Lifestyle Intervention Research Articles

Behavior-change lifestyle interventions for the treatment of obesity in children and adolescents: A scoping review.

Behavior-change lifestyle interventions are fundamental in children and adolescent obesity management. This scoping review discusses optimal behavior-change lifestyle interventions in the treatment of overweight and obesity in children and adolescents. A literature search on diet, physical activity, and behavioral intervention for obesity treatment in children and adolescents aged 0-19 years was conducted in the Cochrane Library, MEDLINE (OVID), EMBASE, and ClinicalTrials.gov. Systematic reviews and meta-analyses with randomized controlled trials (RCTs) published in English from June 2016 to November 2022 were retrieved to identify recent advancements. Obesity outcomes included body weight, body mass index (BMI), BMI z-score, and fat percentage, among others. The 28 located reviews included: four studies on diet therapy; five on physical activity (exercise training); one on sedentary activities; 18 on multicomponent behavior-change lifestyle interventions, including three that incorporated gaming; three with eHealth, mobile health (mHealth), or telehealth, with one in each category; and two on motivational interviewing. Behavior-change lifestyle interventions to reduce obesity in children and adolescents were associated with moderate effects, with low-quality evidence for diet therapy and high-quality evidence for exercise training, both for weight or BMI reduction. Long-term intensive multicomponent behavioral interventions with parental involvement demonstrated better effects.

Modifiable Risk Factors for Breast Cancer: Insights From Systematic Reviews.

To conduct a comprehensive review of reversible factors associated with breast cancer, with the aim of offering insights for the creation of early intervention strategies for breast cancer prevention. The PubMed, EMBASE, and Scopus databases were systematically searched to collect systematic reviews and meta-analyses related to breast cancer risk. Searches were limited to literature published from the inception of each database up to May 1, 2024. Two investigators independently screened the literature, extracted data, and assessed the methodological quality and evidence synthesis of the studies included in our review. We included 31 systematic reviews in our analysis, and breast cancer risk factors were divided into four categories: diet and lifestyle habits, reproductive and familial factors, body weight and physical activity, and environmental and miscellaneous factors. Our findings suggest that a high-fat diet, low intake of dietary fiber, alcohol consumption, smoking, and obesity are linked to a higher risk of breast cancer. Conversely, physical activity and breastfeeding appear to lower breast cancer risk. However, the methodological and evidence quality of the reviewed studies was generally low, necessitating caution in the application of these findings. Additionally, there is a need for more research into lifestyle interventions to better develop and advocate for effective breast cancer prevention strategies.

Development of the Dutch translational knowledge agenda for inherited metabolic diseases

AbstractBackgroundInherited metabolic diseases (IMDs) may have considerable implications for patients and their families. Despite their individual rarity, covering a spectrum of over 1800 distinct diseases, the diseases collectively exert a significant impact, with often lifelong disabilities. The United for Metabolic Diseases consortium was established to catalyze research with translation into the best possible care.AimTo generate a translational knowledge agenda, which identifies and prioritizes research questions, directly relevant to patient care or for IMD patients and their families.Methods and ResultsFollowing a process established by the Knowledge Institute of the Dutch Association of Medical Specialists, we generated a comprehensive translational knowledge agenda for IMDs. A multidisciplinary steering committee, composed of 12 diverse metabolic experts collected research questions through an online questionnaire using snowballing. The 462 proposed questions were categorized and prioritized during a meeting attended by 22 representatives of all stakeholder groups. The resulting top 10 research questions cover multiple themes, i.e. prediction of disease progression, development of novel tools, mechanistic insights, improved diagnostics, therapeutic integration of multi‐omics techniques, assessment of impact on daily life, expanding treatment avenues, optimal study designs, effect of lifestyle interventions, and data utilization using FAIR principles.DiscussionThis collective endeavor reflects the collaborative spirit needed for rare disease research. This knowledge agenda will guide funding directions and applications but will also boost interdisciplinary collaboration to push the field of IMDs research forward in a renewed UMD consortium. Patient engagement, transparency, and a comprehensive approach make this knowledge agenda a pivotal step toward addressing the pressing research needs and priorities in this domain.

Reallocating Time Between 24-h Movement Behaviors for Obesity Management Across the Lifespan: A Pooled Data Meta-Analysis of More Than 9800 Participants from Seven Countries.

