Lifestyle-related Chronic Diseases Research Articles

Early Outcomes of Orthopedic Pre-surgical Patients Enrolled in an Intensive, Interprofessional Lifestyle Medicine Program to Optimize Health

Recently, lifestyle medicine (LSM) application has shown feasibility for musculoskeletal pain patients with co-existing lifestyle-related chronic diseases. This study describes early results of a LSM program for musculoskeletal patients with goals to optimize health prior to orthopedic surgery. Fifty-four patients (age: 61 ± 11 years; 39 [72%] females) completed the program from 3/8/22-12/1/23. Data included patient goals, utilization, goal attainment, and patient outcomes. Most patients (41/54 [76%]) enrolled with established surgical dates. Mean BMI was 43.2 ± 5.3 kg/m2, and 89% had ≥2 lifestyle-related chronic diseases. The majority reported impaired sleep (79%) and zero cumulative minutes of physical activity/week (57%). Mean program duration was 13 ± 8 weeks involving 5 ± 4 visits with members of the interprofessional team. Fifty-two (96%) patients successfully attained pre-program goals, and 49/54 (91%) met their surgical goal. Of the patients enrolled without surgical dates, 11/13 (85%) optimized their health and proceeded to surgery. Forty-two (78%) patients reported decreases in weight and BMI, averaging 11 ± 7 lbs and 1.8 ± 1.3 kg/m2, respectively. Rates of improvement in pain, PROMIS-10 physical and mental health, and PHQ-4 were 52%, 37%, 45%, and 47%, respectively. These data demonstrate the feasibility and effectiveness of a LSM program to address whole-person health optimization and enable orthopedic patients to improve lifestyle behaviors and proceed to orthopedic surgery.

Surviving & Thriving; a healthy lifestyle app for new US firefighters: usability and pilot study protocol.

In the United States (US), new firefighters' fitness and health behaviors deteriorate rapidly after fire academy graduation. Over the long-term, this increases their risks for chronic diseases. This study protocol describes the proposed usability testing and pilot study of a newly designed and developed healthy lifestyle smartphone app, "Surviving & Thriving", tailored towards young US firefighters. "Surviving & Thriving" will provide interactive educational content on four lifestyle factors; nutrition, sleep, physical activity, and resilience, and include a personalized journey, habit tracker, and elements of gamification to promote engagement and long-term healthy behavior change. The first phase of the app development entails alpha testing by the research team and pre-beta testing by a fire service expert panel which will help refine the app into a pre-consumer version. Upon completion of the full app prototype, beta 'usability' testing will be conducted among new fire academy graduates from two New England fire academies to collect qualitative and quantitative feedback via focus groups and satisfaction surveys, respectively. A last phase of piloting the app will evaluate the app's efficacy at maintaining/improving healthy lifestyle behaviors, mental health metrics, and physical fitness metrics. We will also evaluate whether firefighters' perceived "health cultures" scores (ratings of each fire station's/fire department's environments as to encouraging/discouraging healthy behaviors) modify the changes in health metrics after utilizing the app for three to six months. This novel user-friendly app seeks to help new firefighters maintain/improve their health and fitness more effectively, reducing their risk of lifestyle-related chronic disease. Firefighters who can establish healthy habits early in their careers are more likely to sustain them throughout their lives.

Relationship of Chronic Systemic Inflammation to Both Chronic Lifestyle-Related Diseases and Osteoarthritis: The Case for Lifestyle Medicine for Osteoarthritis.

Systemic inflammation is a root cause of lifestyle-related chronic diseases and may also play a role in the development and progression of osteoarthritis (OA). Lifestyle medicine seeks to treat, prevent, and reverse lifestyle-related chronic disease via 6 pillars: nutrition, sleep health, stress management, physical activity, social connections, and risky behavior avoidance/reduction. This article presents a review of the literature in which we assess the connections between the 6 pillars of lifestyle medicine, chronic systemic inflammation, and OA. We also discuss the whole-person approach that lifestyle medicine interventions can provide to reduce chronic systemic inflammation and affect the development or progression of OA.

