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Formisano E, Proietti E, Borgarelli C, Sukkar SG, Albertelli M, Boschetti M, Pisciotta L. The impact of overweight on lipid phenotype in different forms of dyslipidemia: a retrospective cohort study. J Endocrinol Invest 2024:10.1007/s40618-024-02368-5. [PMID: 38605186 DOI: 10.1007/s40618-024-02368-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 03/26/2024] [Indexed: 04/13/2024]
Abstract
PURPOSE Dyslipidemia plays a pivotal role in increasing cardiovascular risk. In clinical practice the misleading association between altered lipid profile and obesity is common, therefore genetically inherited dyslipidemias may not completely be addressed among patients with overweight. Thus, we aim to investigate the influence of overweight and obesity on the lipid phenotype in a cohort of patients with different forms of dyslipidemia. METHODS A retrospective analysis was conducted on patients with dyslipidemia from 2015 to 2022. Patients were stratified in familial hypercholesterolemia (FH), familial combined hyperlipidemia (FCHL), non-familial hyperlipidemia or polygenic hypercholesterolemia (PH). Clinical characteristics and lipid profile were evaluated. RESULTS Of the total of 798 patients, 361 were affected by non-familial hyperlipidemia (45.2%), while FCHL, FH and PH was described in 19.9%, 14.0% and 20.9% of patients, respectively. Overweight prevalence was higher in FCHL and non-familial hyperlipidemia patients than FH and PH patients. Subjects with overweight and obesity were independently associated with lower levels of high-density lipoprotein cholesterol (HDL-C) compared to patients with normal weight (52.4 and 46.0 vs 58.1, respectively; p < 0.0001); levels of triglycerides (TG) and non-HDL-C were higher in patients with overweight and obesity than patients with normal weight (257.3 and 290.9 vs 194.8, and 221.5 and 219.6 vs 210.1, p < 0.0001 and p = 0.01, respectively), while no differences were observed between patients with overweight and obesity. CONCLUSION While dyslipidemias can be influenced by various factors, an important determinant may lie in genetics, frequently acting as an underlying cause of altered lipid profiles, even in cases of overweight conditions.
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Affiliation(s)
- E Formisano
- Department of Internal Medicine, University of Genoa, Viale Benedetto XV 6, 16132, Genoa, Italy
- Dietetics and Clinical Nutrition Unit, IRCCS Policlinic Hospital San Martino, 16132, Genoa, Italy
| | - E Proietti
- Department of Internal Medicine, University of Genoa, Viale Benedetto XV 6, 16132, Genoa, Italy
| | - C Borgarelli
- Department of Internal Medicine, University of Genoa, Viale Benedetto XV 6, 16132, Genoa, Italy
| | - S G Sukkar
- Dietetics and Clinical Nutrition Unit, IRCCS Policlinic Hospital San Martino, 16132, Genoa, Italy
| | - M Albertelli
- Department of Internal Medicine, University of Genoa, Viale Benedetto XV 6, 16132, Genoa, Italy
- Endocrinology Unit, IRCCS Ospedale Policlinico San Martino, 16132, Genoa, Italy
| | - M Boschetti
- Department of Internal Medicine, University of Genoa, Viale Benedetto XV 6, 16132, Genoa, Italy
- Endocrinology Unit, IRCCS Ospedale Policlinico San Martino, 16132, Genoa, Italy
| | - L Pisciotta
- Department of Internal Medicine, University of Genoa, Viale Benedetto XV 6, 16132, Genoa, Italy.
- Dietetics and Clinical Nutrition Unit, IRCCS Policlinic Hospital San Martino, 16132, Genoa, Italy.
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Nakahata M, Tanaka-Mizuno S, Yamaguchi F, Takeuchi M, Kawakami K. Does nutritional guidance reduce cardiovascular events in patients with type 2 diabetes mellitus? A retrospective cohort study using a nationwide claims database. Acta Diabetol 2023; 60:1541-1549. [PMID: 37421440 DOI: 10.1007/s00592-023-02147-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 06/25/2023] [Indexed: 07/10/2023]
Abstract
AIM To examine the effect of nutritional guidance (NG) provided by a registered dietitian under the direction of a physician on the development of subsequent cardiovascular events in patients with early-stage type 2 diabetes mellitus (T2DM). MATERIALS AND METHODS This retrospective cohort study used the JMDC claims database to explore patients aged 18 years or older who first met the diagnostic criteria for T2DM at a health checkup between January 2011 and January 2019. The last day of the observation period was set for 28 February, 2021. Exposure was defined as receiving NG within 180 days of diagnosis of T2DM. The primary outcome was a composite endpoint of coronary artery disease (CAD) and cerebrovascular disease, and the secondary outcomes were each event, and time to event was compared. The propensity score weighting method was used for adjusting the distribution of confounding variables. Cox regression was conducted to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). RESULTS Overall, 31,378 patients met the eligibility criteria at an annual health checkup. 9.6% received NG (n = 3013). Patients who attended ≥ 1 NG after diagnosis had significantly reduced risk of cardiovascular composite (adjusted HR 0.75, 95% CI 0.58-0.97) and cerebrovascular disease (adjusted HR 0.65, 95% CI 0.47-0.90) during approximately 3.3 years of follow-up. In contrast, no difference was observed for CAD. CONCLUSIONS Receiving NG in early-stage diabetes may reduce the incidence of cardiovascular events, especially cerebrovascular events.
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Affiliation(s)
- Misaki Nakahata
- Department of Pharmacoepidemiology, Graduate School of Medicine, Kyoto University, Yoshidakonoe-Cho, Sakyo-Ku, Kyoto, 606-8501, Japan
| | - Sachiko Tanaka-Mizuno
- Department of Pharmacoepidemiology, Graduate School of Medicine, Kyoto University, Yoshidakonoe-Cho, Sakyo-Ku, Kyoto, 606-8501, Japan.
- Department of Digital Health and Epidemiology, Graduate School of Medicine, Kyoto University, Yoshidakonoe-Cho, Sakyo-Ku, Kyoto, 606-8501, Japan.
| | - Fumitaka Yamaguchi
- Department of Pharmacoepidemiology, Graduate School of Medicine, Kyoto University, Yoshidakonoe-Cho, Sakyo-Ku, Kyoto, 606-8501, Japan
| | - Masato Takeuchi
- Department of Pharmacoepidemiology, Graduate School of Medicine, Kyoto University, Yoshidakonoe-Cho, Sakyo-Ku, Kyoto, 606-8501, Japan
| | - Koji Kawakami
- Department of Pharmacoepidemiology, Graduate School of Medicine, Kyoto University, Yoshidakonoe-Cho, Sakyo-Ku, Kyoto, 606-8501, Japan
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Ringvoll H, Kolberg M, Rangul V, Hafskjold I, Haug EB, Blomhoff R, Henriksen HB, Horn J. Postpartum lifestyle behaviour among women with prior gestational diabetes mellitus: evidence from the HUNT study. BMJ Nutr Prev Health 2023; 6:173-181. [PMID: 38618544 PMCID: PMC11009551 DOI: 10.1136/bmjnph-2022-000612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 09/19/2023] [Indexed: 04/16/2024] Open
Abstract
Introduction Women with a history of gestational diabetes mellitus (GDM) are at increased risk of type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD). Recommendations for postpartum follow-up include targeted lifestyle advice to lower the risk.The aim of this study was to compare postpartum lifestyle behaviours and perceptions among women with and without a history of GDM. In addition, we examined whether lifestyle behaviours of women with a history of GDM participating in a lifestyle intervention study differed from lifestyle behaviours of women with a history of GDM in the general population. Research design and methods We linked data from the fourth survey of the population-based Trøndelag Health Study (HUNT4) to information from the Medical Birth Registry of Norway for women with registered births between 2000 and 2019. Using logistic regression, we compared lifestyle behaviours in women with and without GDM. In secondary analyses, lifestyle behaviours in women with GDM participating in a postpartum lifestyle intervention study were compared with HUNT participants with GDM using Fisher's exact tests/t-tests. Results A high proportion of the women in our population, regardless of GDM history, reported several unhealthy lifestyle behaviours. We found no significant association between history of GDM and lifestyle behaviours. The lifestyle intervention study for women with a history of GDM appeared to recruit women with more favourable lifestyle behaviours. Conclusions Women, regardless of GDM history, could potentially benefit from further support for lifestyle improvement, but it may be especially important in women with a history of GDM given their increased risk of T2DM and CVD. Interventions targeting women with GDM might not reach the women with the unhealthiest lifestyle behaviours, and measures to reach out to all women should be further investigated.