The distribution of time across physical activity, sedentary behaviors, and sleep appears to be essential for the management of obesity. However, the impact of reallocating time among these behaviors, collectively known as 24-h movement behaviors, remains underexplored. This study examines the theoretical effects of reallocating time between 24-h movement behaviors on obesity indicators across different age groups. We performed a pooled data meta-analysis of 9818 participants from 11 observational and experimental studies. To estimate the time spent in movement behaviors, we reprocessed and harmonized individual-level raw accelerometer-derived data. Isotemporal substitution models estimated theoretical changes in body mass index (BMI) and waist circumference (WC) associated with time reallocation between movement behaviors. We performed the analysis separately for children, adolescents, adults, and older adults. Even minor reallocations of 10min led to significant changes in obesity indicators, with pronounced effects observed when 30min were reallocated. The most substantial adverse effects on BMI and WC occurred when moderate-to-vigorous physical activity (MVPA) was reallocated to other movement behaviors. For 30-min reallocations, the largest increase in BMI (or BMI z-score for children) occurred when MVPA was reallocated to light-intensity physical activity (LPA) in children (0.26 units, 95% confidence interval [CI] 0.15, 0.37) and to sedentary behavior (SB) in adults (0.72kg/m2, 95% CI 0.47, 0.96) and older adults (0.73kg/m2, 95% CI 0.59, 0.87). The largest increase in WC was observed when MVPA was substituted with LPA in adults (2.66cm, 95% CI 1.42, 3.90) and with SB in older adults (2.43cm, 95% CI 2.07, 2.79). Conversely, the highest magnitude of the decrease in obesity indicators was observed when SB was substituted with MVPA. Specifically, substituting 30min of SB with MVPA was associated with a decrease in BMI z-score by - 0.15 units (95% CI - 0.21, - 0.10) in children and lower BMI by - 0.56kg/m2 (95% CI - 0.74, - 0.39) in adults and by - 0.52kg/m2 (95% CI - 0.61, - 0.43) in older adults. Reallocating time away from sleep and LPA showed several significant changes but lacked a consistent pattern. While the predicted changes in obesity indicators were generally consistent across age groups, inconsistent findings were observed in adolescents, particularly for reallocations between MVPA and other behaviors. This investigation emphasizes the crucial role of MVPA in mitigating obesity risk across the lifespan, and the benefit of substituting SB with low-intensity movement behaviors. The distinct patterns observed in adolescents suggest a need for age-specific lifestyle interventions to effectively address obesity. Emphasizing manageable shifts, such as 10-min reallocations, could have significant public health implications, promoting sustainable lifestyle changes that accommodate individuals with diverse needs, including those with severe obesity.

Effects of Physical Activity and Exercise Interventions on Health Outcomes in Occupational Drivers: A Systematic Review.

Occupational drivers are exposed to a wide range of risk factors, including sedentary behavior and physical inactivity, which can contribute to various chronic diseases. However, exercise interventions are likely to alleviate the negative associations and reduce chronic disease risks. This systematic review aimed to inventorize research studies investigating the effects of physical activity and exercise interventions on health outcomes in occupational drivers, and to assess interventions that have demonstrated effectiveness on health outcomes in occupational drivers. The electronic databases "Web of Science," "Scopus," and "PubMed" were searched using keywords related to "occupational drivers," "exercise," and "health outcomes." Studies were included if they examined the effects of physical activity and exercise among occupational drivers on the following health outcomes: pain, disability, lifestyle factors (sleep, weight, physical activity, nutrition), fatigue, stress, and cardiometabolic risk factors. The methodological quality of the studies was assessed by the Cochrane Risk of Bias tools for randomized and non-randomized studies. Fourteen articles were included (three randomized and 11 non-randomized controlled trials). All studies were judged to have an overall risk of bias as "some concerns, low, moderate or serious." Evidence suggests that stretching and isometric exercises have significantly improved pain, disability, and fatigue. In contrast, multicomponent lifestyle interventions have enhanced physical activity levels, cardiometabolic risk factors, anthropometrics (body mass index, weight, waist circumference), sleep, and dietary intake among occupational drivers. The available evidence indicates the potential benefits of exercise interventions and physical activity for health outcomes in occupational drivers. However, high-quality studies are needed in the future to establish stronger evidence supporting the effect of the exercise intervention.