Outcomes of Patient Education in Nurse-led Clinics: A Systematic Review.

Patient education is an independent role of nurses performed in nurse-led clinics (NLCs). The measurement of patient education outcomes validates whether nursing educational interventions have a positive effect on patients, which helps determine whether changes in care are needed. Standardized nursing terminologies facilitate the evaluation of educational outcomes. We aimed to explore the outcomes of patient education in NLCs based on the Nursing Outcome Classification (NOC) system. The review was conducted according to PRISMA guidelines. We searched "Medline", "Embase", "Web of Science", and "Scopus" databases for articles published between 2000 and 2022. Based on the search strategy, 1157 articles were retrieved from PubMed, Scopus, Web of Science, and Embase databases. After excluding the duplicates, 978 articles were appraised. 133 articles remained after reading the titles and abstracts of the articles. In the next step, the articles were evaluated regarding methodology, research population, and exclusion criteria, after which 112 articles were omitted, and finally, 21 articles were included in the full-text review. We assessed all included studies using the Quality Assessment of Controlled Intervention Studies checklist. A total of 21 randomized controlled trials met the inclusion criteria. "Physiologic health", "functional health", "psychosocial health", "health knowledge and behavior", and "perceived health" were the domains of nursing outcomes investigated as Patient Education Outcomes in NLCs. Most of the outcomes were linked to lifestyle-related chronic diseases and, further studies are needed to determine the effects of patient education provided in NLCs in terms of family/society health outcomes.

Factors associated with dietary behaviour change support in patients: A qualitative study among community nurses.

To explore which factors, influencing dietary behaviour change support among patients by Dutch community nurses (CNs; nurses), are key focal points in training programmes. Nurses have an important role in counselling patients towards healthier dietary behaviour to prevent or delay long-term complications from chronic lifestyle-related diseases. Most nurses do not incorporate dietary behaviour change support in their routines to the fullest potential. A qualitative descriptive study. Data were collected in the Netherlands in 2018-2019 via semi-structured face-to-face interviews with 18 nurses. Interview guide themes were informed by the COM-B model, using validated descriptions in Dutch. Data were recorded, transcribed and analysed using inductive thematic analysis. Factors that affected dietary behaviour change support were linked to (1) the nurse (role identity, dietary knowledge and competences such as methodical approach, behaviour change techniques and communication techniques), (2) nurse-patient encounter (building a relationship with a patient, supporting patient autonomy and tailoring the approach) and (3) cooperation and organizational context. It is of utmost importance to pay attention to nurses' role identity regarding dietary behaviour change support, as this underlies professional behaviour. This should be accompanied by improving competences on dietary behaviour change support. Focus on competences regarding the application of behaviour change technique is crucial. Furthermore, having a relationship of trust with a patient was important for discussing sensitive topics such as diet. The promotion of a healthy diet provides opportunities to contribute to patient autonomy and self-management. Well-fitted training offers for (senior) nurses will lead to improved professional practice of nurses, leading to healthier dietary behaviour of patients. A nurse provided feedback on the interview guide.

Understanding health behavior change by motivation and reward mechanisms: a review of the literature.

The global rise of lifestyle-related chronic diseases has engendered growing interest among various stakeholders including policymakers, scientists, healthcare professionals, and patients, regarding the effective management of health behavior change and the development of interventions that facilitate lifestyle modification. Consequently, a plethora of health behavior change theories has been developed with the intention of elucidating the mechanisms underlying health behavior change and identifying key domains that enhance the likelihood of successful outcomes. Until now, only few studies have taken into account neurobiological correlates underlying health behavior change processes. Recent progress in the neuroscience of motivation and reward systems has provided further insights into the relevance of such domains. The aim of this contribution is to review the latest explanations of health behavior change initiation and maintenance based on novel insights into motivation and reward mechanisms. Based on a systematic literature search in PubMed, PsycInfo, and Google Scholar, four articles were reviewed. As a result, a description of motivation and reward systems (approach/wanting = pleasure; aversion/avoiding = relief; assertion/non-wanting = quiescence) and their role in health behavior change processes is presented. Three central findings are discussed: (1) motivation and reward processes allow to distinguish between goal-oriented and stimulus-driven behavior, (2) approach motivation is the key driver of the individual process of behavior change until a new behavior is maintained and assertion motivation takes over, (3) behavior change techniques can be clustered based on motivation and reward processes according to their functional mechanisms into facilitating (= providing external resources), boosting (= strengthening internal reflective resources) and nudging (= activating internal affective resources). The strengths and limitations of these advances for intervention planning are highlighted and an agenda for testing the models as well as future research is proposed.

