.2 Meanwhile, patients' perception of recovery after cardiovascular interventions is one of the key factors in predicting lifestyle changes in CVD patients. These patients should have a full awareness of a healthy lifestyle about physical activity, alcohol and tobacco use, and diet, as well as a proper perception of recovery after cardiovascular interventions.3 Hence, the results of a randomized controlled trial in the UK that assessed the impact of educational and rehabilitation programs on patients 'perceptions after myocardial infarction (MI) showed that educational and rehabilitation programs can lead to positive changes in patients' perceptions of recovery after cardiovascular interventions and lifestyle after MI, especially after three months of intervention. Also, patients in the intervention group reported fewer symptoms of angina compared to patients in the control group. Overall, educational and rehabilitation programs were effective in changing the perception of CVD patients and improving the functional outcome of patients after MI.4 In contrast, the results of another study in the Netherlands that evaluated the effect of a lifestyle intervention on CVD risk indicators in patients with familial hypercholesterolemia showed that there was no significant improvement between the intervention and control groups (usual care).5 The importance of this issue becomes clearer when these patients undergo invasive cardiovascular interventions. Despite the benefits of cardiovascular interventions, patients need to change their lifestyles. On the other hand, there is a link between patients' perceptions of recovery after cardiovascular interventions and lifestyle changes. Therefore, there is a need for serious attention to patients' perception of recovery after cardiovascular interventions. Obviously, patients' perceptions of recovery after cardiovascular interventions can be an important predictor of their lifestyle changes. However, to our knowledge, studies in this field are very limited. Therefore, it is suggested that researchers in future studies pay special attention to the perception of CVD patients of recovery after cardiovascular interventions as an important predictor of lifestyle changes in them after cardiovascular interventions.

Patient-Centered Care for Obesity: How Health Care Providers Can Treat Obesity While Actively Addressing Weight Stigma and Eating Disorder Risk

Patient-Centered Care for Obesity: How Health Care Providers Can Treat Obesity While Actively Addressing Weight Stigma and Eating Disorder Risk

Short-term effects of lifestyle intervention in the reversion to normoglycemia in people with prediabetes

AimsTo evaluate the short-term effect of lifestyle intervention in people with prediabetes. MethodsA stratified multistage sampling method was used in the recruitment of residents of the Jiangsu Province, China in 2017, who had no previous diagnosis of diabetes. Physical examination and laboratory tests were performed, and questionnaires were completed. Those with a prediabetes diagnosis at baseline were included in the cohort and participants were randomized to the intervention group or the control group. The intervention group received a lifestyle intervention strategy, which included exercise, diet and peer educations. The control group received general health education. Participants were followed up in 2018. ResultsA total of 2005 individuals were included in the analysis. At follow-up, there were 516 (36.7%) individuals in the intervention group and 207 (34.5%) individuals in the control group with normal blood glucose levels. The decline in waist circumference and fasting plasma glucose levels was significantly higher in the intervention group than in the control group. This was still observed after adjusting for variables (odds ratio 1.32, P = 0.02). Females or younger individuals who had lower body mass index and plasma glucose levels at baseline were more likely to reverse to normoglycemia at follow-up. ConclusionsCompared with a strategy of general health education, a lifestyle intervention strategy could reverse glucose levels to normoglycemia in individuals with prediabetes.

Bandura's Self-Efficacy Model Used to Explore Participants' Experiences of Health, Lifestyle, and Work After Attending a Vocational Rehabilitation Program with Lifestyle Intervention - A Focus Group Study.

PurposeWe aimed to use the self-efficacy model to examine the participants’ experience, attitudes, and viewpoints regarding the association between work, health and lifestyle factors that influence work participation after completing a new one-year multidisciplinary vocational rehabilitation (VR) programme with a lifestyle intervention for people on or at risk of sick leave due to obesity or obesity-related problems.Materials and MethodsThis case study was based on focus group (FG) interviews with 11 previous participants. The interviews were conducted 2 to 4 years after they completed the program, between August and September 2019. The analysis followed Braun and Clarke’s six-phase reflexive thematic analysis (RTA) approach.ResultsThe main theme “Work participation enhances quality of life” was prominent and related to mastery experience. Four sub-themes directly and indirectly affect work participation. The first sub-theme is “My attitude to life”, influenced by mastery experiences. Next, “Body size matters”, related to physiological and affective states. “Good physical capacity profit in everyday life” is associated to physiological and affective states, and the last “Support from the surroundings” influenced by vicarious experience and Verbal Persuasion.ConclusionThis study’s main finding highlights how participants value work participation as a meaningful activity that positively influences their work self-efficacy. Future VR programs should pay attention to interventions focusing on the workplace, cognitive approaches to develop skills for coping strategies, lifestyle change purposing BMI reduction, physical activity, and support from the surroundings.Clinical TrialsTechnical information about the study on Clinical Trials NCT03286374.