Evaluation of the efficacy and safety of controlled-release phentermine/topiramate in adults with obesity in Korea: A randomized, double-blind, placebo-controlled, phase 4 trial (QUEEN's study).

This study evaluated the efficacy and safety of a combination of phentermine and delayed-release topiramate (PHEN/TPM CR) versus placebo as an adjunct to standard lifestyle recommendations in Korean adults. This 56-week, randomized, double-blind, placebo-controlled, phase 4 trial enrolled adults (age 19-70 years) with obesity (BMI ≥ 25 kg/m2) at eight sites in South Korea. After a 12-week lifestyle programme, participants were randomly assigned in a 1:1 ratio to receive PHEN/TPM CR or placebo. PHEN/TPM CR was commenced at 3.75 mg/23 mg daily for 14 days and increased to 7.5 mg/46 mg daily, and to 15 mg/92 mg if 3% weight loss was not achieved after 12 weeks. The primary outcomes were percentage change in body weight from baseline to Week 56. A total of 232 participants underwent randomization. At 56 weeks, the percentage change in body weight was -8.3% with PHEN/TPM CR and -2.3% with placebo (treatment difference -6.1%; 95% confidence interval [CI], -7.7 to -4.5, p < 0.001). Participants receiving PHEN/TPM CR were more likely to achieve ≥5% weight loss compared with those receiving placebo (68.5% vs. 25.0%, odds ratio [OR], 6.4; 95% CI, 3.5 to 11.6; p < 0.001). Dizziness, paraesthesia and dry mouth were more common in the PHEN/TPM CR group, although most adverse events were mild or moderate. Administration of PHEN/TPM CR plus lifestyle intervention in Korean adults with obesity resulted in a greater reduction in body weight and adiposity than lifestyle intervention alone.

Insulin clearance at randomisation and in response to treatment in youth with type 2 diabetes: a secondary analysis of the TODAY randomised clinical trial.

Insulin resistance and compensatory hyperinsulinaemia are core features leading to beta cell failure in youth-onset type 2 diabetes. Insulin clearance (IC) is also a key regulator of insulin concentrations, but few data exist on IC in youth-onset type 2 diabetes. In a secondary analysis of our Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) randomised clinical trial, we investigated potential sex-, race-, ethnicity-and treatment-related differences in IC in youth-onset type 2 diabetes and aimed to identify metabolic phenotypes associated with IC at baseline and in response to metformin, metformin plus a lifestyle intervention, and metformin plus rosiglitazone. A total of 640 youth aged 10-18 years with type 2 diabetes underwent fasting blood tests, anthropometric measurements, dual-energy x-ray absorptiometry to estimate subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT) mass, and OGTTs longitudinally over 5 years. IC was calculated from the fasting C-peptide:insulin ratio (fasting IC) and 2 h OGTT C-peptide incremental AUC (iAUC):insulin iAUC ratio (2 h IC). Linear mixed models were used to assess covariate effects on the mean of IC over repeated time points. Baseline fasting IC (×10-2 nmol/pmol) was significantly lower in female participants than male participants (median [IQR] 0.72 [0.57-0.93] vs 0.79 [0.63-1.00], respectively; p=0.04) and in non-Hispanic Black participants than Hispanic and non-Hispanic White participants (median [IQR] 0.64 [0.51-0.81] vs 0.78 [0.64-1.00] vs 0.84 [0.68-1.01], respectively; p<0.0001). Similar results were observed for 2 h IC. Lower IC most strongly correlated with higher weight over time (% change [95% CI] in IC per 5 kg increase: fasting IC -1.52 [-2.05, -0.99]; 2 h IC -3.46 [-4.05, -2.86]). Lower IC also correlated with other markers of adiposity (higher BMI and SAT mass), and markers of insulin sensitivity (higher waist:height ratio, VAT mass, VAT:SAT mass ratio, triacylglycerol concentrations, triacylglycerol:HDL-cholesterol ratio, aspartate aminotransferase [AST] and alanine aminotransferase [ALT] concentrations, and systolic and diastolic BP, and lower HDL-cholesterol and total and high molecular weight adiponectin concentrations) over time. Beta cell function as determined from OGTTs, not insulin sensitivity or IC, was predictive of persistently elevated blood glucose levels. IC was higher with metformin+rosiglitazone than metformin alone (p=0.03 for fasting IC; p=0.02 for 2 h IC) and metformin+lifestyle (2 h IC, p=0.005), but not after adjusting for adiponectin (p value not significant for all). In youth with type 2 diabetes, low IC is correlated with female sex, non-Hispanic Black race and ethnicity, and markers of adiposity and insulin resistance, but not with beta cell function. Along with insulin sensitivity and adiponectin, IC increased in response to rosiglitazone treatment. These findings suggest that, in youth-onset type 2 diabetes, low IC is a compensatory response to changes in insulin sensitivity and/or adiponectin concentrations and is not a mediator of beta cell function. ClinicalTrials.gov NCT00081328 DATA AVAILABILITY: Data from the TODAY study (V4; https://doi.org/10.58020/2w6w-pv88 ) reported here are available on request from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Central Repository (NIDDK-CR) Resources for Research ( https://repository.niddk.nih.gov/ ).

