Lifestyle Modification Program Research Articles

Role of Synchronized Lifestyle Modification Program and Physiotherapy in Peripheral Neuropathy in Insulin Dependent Type 2 Diabetics

Background: Distal symmetrical polyneuropathy is the most common form of diabetic peripheral neuropathy. Management of peripheral neuropathy through dietary modification and exercise synchronized with circadian rhythm optimizes metabolic parameters, thus restoring nerve functions. Aim: To determine the effect of Synchronized lifestyle modification program (SLP) and Physiotherapy on Michigan neuropathy screening instrument (MNSI), Fasting blood glucose (FBG), HbA1c, Lipid profile and Nerve conduction studies (NCS) in insulin dependent type 2 diabetic neuropathy patients. Study Design: Randomized Controlled Trial Place and Duration: Study was carried out in Physiology department of Islamic International Medical College (Riphah international University) in collaboration with Physiotherapy Department, Railway Hospital, Rawalpindi for a duration of 1 year from October 2020 to October 2021. Methodology: 120 Type 2 diabetic neuropathic patients on insulin were recruited after written informed consent. Baseline evaluation included; assessment of lifestyle pattern, MNSI, FBG, HbA1c, lipid profile and NCS. Patients were divided into Group A (Control) and Group B (Experimental). Group B was subdivided into Group B1 who received SLP, Group B2 received combined SLP and Physiotherapy and Group B3 received Physiotherapy for 12 weeks. Analysis of parameters was done by repeated measure ANOVA. p≤0.05 was considered as significant. Results: MNSI, FBG, HbA1c, serum cholesterol, TGs and LDLs were significantly improved in Group B2. HDL levels and Nerve conduction parameters were not found to be significant. Conclusion: Combined Synchronized Lifestyle Modification Program and Physiotherapy is more effective in type 2 diabetic neuropathy patients on Insulin. Keywords: Synchronized lifestyle modification programme, Diabetic peripheral neuropathy, Distal symmetrical polyneuropathy.

Effectiveness of Incentives for Improving Diabetes-Related Health Indicators in Chronic Disease Lifestyle Modification Programs: a Systematic Review and Meta-Analysis.

We examined the effectiveness of providing incentives to participants in lifestyle modification programs to improve diabetes-related health indicators: body weight, body mass index (BMI), blood pressure, cholesterol, and hemoglobin A1C (HbA1C). We also examined the potential effect of 4 different incentive domains (ie, type, monetary value, attainment certainty, and schedule) on those indicators. We searched Medline, Embase, PsycINFO, and Cochrane Library to identify relevant studies published from January 2008 through August 2021. We used a random-effects model to pool study results and examine between-study heterogeneity by using the I2 statistic and the Cochran Q test. We also conducted moderator analyses by using a mixed-effects model to examine differences between subgroups of incentive domains (eg, incentive type [cash vs other types]). Our search yielded 10,965 articles, of which 19 randomized controlled trials met our selection criteria. The random-effects model revealed that, relative to the control group, the incentive group had significant reductions in weight (-1.85kg; 95% CI, -2.40 to -1.29; P < .001), BMI (-0.47kg/m2; 95% CI, -0.71 to -0.22; P < .001), and both systolic blood pressure (-2.59 mm HG; 95% CI, -4.98 to -0.20; P = .03) and diastolic blood pressure (-2.62 mm Hg; 95% CI, -4.61 to -0.64; P = .01). A reduction in cholesterol level was noted but was not significant (-2.81 mg/dL; 95% CI, -8.89 to -3.28; P = .37). One study found a significant reduction in hemoglobin A1c (-0.17%; 95% CI, -0.30% to -0.05%; P < .05). The moderator analyses showed that the incentive effect did not vary significantly between the subgroups of the incentive domains, except on weight loss for the attainment certainty domain, suggesting that a variety of incentive subgroups could be equally useful. Providing incentives in lifestyle modification programs is a promising strategy to decrease weight, BMI, and blood pressure.

Modification of the diabetes prevention program for the treatment of nonalcoholic fatty liver disease: A pilot study.

The Diabetes Prevention Program (DPP) is the gold standard lifestyle modification program that reduces incident type 2 diabetes mellitus. Patients with prediabetes and patients with non-alcoholic fatty liver disease (NAFLD) often share metabolic features; we hypothesized that the DPP could be adapted and used to improve outcomes in patients with NAFLD. NAFLD patients were recruited into a 1year modified DPP. Demographics, medical comorbidities, and clinical laboratory values were collected at baseline, 6 and 12months. The primary endpoint was change in weight at 12months. Secondary endpoints were changes in hepatic steatosis, metabolic comorbidities, and liver enzymes (per-protocol basis) and retention at 6 and 12months. Fourteen NAFLD patients enrolled; three dropped out before 6months. From baseline to 12months, hepatic steatosis (p=0.03), alanine aminotransferase (p=0.02), aspartate aminotransferase (p= 0.02), high-density lipoprotein (p=0.01) and NAFLD fibrosis score (p<0.001) improved, but low-density lipoprotein worsened (p=0.04). Seventy-nine percent of patients completed the modified DPP. Patients lost weight and had improvements in five out of six indicators of liver injury and lipid metabolism. NCT04988204.