Efficacy of lifestyle intervention in adults with impaired glucose tolerance with and without impaired fasting plasma glucose: A post hoc analysis of Da Qing Diabetes Prevention Outcome Study.

The extent that pre-diabetic fasting plasma glucose (FPG) levels influence the effectiveness of lifestyle interventions in preventing type 2 diabetes (T2DM) is uncertain. We aimed to determine if the outcome of lifestyle intervention in people with impaired glucose tolerance (IGT) differs in those with normal or impaired FPG levels. Data were used from the Da Qing Diabetes Prevention Outcome Study, which was a 30-year follow-up of a 6-year randomized trial of lifestyle intervention in 576 people with IGT. We then conducted a post-hoc analysis to compare the efficacy of intervention to reduce the incidence of T2DM and its complications in those with baseline FPG <100 mg/dL and FPG ≥100 mg/dL. Lifestyle intervention reduced the cumulative incidence of T2DM by 37%-46% in those with baseline FPG <100 mg/dL and by 47%-51% in those with FPG ≥100 mg/dL. The FPG <100 mg/dL group had a lower cumulative incidence of diabetes and 6.41 years median delay in its onset compared with 2.21 years delay in the FPG ≥100 mg/dL group. In those with FPG <100 mg/dL intervention was associated with at least as great a reduction in cardiovascular disease and all-cause mortality as in the FPG ≥100 mg/dL group. Lifestyle intervention reduced the incidence of T2DM in people with IGT regardless of baseline FPG levels, and in those with FPG <100 mg/dL led to a substantial delay in its onset. All persons with IGT, with normal or impaired FPG levels, may benefit from lifestyle intervention to delay its onset and mitigate the incidence of T2DM.

Lifestyle and Work-Related Factors Associated with Work Ability and Work Participation for People with Obesity: A Prospective Observational Study After Vocational Rehabilitation

PurposeWe aimed to investigate which changes in the explanatory factors that were associated with positive change in the work ability score (WAS) and degree of work participation (DWP) for participants in a new 1-year vocational rehabilitation (VR) program for people on or at risk of sick leave due to obesity or obesity-related problems.Patients and MethodsThis prospective observational study included 95 participants with a body mass index (BMI) above 30 kg/m2. The 1-year multidisciplinary VR program with an integrated work and lifestyle intervention included 4 weeks of inpatient stay followed-up by five meetings. Differences between baseline and 12-month follow-up data were analyzed for the change in explanatory variables WAS, DWP, health-related quality of life (HRQoL), BMI, and return-to-work self-efficacy (RTWSE). The primary outcome was measured by multiple linear regression for predicting WAS and DWP.ResultsWe found significant changes in WAS (1.51, 95% CI: 0.83 to 2.20, p<0.001), DWP (18.69, 95% CI: 8.35 to 29.02, p<0.001), HRQoL (2.57, 95% CI: 1.35 to 3.79, p<0.001), BMI (−2.33, 95% CI: −3.10 to −1.56, p<0.001), and in RTWSE (15.89, 95% CI: 4.07 to 27.71, p = 0.009). Regression analysis yielded a strong association between WAS at 12-month follow-up with an increase in HRQoL (β=0.27, 95% CI: 0.16 to 0.38, p<0.001) and WAS baseline (β=0.49, 95% CI: 0.28 to 0.71, p<0.001). Further, regression analysis demonstrated a strong association between DWP at 12-month follow-up with return-to-work expectancy (RTWEXP) (β=−10.62, 95% CI: −15.25 to −6.03, p<0.001).ConclusionThe results indicate positive changes in WAS, DWP, HRQoL, BMI, and RTWSE from baseline to 12-month follow-up. For people with BMI above 30 kg/m2, changes in HRQoL are important for an increase in WAS, and a high RTWEXP is essential to achieve work participation. Future studies examining VR programs with lifestyle interventions for people with obesity are recommended.

Changes to body mass index, work self-efficacy, health-related quality of life, and work participation in people with obesity after vocational rehabilitation: a prospective observational study