The interplay between hypothalamic and brainstem nuclei in homeostatic control of energy balance.

Energy balance and body weight are tightly regulated by homeostatic and hedonic systems of the brain. These systems are ultimately finely tuned by hypothalamic and extrahypothalamic neurocircuitry that modulate feeding and the appetite signalling cascade. The hypothalamus has been extensively researched and its role in homeostatic regulation of energy balance is well established. Later on, evidence indicated that extrahypothalamic signalling also has a critical role in regulation of body mass across the lifespan. One of these brain regions was the brainstem and specifically the dorsal vagal complex (DVC), which comprises of the area postrema (AP), nucleus of the solitary tract (NTS) and dorsal motor complex of the vagus (DMV). These brain stem nuclei were shown to also finely tune feeding behaviour through catecholaminergic, glutamatergic, and GABAergic signals. Moreover, these nuclei also receive afferent signals from the viscera through the gut, as well as humoral input from the bloodstream. Therefore, these brain stem nuclei are deemed as the port of entry where initial appetite-related signals are first conveyed and then modulated to the forebrain to hypothalamic and extrahypothalamic regions such as the arcuate nucleus (ARC) and parabrachial nucleus (PBN). Understanding the intricate interactions and projections between hypothalamic and brainstem nuclei is instrumental to comprehend energy balance regulation as a whole and to potentially address metabolic conditions such as diabetes and obesity. Further research in this area may lead to the development of targeted pharmacological and lifestyle intervention strategies that could lead to mitigation of metabolic disorders and/or promote a healthier body mass across the life span.

Effects of School-Based Lifestyle Interventions on Cardiovascular Health in Chinese Children and Adolescents: A Post Hoc Analysis of a National Multicenter Study.

We evaluated the effects of a national school-based lifestyle intervention program against childhood obesity on improving cardiovascular health (CVH), assessed using the recently introduced Life's Essential 8 metric framework. Our post hoc analysis of the national school-based lifestyle intervention targeting diet and physical activity included 94 schools with eligible students aged 7 to 17 years (intervention group n=30 629; control group n=26 581). We assessed CVH metrics by individual scores for 4 health behaviors (diet, physical activity, nicotine exposure, and body mass index) and 3 health factors (blood lipids, glucose, and pressure). These scores were subsequently combined to calculate the CVH score, health behavior score, and health factor score. The primary outcomes were these 3 composite scores and high CVH (CVH score≥80). All analyses applied a likelihood-based random-effects regression modeling following the intention-to-treat. The school-based lifestyle intervention was associated with a 0.89-point increase in the CVH score (95% CI, 0.03-1.74), 14% greater odds of having high CVH (odds ratio, 1.14 [95% CI, 1.01-1.29]), and a 1.35-pointimprovement in the health behavior score (95% CI, 0.32-2.38). According to our subgroup analyses, this intervention had stronger favorable effects on CVH and health behavior scores in primary (grades 1-6) and junior (grades 7-9) schools than in senior high (grades 10-12) schools (P<0.001). This school-based lifestyle intervention improved CVH behaviors in Chinese children and adolescents. The differences in the intervention effect according to school grade imply critical windows for forming healthy lifestyles at younger ages. URL: https://www.clinicaltrials.gov; Unique identifier: NCT02343588.