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Affiliation(s)
- Hanne Ringvoll
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Faculty of Medicine and Health Sciences, Trondheim, Norway
| | - Marit Kolberg
- Center for Oral Health Services and Research, Trondheim, Norway
| | - Vegar Rangul
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Faculty of Medicine and Health Sciences, Trondheim, Norway
- Nord University, Levanger, Norway
- Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Ingrid Hafskjold
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Faculty of Medicine and Health Sciences, Trondheim, Norway
| | - Eirin Beate Haug
- K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Rune Blomhoff
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
- Department of Clinic Service, Division of Cancer Medicine, Oslo University Hospital, Oslo, Norway
| | - Hege Berg Henriksen
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Julie Horn
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Faculty of Medicine and Health Sciences, Trondheim, Norway
- Department of Obstetrics and Gynecology, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
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Stadelmaier J, Roux I, Petropoulou M, Schwingshackl L. Empirical evidence of study design biases in nutrition randomised controlled trials: a meta-epidemiological study. BMC Med 2022; 20:330. [PMID: 36217133 PMCID: PMC9552513 DOI: 10.1186/s12916-022-02540-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 08/23/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Instruments to critically appraise randomised controlled trials (RCTs) are based on evidence from meta-epidemiological studies. We aim to conduct a meta-epidemiological study on the average bias associated with reported methodological trial characteristics such as random sequence generation, allocation concealment, blinding, incomplete outcome data, selective reporting, and compliance of RCTs in nutrition research. METHODS We searched the Cochrane Database of Systematic Reviews, for systematic reviews of RCTs, published between 01 January 2010 and 31 December 2019. We combined the estimates of the average bias (e.g. ratio of risk ratios [RRR] or differences in standardised mean differences) in meta-analyses using the random-effects model. Subgroup analyses were conducted to investigate the potential differences among the RCTs with low versus high/unclear risk of bias with respect to the different types of interventions (e.g. micronutrients, fatty acids, dietary approach), outcomes (e.g. mortality, pregnancy outcomes), and type of outcome (objective, subjective). Heterogeneity was assessed through I2 and τ2, and prediction intervals were calculated. RESULTS We included 27 Cochrane nutrition reviews with 77 meta-analyses (n = 927 RCTs). The available evidence suggests that intervention effect estimates may not be exaggerated in RCTs with high/unclear risk of bias (versus low) judgement for sequence generation (RRR 0.97, 95% CI 0.93 to 1.02; I2 = 28%; τ2 = 0.002), allocation concealment (RRR 1.00, 95% CI 0.96 to 1.04; I2 = 27%; τ2 = 0.001), blinding of participants and personnel (RRR 0.95, 95% CI 0.91 to 1.00; I2 = 23%; τ2 = 0), selective reporting (RRR 0.97, 95% CI 0.92 to 1.02; I2 = 24%; τ2 = 0), and compliance (RRR 0.95, 95% CI 0.89 to 1.02; I2 = 0%; τ2 = 0). Intervention effect estimates seemed to be exaggerated in RCTs with a high/unclear risk of bias judgement for blinding of outcome assessment (RRR 0.81, 95% CI 0.70 to 0.94; I2 = 26%; τ2 = 0.03), which was predominately driven by subjective outcomes, and incomplete outcome data (RRR 0.92, 95% CI 0.88 to 0.97; I2 = 22%; τ2 = 0.001). For continuous outcomes, no differences were observed, except for selective reporting. CONCLUSIONS On average, most characteristics of nutrition RCTs may not exaggerate intervention effect estimates, but the average bias appears to be greatest in trials of subjective outcomes. Replication of this study is suggested in this field to keep this conclusion updated.
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Affiliation(s)
- Julia Stadelmaier
- Institute for Evidence in Medicine, Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
| | - Isabelle Roux
- Institute for Evidence in Medicine, Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Maria Petropoulou
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Centre, University of Freiburg, Freiburg, Germany
| | - Lukas Schwingshackl
- Institute for Evidence in Medicine, Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Ye Z, Cao Y, Miao C, Liu W, Dong L, Lv Z, Iheozor-Ejiofor Z, Li C. Periodontal therapy for primary or secondary prevention of cardiovascular disease in people with periodontitis. Cochrane Database Syst Rev 2022; 10:CD009197. [PMID: 36194420 PMCID: PMC9531722 DOI: 10.1002/14651858.cd009197.pub5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
BACKGROUND There may be an association between periodontitis and cardiovascular disease (CVD); however, the evidence so far has been uncertain about whether periodontal therapy can help prevent CVD in people diagnosed with chronic periodontitis. This is the third update of a review originally published in 2014, and most recently updated in 2019. Although there is a new multidimensional staging and grading system for periodontitis, we have retained the label 'chronic periodontitis' in this version of the review since available studies are based on the previous classification system. OBJECTIVES To investigate the effects of periodontal therapy for primary or secondary prevention of CVD in people with chronic periodontitis. SEARCH METHODS An information specialist searched five bibliographic databases up to 17 November 2021 and additional search methods were used to identify published, unpublished, and ongoing studies. We also searched the Chinese BioMedical Literature Database, the China National Knowledge Infrastructure, the VIP database, and Sciencepaper Online to March 2022. SELECTION CRITERIA We included randomised controlled trials (RCTs) that compared active periodontal therapy to no periodontal treatment or a different periodontal treatment. We included studies of participants with a diagnosis of chronic periodontitis, either with CVD (secondary prevention studies) or without CVD (primary prevention studies). DATA COLLECTION AND ANALYSIS Two review authors carried out the study identification, data extraction, and 'Risk of bias' assessment independently and in duplicate. They resolved any discrepancies by discussion, or with a third review author. We adopted a formal pilot-tested data extraction form, and used the Cochrane tool to assess the risk of bias in the studies. We used GRADE criteria to assess the certainty of the evidence. MAIN RESULTS There are no new completed RCTs on this topic since we published our last update in 2019. We included two RCTs in the review. One study focused on the primary prevention of CVD, and the other addressed secondary prevention. We evaluated both as being at high risk of bias. Our primary outcomes of interest were death (all-cause and CVD-related) and all cardiovascular events, measured at one-year follow-up or longer. For primary prevention of CVD in participants with periodontitis and metabolic syndrome, one study (165 participants) provided very low-certainty evidence. There was only one death in the study; we were unable to determine whether scaling and root planning plus amoxicillin and metronidazole could reduce incidence of all-cause death (Peto odds ratio (OR) 7.48, 95% confidence interval (CI) 0.15 to 376.98), or all CVD-related death (Peto OR 7.48, 95% CI 0.15 to 376.98). We could not exclude the possibility that scaling and root planning plus amoxicillin and metronidazole could increase cardiovascular events (Peto OR 7.77, 95% CI 1.07 to 56.1) compared with supragingival scaling measured at 12-month follow-up. For secondary prevention of CVD, one pilot study randomised 303 participants to receive scaling and root planning plus oral hygiene instruction (periodontal treatment) or oral hygiene instruction plus a copy of radiographs and recommendation to follow-up with a dentist (community care). As cardiovascular events had been measured for different time periods of between 6 and 25 months, and only 37 participants were available with at least one-year follow-up, we did not consider the data to be sufficiently robust for inclusion in this review. The study did not evaluate all-cause death and all CVD-related death. We are unable to draw any conclusions about the effects of periodontal therapy on secondary prevention of CVD. AUTHORS' CONCLUSIONS For primary prevention of cardiovascular disease (CVD) in people diagnosed with periodontitis and metabolic syndrome, very low-certainty evidence was inconclusive about the effects of scaling and root planning plus antibiotics compared to supragingival scaling. There is no reliable evidence available regarding secondary prevention of CVD in people diagnosed with chronic periodontitis and CVD. Further trials are needed to reach conclusions about whether treatment for periodontal disease can help prevent occurrence or recurrence of CVD.