S1398 Lifestyle Modifications Decrease Hepatic Steatosis in Taiwanese With Metabolic-Associated Fatty Liver Disease

Introduction: Metabolic-associated fatty liver disease (MAFLD) represents a growing global problem and is associated with increasing obesity prevalence. Lifestyle modifications are the currently recommended approaches for MAFLD. Fibroscan device/transient elastography may be used to estimate the degree of liver scarring and steatosis using a controlled attenuation parameter (CAP) value. This study evaluated the short-term effect of lifestyle modifications on transient elastography values in an obese population with MAFLD. Methods: Thirty-two MAFLD patients aged between 18-60 years old who had a body mass index (BMI) of ≧23 kg/m2 with evidence of fatty liver disease by abdominal ultrasound were recruited for this prospective study. All subjects participated in a 3-month program of lifestyle modification. Sequential demographic parameters and biochemical tests were compared before and after program completion. Liver fat and fibrosis changes were measured using transient elastography with CAP and liver stiffness measurements (LSM). Results: The mean age was 38.7 years old. The body weight (88.09 kg vs. 80.35 kg), body mass index (32.24 kg/m2 vs. 29.4 kg/m2), waist (103.19 cm vs. 95.75 cm) and hip circumference (111.67 cm vs. 104.75 cm), and blood pressure (128/78 mmHg vs. 119/71 mmHg) significantly improved after intervention. Aspartate aminotransaminase (24.06 U/L vs. 18.91 U/L), alanine aminotransaminase (33 U/L vs. 23.72 U/L), creatinine (0.75 mg/dL vs. 0.70 mg/dL), cholesterol (176.41 mg/dL vs. 166.22 m/dL), gamma-glutamyl transferase (26.59 IU/L vs. 19.81 IU/L), and low-density lipoprotein cholesterol (115.63 mg/dL vs. 103.19 mg/dL) also improved after the 3-month intervention. The average CAP significantly decreased after intervention (297.5 dB/m vs. 255.0 dB/m), however, no significant difference in LSM was observed (5.24 kPa vs. 4.82 kPa) after intervention. (Figure) Conclusion: This study demonstrated that liver fat, assessed by CAP score, significantly reduced after a 3-month structured lifestyle modification program in patients with MAFLD. In addition, weight reduction, which is the major determining factor for MALFD improvement and/or resolution, was achieved with the structured program, and the CAP value may be used to monitor liver steatosis and respond to intervention. It is believed that this is the first study that evaluates the utility of CAP values for monitoring hepatic steatosis in an obese population with MAFLD through exercise and diet modification. (Table)Figure 1.: Controlled Attenuation Parameter (CAP) and Liver Stiffness (LSM) values before and after intervention. Table 1. - Comparison of Parameters and Biochemical Testing Before and After Intervention Pre-intervention Post-intervention Difference p-value Waist (cm) 103.19±13.12 95.75 ± 11.96 -7.44 ± 3.72 < 0.001 Hip (cm) 111.67 ± 10.72 104.75 ± 10.55 -6.92 ± 3.27 < 0.001 Weight (kg) 88.09 ± 20.75 80.35 ± 19.51 -7.74 ± 3.97 < 0.001 WHR 0.92 ± 0.06 0.91 ± 0.05 -0.01 ± 0.02 0.026 Body Fat (%) 37.07 ± 4.18 34.27 ± 4.44 -2.8 ± 1.44 < 0.001 BMI (kg/m2) 32.24 ± 4.98 29.4 ± 4.72 -2.84 ± 1.35 < 0.001 SBP (mmHg) 127.66 ± 15.57 119.09 ± 12.02 -8.56 ± 10.61 < 0.001 DBP (mmHg) 78.03 ± 13.58 71.09 ± 8.29 -6.94 ± 13.23 0.006 Heart rate (BPM) 84.5 ± 11.45 76.03 ± 10.91 -8.47 ± 12.06 < 0.001 HbA1c (%) 5.44 ± 0.54 5.47 ± 0.36 0.03 ± 0.33 0.67 Fasting Glucose (mg/dL) 89.44 ± 8.06 92.22 ± 7.56 2.78 ± 6.59 0.023 AST (U/L) 24.06 ± 8.85 18.91 ± 6.4 -5.16 ± 8.76 0.002 ALT (U/L) 33 ± 20.76 23.72 ± 14.72 -9.28 ± 19.79 0.012 GGT (IU/L) 26.59 ± 18.23 19.81 ± 14.83 -6.78 ± 10.05 0.001 BUN (mg/dL) 11.09 ± 2.23 11.31 ± 2.29 0.22 ± 2.55 0.631 Creatinine (mg/dL) 0.75 ± 0.17 0.70 ± 0.14 -0.05 ± 0.08 0.002 Chol (mg/dL) 176.41 ± 31.32 166.22 ± 32.13 -10.19 ± 24.14 0.023 TG (mg/dL) 122.59 ± 49.11 113.28 ± 61.32 -9.31 ± 46.8 0.269 HDL (mg/dL) 42.88 ± 8.29 43.94 ± 8.86 1.06 ± 4.99 0.238 LDL (mg/dL) 115.63 ± 28.03 103.19 ± 29.83 -12.44 ± 20.59 0.002 HOMA-IR (mg/dL) 2.65 ± 1.61 2.45 ± 1.85 -0.2 ± 1.94 0.564 WHR, waist-hip ratio; BMI, body mass index; SBP, systolic blood pressure; DBP, diastolic blood pressure; BPM, beats per minute. HbA1c, hemoglobin A1c; AST, aspartate aminotransferase; ALT, alanine aminotransferase; GGT, gamma-glutamyl transferase; BUN, blood urea nitrogen; Chol, total cholesterol; TG, triglyceride; HDL, high-density lipoprotein; LDL, low-density lipoprotein; HOMA-IR, Homeostatic Model Assessment for Insulin Resistance.