Effects of a physical activity intervention on perceived stress, fatigue, and depressive symptoms in older adults: A secondary analysis of the LIFE Study.

Engaging in physical activity is critical for maintaining well-being in older adults, particularly those at heightened risk for mobility disability. We assessed the effects of a physical activity (PA) intervention on perceived stress, fatigue, and depressive symptoms compared to a health education (HE) program in older adults with mobility challenges and evaluated differential effects of the interventions among those with the poorest self-rated mental health at baseline. Secondary data analysis of the Lifestyle Interventions and Independence for Elders (LIFE) Study, a single-blinded, parallel randomized controlled trial conducted between February 2010 and December 2013. The PA intervention included walking, strength exercises, balance training, and flexibility activities. The HE intervention consisted of workshops on health topics for older adults. The main outcomes for our analysis included standardized scales with participants self-reporting their stress, fatigue, and depressive symptoms at baseline, 12 months, and 24 months post-randomization. Results from the 1,495 participants (Mage = 78 years; 66% female in both groups) showed no significant between-group differences in perceived stress, fatigue, or depressive symptom scores over time. However, in both intervention groups, participants with worse baseline scores showed a steady improvement in symptom scores over time compared to the remaining participants, who showed some decline (p-value for interaction<0.05). Among mobility-impaired individuals, a long-duration, group-based PA intervention had no more impact on stress, fatigue, or depressive symptoms compared to a group-based HE intervention. However, participants with higher symptoms at baseline showed improvement over time in both intervention groups.

Acupuncture and electroacupuncture for cyclic vomiting syndrome with tachygastria in an adult: A case report.

Cyclic vomiting syndrome (CVS) is characterized by recurrent episodes of acute vomiting lasting <1 week, occurring independently and chronically. Management typically involves lifestyle interventions, supportive care, and preventative medication. In rare cases, CVS persists for decades in adults, requiring a multidisciplinary approach to improve symptoms and quality of life. A 30-year-old male patient presented with a 7-year history of recurrent nausea and vomiting, which initially began in 2017. The episodes occurred without identifiable triggers such as alcohol or overeating, increasing in frequency from once every 4 months to 2 months. He expressed fear of severe deterioration, impacting his ability to eat freely, work, and enjoy his hobbies. He was diagnosed with CVS based on the Rome criteria. Cutaneous electrogastrography showed postprandial power decrease and tachygastria. Regular acupuncture treatments, including electroacupuncture at ST36 with 3 Hz, were administered twice a week for 3 weeks, followed by weekly sessions for 5 additional weeks. Over 11 treatment sessions across 8 weeks, no nausea or vomiting was observed. The visual analog scale (VAS) score for subjective gastrointestinal discomfort decreased from 67 to 0 after 4 weeks. The Nausea Severity Scale (NSS) score dropped from 14 to 0 after 4 weeks. The Functional Dyspepsia-related QoL score decreased from 16 to 0 after 8 weeks. The Nepean Dyspepsia Index-Korean version decreased from 80 to 8 after 8 weeks. Furthermore, the patient expressed high satisfaction with the treatment, and no adverse events were observed. Acupuncture offers a significant and safe approach to relieving symptoms and enhancing the quality of life for patients with nausea and vomiting. Although this is a single case report, the findings suggest that acupuncture can improve treatment compliance and manage symptoms in adults with CVS. Further research, including clinical trials, is required to confirm these findings and understand the underlying mechanisms.

RE: "Narrative Review of Lifestyle Interventions in Breast Cancer Survivors: Current Evidence and Future Directions".

RE: "Narrative Review of Lifestyle Interventions in Breast Cancer Survivors: Current Evidence and Future Directions".

Comparing Synchronous and Asynchronous Remotely Delivered Lifestyle Interventions: Protocol for a Randomized Noninferiority Trial.