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Affiliation(s)
- Zelin Ye
- Department of Imaging, West China School of Stomatology, Chengdu, China
| | - Yubin Cao
- Department of Head and Neck Oncology, State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Cheng Miao
- Department of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Wei Liu
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Li Dong
- Department of Cardiovascular Medicine, Hospital of Traditional Chinese Medicine Affiliated to Southwest Medical University, Luzhou, China
| | - Zongkai Lv
- Department of Stomatology, Nan Chong Central Hospital, Second Clinical Medical College of Chuan Bei Medical College, Nanchong, China
| | | | - Chunjie Li
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
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Córdoba García R, Camarelles Guillem F, Muñoz Seco E, Gómez Puente JM, San José Arango J, Ramírez Manent JI, Martín Cantera C, del Campo Giménez M, Revenga Frauca J, Egea Ronda A, Cervigón Portaencasa R, Rodríguez Benito L. [PAPPS expert group: Lifestyle recommendations]. Aten Primaria 2022; 54 Suppl 1:102442. [PMID: 36435590 PMCID: PMC9705217 DOI: 10.1016/j.aprim.2022.102442] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 07/01/2022] [Indexed: 11/24/2022] Open
Abstract
We present the recommendations of the Preventive Activities and Health Promotion Programme (PAPPS) of the semFYC (Spanish Society of Family and Community Medicine) to promote healthy lifestyles using intervention methodology, and preventive actions against tobacco and alcohol use, healthy eating, physical activity in leisure time, prevention of traffic accidents, and child restraint systems. The recommendations have been updated, and new aspects highlighted, such as the definition of low-risk alcohol consumption, and the references have been updated. For the main recommendations, we include specific tables showing the quality of the evidence and the strength of the recommendation.
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Affiliation(s)
- Rodrigo Córdoba García
- Medicina de Familia y Comunitaria, Centro de Salud Delicias Sur. Coordinación del Grupo de ESPS, Zaragoza, España.
| | | | - Elena Muñoz Seco
- Medicina de Familia y Comunitaria, Unidad Básica de Salud Es Castell. Ibsalut, Menorca, España
| | - Juana M. Gómez Puente
- Enfermería Familiar y Comunitaria, Centro de Salud San Carlos, San Lorenzo de El Escorial, Madrid, España
| | - Joaquín San José Arango
- Medicina de Familia y Comunitaria, Centro de Salud Vilagarcía. Grupo de Trabajo de Alimentación y Nutrición, Pontevedra, España
| | - José Ignacio Ramírez Manent
- Medicina de Familia y Comunitaria, Centro de Salud de Calviá, Instituto de Investigación Sanitaria Illes Balears (IdIsBa), Islas Baleares, España
| | - Carlos Martín Cantera
- Medicina de Familia y Comunitaria, Grupo de Investigación Estilos de Vida, IDIAP Jordi Gol, Barcelona, España
| | - María del Campo Giménez
- Medicina de Familia y Comunitaria, Gerencia de Atención Integrada de Albacete, SESCAM, Albacete, España
| | | | - Ana Egea Ronda
- Medicina de Familia y Comunitaria, Consultorio de San Antonio de Benagéber, Valencia, España
| | | | - Laura Rodríguez Benito
- Medicina de Familia y Comunitaria, Manor Practice Surgery, Wallington Sutton, Londres, Reino Unido
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Whatnall M, Clarke ED, Adam MTP, Ashton LM, Burrows T, Hutchesson M, Collins CE. Diet Quality of Adolescents and Adults Who Completed the Australian Healthy Eating Quiz: An Analysis of Data over Six Years (2016-2022). Nutrients 2022; 14:nu14194072. [PMID: 36235723 PMCID: PMC9570644 DOI: 10.3390/nu14194072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 09/28/2022] [Accepted: 09/29/2022] [Indexed: 11/16/2022] Open
Abstract
Diet quality is influenced by demographics and can change over time. This study aimed to (1) compare diet quality among adolescents/adults who completed the online Healthy Eating Quiz (HEQ) by demographic characteristics, and (2) to evaluate change in score over time for repeat completers. HEQ data collected between July 2016 and May 2022 were analysed, including demographics (age, gender, vegetarian status, socio-economic status, number of people main meals are shared with, country), and diet quality calculated using the Australian Recommended Food Score (ARFS) (range 0−73) for respondents aged ≥ 16 years. Differences in ARFS by demographic characteristics and change in score over time, adjusted for age, gender and vegetarian status, were tested by linear regression. The participants (n = 176,075) were predominantly female (70.4%), Australian (62.8%), and aged 18−24 years (27.7%), with 4.0% (n = 7087) repeat completers. Mean ± SD ARFS was 33.9 ± 9.4/73. Results indicate that ARFS was significantly lower among males and significantly higher with increasing age group, higher socio-economic status, in vegetarians, those who shared main meals with others, and those living in Australia (p-values < 0.001). Mean change in ARFS over time (2.3 ± 6.9) was significantly higher for those with lower baseline scores (p < 0.001). Publicly available, brief dietary assessment tools have the potential to improve diet quality at the population level.
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Affiliation(s)
- Megan Whatnall
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, Newcastle, NSW 2308, Australia
- Food and Nutrition Research Program, Hunter Medical Research Institute, New Lambton Heights, Newcastle, NSW 2305, Australia
| | - Erin D. Clarke
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, Newcastle, NSW 2308, Australia
- Food and Nutrition Research Program, Hunter Medical Research Institute, New Lambton Heights, Newcastle, NSW 2305, Australia
| | - Marc T. P. Adam
- School of Information and Physical Sciences, College of Engineering, Science and Environment, University of Newcastle, Callaghan, Newcastle, NSW 2308, Australia
| | - Lee M. Ashton
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, Newcastle, NSW 2308, Australia
- School of Education, College of Human and Social Futures, University of Newcastle, Callaghan, Newcastle, NSW 2308, Australia
- Active Living Research Program, Hunter Medical Research Institute, New Lambton Heights, Newcastle, NSW 2305, Australia
| | - Tracy Burrows
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, Newcastle, NSW 2308, Australia
- Food and Nutrition Research Program, Hunter Medical Research Institute, New Lambton Heights, Newcastle, NSW 2305, Australia
| | - Melinda Hutchesson
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, Newcastle, NSW 2308, Australia
- Food and Nutrition Research Program, Hunter Medical Research Institute, New Lambton Heights, Newcastle, NSW 2305, Australia
| | - Clare E. Collins
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, Newcastle, NSW 2308, Australia
- Food and Nutrition Research Program, Hunter Medical Research Institute, New Lambton Heights, Newcastle, NSW 2305, Australia
- Correspondence:
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8
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Bradley T, Campbell E, Dray J, Bartlem K, Wye P, Hanly G, Gibson L, Fehily C, Bailey J, Wynne O, Colyvas K, Bowman J. Systematic review of lifestyle interventions to improve weight, physical activity and diet among people with a mental health condition. Syst Rev 2022; 11:198. [PMID: 36085250 PMCID: PMC9462072 DOI: 10.1186/s13643-022-02067-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 09/01/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND People with a mental health condition experience an elevated risk of chronic disease and greater prevalence of health and behaviours. Lifestyle interventions aim to reduce this risk by modifying health behaviours such as physical activity and diet. Previous reviews exploring the efficacy of such interventions for this group have typically limited inclusion to individuals with severe mental illness (SMI), with a focus of impact on weight. This review assessed the efficacy of lifestyle interventions delivered in community or outpatient settings to people with any mental health condition, on weight, physical activity and diet. METHODS Eligible studies were randomised or cluster-randomised controlled trials published between January 1999 and February 2019 aiming to improve weight, physical activity or diet, for people with any mental health condition. Two reviewers independently completed study screening, data extraction and assessment of methodological quality. Primary outcome measures were weight, physical activity and diet. Secondary outcome measures were body mass index (BMI), waist circumference, sedentary behaviour and mental health. Where possible, meta-analyses were conducted. Narrative synthesis using vote counting based on direction of effect was used where studies were not amenable to meta-analysis. RESULTS Fifty-seven studies were included (49 SMI only), with 46 contributing to meta-analyses. Meta-analyses revealed significant (< 0.05) effect of interventions on mean weight loss (-1.42 kg), achieving 5% weight loss (OR 2.48), weight maintenance (-2.05 kg), physical activity (IPAQ MET minutes: 226.82) and daily vegetable serves (0.51), but not on fruit serves (0.01). Significant effects were also seen for secondary outcomes of BMI (-0.48 units) and waist circumference (-0.87cm), but not mental health (depression: SMD -0.03; anxiety: SMD -0.49; severity of psychological symptoms: SMD 0.72). Studies reporting sedentary behaviour were not able to be meta-analysed. Most trials had high risk of bias, quality of evidence for weight and physical activity were moderate, while quality of evidence for diet was low. CONCLUSION Lifestyle interventions delivered to people with a mental health condition made statistically significant improvements to weight, BMI, waist circumference, vegetable serves and physical activity. Further high-quality trials with greater consistency in measurement and reporting of outcomes are needed to better understand the impact of lifestyle interventions on physical activity, diet, sedentary behaviour and mental health and to understand impact on subgroups. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42019137197.