Lifestyle Therapy Targeting Hyperinsulinemia Normalizes Hyperglycemia and Surrogate Markers of Insulin Resistance in a Large, Free-Living Population

This article reports the evaluation of a personalized, team-based comprehensive lifestyle modification program targeting known triggers of hyperinsulinemia and insulin resistance. A retrospective chart review was undertaken for 536 participants in a novel high-intensity lifestyle behavioral modification program. Surrogate markers of insulin resistance and metabolic syndrome‒related pathologies were measured before and after participation in the the program. Reversal of metabolic syndrome was present in 42% of participants who met the criteria for this syndrome. Additional changes seen in this cohort include: 36% decrease in triglyceride to high-density lipoprotein cholesterol ratio; 5% (-7.2 mm Hg) decrease in systolic blood pressure and 4% (-3.8 mm Hg) decrease in diastolic blood pressure; decreased abdominal adiposity and waist circumference (-7.6 cm); increased high-density lipoprotein cholesterol (1.3 mg/dL); and 23% (-57.1 mg/dL) decrease in serum triglycerides. Hyperglycemia was normalized in 35% of participants with prediabetes. Only 2% of those with prediabetes progressed to type 2 diabetes mellitus. Among those with type 2 diabetes mellitus, 46% experienced a reduction in HbA1c to below diabetic cut offs. Compared to baseline, the Metabolic Syndrome Severity Score decreased by 30% among those with metabolic syndrome, 11% among those with prediabetes, 26% among those with type 2 diabetes mellitus, and 38% among those with uncontrolled type 2 diabetes mellitus. Cardiorespiratory fitness, measured by the calculated Metabolic Equivalent of Task maximum, increased by 30% in the metabolic syndrome cohort, 28% in the prediabetic cohort, 29% in the type 2 diabetes mellitus cohort, 29% in the uncontrolled type 2 diabetes mellitus cohort, and 32% in the cohort with obesity. Modifying lifestyle factors that trigger hyperinsulinemia provided pleiotropic improvements to all measured surrogate markers of insulin resistance, mitigated the progressive nature of the insulin resistance and metabolic syndrome‒related chronic pathologies, reduced Metabolic Syndrome Severity Score, and improved cardiorespiratory fitness. These results suggest that earlier identification of the diagnostic criteria of metabolic syndrome and/or Metabolic Syndrome Severity Score and the prompt initiation of a comprehensive therapeutic lifestyle approach would significantly mitigate disease burden.

The iHealth-T2D study: a cluster randomised trial for the prevention of type 2 diabetes amongst South Asians with central obesity and prediabetes—a statistical analysis plan