Remotely delivered lifestyle interventions have emerged to increase the reach and accessibility of traditional interventions that involve numerous in-person visits. Remote interventions can be delivered synchronously via videoconference software or phone or asynchronously via online platforms. Asynchronously delivered interventions are convenient and flexible in that they allow people to participate at any time and as such, they may be more sustainable. Evidence for asynchronous interventions is needed given their potential for convenience and sustainability, which may have implications for weight loss maintenance. This is a randomized noninferiority trial comparing 2 remotely delivered lifestyle interventions: one that is delivered synchronously via videoconference meetings and one that is delivered asynchronously through private Facebook (Meta) groups. We hypothesize that the percent weight loss difference between conditions at 6 and 12 months will be less than 2% and that the asynchronous condition will cost less to deliver per pound lost. We also hypothesize that engagement will be higher in the asynchronous condition at 12, 18, and 24 months and that the asynchronous condition will have greater weight loss at 24 months. We will randomize 328 participants with overweight or obesity to a remotely delivered lifestyle intervention that is delivered either synchronously or asynchronously. Delivery of the synchronous lifestyle intervention will be via videoconference group sessions, whereas the delivery of the asynchronous lifestyle intervention will be via private Facebook groups. The lifestyle intervention in both conditions is based on the Diabetes Prevention Program. The intervention goals are to lose 5%-10% of baseline weight and to work toward 300 minutes per week of moderate intensity physical activity. The core intervention will last for 12 months and be led by counselors in each group. This will be followed by a 12-month maintenance phase to be led by participant volunteers from each group. Participant engagement and weight loss maintenance will be assessed during this phase. The primary outcome is mean percent weight loss at 6 and 12 months. The noninferiority margin for differences in weight loss between conditions is 2% at both 6 and 12 months. We will model percent weight loss at 6 and 12 months using general linear regression models with the intent-to-treat sample. Secondary outcomes include engagement, collective efficacy, cost, and weight loss at 18 and 24 months. The funding period began on August 17, 2023, and the study was approved by the University of Connecticut Institutional Review Board on August 17, 2023. Participant recruitment will begin December 2024 and the intervention will begin February 2024. If hypotheses are confirmed, this work will provide evidence that asynchronously delivered remote interventions are as efficacious as synchronously delivered ones and more sustainable such that people will engage in them longer and retain more weight loss for less cost. ClinicalTrials.gov NCT06393725; https://tinyurl.com/4kzzwkc9. PRR1-10.2196/65323.

Effect of a yoga and naturopathy-based lifestyle intervention with nine-month follow-up on lipid profile in patients with hypertension: A two-arms parallel group randomized controlled trial.

Hypertension is recognized as a modifiable risk factor for cardiovascular diseases, alongside dyslipidemia. Studies have revealed that between 15% to 31% of individuals have both hypertension and dyslipidemia. However, emerging evidence suggests that natural therapies and yoga can help manage mild increases in blood pressure. This study aims to evaluate the impact of yogic and naturopathy treatments on lipid profiles in hypertensive patients, thereby contributing to the existing literature. A randomized controlled experiment was conducted, involving 262 hypertensive patients randomly assigned to either the study group (SG) or control group (CG). The SG, consisting of 131 individuals, received yoga and naturopathic treatments for 10 days, while the CG (n=131) did not. The lipid profile was measured at the beginning and end of the 10 days and they were followed-up and reassessed after 9 months. The study involved a total of 262 individuals, with 111 in the SG and 125 in the CG. After the 10-day intervention period, the SG showed significant reductions in Total cholesterol (TC), Triglycerides (TG), High-density lipoprotein (HDL-C), Low-density lipoprotein (LDL-C), Very-low density lipoprotein (VLDL), Apolipoprotein-A (Apo-A), Apolipoprotein-B (Apo-B), and Lipoprotein-A(Lp-A) (p<0.001) compared to the CG. Also, the change was observed after 9 months in Apo-A, Apo-B, and Lp-A significantly (p<0.001). These findings underscore the potential of naturopathic and yogic interventions in improving lipid profiles in hypertensive patients, thereby contributing to the current literature. In conjunction with conventional management, these specific interventions could be considered as a safer form of complementary therapy in the treatment of dyslipidemia among hypertensive patients. Thus, these findings hold promise for the integration of naturopathic and yogic therapies in the standard care of hypertensive patients.

The SLaM Brain Health Clinic: remote biomarker enhanced memory clinic for people with mild cognitive impairment within a National Health Service mental health trust.