BackgroundPeople on or at risk of sick leave from work due to obesity or obesity-related problems participated in a new vocational rehabilitation (VR). The study aimed to examine the outcome changes in the participants’ health-related quality of life (HRQoL), body mass index (BMI), return to work self-efficacy (RTWSE), work ability scale (WAS) and degree of work participation (DWP) after their participation in the 12-month VR programme. The secondary aim was to examine associations between the outcome changes and HRQoL at 12-month follow-up, measured with the HRQoL 15D instrument (15D).MethodsThis prospective observational study included 95 participants. The one-year multidisciplinary VR programme with an integrated work and lifestyle intervention included 4 weeks of inpatient stay followed-up by 5 meetings. A paired sample t-test was used to examine changes in HRQoL, BMI, RTWSE, WAS, and DWP between baseline and the 12-month follow-up. Multiple linear regression analyses explored associations between changes in HRQoL and the outcome variables.ResultsThe participants achieved statistically significant changes in HRQoL (2.57, 95% CI: 1.35 to 3.79), BMI (− 2.33, 95% CI: − 3.10 to − 1.56), RTWSE (15.89, 95% CI: 4.07 to 27.71), WAS (1.51, 95% CI: 0.83 to 2.20) and DWP (18.69, 95% CI: 8.35 to 29.02). At 12 months, a significant association was found between HRQoL and BMI (B = − 0.34, 95% CI: − 0.65 to − 0.04), RTWSE (B = 0.02, 95% CI: 0.004 to 0.04), WAS (B = 0.91, 95% CI: 0.55 to 1.28), DWP (B = − 0.02, 95% CI: − 0.04 to 0.001) and work absence (B = − 0.01, 95% CI: − 0.02 to − 0.002). The regression model explained 71.8% of the HRQoL variance.ConclusionThe results indicated positive changes in HRQoL, BMI, RTWSE, WAS and DWP from baseline to the 12-month follow-up. Factors associated with HRQoL at the 12-month follow-up were decreased BMI, increased RTWSE, improved WAS and reduced work absence. Future studies examining VR programmes with lifestyle interventions for people with obesity are recommended.Trial registrationNorwegian Regional Committee for Medical and Health Research Ethics (REC) 2017/573, Clinical Trials NCT03286374, registered 18. September 2017.https://clinicaltrials.gov/ct2/results?cond=Obesity&term=Anita+Dyb+Linge&cntry=NO&state=&city=&dist=

Update on technologies, medicines and treatments.

An abstract presented at the 2020 European Association for the Study of Diabetes (EASD) suggests that, in future, we might be able to monitor longer term exposure to glucose through our tears. The study measured glycated albumin (GA) in lacrimal fluid and found this to be strongly correlated to glycated albumin in blood, an indicator of glycaemia over a 2 week period.

Hypercholesterolemia and cardiovascular disease: What to do before initiating pharmacological therapy

The availability of efficient lipid-lowering drugs has substantially reduced the incidence and mortality for cardiovascular disease (CVD). Despite that, CVD still represents a major cause of death and disability; efforts are thus required to prevent this disease, since reducing the established CV risk factors may slow or prevent the onset of cardiovascular events. Current guidelines recommend a healthier lifestyle for all CV risk categories, as it may have a beneficial impact on several risk factors; in individuals with a low-to-moderate hypercholesterolemia, which are not eligible for a pharmacological approach and are not far from the cholesterol target recommended for their risk category, functional foods or nutraceuticals may be considered as supplement to reduce their CV risk status. Of note, counseling and lifestyle intervention in people at moderate CV risk represents a major issue for both preventing a further risk increase and reducing the need for drugs. Studies on general populations have clearly indicated that lifestyle interventions translate into a clinical benefit, with reduction of the incidence of myocardial infarction and the risk of developing type 2 diabetes.

Healthy Eating and Active Lifestyle After Bowel Cancer (HEAL ABC): feasibility randomised controlled trial protocol

BackgroundTargeting modifiable lifestyle factors including diet and physical activity represents a potentially cost-effective strategy that could support a growing population of colorectal cancer survivors and improve their health outcomes. Currently, effective, evidence-based interventions and resources helping people after bowel cancer to adopt new lifestyle habits are lacking. The aim of this trial is to test the Healthy Eating and Active Lifestyle After Bowel Cancer (HEAL-ABC) intervention to inform a future definitive randomised controlled trial.Methods/designThis is a feasibility randomised controlled trial. A total of 72 survivors who have completed surgery and all anticancer treatments will be recruited. The intervention group will receive HEAL-ABC resources based on behaviour change theory combined with supportive telephone calls informed by motivational interviewing every 2 weeks during the 3-month intervention, and once a month for 6 months to follow-up. Participants in the control group will follow usual care and have access to resources available in the public domain. The study is testing feasibility of the intervention including adherence and ability to collect data on anthropometry, body composition, diet, physical activity, behaviour change, quality of life, blood markers, contact with healthcare services, morbidities and overall survival.DiscussionThe proposed study will add to the evidence base by addressing an area where there is a paucity of data. This study on lifestyle interventions for people after colorectal cancer follows the Medical Research Council guidance on evaluating complex interventions in clinical practice. It focuses on people living after treatment for colorectal cancer and targets an important research area identified by cancer survivors as a research priority reported by the National Cancer Institute and James Lind Alliance UK.Trial registrationClinicalTrials.gov NCT04227353 approved on the 13th of January 2020