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Affiliation(s)
- Tegan Bradley
- University of Newcastle, University Drive, Callaghan, NSW 2308 Australia
- Hunter Medical Research Institute, Lot 1, Kookaburra Cct, New Lambton Heights, NSW 2305 Australia
| | - Elizabeth Campbell
- Hunter New England Population Health, Locked Bag 10, Wallsend, NSW 2287 Australia
| | - Julia Dray
- University of Newcastle, University Drive, Callaghan, NSW 2308 Australia
- Hunter Medical Research Institute, Lot 1, Kookaburra Cct, New Lambton Heights, NSW 2305 Australia
| | - Kate Bartlem
- University of Newcastle, University Drive, Callaghan, NSW 2308 Australia
- Hunter Medical Research Institute, Lot 1, Kookaburra Cct, New Lambton Heights, NSW 2305 Australia
| | - Paula Wye
- University of Newcastle, University Drive, Callaghan, NSW 2308 Australia
| | - Grace Hanly
- University of Newcastle, University Drive, Callaghan, NSW 2308 Australia
- Hunter Medical Research Institute, Lot 1, Kookaburra Cct, New Lambton Heights, NSW 2305 Australia
| | - Lauren Gibson
- University of Newcastle, University Drive, Callaghan, NSW 2308 Australia
- Hunter Medical Research Institute, Lot 1, Kookaburra Cct, New Lambton Heights, NSW 2305 Australia
| | - Caitlin Fehily
- University of Newcastle, University Drive, Callaghan, NSW 2308 Australia
- Hunter Medical Research Institute, Lot 1, Kookaburra Cct, New Lambton Heights, NSW 2305 Australia
| | - Jacqueline Bailey
- University of Newcastle, University Drive, Callaghan, NSW 2308 Australia
| | - Olivia Wynne
- University of Newcastle, University Drive, Callaghan, NSW 2308 Australia
| | - Kim Colyvas
- University of Newcastle, University Drive, Callaghan, NSW 2308 Australia
| | - Jenny Bowman
- University of Newcastle, University Drive, Callaghan, NSW 2308 Australia
- Hunter Medical Research Institute, Lot 1, Kookaburra Cct, New Lambton Heights, NSW 2305 Australia
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Lemp JM, Nuthanapati MP, Bärnighausen TW, Vollmer S, Geldsetzer P, Jani A. Use of lifestyle interventions in primary care for individuals with newly diagnosed hypertension, hyperlipidaemia or obesity: a retrospective cohort study. J R Soc Med 2022; 115:289-299. [PMID: 35176215 PMCID: PMC9340092 DOI: 10.1177/01410768221077381] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Lifestyle interventions can be efficacious in reducing cardiovascular disease risk factors and are recommended as first-line interventions in England. However, recent information on the use of these interventions in primary care is lacking. We investigated for how many patients with newly diagnosed hypertension, hyperlipidaemia or obesity, lifestyle interventions were recorded in their primary care electronic health record. DESIGN A retrospective cohort study. SETTING English primary care, using UK Clinical Practice Research Datalink. PARTICIPANTS A total of 770,711 patients who were aged 18 years or older and received a new diagnosis of hypertension, hyperlipidaemia or obesity between 2010 and 2019. MAIN OUTCOME MEASURES Record of lifestyle intervention and/or medication in 12 months before to 12 months after initial diagnosis (2-year timeframe). RESULTS Analyses show varying results across conditions: While 55.6% (95% CI 54.9-56.4) of individuals with an initial diagnosis of hypertension were recorded as having lifestyle support (lifestyle intervention or signposting) within the 2-year timeframe, this number was reduced to 45.2% (95% CI 43.8-46.6) for hyperlipidaemia and 52.6% (95% CI 51.1-54.1) for obesity. For substantial proportions of individuals neither lifestyle support nor medication (hypertension: 12.2%, 95% CI 11.9-12.5; hyperlipidaemia: 32.2%, 95% CI 31.2-33.3; obesity: 43.9%, 95% CI 42.3-45.4) were recorded. Sensitivity analyses confirm that limited proportions of patients had lifestyle support recorded in their electronic health record before they were first prescribed medication (diagnosed and undiagnosed), ranging from 12.1% for hypertension to 19.7% for hyperlipidaemia, and 19.5% for obesity (23.4% if restricted to Orlistat). CONCLUSIONS Limited evidence of lifestyle support for individuals with cardiovascular risk factors (hypertension, hyperlipidaemia, obesity) recommended by national guidelines in England may stem from poor recording in electronic health records but may also represent missed opportunities. Given the link between progression to cardiovascular disease and modifiable lifestyle factors, early support for patients to manage their conditions through non-pharmaceutical interventions by establishing lifestyle modification as first-line treatment is crucial.
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Affiliation(s)
- Julia M Lemp
- Heidelberg Institute of Global Health, Heidelberg University and University Hospital, 69120 Heidelberg, Germany
| | - Meghana Prasad Nuthanapati
- Department of Economics and Centre for Modern Indian Studies, University of Goettingen, 37073 Göttingen, Germany
| | - Till W Bärnighausen
- Heidelberg Institute of Global Health, Heidelberg University and University Hospital, 69120 Heidelberg, Germany.,Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA 02115, USA.,Africa Health Research Institute, Somkhele, Mtubatuba, 3935, South Africa
| | - Sebastian Vollmer
- Department of Economics and Centre for Modern Indian Studies, University of Goettingen, 37073 Göttingen, Germany
| | - Pascal Geldsetzer
- Heidelberg Institute of Global Health, Heidelberg University and University Hospital, 69120 Heidelberg, Germany.,Division of Primary Care and Population Health, Stanford University, Stanford, CA 94305, USA
| | - Anant Jani
- Heidelberg Institute of Global Health, Heidelberg University and University Hospital, 69120 Heidelberg, Germany.,Oxford Martin School, Oxford University, Oxford OX1 3BD, UK
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Esch T, Stefano GB. The BERN Framework of Mind-Body Medicine: Integrating Self-Care, Health Promotion, Resilience, and Applied Neuroscience. Front Integr Neurosci 2022; 16:913573. [PMID: 35910341 PMCID: PMC9330052 DOI: 10.3389/fnint.2022.913573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 06/20/2022] [Indexed: 11/13/2022] Open
Abstract
Background: Mind-body medicine (MBM) focuses on improving our understanding of how the interactions between the brain, mind, body, and behavior can be used to promote health. In this narrative review, we present the basic principles of MBM, including the introduction of a rational framework for the implementation of MBM-based interventions. We also discuss the contributions of MBM to motivation and reward systems in the brain including those that may specifically involve the mitochondria.Results: MBM can be used to promote health in patients with chronic diseases, especially conditions identified as lifestyle-related. MBM builds on salutogenesis, which is a paradigm that focuses on health (as opposed to disease) determinants and the development of individual resilience and coherence factors as a means to reduce stress, decrease the burden of disease, and improve the quality of life. This approach involves several well-known principles of self-healing and self-care. MBM interventions typically include behavioral modification techniques in conjunction with cognitive work focused on stress regulation, exercise, relaxation, meditation, and nutrition. We suggest the use of the acronym “BERN” (Behavior, Exercise, Relaxation, and Nutrition) to summarize the operational framework of this approach.Discussion: Different BERN techniques act via shared autoregulatory central nervous system (CNS) reward and motivation circuitries. These systems rely on numerous neurobiological signaling pathways with overlapping effector molecules that converge, e.g., on nitric oxide (NO) as a common effector molecule. NO is critically coupled to reward physiology, stress reduction, and self-regulation as it modulates the responses of various mitochondrial, nuclear, and chromosomal processes within brain cells. NO has also been implicated in relevant outcomes (e.g., the placebo response).Conclusions: MBM interventions typically follow the BERN model and aim to strengthen health and resilience, and reduce stress. The mechanisms of action of these processes involve the CNS reward systems and correlate with placebo and self-healing pathways.