The novel South London and Maudsley Brain Health Clinic (SLaM BHC) leverages advances in remote consultations and biomarkers to provide a timely, cost-efficient and accurate diagnosis in mild cognitive impairment (MCI). To describe the organisation, patient cohort and acceptability of the remote diagnostic and interventional procedures. We describe the recruitment, consultation set-up, the clinical and biomarker programme, and the two online group interventions for cognitive wellbeing and lifestyle change. We evaluate the acceptability of the remote consultations, lumbar puncture, saliva genotyping, and remote cognitive and functional assessments. We present the results of the first 68 (mean age 73, 55% female, 43% minoritised ethnicity) of 146 people who enrolled for full remote clinical, cognitive, genetic, cerebrospinal fluid and neuroimaging phenotyping. A total of 86% were very satisfied/satisfied with the remote service. In all, 67% consented to lumbar puncture, and 95% of those were very satisfied, all having no significant complications. A total of 93% found taking saliva genotyping very easy/easy, and 93% found the cognitive assessments instructions clear. In all, 98% were satisfied with the Cognitive Wellbeing Group, and 90% of goals were achieved in the Lifestyle Intervention Group. The SLaM BHC provides a highly acceptable and safe clinical model for remote assessments and lumbar punctures in a representative, ethnically diverse population. This allows early and accurate diagnosis of Alzheimer's disease, differentiation from other MCI causes and targets modifiable risk factors. This is crucial for future disease modification, ensuring equitable access to research, and provides precise, timely and cost-efficient diagnoses in UK mental health services.

Key challenges of post-liver transplant weight management.

Liver transplantation serves as a life-saving intervention for patients with end-stage liver disease, yet long-term survival remains a challenge. Post-liver transplant obesity seems to have a significant contribution to this challenge and it emerges as a significant risk factor for graft steatosis, metabolic syndrome and de-novo malignancy development. This review synthesizes current literature on prevalence, risk factors and management strategies for post-liver transplant obesity, emphasizing its impact on graft and patient survival. Literature review consultation was conducted in Medline/PubMed, SciELO and EMBASE, with the combination of the following keywords: Weight management, liver transplantation, immunosuppressive therapy, lifestyle interventions, bariatric surgery. Immunosuppressive therapy has a significant influence on long-term survival of liver transplant patients, yet it seems to have lesser effect on post-transplant obesity development than previously thought. However, it significantly contributes to the development of other components of metabolic syndrome. Key predisposing factors for post-transplant obesity development encompass elevated recipient and donor body mass index, a history of alcoholic liver disease, hepatocellular carcinoma, male gender, the absence of cellular rejection and the marital status of the recipient. Tailored immunosuppressive regimens, pharmacotherapy, lifestyle interventions and bariatric surgery represent key components in mitigating post-transplant obesity and improving long-term survival and quality of life in this group of patients. Timely identification and intervention thus hold paramount importance. Further research is warranted to refine optimal management strategies and enhance outcomes in this patient population.

Intuitive eating predictors and outcomes in people with severe mental illness participating in a lifestyle intervention.

People with severe mental illness (SMI) are at higher risk of preventable diseases than the general population; poor diet contributes to heightened risk. Adaptive approaches designed to improve intuitive eating may improve dietary behaviours in people with SMI. Aims of this study were to investigate predictors of, and assess the impact of a nutrition program on, intuitive eating in people with SMI. This was a retrospective analysis of an exercise and nutrition program for people with SMI. The primary outcome was intuitive eating assessed using the Intuitive Eating Scale 2 (IES2); psychological distress was measured using the Kessler-6 scale. Regression analyses were conducted on baseline data; change in intuitive eating was assessed using Wilcoxon tests. A total of 93 participants had complete data for regression analyses, and 32 completed pre/post-assessments. The most common mental health diagnosis was psychotic disorder (35%); 74% had BMI > 25 kg/m2. The regression model significantly predicted total IES2 score and three intuitive eating domains. Body mass index (BMI) was negatively associated with these outcomes (β = -0.234 to -0.248; p < 0.05). Both BMI and psychological distress were negatively associated with body-food choice congruence (B-FCC), and only B-FCC was improved at post-intervention. Higher BMI and psychological distress were associated with lower intuitive eating in people with SMI. Nutrition interventions may improve B-FCC in people with SMI. SO WHAT?: Given the interrelatedness of BMI and psychological distress with psychosocial stressors, nutritional interventions should be implemented alongside holistic approaches to improve health equality.