BackgroundSouth Asians are at high risk of type 2 diabetes (T2D). Lifestyle modification is effective at preventing T2D amongst South Asians, but the approaches to screening and intervention are limited by high costs, poor scalability and thus low impact on T2D burden. An intensive family-based lifestyle modification programme for the prevention of T2D was developed. The aim of the iHealth-T2D trial is to compare the effectiveness of this programme with usual care.MethodsThe iHealth-T2D trial is designed as a cluster randomised controlled trial (RCT) conducted at 120 sites across India, Pakistan, Sri Lanka and the UK. A total of 3682 South Asian men and women with age between 40 and 70 years without T2D but at elevated risk for T2D [defined by central obesity (waist circumference ≥ 95 cm in Sri Lanka or ≥ 100 cm in India, Pakistan and the UK) and/or prediabetes (HbA1c ≥ 6.0%)] were included in the trial. Here, we describe in detail the statistical analysis plan (SAP), which was finalised before outcomes were available to the investigators. The primary outcome will be evaluated after 3 years of follow-up after enrolment to the study and is defined as T2D incidence in the intervention arm compared to usual care. Secondary outcomes are evaluated both after 1 and 3 years of follow-up and include biochemical measurements, anthropometric measurements, behavioural components and treatment compliance.DiscussionThe iHealth-T2D trial will provide evidence of whether an intensive family-based lifestyle modification programme for South Asians who are at high risk for T2D is effective in the prevention of T2D. The data from the trial will be analysed according to this pre-specified SAP.Ethics and disseminationThe trial was approved by the international review board of each participating study site. Study findings will be disseminated through peer-reviewed publications and in conference presentations.Trial registrationEudraCT 2016–001,350-18. Registered on 14 April 2016. ClinicalTrials.gov NCT02949739. Registered on 31 October 2016.

Diet, Fertility and the Australian Primary Health Care Setting — A Review

Background: The relationship between diet and fertility continues to emerge, yet interventions underutilise this evidence within Australian primary health care (PHC). Infertility affects approximately 9% of the world’s population and 16% of Australian couples trying to conceive naturally. Current PHC practices do not address nor encourage improved diet for sperm and oocyte quality, ovulation and sperm production. Due to a lack of resources and training, general practitioners typically refer these individuals to fertility clinics for medical management. As a result, Australia ranks as the 6th highest global utiliser of assisted reproductive technology, with annual costs to treat infertility exceeding $46,000,000. Aim: To synthesise current evidence for the diet-fertility relationship and identify suitable PHC interventions for improving fertility related lifestyle risk factors. Method: A database search for published peer reviewed articles using MEDLINE, Scopus, Google Scholar, PubMed and Global Health was carried out, and narratively synthesised. Results: Poor diet, central adiposity and unhealthy weight are modifiable risk factors impacting fertility, and common amongst the Australian adult population. There are opportunities to address these risk factors by modifying existing lifestyle modification programs to improve the overall fertility profile of this demographic within PHC. Conclusion: It is possible to optimise fertility through lifestyle interventions that encompass dietary modification. Health and fertility treatment costs can potentially be improved if changes to diet and lifestyle are consistently addressed as first line management for infertility within PHC for appropriate individuals. Understanding evidence for interventions have importuning implications for policy and practice. Further work needs to describe how fertility lifestyle interventions can successfully translate into PHC practice.

Modifications decrease hepatic steatosis in Taiwanese with metabolic‐associated fatty liver disease

Metabolic-associated fatty liver disease (MAFLD) is a growing global problem associated with increasing obesity prevalence. Lifestyle modifications are currently recommended, including weight reduction, exercise, and diet control. This study evaluated the short-term effect of lifestyle modifications on transient elastography (TE) values in an obese population with MAFLD. Thirty-two MAFLD patients were recruited for this prospective studyand all subjects participated in a 3-month program of lifestyle modification. Sequential demographic parameters and biochemical tests were compared before and after program completion. Liver fat and fibrosis changes were measured using TE with controlled attenuated parameter (CAP)and liver stiffness measurements (LSM). The mean age was 38.7 years old (10 males). The body weight (88.09 kg vs. 80.35 kg), body mass index (32.24 kg/m2 vs. 29.4 kg/m2 ), waist (103.19 cm vs. 95.75 cm), and hip circumference (111.67 cm vs. 104.75 cm), and blood pressure (128/78 mmHg vs. 119/71 mmHg) significantly improved before and after the intervention, respectively. Aspartate aminotransaminase (24.06 U/L vs. 18.91 U/L), alanine aminotransaminase (33 U/L vs. 23.72 U/L), creatinine (0.75 mg/dl vs. 0.70 mg/dl), cholesterol (176.41 mg/dl vs. 166.22 m/dl), gamma-glutamyl transferase (26.59 IU/L vs. 19.81 IU/L), and low-density lipoprotein cholesterol (115.63 mg/dl vs. 103.19 mg/dl) also improved after the 3-month intervention. The average CAP significantly decreased after intervention (297.5dB/m vs. 255.0 dB/m), however, no significant difference in LSM was observed (5.24 kPa vs. 4.82 kPa). The current study suggests that short-term lifestyle modification can effectively improve hepatic steatosis, and TE may serve as a monitoring tool for therapeutic intervention.