A brief self-compassionate reflective writing task can manage negative reactions following an eating transgression

ABSTRACT Objective This study investigated the efficacy of brief 3-minute reflective writing tasks to manage reactions following an upsetting self-perceived eating transgression. Methods Participants (N = 270) identified their own recent upsetting eating scenario and were randomised to complete a writing task encouraging either self-reflective re-construal or self-compassion. All state outcomes were measured immediately pre- and post-intervention, except for state self-compassion which was measured at post-intervention only. Eating regulation and healthy eating behaviours were reported by participants who completed the follow-up (N = 187, 69.3% of the original sample) two weeks after the intervention. Results Both writing tasks resulted in reduced anxiety, and increased confidence and self-esteem, at post-intervention. The self-compassion writing task led to higher state self-compassion, and lower general negative affect and depression, than the self-reflective re-construal writing task. Moreover, participants in the self-compassion group reported eating a healthier and more balanced diet during the follow-up period than participants in the self-reflection group. Conclusions The current study has provided further evidence for the efficacy of brief self-compassionate reflective writing to regulate negative affectivity and promote healthy eating behaviours in a non-clinical sample, thus revealing important potential application for this approach in the context of eating pathology and lifestyle-related chronic disease.

Prevalence and Associated Factors of Osteoporosis in Chronic Obstructive Pulmonary Disease Patients

Background: Chronic Obstructive Pulmonary Disease (COPD) is a lifestyle-related chronic inflammatory pulmonary disease and a major cause of morbidity and mortality globally. In this study, we evaluated the prevalence and associated factors of osteopenia and osteoporosis in COPD patients.
 Methods:A total of 91 COPD patients were recruited from October 2017 and December 2018. Lung function test, CAT score, 6-minutes’ walk test, Modified Medical Research Council (MMRC) dyspnea score and body mass index, air flow obstruction, dyspnea, and exercise capacity (BODE index) were evaluated in the patients. Bone Mineral Density (BMD) measurements of the femoral neck, total femur (including femoral neck, trochanter, and intertrochanter area), and lumbar spine were conducted using dual-energy X-ray absorptiometry. A T-score which was 2.5 standard deviations (SDs) below the average value was indicative of osteoporosis, in accordance with the World Health Organization criteria. We excluded COPD patients who had asthma, malignancy, and fracture.
 Results: There were 86 males (mean age ± SD: 66.49±9.40 years) and 5 females (mean age±SD: 65.40±12.40 years). Among all the patients, 46 (51.1 %) patients had osteopenia and 36 (40 %) had osteoporosis. Comparing COPD grades showed grade 2 was a more prevalent grade (41.1 %). There was no statistically association between femoral neck T score (mean±SD: -2.21±0.89) and COPD grade (P= 0.58), while lumber spine T score (mean±SD: -2.13±1.11) was statistically decreased with increasing severity of COPD (p= 0.02).
 Conclusion: The results of our study demonstrated that osteoporosis is common among COPD patients. Moreover, we found significant correlations between BMI, walking test, FEV1, MMRC, and BODE index.