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Affiliation(s)
- Tobias Esch
- Institute for Integrative Health Care and Health Promotion, School of Medicine, Witten/Herdecke University, Witten, Germany
- *Correspondence: Tobias Esch
| | - George B. Stefano
- Center for Cognitive and Molecular Neuroscience, First Faculty of Medicine, Charles University, Prague, Czechia
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11
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Effectiveness of Written Dietary Advice for Improving Blood Lipids in Primary Care Adults-A Pragmatic Randomized Controlled Trial (MYDICLIN). Nutrients 2022; 14:nu14051022. [PMID: 35267997 PMCID: PMC8912386 DOI: 10.3390/nu14051022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 02/10/2022] [Accepted: 02/23/2022] [Indexed: 11/17/2022] Open
Abstract
Lifestyle management is the first line of treatment for moderately elevated blood lipids in healthy individuals. We investigated the effectiveness of providing food-based written advice for lowering low-density lipoprotein (LDL) cholesterol (intervention) or triglycerides (control) in a pragmatic randomized controlled trial with two parallel arms from 2018-2019 at a rural primary health care center. We sent feedback letters after 3 weeks and 6 months. Out of the 113 adult primary care patients randomized, 112 completed the study. There were no differences between the intervention and control groups for changes in LDL cholesterol after 3 weeks (mean ± standard deviation -0.21 ± 0.38 vs. -0.11 ± 0.34 mmol/L, p = 0.45) or 6 months (-0.05 ± 0.47 vs. 0.02 ± 0.41 mmol/L, p = 0.70) (primary outcome). Following the advice to consume plant sterols and turmeric was associated with a reduction in LDL cholesterol after 3 weeks. Following the advice to consume less carbohydrates was associated with reduced triglycerides. In the intervention arm, 14 individuals (25%) reduced their LDL cholesterol by ≥10% after three weeks. Their reduction was attenuated but maintained after six months (-7.1 ± 9.2% or -0.31 ± 0.38 mmol/L, p = 0.01 compared with baseline). They differed only in higher adherence to the advice regarding turmeric. In conclusion, this undemanding intervention had little effect on blood lipids for most individuals.
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Pavía-López AA, Alcocer-Gamba MA, Ruiz-Gastelum ED, Mayorga-Butrón JL, Mehta R, Díaz-Aragón FA, Aldrete-Velasco JA, López-Juárez N, Cruz-Bautista I, Chávez-Mendoza A, Secchi-Nicolás NC, Guerrero-Martínez FJ, Cossio-Aranda JE, Mendoza-Zubieta V, Fanghänel-Salmon G, Valdivia-Proa M, Olmos-Domínguez L, Aguilar-Salinas CA, Dávila-Maldonado L, Vázquez-Rangel A, Pavia-Aubry V, Nava-Hernández MDLA, Hinojosa-Becerril CA, Anda-Garay JC, Ríos-Ibarra MODL, Berni-Betancourt AC, López-Cuellar J, Araiza-Garaygordobil D, Rivera-Reyes R, Borrayo-Sánchez G, Tapia-Hernández M, Cano-Nigenda CV, Guerra-López A, Elías-López J, Figueroa-Morales MA, Montaño-Velázquez BB, Velasco-Hidalgo L, Rodríguez-Lozano AL, Pimentel-Hernández C, Baquero-Hoyos MM, Romero-Moreno F, Rodríguez-Vega M. Guía de práctica clínica mexicana para el diagnóstico y tratamiento de las dislipidemias y enfermedad cardiovascular aterosclerótica. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2022; 92:1-62. [PMID: 35275904 PMCID: PMC9290432 DOI: 10.24875/acm.m22000081] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Accepted: 01/14/2022] [Indexed: 11/17/2022] Open
Abstract
ANTECEDENTES Las enfermedades cardiovasculares son la principal causa mundial de mortalidad y México no es la excepción. Los datos epidemiológicos obtenidos en 1990 mostraron que los padecimientos cardiovasculares representaron el 19.8% de todas las causas de muerte en nuestro país; esta cifra se incrementó de manera significativa a un 25.5% para 2015. Diversas encuestas nacionales sugieren que más del 60% de la población adulta tiene al menos un factor de riesgo para padecer enfermedades cardiovasculares (obesidad o sobrepeso, hipertensión, tabaquismo, diabetes, dislipidemias). Por otro lado, datos de la Organización Panamericana de la Salud han relacionado el proceso de aterosclerosis como la primer causa de muerte prematura, reduciendo la expectativa de vida de manera sensible, lo que tiene una enorme repercusión social. OBJETIVO Este documento constituye la guía de práctica clínica (GPC) elaborada por iniciativa de la Sociedad Mexicana de Cardiología en colaboración con la Sociedad Mexicana de Nutrición y Endocrinología, A.C., Asociación Nacional de Cardiólogos de México, A.C., Asociación Mexicana para la Prevención de la Aterosclerosis y sus Complicaciones, A.C., Comité Normativo Nacional de Medicina General, A.C., Colegio Nacional de Medicina Geriátrica, A.C., Colegio de Medicina Interna de México, A.C., Sociedad Mexicana de Angiología y Cirugía Vascular y Endovenosa, A.C., Instituto Mexicano de Investigaciones Nefrológicas, A.C. y la Academia Mexicana de Neurología, A.C.; con el apoyo metodológico de la Agencia Iberoamericana de Desarrollo y Evaluación de Tecnologías en Salud, con la finalidad de establecer recomendaciones basadas en la mejor evidencia disponible y consensuadas por un grupo interdisciplinario de expertos. El objetivo de este documento es el de brindar recomendaciones basadas en evidencia para ayudar a los tomadores de decisión en el diagnóstico y tratamiento de las dislipidemias en nuestro país. MATERIAL Y MÉTODOS Este documento cumple con estándares internacionales de calidad, como los descritos por el Instituto de Medicina de EE.UU., el Instituto de Excelencia Clínica de Gran Bretaña, la Red Colegiada para el Desarrollo de Guías de Escocia y la Red Internacional de Guías de Práctica Clínica. Se integró un grupo multidisciplinario de expertos clínicos y metodólogos con experiencia en revisiones sistemáticas de la literatura y el desarrollo de guías de práctica clínica. Se consensuó un documento de alcances, se establecieron las preguntas clínicas relevantes, se identificó de manera exhaustiva la mejor evidencia disponible evaluada críticamente en revisiones sistemáticas de la literatura y se desarrollaron las recomendaciones clínicas. Se utilizó la metodología de Panel Delphi modificado para lograr un nivel de consenso adecuado en cada una de las recomendaciones contenidas en esta GPC. RESULTADOS Se consensuaron 23 preguntas clínicas que dieron origen a sus respectivas recomendaciones clínicas. CONCLUSIONES Esperamos que este documento contribuya a la mejor toma de decisiones clínicas y se convierta en un punto de referencia para los clínicos y pacientes en el manejo de las dislipidemias y esto contribuya a disminuir la morbilidad y mortalidad derivada de los eventos cardiovasculares ateroscleróticos en nuestro país. BACKGROUND Cardiovascular diseases are the leading cause of mortality worldwide and Mexico is no exception. The epidemiological data obtained in 1990 showed that cardiovascular diseases represented 19.8% of all causes of death in our country. This figure increased significantly to 25.5% for 2015. Some national surveys suggest that more than 60% of the adult population has at least one risk factor for cardiovascular disease (obesity or overweight, hypertension, smoking, diabetes, dyslipidemias). On the other hand, data from the Pan American Health Organization have linked the process of atherosclerosis as the first cause of premature death, significantly reducing life expectancy, which has enormous social repercussions. OBJECTIVE This document constitutes the Clinical Practice Guide (CPG) prepared at the initiative of the Mexican Society of Cardiology in collaboration with the Mexican Society of Nutrition and Endocrinology, AC, National Association of Cardiologists of Mexico, AC, Mexican Association for the Prevention of Atherosclerosis and its Complications, AC, National Normative Committee of General Medicine, AC, National College of Geriatric Medicine, AC, College of Internal Medicine of Mexico, AC, Mexican Society of Angiology and Vascular and Endovenous Surgery, AC, Mexican Institute of Research Nephrological, AC and the Mexican Academy of Neurology, A.C.; with the methodological support of the Ibero-American Agency for the Development and Evaluation of Health Technologies, in order to establish recommendations based on the best available evidence and agreed upon by an interdisciplinary group of experts. The objective of this document is to provide evidence-based recommendations to help decision makers in the diagnosis and treatment of dyslipidemias in our country. MATERIAL AND METHODS This document complies with international quality standards, such as those described by the Institute of Medicine of the USA, the Institute of Clinical Excellence of Great Britain, the Scottish Intercollegiate Guideline Network and the Guidelines International Network. A multidisciplinary group of clinical experts and methodologists with experience in systematic reviews of the literature and the development of clinical practice guidelines was formed. A scope document was agreed upon, relevant clinical questions were established, the best available evidence critically evaluated in systematic literature reviews was exhaustively identified, and clinical recommendations were developed. The modified Delphi Panel methodology was used to achieve an adequate level of consensus in each of the recommendations contained in this CPG. RESULTS 23 clinical questions were agreed upon which gave rise to their respective clinical recommendations. CONCLUSIONS We consider that this document contributes to better clinical decision-making and becomes a point of reference for clinicians and patients in the management of dyslipidemias and this contributes to reducing the morbidity and mortality derived from atherosclerotic cardiovascular events in our country.