Role of Yoga on Glycaemic Control and Other Health Parameters in Type 2 Diabetes Mellitus (T2DM) – A Review of Controlled Studies

It is reported that about 1 in 11 adults have diabetes mellitus (DM) globally. A total of 415 million people have DM and an estimated 193 million people have undiagnosed DM worldwide. Where, type 2 diabetes mellitus (T2DM) accounts for around 90% of patients with DM. Yoga interventions appeared to be more effective in T2DM as compared to physical exercise interventions which may be because of various aspects of yoga other than the physical one. The yoga intervention involves subtle components such as mindfulness, relaxation, breath regulation, and notional corrections. The mechanism through which yoga works may be the down-regulation of the sympathetic nervous system and the hypothalamic-pituitary-adrenal axis which may lead to the improvement in psychological health, quality of sleep, autonomic balance, and reduction in insulin resistance. Lifestyle modification programs such as yoga interventions on a regular basis for long duration have potential to manage and cure T2DM. The government and the concerned bodies should pay attention to this area.

Effect of lifestyle interventions on oxidative stress in elderly hypertensive and in normal individuals

Introduction: Oxidative stress has emerged as one of the important factors of aging as well as various diseases including hypertension. A Few changes in lifestyle like food habits and exercise leads to significant decrease in the oxidative stress and inflammation which in turn improves the endothelium functions. Aim: The present study was designed to assess and compare the effect of lifestyle modifications on oxidative stress in elderly essential hypertensive patients as well as in normotensive elderly subjects. Materials and Methods: One hundred four normotensive elderly subjects of group I and one hundred eighty-six elderly hypertensive patients of group II between 60 to 80 years of age successfully completed three months lifestyle modifications program conducted in the department of physiology, Santosh Medical College Ghaziabad. Oxidative stress markers GSH, SOD, MDA and blood pressure were measured before and after lifestyle modification program. Results: The findings of the present study showed that SBP (p&lt;0.001), DBP (p&lt;0.001), MAP (p&lt;0.001) were significantly low in group II hypertensive patients in comparison of group I normotensive subjects. Value of SOD increased significantly in group II hypertensive patients in comparison to group I normotensive subjects.

Effectiveness of a lifestyle modification programme in the treatment of depression symptoms in primary care.

BackgroundDepression symptoms are prevalent in the general population, and their onset and continuation may be related to biological and psychosocial factors, many of which are related to lifestyle aspects. Health promotion and lifestyle modification programmes (LMPs) may be effective on reducing the symptoms. The objective of this study was to analyse the clinical effectiveness of a LMP and a LMP plus Information and Communication Technologies, when compared to Treatment as Usual (TAU) over 6 months. The interventions were offered as an adjuvant treatment delivered in Primary Healthcare Centers (PHCs) for people with depression symptoms.MethodsWe conducted an open-label, multicentre, pragmatic, randomized clinical trial. Participants were recruited from several PHCs. Those participants visiting general practitioner for any reason, who also met the inclusion criteria (scoring 10 to 30 points on the Beck II Self-Applied Depression Inventory) were invited to take part in the study. TAU+LMP consisted of six weekly 90-min group sessions focused on improving lifestyle. TAU+LMP + ICTs replicated the TAU+LMP format, plus the addition of a wearable smartwatch to measure daily minutes walked and sleep patterns. A total of 188 participants consented to participate in the study and were randomized. We used linear mixed models, with a random intercept and an unstructured covariance to evaluate the impact of the interventions compared to TAU.ResultsBoth interventions showed a statistically significant reduction on depressive symptoms compared to TAU (TAU+LMP vs. TAU slope difference, b = −3.38, 95% CI= [−5.286, −1.474] p = 0.001 and TAU+LMP+ICTs vs. TAU slope difference, b = −4.05, 95% CI = [−5.919, −2.197], p < 0.001). These reductions imply a moderate effect size. In the TAU+LMP+ICTs there was a significant increase regarding minutes walking per week (b = 99.77) and adherence to Mediterranean diet (b = 0.702). In the TAU+LMP there was a significant decrease regarding bad sleep quality (b = −1.24).ConclusionTAU+LMPs administered in PHCs to people experiencing depression symptoms were effective on reducing these symptoms compared to TAU. They also have a positive impact on changing several lifestyle factors. These findings indicate that these interventions can be promising strategies for PHCs.

Intervention in Older Urban-Dwelling Veterans With Dysmobility: Protocol for a Pilot Feasibility Clinical Trial.