Healthcare Professionals’ Insights on the Integration of Kinesiologists into Ontario’s Health System

ABSTRACT Introduction/Purpose Kinesiologists are well suited to work collaboratively or independently within the health system to improve patient/client care and well-being. This cross-sectional survey explored perceptions of the integration of registered kinesiologists (RKins) into the health system in Ontario. Methods RKins (n = 202) and other health professionals (OHP; n = 337), including physicians, physiotherapists, nurse practitioners, etc., participated in an online survey. Results RKins reported working in diverse practice environments, and more than half reported receiving patients/clients through referrals. Of the OHP, 37.7% had ongoing professional interactions with RKins and 86.7% reported high satisfaction with these interactions; 32.6% of OHP reported referring patients/clients to RKins, primarily for exercise prescription (86.0%), treatment of clinical conditions (48.8%), and patient education (46.5%). Perceived barriers to referral included lack of awareness of the RKins’ scope of practice (81.0%), inadequate funding for services (67.1%), and low confidence in the clinical competency of RKins (61.8%). Conclusions RKins are experts in exercise-based interventions to prevent, treat, and manage many chronic lifestyle-related diseases. Initiatives to increase awareness of the RKins’ scope of practice, clinical competency, and standards of practice and to increase funding for RKin services are important next steps.

Implications of lifestyle medicine in medical practice.

Globally, we are seeing a rise in non-communicable diseases such as obesity, hypertension, diabetes, metabolic syndrome, chronic respiratory diseases, cancer, etc., due to stressful lifestyle in this competitive world. Most of the non-communicable diseases are associated with lifestyle behavior. Presently, the role of lifestyle medicine is very critical and important in the management of chronic lifestyle-associated disorders. Considering the above facts, we decided to review the literature to gain a deeper insight into the implications of lifestyle medicine in medical practice. A literature search was conducted on PubMed, Scopus and Google Scholar databases. We observed that lifestyle medicine intervention is a growing and newer discipline and is being employed along with conventional management of non-communicable diseases by medical practitioners today, as they are strongly associated with lifestyle behaviors and practices. Motivation for change in lifestyle is challenging because it depends on the patient's determination and eagerness to adapt and accommodate to the newer lifestyle pattern. The medical practitioners should spend time in coaching patients on lifestyle-related health education. Guidance and coaching by medical practitioners will help patients adapt to practices of maintaining regular physical activity, a balanced diet, good sleep hygiene, and avoid addictions of tobacco and alcohol as part of life. Introducing real and progressive evidence-based behavioral changes to reduce the risks of lifestyle-related acute and chronic diseases in medical practice will reduce the burden of non-communicable disease.

Lifestyle Medicine: A Promising tool to Restoring Health

Lifestyle Medicine is the application of evidence-based lifestyle approaches for the prevention, treatment, and even the reversal of lifestyle-related chronic diseases such as diabetes, hypertension, heart disease, obesity, polycystic ovarian diseases, dementia, arthritis, and cancers

Recent advances in the extraction, chemical composition, therapeutic potential, and delivery of cardamom phytochemicals.

Dietary phytochemicals including plant-derived alkaloids, carotenoids, organosulfur compounds, phenolics, and phytosterols, are health-promoting bioactive compounds that help in the prevention and mitigation of chronic diseases and microbial infections beyond basic nutrition supply. This article covers recent advances in the extraction, chemical composition, therapeutic potential (nutraceutical and antimicrobial), and delivery of black and green cardamom-derived phytochemicals. In recent years, advance extraction techniques (e.g., enzyme- assisted-, instant controlled pressure drop-, microwave- assisted-, pressurized liquid-, sub- critical-, supercritical fluid-, and ultrasound-assisted extractions) have been applied to obtain phytochemicals from cardamom. The bioactive constituents identification techniques, specifically GC-MS analysis revealed that 1,8-cineole and α-terpinyl acetate were the principle bioactive components in black and green cardamom. Regarding therapeutic potential, research findings have indicated desirable health properties of cardamom phytochemicals, including antioxidant-, anti-hypercholesterolemic, anti-platelet aggregation, anti-hypertensive, and gastro-protective effects. Moreover, antimicrobial investigations revealed that cardamom phytochemicals effectively inhibited growth of pathogenic microorganisms (bacteria and fungi), biofilm formation inhibition (Gram-negative and Gram-positive bacteria) and bacterial quorum sensing inhibition. Encapsulation and delivery vehicles, including microcapsules, nanoparticles, nanostructured lipid carriers, and nanoliposomes were effective strategies to enhance their stability, bioavailability and bioefficacy. In conclusion, cardamom phytochemicals had promising therapeutic potentials (antioxidant and antimicrobial) due to polyphenols, thus could be used as functional additive to increase shelf life, inhibit oxidative rancidity and confer pleasant aroma to commercial edibles as well as mitigate oxidative stress and lifestyle related chronic diseases (e.g., cardiovascular and gastrointestinal diseases). A future perspective concerning the fabrication of functional foods, nutraceuticals and antibiotics to promote cardamom phytochemicals applications as biotherapeutic agents at large-scale requires thorough investigations, e.g., optimum dose and physical form of supplementation to obtain maximum health benefits.