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Affiliation(s)
| | - Marco A Alcocer-Gamba
- Sociedad Mexicana de Cardiología, Ciudad de México, México
- Facultad de Medicina, Universidad Autónoma de Querétaro, Qro., México
| | | | - José L Mayorga-Butrón
- Departamento de Posgrado, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, México
- Instituto Nacional de Pediatría, Secretaría de Salud, Ciudad de México, México
| | - Roopa Mehta
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
| | - Filiberto A Díaz-Aragón
- Asociación Nacional de Cardiólogos de México, Ciudad de México, México
- Departamento de Posgrado, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, México
| | | | - Nitzia López-Juárez
- Unidad Médica de Alta Especialidad Hospital de Cardiología del Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
- Sociedad Mexicana de Nutrición y Endocrinología, Ciudad de México, México
| | - Ivette Cruz-Bautista
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
- Sociedad Mexicana de Nutrición y Endocrinología, Ciudad de México, México
| | - Adolfo Chávez-Mendoza
- Unidad Médica de Alta Especialidad Hospital de Cardiología del Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | | | - Francisco J Guerrero-Martínez
- Sociedad Mexicana de Cardiología, Ciudad de México, México
- Asociación Mexicana para la Prevención de la Aterosclerosis y sus Complicaciones, Ciudad de México, México
| | | | | | - Guillermo Fanghänel-Salmon
- Asociación Mexicana para la Prevención de la Aterosclerosis y sus Complicaciones, Ciudad de México, México
| | | | - Luis Olmos-Domínguez
- Unidad Médica de Alta Especialidad Hospital de Cardiología del Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | | | | | | | | | - María de Los A Nava-Hernández
- Sociedad Mexicana de Cardiología, Ciudad de México, México
- Facultad de Medicina, Universidad Autónoma de Querétaro, Qro., México
| | | | - Juan C Anda-Garay
- Colegio de Medicina Interna de México, Ciudad de México, México
- Hospital de especialidades Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | | | | | | | | | - Romina Rivera-Reyes
- Sociedad Mexicana de Cardiología, Ciudad de México, México
- Facultad de Medicina, Universidad Autónoma de Querétaro, Qro., México
| | - Gabriela Borrayo-Sánchez
- Asociación Nacional de Cardiólogos de México, Ciudad de México, México
- Instituto Mexicano del Seguro Social, Ciudad de México, México
| | | | | | | | - Josué Elías-López
- Unidad Médica de Alta Especialidad Hospital de Cardiología del Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Marco A Figueroa-Morales
- Unidad Médica de Alta Especialidad Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Bertha B Montaño-Velázquez
- Ibero American Agency for Development & Assessment of Health Technologies (A2DAHT), Ciudad de México, México
| | | | - Ana L Rodríguez-Lozano
- Departamento de Posgrado, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, México
| | | | | | | | - Mario Rodríguez-Vega
- Ibero American Agency for Development & Assessment of Health Technologies (A2DAHT), Ciudad de México, México
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Schwingshackl L, Balduzzi S, Beyerbach J, Bröckelmann N, Werner SS, Zähringer J, Nagavci B, Meerpohl JJ. Evaluating agreement between bodies of evidence from randomised controlled trials and cohort studies in nutrition research: meta-epidemiological study. BMJ 2021; 374:n1864. [PMID: 34526355 PMCID: PMC8441535 DOI: 10.1136/bmj.n1864] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/15/2021] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To evaluate the agreement between diet-disease effect estimates of bodies of evidence from randomised controlled trials and those from cohort studies in nutrition research, and to investigate potential factors for disagreement. DESIGN Meta-epidemiological study. DATA SOURCES Cochrane Database of Systematic Reviews, and Medline. REVIEW METHODS Population, intervention or exposure, comparator, outcome (PI/ECO) elements from a body of evidence from cohort studies (BoE(CS)) were matched with corresponding elements of a body of evidence from randomised controlled trials (BoE(RCT)). Pooled ratio of risk ratios or difference of mean differences across all diet-disease outcome pairs were calculated. Subgroup analyses were conducted to explore factors for disagreement. Heterogeneity was assessed through I2 and τ2. Prediction intervals were calculated to assess the range of possible values for the difference in the results between evidence from randomised controlled trials and evidence from cohort studies in future comparisons. RESULTS 97 diet-disease outcome pairs (that is, matched BoE(RCT) and BoE(CS)) were identified overall. For binary outcomes, the pooled ratio of risk ratios comparing estimates from BoE(RCT) with BoE(CS) was 1.09 (95% confidence interval 1.04 to 1.14; I2=68%; τ2=0.021; 95% prediction interval 0.81 to 1.46). The prediction interval indicated that the difference could be much more substantial, in either direction. We further explored heterogeneity and found that PI/ECO dissimilarities, especially for the comparisons of dietary supplements in randomised controlled trials and nutrient status in cohort studies, explained most of the differences. When the type of intake or exposure between both types of evidence was identical, the estimates were similar. For continuous outcomes, small differences were observed between randomised controlled trials and cohort studies. CONCLUSION On average, the difference in pooled results between estimates from BoE(RCT) and BoE(CS) was small. But wide prediction intervals and some substantial statistical heterogeneity in cohort studies indicate that important differences or potential bias in individual comparisons or studies cannot be excluded. Observed differences were mainly driven by dissimilarities in population, intervention or exposure, comparator, and outcome. These findings could help researchers further understand the integration of such evidence into prospective nutrition evidence syntheses and improve evidence based dietary guidelines.