BackgroundThe majority of older veterans do not meet the minimum healthy diet or physical activity recommendations despite known benefits. Identifying ways to increase adherence to programs that improve dietary quality and physical activity may reduce the risk of disability in older veterans. Peer-based interventions may be one method for facilitating lasting behavior change because peers often share a common culture and knowledge regarding problems their community experiences.ObjectiveThis study aims to develop, pilot, and evaluate a theory-driven, 12-week, peer-led nutrition and exercise intervention that targets older veterans with dysmobility and assess its feasibility in 2 diverse urban areas with underrepresented populations.MethodsCommunity-dwelling veterans aged >65 years with self-reported dysmobility (defined as difficulty in at least 1 of the following: walking quickly across a street, walking a mile, ascending a flight of stairs, rising from a chair without the use of arms, or a fear of falling) from 2 Department of Veterans Affairs Geriatric Research, Education, and Clinic Centers (Baltimore, Maryland, and San Antonio, Texas) will be eligible to participate. First, this study will use validated mixed methods via web-based surveys (n=50 per site) to assess potential physical, social or environmental, and behavioral or lifestyle barriers that affect physical activity and dietary quality (phase 1). Next, we will use knowledge gained from these assessments and feedback from a focus group (n=10 per site) to adapt established Department of Veterans Affairs diet and exercise program materials to develop peer-led intervention materials and train peer leaders (n=3 per site). Finally, we will determine the feasibility and acceptability of the intervention to assess reach (recruitment and retention), adoption (satisfaction, perceived utility, attendance, and engagement), and implementation (fidelity of intervention), as well as the estimated magnitude and potential impact on selected outcomes (ie, diet quality and mobility) in 20 older veterans with dysmobility (n=10 per site).ResultsThe study was funded on January 1, 2022, with a projected data collection period of June 1, 2022, to December 31, 2023.ConclusionsThis study offers an innovative approach to identifying strategies that increase long-term adherence to lifestyle modification programs that improve dietary quality and physical activity in older veterans with dysmobility.Trial RegistrationClinicalTrials.gov NCT04994938; https://clinicaltrials.gov/ct2/show/NCT04994938International Registered Report Identifier (IRRID)PRR1-10.2196/39192

The impact of positive social reinforcement on time-to-attrition from the Diabetes Prevention Program in college students at high risk for Type II Diabetes: a study protocol for a phase 3, multicenter, cluster randomized trial

Introduction: The prevalence of type 2 diabetes mellitus (T2DM) in young adults has increased considerably in the pastdecade. Evidence shows that lifestyle modification programs such as the Diabetes Prevention Program (DPP) areeffective in improving health behaviors and lowering the risk of diabetes. DPP follow-up studies have found that a lackof retention can reduce the effectiveness of such programs. Adding a positive social reinforcement platform is a novelstrategy to provide educational resources to facilitate lifestyle changes. However, evidence regarding the effect ofpositive social reinforcement as a theory-based strategy to prolong retention within the DPP is limited. The current studyprotocol aims to evaluate the efficacy of the online Prevent Diabetes® Program, including a Positive Inter@ctiOn forumon time-to-attrition from the DPP among college students at high risk for T2DM.Methods: This study protocol is a phase 3, multicenter, double-blinded, cluster-randomized, superiority, controlled trialconducted in West Virginia, Alabama, and Mississippi. Four hundred eigclthty college students will be centrallyrandomized in a cluster-wise 1:1 ratio to the online Prevent Diabetes® Program integrated with the Positive Inter@ctiOnforum or to the online Prevent Diabetes® Program alone for 12 months. The primary outcome is time-to-attrition fromthe DPP.Discussion: Successful completion of the study will provide valuable information on whether implementing theory-basedhealth behavior strategies can improve the retention of participants in the online DPP and contribute to enhancing DPPeffectiveness.

Descriptive study to identify the barriers of healthy diet among children in selected school of Kashmir with a view to develop a lifestyle modification programme

Globally, around 16 million babies are born to adolescent girls between the ages of 15 and 19 years. Although rates of births among adolescent girls have declined in all regions since 1990 but still remain high in Africa, Asia, Latin America, and Caribbean. Nearly 50% of all women aged 20–24 years in Asia and Africa are married by the age of 18 years, placing them at a higher risk for early pregnancy, maternal disability, and death. Adolescence is a critical age group as this is a period to develop specific expertise and hone individual skills to enter the mainstream workforce and contribute to the economic productivity. It is also a period when major changes in health and health-related behaviours such as smoking and substance abuse, unsafe sexual practices, poor eating, and lack of exercise occur, which may substantially impact health outcomes in later life. Due to the success of child survival initiatives over the last few decades, there has been a dramatic rise in the population of adolescents especially in low- and middle-income countries. There is an unacceptable rate of mortality among adolescents, as an estimated 1.3 million adolescents died in 2012; 70% of these deaths occurred in Africa and Southeast Asia. Based on the problem selected and objectives of the study, descriptive research design was selected to identify the barriers of healthy diet among school going children in a selected school of Kashmir with a view to develop a lifestyle modification programme. Sixty subjects were selected in selected area of Kashmir by non-probability sampling technique for this study. Self-structured checklist was used for data collection and was analysed by descriptive and inferential statistics using chi-square and t-test. The findings also revealed that statistically significant association was found between barriers to healthy diet with these variables (educational status and Fathers education) whereas no significant association was found between barriers to healthy diet with these variables (age, area of residence and mothers education) at (p

Descriptive study to identify the barriers of physical activity among adolescents in selected school of Kashmir with a view to develop a lifestyle modification programme

Descriptive study to identify the barriers of physical activity among adolescents in selected school of Kashmir with a view to develop a lifestyle modification programme