A tele-nursing program for elderly with lifestyle-related chronic diseases during the COVID-19 pandemic in a municipality: an implementation report

A tele-nursing program for elderly with lifestyle-related chronic diseases during the COVID-19 pandemic in a municipality: an implementation report

Association between environmental lead/cadmium co-exposure in drinking water and soil and type 2 diabetes mellitus/obesity in Southern China.

Lead (Pb) and cadmium (Cd) in environment can be directly absorbed by drinking water and soil. However, data on human Pb and Cd exposure by drinking water and soil and its long-term consequence for type 2 diabetes mellitus (T2DM) and obesity are lacking. Our study aims to explore the association of typical heavy metals co-exposure in drinking water and soil to the community residents with T2DM and obesity indices in two cities of southern China. A cross-sectional study enrolling total 1,274 participants was performed and the local water and soil samples were collected in two communities in southern China. The average daily dose (ADD) of heavy metals was calculated to assess the exposure. The obesity indices comprise body mass index (BMI), waist-to-hip ratio (WHR) and waist circumference (WC). Binary, multiple logistic and linear regressions were employed for assessing the associations of Pb and Cd exposure with T2DM and obesity. The results showed that there weren't any significant correlations between ADDs of Pb/Cd and T2DM in community residents (all Ps>0.05). Compared with those with 18.5 ≤ BMI <24, with 1 μg/kg bw/d ADD of Pb increase in exposure are associated with 49.2–56.1% lower likelihood of overweight. Besides, with ADDs of Pb exposure was increased by 1 μg/kg bw/d and WHR decreasing by 0.01–0.02, and WC decreasing by 2.22–4.67 cm. We speculate that Pb causes weight loss because it damages the absorption function of the gastrointestinal tract as an initial injury. 1μg/kg bw/d ADD of Cd increase is associated with 100.9% upper likelihood of low weight in Model 1. It suggests that Pb/Cd pollution in the local environment was serious and harmful to residents' health. Government should introduce relevant oversight and accountability systems to improve the prevention and management of lifestyle-related chronic diseases in the future.

Empowering learners to provide dietary counselling.

Despite calls to increase dietary counselling by physicians to help address the epidemic of lifestyle-related chronic disease, medical education does not equip future physicians with the training to provide effective dietary counselling. In addition to the multiple barriers that clinician educators face in implementing clinically relevant nutrition education curricula, evaluation modalities in the nutrition education literature that assess student skills and behaviour remain limited. We implemented a brief, virtual nutrition education intervention in a US medical school during the outpatient clinical clerkship and assessed how our curriculum influenced students' development of dietary counselling skills. Student feedback revealed appreciation for learning how to approach conversations about diet in a non-judgmental manner and specific strategies to use during counselling. We thematically analysed the free-text responses from 81 dietary counselling encounter forms submitted by students. Three emergent themes reflected the key dietary counselling skills students demonstrated during patient encounters: (1) eliciting drivers of current eating patterns and barriers to healthier eating patterns, (2) individualising recommendations and (3) recommending evidence-based strategies. After receiving brief, clinically relevant, virtual nutrition education, students were able to successfully apply dietary counselling skills to patient care. In conjunction with indirect skill assessment through targeted documentation, we offer a sustainable approach for feasible nutrition education paired with meaningful evaluation.