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Affiliation(s)
- Lukas Schwingshackl
- Institute for Evidence in Medicine, Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Sara Balduzzi
- Institute of Medical Biometry and Statistics, Medical Centre - University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Jessica Beyerbach
- Institute for Evidence in Medicine, Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Nils Bröckelmann
- Institute for Evidence in Medicine, Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Sarah S Werner
- Institute for Evidence in Medicine, Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jasmin Zähringer
- Institute for Evidence in Medicine, Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Blin Nagavci
- Institute for Evidence in Medicine, Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Joerg J Meerpohl
- Institute for Evidence in Medicine, Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Cochrane Germany, Cochrane Germany Foundation, Freiburg, Germany
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Low JHM, Toh DWK, Ng MTT, Fam J, Kua EH, Kim JE. A Systematic Review and Meta-Analysis of the Impact of Different Intensity of Dietary Counselling on Cardiometabolic Health in Middle-Aged and Older Adults. Nutrients 2021; 13:nu13092936. [PMID: 34578814 PMCID: PMC8469488 DOI: 10.3390/nu13092936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 08/18/2021] [Accepted: 08/21/2021] [Indexed: 11/16/2022] Open
Abstract
Dietary counselling has been identified as one of the nutritional strategies to alleviate cardiometabolic health conditions. Its effectiveness however may vary due to factors such as intensity level and provider while this has not been comprehensively studied. This systematic review and meta-analysis aimed to assess the effects of dietary counselling on the cardiometabolic health in middle-aged and older adults and the sub-group analyses with dietary counselling intensity and the provider were also assessed. Four databases including PubMed, CINAHL Plus with Full Text, Cochrane Library and EMBASE were systematically searched. Data from 22 randomised controlled trials (RCTs) were compiled and those from 9 RCTs were utilised for meta-analysis. Dietary counselling lowered total cholesterol (TC) and fasting blood sugar (FBS) but had no impact on triglycerides (TG) and low-density lipoprotein (LDL). Sub-group analysis revealed significant lowering effect of high intensity dietary counselling for TG (weighted mean difference (WMD): −0.24 mmol/L, 95% confidence intervals (CIs): −0.40 to −0.09), TC (WMD: −0.31 mmol/L, 95% CIs: −0.49 to −0.13), LDL (WMD: −0.39 mmol/L, 95% CIs: −0.61 to −0.16) and FBS (WMD: −0.69 mmol/L, 95% CIs: −0.99 to −0.40) while medium or low intensity dietary counselling did not show favouring effects. Counselling provider showed differential responses on cardiometabolic health between dietitian and all other groups. The findings from this systematic review and meta-analysis suggest that dietary counselling is a beneficial dietary strategy to improve cardiometabolic health in middle-aged and older adults with the emphasis on the counselling intensity.
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Affiliation(s)
- Jasmine Hui Min Low
- Department of Food Science & Technology, Faculty of Science, National University of Singapore, Singapore 117543, Singapore; (J.H.M.L.); (D.W.K.T.)
| | - Darel Wee Kiat Toh
- Department of Food Science & Technology, Faculty of Science, National University of Singapore, Singapore 117543, Singapore; (J.H.M.L.); (D.W.K.T.)
| | - Magdeline Tao Tao Ng
- National University of Singapore Libraries, National University of Singapore, Singapore 117543, Singapore;
| | - Johnson Fam
- Department of Psychological Medicine, National University of Singapore, Singapore 119228, Singapore; (J.F.); (E.H.K.)
| | - Ee Heok Kua
- Department of Psychological Medicine, National University of Singapore, Singapore 119228, Singapore; (J.F.); (E.H.K.)
| | - Jung Eun Kim
- Department of Food Science & Technology, Faculty of Science, National University of Singapore, Singapore 117543, Singapore; (J.H.M.L.); (D.W.K.T.)
- Correspondence: ; Tel.: +65-6516-1136
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"My Patients Asked Me If I Owned a Fruit Stand in Town or Something." Barriers and Facilitators of Personalized Dietary Advice Implemented in a Primary Care Setting. J Pers Med 2021; 11:jpm11080747. [PMID: 34442392 PMCID: PMC8399817 DOI: 10.3390/jpm11080747] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 07/23/2021] [Accepted: 07/26/2021] [Indexed: 12/16/2022] Open
Abstract
Primary care is especially well positioned to address prevention of non-communicable diseases. However, implementation of health promotion activities such as personalized dietary advice is challenging. The study aim was to understand barriers and facilitators of the personalized dietary advice component of a lifestyle intervention in primary care, as perceived by health center professionals and program participants. Thirteen focus groups were conducted with 49 professionals and 47 participants. Audio recordings were transcribed. Professional group text was coded using the Consolidated Framework for Implementation Research (CFIR). Participant group text was coded via an inductive approach with thematic analysis. Across most CFIR domains, both barriers and facilitators were equally present, except for ‘characteristics of individuals’, which were primarily facilitators. Intervention characteristics was the most important domain, with barriers in design and packaging (e.g., the ICT tool) and complexity. Facilitators included high evidence strength and quality, adaptability, and relative advantage. Participants described the importance of more personalized advice, the value of follow-up with feedback, and the need to see outcomes. Both professionals and patients stated that primary care was the place for personalized dietary advice intervention, but that lack of time, workload, and training were barriers to effective implementation. Implementation strategies targeting these modifiable barriers could potentially increase intervention adoption and intervention effectiveness.
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van der Haar S, Hoevenaars FPM, van den Brink WJ, van den Broek T, Timmer M, Boorsma A, Doets EL. Exploring the Potential of Personalized Dietary Advice for Health Improvement in Motivated Individuals With Premetabolic Syndrome: Pretest-Posttest Study. JMIR Form Res 2021; 5:e25043. [PMID: 34185002 PMCID: PMC8277310 DOI: 10.2196/25043] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 04/11/2021] [Accepted: 05/19/2021] [Indexed: 12/12/2022] Open
Abstract
Background Dietary quality plays an essential role in the prevention and management of metabolic syndrome (MetS). Objective The aim of this pilot study is to organize personalized dietary advice in a real-life setting and to explore the effects on dietary intake, metabolic health, and perceived health. Methods We followed a one-group pretest-posttest design and included 37 individuals at risk of MetS, who indicated motivation to change dietary behavior. For a period of 16 weeks, participants received personalized advice (t=0 and t=8) and feedback (t=0, t=4, t=8, t=12 and t=16) on dietary quality and metabolic health (ie, waist circumference, BMI, blood pressure, lipid profile, fasting glucose levels, and C-peptide). Personalized advice was generated in a two-stage process. In stage 1, an automated algorithm generated advice per food group, integrating data on individual dietary quality (Dutch Healthy Diet Index; total score 8-80) and metabolic health parameters. Stage 2 included a telephone consultation with a trained dietitian to define a personal dietary behavior change strategy and to discuss individual preferences. Dietary quality and metabolic health markers were assessed at t=0, t=8, and t=16. Self-perceived health was evaluated on 7-point Likert scales at t=0 and t=16. Results At the end of the study period, dietary quality was significantly improved compared with the baseline (Dutch Healthy Diet Index +4.3; P<.001). In addition, lipid profile (triglycerides, P=.02; total cholesterol, P=.01; high-density lipoprotein, P<.001; and low-density lipoprotein, P<.001), BMI (P<.001), waist circumference (P=.01), and C-peptide (P=.01) were all significantly improved, whereas plasma glucose increased by 0.23 nmol/L (P=.04). In line with these results, self-perceived health scores were higher at t=16 weeks than at baseline (+0.67; P=.005). Conclusions This exploratory study showed that personalized dietary advice resulted in positive effects on dietary behavior, metabolic health, and self-perceived health in motivated pre-MetS adults. The study was performed in a do-it-yourself setting, highlighting the potential of at-home health improvement through dietary changes. Trial Registration ClinicalTrials.gov NCT04595669; https://clinicaltrials.gov/ct2/show/NCT04595669
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Affiliation(s)
- Sandra van der Haar
- Wageningen Food & Biobased Research, Wageningen University & Research, Wageningen, Netherlands
| | - Femke P M Hoevenaars
- Microbiology & Systems Biology Department, TNO, Netherlands Organization for Applied Scientific Research, Zeist, Netherlands
| | - Willem J van den Brink
- Microbiology & Systems Biology Department, TNO, Netherlands Organization for Applied Scientific Research, Zeist, Netherlands
| | - Tim van den Broek
- Microbiology & Systems Biology Department, TNO, Netherlands Organization for Applied Scientific Research, Zeist, Netherlands
| | - Mariëlle Timmer
- Wageningen Food & Biobased Research, Wageningen University & Research, Wageningen, Netherlands
| | - André Boorsma
- Microbiology & Systems Biology Department, TNO, Netherlands Organization for Applied Scientific Research, Zeist, Netherlands
| | - Esmée L Doets
- Wageningen Food & Biobased Research, Wageningen University & Research, Wageningen, Netherlands
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Krachler B, Jerdén L, Tönnesen H, Lindén C. Medical licensing examinations in both Sweden and the US favor pharmacology over lifestyle. Prev Med Rep 2021; 23:101453. [PMID: 34194960 PMCID: PMC8227799 DOI: 10.1016/j.pmedr.2021.101453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 04/18/2021] [Accepted: 04/25/2021] [Indexed: 11/16/2022] Open
Abstract
Lifestyle is a causative factor in most non-communicable diseases. Medical licensing examinations emphasize pharmacology over lifestyle. Future doctors in Sweden and US may not be equipped to address lifestyle-factors.