Polyphenol-Derived Microbiota Metabolites and Cardiovascular Health: A Concise Review of Human Studies

Polyphenols, plant-derived secondary metabolites, play crucial roles in plant stress responses, growth regulation, and environmental interactions. In humans, polyphenols are associated with various health benefits, particularly in cardiometabolic health. Despite growing evidence of polyphenols’ health-promoting effects, their mechanisms remain poorly understood due to high interindividual variability in bioavailability and metabolism. Recent research highlights the bidirectional relationship between dietary polyphenols and the gut microbiota, which can influence polyphenol metabolism and, conversely, be modulated by polyphenol intake. In this concise review, we summarized recent advances in this area, with a special focus on isoflavones and ellagitannins and their corresponding metabotypes, and their effect on cardiovascular health. Human observational studies published in the past 10 years provide evidence for a consistent association of isoflavones and ellagitannins and their metabotypes with better cardiovascular risk factors. However, interventional studies with dietary polyphenols or isolated microbial metabolites indicate that the polyphenol–gut microbiota interrelationship is complex and not yet fully elucidated. Finally, we highlighted various pending research questions that will help identify effective targets for intervention with precision nutrition, thus maximizing individual responses to dietary and lifestyle interventions and improving human health.

Long-term impact of Diabetes Prevention Program interventions on walking endurance

ObjectivesType 2 diabetes (T2D) and prediabetes are associated with poor walking endurance, a marker of physical function. We aimed to examine the long-term effects of metformin or intensive lifestyle intervention in adults at high risk of T2D on their 6-min walk test (6MWT) performance.MethodsParticipants were randomized in the 3-year Diabetes Prevention Program (DPP) to one of the three groups: lifestyle intervention, metformin, or placebo, and were subsequently followed in the DPP Outcomes Study. A 6MWT was conducted 20 years after randomization. Associations between DPP interventions and 6MWT completion (achieving a distance ≥200 m) were assessed using logistic regression. Among the test completers, differences in distance walked (6MWD) were evaluated using multivariable linear regression. Additional variables of interest included concomitant measures of body mass index (BMI) and grip strength along with mean measures of HbA1c and self-reported physical activity (PA).ResultsData on 1830 participants were analyzed. The interventions were not associated with test completion or the 6MWD among test completers (362, 364, and 360 m in the lifestyle, metformin, and placebo groups, respectively, p = 0.8). Age, education, grip strength, and PA were each significantly associated with the 6MWT completion and the 6MWD after adjustment. Grip strength, PA, and education were positively associated with the 6MWD, while age, BMI, and HbA1c were negatively associated with the 6MWD.ConclusionWe confirmed that the 6MWT is related to other measures of physical ability such as PA and grip strength in persons at risk for and with T2D, suggesting potential long-term benefits of maintaining a healthy lifestyle. However, we did not observe a sustained effect of the original randomized interventions.Clinical trial registrationhttp://www.clinicaltrials.gov/ct/show/NCT00004992, identifier DPP NCT00004992; http://www.clinicaltrials.gov/ct/show/NCT00038727, identifier DPPOS NCT00038727

What is the Current Knowledge and Experience on Preventive Pathway for Healthy Ageing in Italy? A Scoping Review.

Worldwide population is ageing rapidly. Lifestyle factors are essential targets for leading to behaviour change interventions that promote healthy aging. We performed a scoping review aimed to underline the current knowledge and experience on preventive interventions for healthy and active ageing in Italy. Secondly, it intended to study the manner in which this country will pursue the topic in this research area. The search was conducted on different databases: PubMed, CINAHL, Embase, and Scopus on July 25th, 2023, and search results were filtered to include only articles published from 2003. A total of 951 potentially relevant records were retrieved. After duplicates removal, 810 unique records were screened. Finally, four studies fulfilling established criteria were included. All the studies were conducted in the northern and central regions of Italy. The investigated populations were older adults, and all four studies were focused mainly on primary prevention and health promotion strategies based on self-efficacy and motivation of the participants, including physical activity, diet and cognitive training. In addition, two studies used mobile health technologies to deliver the preventive intervention for healthy ageing. Our scoping review underlines the limited knowledge and experience of preventive healthy aging interventions in the national setting. The new preventive pathway that promotes healthy ageing healthily should be based on tailored lifestyle interventions, managed by multidisciplinary teams with the use of digital tools, in order to improve older people's safety. The characteristics of the settings are still not clear.