Stigma evaluation for diabetes and other chronic non-communicable disease patients: Development, validation and clinical use of stigma scale - The Kanden Institute Stigma Scale.

The aim of this study was to develop a scale to evaluate disease stigma in patients with lifestyle-related chronic non-communicable diseases (LCNCDs), which we named the Kanden Institute Stigma Scale (KISS), and to consider its possible clinical application for patients with diabetes. An initial 90 questions were drafted and categorized into six subscales according to the manifestations of stigma. The final version of the KISS was developed as a 24-item questionnaire comprising four items for each subscale. A total of 539 outpatients including 452 patients with diabetes and 87 patients without diabetes were recruited. Construct validity was confirmed by assessing the correlation with previously established measures. Confirmatory factor analysis showed the KISS to have good model fitness (adjusted goodness-of-fit index = 0.856). Test-retest reproducibility analysis showed that the intraclass coefficient of the first and a second KISS was 0.843 (P < 0.001), indicating excellent reproducibility. The KISS showed higher scores for patients with diabetes than for patients without diabetes (12.23 ± 0.49 vs 5.76 ± 0.73, P < 0.05). The KISS score was significantly higher in type 1 and type 2 diabetes patients taking insulin therapy than in type 2 diabetes patients not taking insulin (P < 0.05). The KISS is a validated and reliable questionnaire for assessment of stigma among patients with diabetes as well as other lifestyle-related chronic non-communicable diseases, and might contribute to identifying and rectifying diabetes stigma, as well promoting awareness among health care professionals of this very consequential health problem.

Pasos Hacia La Salud II: study protocol for a randomized controlled trial of a theory- and technology-enhanced physical activity intervention for Latina women, compared to the original intervention

BackgroundLatinas are at increased risk for many lifestyle-related chronic diseases and are one of the least physically active populations in the US Innovative strategies are needed to help Latinas achieve the health benefits associated with physical activity (PA). This manuscript describes the study protocol of the Pasos Hacia La Salud II Study, which builds upon our previous research to test an enhanced individually-tailored, text-message and website-delivered, Spanish-language intervention (enhanced intervention), in comparison to the original web-based Pasos Hacia La Salud Intervention (original intervention).MethodsSedentary Latinas between the ages of 18–65 will be recruited and will complete an orientation and baseline assessments. Participants will be subsequently randomized to the original intervention, or the Enhanced Intervention, which has greater targeting of theoretical constructs such as self-efficacy, enjoyment, and social support, and which uses text messages and more dynamic and refined website features to encourage increased website use. Using a linear mixed effects regression model, we will simultaneously estimate the intervention effects on mean accelerometer-measured hours/week of moderate-to-vigorous PA (MVPA) at 6, 12, 18, and 24 months, with a subject-specific intercept (intent-to-treat sample). Change in self-reported MVPA, measured via the 7-day Physical Activity Recall, will be assessed as a secondary outcome using a similar model. We will investigate potential mediators of the intervention effect using a multiple mediation approach, and potential moderators by evaluating potential interactions. As an exploratory outcome, we will study the differences (among both study arms) in cost, in US dollars, per minute increases in weekly mean MVPA.DiscussionThe original Pasos PA intervention showed efficacy in helping Latinas increase PA; we expect the Enhanced Intervention to help a larger proportion of participants to increase and maintain their PA long term. This web- and text-based enhanced intervention could have great reach and dissemination potential, which could be capitalized on in the future to help to advance health equity. Adaptations made in response to the COVID-19 pandemic are also described in this manuscript.Trial registrationClinical Trial Number: NCT03491592. First posted April 9, 2018.

Microvascular Dysfunction in Heart Failure with Preserved Ejection Fraction: Pathophysiology, Assessment, Prevalence and Prognosis.