The 6-Month Efficacy of an Intensive Lifestyle Modification Program on Type 2 Diabetes Risk Among Rural Women with Prior Gestational Diabetes Mellitus: a Cluster Randomized Controlled Trial

This study aimed to evaluate the efficacy of an intensive lifestyle modification program tailored to rural Chinese women with prior gestational diabetes mellitus compared with usual care. In a cluster randomized controlled trial, 16 towns (clusters) in two distinct rural areas in China were randomly selected (8 towns per district); and 320 women with prior gestational diabetes mellitus were recruited from these towns. With stratification for the two study districts, eight towns (160 women) were randomly assigned to the intervention group of a tailored intensive lifestyle modification program and 8 towns (160 women) to the control group. Process measures were collected on attendance, engagement, fidelity, and satisfaction. Primary efficacy outcomes included glycemic and weight-related outcomes, while secondary efficacy outcomes were behavioral outcomes and type 2 diabetes risk score, which were collected at baseline, 3-month, and 6-month follow-up. Generalized estimation equations were used to analyze the data. High attendance (72% of sessions), engagement (67% of interactive activities and group discussions), fidelity (98%), and satisfaction (92%) with the tailored intensive lifestyle modification program were achieved. There were significant reductions in fasting blood glucose, oral glucose tolerance test 2 h, waist circumference, and type 2 diabetes risk score of participants in the intervention group compared to the control group (p < .05). There was no significant intervention effect on body mass index or behavioral outcomes (p > .05). In this study, we demonstrate the successful efficacy of an Intensive Lifestyle Modification Program in reducing type 2 diabetes risk among younger women with prior gestational diabetes mellitus. This tailored program delivered by local healthcare providers is a promising approach for diabetes prevention in rural China, reducing health disparities in rural communities about diabetes prevention. Registered in the Chinese Clinical Trial Registry (ChiCTR2000037956) on 3rd Jan 2018.

The Effect of Lifestyle Modification on Lipid Profile and Body Weight in Obese Subject

Background. The lifestyle modification (LSM) programs program addresses diet, exercise, stress management, and nutritional depletion using cognitive-behavioral approaches to improve the causes of chronic disease. The purpose of the study is to evaluate the effect before and after three months of LSM on lipid profile and body weight parameters of obese subjects Method. The participants of age 25-50 years recruited through personal contact consisted of 20 obese subjects who appeared to engage in diet and regular exercise (get at least 150 minutes of exercise a week). The types of physical exercise aerobic (walking, swimming, jogging) were included in the study. The anthropometric measurements and blood sample was taken before and after three months of LSM. Height (m) is measured using a wall-mounted height bar and body weight (kg) is measured using a scale and its value is used in BMI calculations. The serum of profile lipid was determined by enzymatic colorimetric method and sd-LDL examination was performed indirectly in which the ratio of LDL /Apolipoprotein B. Result. After 3 months of LSM, there was a significant decrease in serum LDL, ApoB, BMI, WC, and FPG (p &lt; 0.05) in the obese subject. However, no significant difference was observed in TG, HDL, sd-LDL, PPG, and HbA1C (p&gt;0.05). Conclusion. Lifestyle modification of obese subjects for three months can decrease parameters of body weight and profiles lipids, which means it can prevent cardiovascular diseases.

Prevalence of chronic kidney diseases and its determinants among Iranian adults: results of the first phase of Shahedieh cohort study

BackgroundChronic kidney disease (CKD) is one of the major global causes of mortality, described as the most neglected chronic disease. This study aimed to determine the prevalence and determinants of CKD in the setting of the Shahedieh cohort study in Yazd, Iran.MethodsThis cross-sectional study was conducted on adults in the baseline phase of the Shahedieh cohort study in Yazd, Iran. In this study, 9781 participants aged 30–73-year-old were investigated. The data used in this study included demographic and clinical variables and blood samples. Adjusted odds ratios were employed using multivariate logistic regression; meanwhile, population attributable risks for CKD were calculated and reported.ResultsCKD prevalence was 27.5% (95%CI: 26.57–28.34) in all participants, 24% in male, and 30.3% in female. The results of multivariate logistic regression analysis identified age (OR = 1.89, 95%CI:1.082–1.96), women (OR = 1.62, 95%CI: 1.45–1.79), BMI ≥ 30 (OR = 1.40,95%CI: 1.20–1.62), diabetes (OR = 1.38, 95%CI: 1.22–1.57), hypertriglyceridemia(OR = 1.20, 95%CI: 1.01–1.43), history of cardiovascular disease (OR = 1.20, 95%CI: 1.01–1.43), hypertension (OR = 1.18, 95%CI: 1.04–1.33), smoking (OR = 1.17, 95% CI: 1.02–1.33), LDL ≥ 130 (OR = 1.15, 95%CI: 1.01–1.31), history of kidney stone (OR = 1.14, 95%CI: 1.01–1.32) and hypercholesterolemia (OR = 1.14, 95%CI: 1.01–1.32) as risk factors for CKD. Among individual factors, obesity (11.25%), Hypertriglyceridemia (9.21%), LDL ≥ 130 (7.12%) had the greatest Population-Attributable Fraction, followed by Hypercholesterolemia (5.2%), diabetes (5.05%), smoking (3.73%) and high blood pressure (2.82%).ConclusionThe results showed that the main determinants of CKD are potentially modifiable risk factors. Therefore, implementing early detection and screening programs in people at risk as well as preventive measures such as lifestyle modification programs and risk factors controlling can prevent the disease.

Impact of Meditation-Based Lifestyle Modification on HRV in Outpatients With Mild to Moderate Depression: An Exploratory Study.

BackgroundThe scientific evaluation of mind-body-interventions (MBI), including yoga and meditation, has increased significantly in recent decades. However, evidence of MBI's efficacy on biological parameters is still insufficient.ObjectivesIn this study, we used HRV analysis to evaluate a novel MBI as a treatment of outpatients with mild to moderate depressive disorder. The Meditation-Based Lifestyle Modification (MBLM) program incorporates all major elements of classical yoga, including ethical principles of yoga philosophy, breathing exercises, postural yoga, and meditation.MethodsIn this exploratory randomized controlled trial, we compared the changes in HRV indices of a MBLM group (N = 22) and a minimal treatment group (MINIMAL, drugs only, N = 17) with those of a multimodal treatment-as-usual group (TAU, according to best clinical practice, N = 22). Electrocardiogram (ECG) recordings were derived from a Holter monitoring device, and HRV indices have been extracted from nearly stationary 20-min periods.ResultsShort-term HRV analysis revealed statistically significant differences in the pre-to-post changes between MBLM and TAU. In particular, the vagal tone mediating RMSSD and the Rényi entropy of symbolic dynamics indicated HRV gains in MBLM participants compared with TAU. Almost no alterations were observed in the MINIMAL group.ConclusionsOur results suggest a benefit in selected HRV parameters for outpatients with mild to moderate depression participating in the MBLM program. For further investigations, we propose analysis of complete 24-h HRV recordings and additional continuous pulse wave or blood pressure analysis to assess long-term modulations and cardiovascular effects.

The Role of Dietary Sulfur-Containing Antioxidants on the Reducing Effects of Lifestyle Modification Program on the NAFLD-Associated CVDs

ObjectivesNon-Alcoholic Fatty Liver Disease (NAFLD) is a silent disease linked to behavioral habits (poor diet and sedentary lifestyle) with inflammatory and oxidative stresses as background, leading to cardiovascular diseases (CVDs) as the worse outcome. These point out to lifestyle modification program(LSMP) as a potential non-pharmacological strategy in modulation NAFLD and CVDs risks. Purpose: To evaluate the LSMP on sulfur-containing markers in the NAFLD- high-risk CVDs course. MethodsIntervention study with 170 subjects with algorithm-diagnosed NAFLD(Fatty Liver Index ≥ 60) undergoing a 10 wks of the LSMP with daily supervised mixed physical exercise and nutritional counseling. Participants, adults (>35 yrs) had data collected before and after 10 wks for variables: demographic, socioeconomic, dietary, anthropometric and plasma biochemistry (inflammatory-oxidative and sulfur-containing markers). CVDs risk was indicated by higher risk of both Plasma Atherogenic Index (PAI) and Coronary Artery Disease (CAD). Statistical analyzes were performed for p = 0.05. ResultsThe sample of 73% women and 51.8% under 60 yrs old presented 37.6% low-physical activity level (PAL) and 95.3% poor-quality diet. At baseline the 30% NAFLD patients presented 13.5% high risk of PAI and 11.2% high-risk CAD along with 90% low PAL and 100% poor-quality diet. Inadequate-food ingestion was detected in protein, lipid, fiber, methionine (Met), Phosphatidylcholine (Pho), choline (Cho) and betaine (Bet). Their plasma profile showed higher inflammatory (us-CRP) and oxidative stress (MDA and GSSG) with lower antioxidant status (GSH) along with higher levels of homocysteine (Hcy) and Trimetylamine N-oxide (TMAO). The 10-wk LSMP improved VO2max (20%) and protein, lipid, fiber, Met, Pho, Cho and Bet intake. There was a reduction of 27% in NAFLD as well as in those with higher-PAI (46.2%) and higher-CAD (45%) associated with improvements in plasma Met, Pho, Cho and Bet, as well in Hcy, and TMAO. ConclusionsBy improving sulfur-containing anti-oxidants and aerobic conditioning (anti-inflammatory effect) the present LSMP was effective in reducing the NAFLD recrudescence to CVDs. Funding SourcesCAPES and CNPq