Heart failure with preserved ejection fraction (HFpEF) currently accounts for approximately half of all new heart failure cases in the community. HFpEF is closely associated with chronic lifestyle-related diseases, such as obesity and type 2 diabetes, and clinical outcomes are worse in those with than without comorbidities. HFpEF is pathophysiologically distinct from heart failure with reduced ejection fraction, which may explain, in part, the disparity of treatment options available between the two heart failure phenotypes. The mechanisms underlying HFpEF are complex, with coronary microvascular dysfunction (MVD) being proposed as a potential key driver in its pathophysiology. In this review, the authors highlight the evidence implicating MVD in HFpEF pathophysiology, the diagnostic approaches for identifying MVD (both invasive and non-invasive) and the prevalence and prognostic significance of MVD.

Assessment of Oxidative Stress and Metabolic Risks With Machine Learning Algorithms in Ethnically Diverse Population: Cross-Sectional Data in Korea and the Netherlands

ObjectivesThe underlying mechanisms for the development of chronic lifestyle-related diseases result from enhanced oxidative stress, and method for quantifying in healthy adult individuals have been investigated in the previous study. However, this predictor targeted the Korean population, and it is currently unclear how to evaluate oxidative stress in diverse ethnicities. On top of that, impaired metabolism is another major process, which is closely related to cellular, organ, and organism levels interacting with oxidative stress to initiate these diseases. Therefore, this study is aimed to develop and validate a predictor to quantify oxidative stress and metabolic risks across the ethnicity. MethodsThis study was conducted using cross-sectional data of the Nutrition Questionnaires plus (NQ plus) study in the Netherlands (n = 618) and the Korea National Health and Nutrition Examination Survey (KNHANES) (n = 6,387). To merge these two separate population data equally, propensity score matching was applied. Based on health space statistical methodology, each axis was obtained from two different binary samples: healthy controls (n = 324) versus oxidative disease cases (n = 391) and metabolic syndrome cases (n = 73). The model development was carried out in 10-fold cross-validation of ridge, elastic-net, and LASSO (least absolute shrinkage and selection operator) regularized regression. Evaluating the predictive accuracy of the fine-tuned model was validated by unmatched data after propensity score matching. ResultsA total of 22 and 18 features were selected in fine-tuned models to distinguish oxidative stress and metabolic risks from healthy controls respectively. The performance of the prediction was assessed with the area under the receiver operating characteristic curve of 0.972 (CI 0.967 to 0.976) and of 0.962 (CI 0.954 to 0.97). ConclusionsThese practical composite biomarkers appear useful to stratify oxidative stress and metabolic risks in healthy adults beyond differences between populations. Further external validation is required to ensure prognostic value and general applicability in longitudinal cohorts. Funding SourcesThis research was supported by the Bio & Medical Technology Development Program of the National Research Foundation (NRF) funded by the Ministry of Science & ICT(2012M3A9C4048761).

Functional Mechanisms of Health Behavior Change Techniques: A Conceptual Review.

BackgroundHealth behavior change is among the top recommendations for improving health of patients with lifestyle-related chronic diseases. An array of behavior change techniques (BCTs) have been developed to support behavior change initiation and maintenance. These BCTs often show limited success when they are not informed by theory, leading to a mismatch between the intention of the BCT and patients’ needs or expectations. Previous studies have identified a number of resources (domains) which patients may require to initiate and maintain health behavior change. Indeed, not yet well established is how BCTs address these resources, i.e., the functional mechanisms of BCTs.PurposeProvide a theoretical framework of the functional mechanisms of BCTs for developing and implementing successful interventions for health behavior change.MethodsConceptual review, including literature analysis and synthesis as well as conceptualization of a new model based on the synthesis.ResultsThrough the integration of dual-process models as well as reward and motivation proceeding, i.e., affective, emotional, or intuitive neurobiological cues, into the rational framework of rather linear cognitive or task-related decision progress, we categorize previously identified resources into three distinct sets: external, internal reflective, and internal affective resources. Based on this triad, we classify BCTs according to their functional mechanisms into facilitating (=providing external resources), boosting (=strengthening internal reflective resources), and nudging (=activating internal affective resources). Consequently, we present a simplified Behavior Change Resource Model (BCRM) that is centered on patients’ resources.ConclusionThe model can be applied to develop health behavior change interventions, which promote engagement and empowerment. Future studies should aim at testing the applicability and practicality of the BCRM.