Low priority of disease prevention and health promotion in medical education may contribute to lack of lifestyle-counseling in clinical practice. Pharmacology-related knowledge is valued 5 times higher compared to lifestyle-related knowledge in examinations on noncommunicable diseases (NCDs) in undergraduate medical education in Sweden. This study aims to establish (i) whether medical licensing examinations are biased to favor pharmacology- over lifestyle-related knowledge and (ii) whether such a bias is present in both Sweden and the US. We identified 204 NCD-related questions from previous Swedish licensing examinations, and 77 cases from a U.S. question bank commonly used to prepare for the United States Medical Licensing Examination® (USMLE®) Step 3. With the help of expected correct answers, we determined distribution of points attainable for knowledge in the respective category (lifestyle / pharmacology / other) for 5 major NCDs: coronary heart disease (CHD), chronic obstructive pulmonary disease (COPD), diabetes, hypertension, and stroke. The percentage of points attainable for lifestyle-related knowledge was 6.7 (95% CI 4.1–9.3) in Sweden and 4.6 (95%CI 0.0–9.1) in the U.S. The respective percentages for pharmacology-related knowledge were 32.6 (95% CI 26.3–38.8) and 44.5 (95% CI 33.2–55.8) percent. The pharmacology vs. lifestyle-quotas were 4.9 in Sweden and 9.8 in the U.S. Likelihoods of equal emphasis on lifestyle and pharmacology in NCDs was < 0.001 in both countries. There is a marked preference for pharmacology over lifestyle in medical licensing examinations in both Sweden and the U.S. Newly qualified doctors may be inadequately prepared to address preventable causes of NCDs.
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Affiliation(s)
- B Krachler
- Department of Public Health and Clinical Medicine, Sustainable Health, Umeå University, Umeå, Sweden
| | - L Jerdén
- Center for Clinical Research Dalarna-Uppsala University, Falun, Sweden.,School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
| | - H Tönnesen
- Clinical Health Promotion Centre, WHO-CC, Region Skåne and Department of Health Sciences, Faculty of Medicine, Lund University, Sweden
| | - C Lindén
- Department of Clinical Sciences, Ophthalmology, Umeå University, Umeå, Sweden
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18
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Receiving advice from a health professional and action taken to reduce dietary sodium intake among adults. Public Health Nutr 2021; 24:3791-3796. [PMID: 33972000 DOI: 10.1017/s1368980021002019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Population reductions in Na intake could prevent hypertension, and current guidelines recommend that clinicians advise patients to reduce intake. This study aimed to estimate the prevalence of taking action and receiving advice from a health professional to reduce Na intake in ten US jurisdictions, including the first-ever data in New York state and Guam. DESIGN Weighted prevalence and 95 % CI overall and by location, demographic group, health status and receipt of provider advice using self-reported data from the 2017 Behavioral Risk Factor Surveillance System optional Na module. SETTING Seven states, the District of Columbia, Puerto Rico and Guam. PARTICIPANTS Adults aged ≥ 18 years. RESULTS Overall, 53·6 % (95 % CI 52·7, 54·5) of adults reported taking action to reduce Na intake, including 54·8 % (95 % CI 52·8, 56·7) in New York and 61·2 % (95 % CI 57·6, 64·7) in Guam. Prevalence varied by demographic and health characteristic and was higher among adults who reported having hypertension (72·5 %; 95 % CI 71·2, 73·7) v. those who did not report having hypertension (43·9 %; 95 % CI 42·7, 45·0). Among those who reported receiving Na reduction advice from a health professional, 82·6 % (95 % CI 81·3, 83·9) reported action v. 44·4 % (95 % CI 43·4, 45·5) among those who did not receive advice. However, only 24·0 % (95 % CI 23·3, 24·7) of adults reported receiving advice from a health professional to reduce Na intake. CONCLUSIONS The majority of adults report taking action to reduce Na intake. Results highlight an opportunity to increase Na reduction advice from health professionals during clinical visits to better align with existing guidelines.
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Lee CL, Aveyard PN, Jebb SA, Piernas C. Using Supermarket Loyalty Card Data to Provide Personalised Advice to Help Reduce Saturated Fat Intake among Patients with Hypercholesterolemia: A Qualitative Study of Participants' Experiences. Nutrients 2021; 13:nu13041146. [PMID: 33807150 PMCID: PMC8066863 DOI: 10.3390/nu13041146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 03/25/2021] [Accepted: 03/25/2021] [Indexed: 11/18/2022] Open
Abstract
Background: The ‘Primary Care SHOPping Intervention for Cardiovascular Disease Prevention’ (PCSHOP) trial tested the effectiveness and feasibility of a behavioural intervention to reduce saturated fat in food purchases. The intervention offered feedback from data collected through a supermarket loyalty card to supplement brief advice from a nurse. This qualitative study aimed to describe participants’ experiences of receiving this intervention. Methods: We conducted semi-structured, one-to-one, telephone interviews with participants from the PCSHOP trial. Interviews were audio-recorded and transcribed verbatim. We employed the one sheet of paper technique and a thematic analysis to develop high-level themes in NVivo software. Results: Twenty-four participants were interviewed (mean age: 63 years (SD 12)). They reported that the brief advice did not provide any new information but they welcomed the sense of accountability the nurse provided. The personalised shopping feedback and healthier swap suggestions provided novel information that challenged previously held beliefs about the saturated fat content of food purchases and encouraged some positive dietary changes. However, the taste preferences of the participant or other household members were a barrier to changing food shopping behaviours. Conclusion: Harnessing loyalty card data is a novel and acceptable method to offering personalised dietary feedback. Yet, issues on the suitability of the healthier swap suggestions limited the extent of dietary change. Trial registration: ISRCTN14279335. Registered 1 September 2017.
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Affiliation(s)
- Charlotte L. Lee
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, UK; (C.L.L.); (P.N.A.); (S.A.J.)
- Oxford Biomedical Research Centre, National Institute for Health Research, Oxford OX2 6GG, UK
| | - Paul N. Aveyard
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, UK; (C.L.L.); (P.N.A.); (S.A.J.)
- Oxford Biomedical Research Centre, National Institute for Health Research, Oxford OX2 6GG, UK
| | - Susan A. Jebb
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, UK; (C.L.L.); (P.N.A.); (S.A.J.)
- Oxford Biomedical Research Centre, National Institute for Health Research, Oxford OX2 6GG, UK
| | - Carmen Piernas
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, UK; (C.L.L.); (P.N.A.); (S.A.J.)
- Correspondence: ; Tel.: +44-18-6528-9284
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Córdoba García R, Camarelles Guillem F, Muñoz Seco E, Gómez Puente JM, San José Arango J, Ramírez Manent JI, Martín Cantera C, Del Campo Giménez M, Revenga Frauca J. [PAPPS expert group. Lifestyle recommendations]. Aten Primaria 2021; 52 Suppl 2:32-43. [PMID: 33388116 PMCID: PMC7801215 DOI: 10.1016/j.aprim.2020.07.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 07/31/2020] [Indexed: 12/01/2022] Open
Abstract
Los determinantes de salud primarios y secundarios explican gran parte de la morbimortalidad observada en atención primaria. Se presentan las recomendaciones del Programa de Actividades Preventivas y Promoción de la Salud (PAPPS) de la semFyC, para la promoción de un estilo de vida saludable mediante la metodología de intervención y las actuaciones preventivas en consumo de tabaco, consumo de alcohol, alimentación saludable, actividad física en el tiempo libre, prevención de accidentes de tráfico y sistemas de retención infantil. Se señalan las pautas más comunes de prevención clínica. Se actualizan las recomendaciones, se señalan aspectos novedosos como la definición de consumo de alcohol de bajo riesgo y se pone al día la bibliografía. Para las principales recomendaciones se incluyen tablas específicas que recogen la calidad de la evidencia y la fuerza de la recomendación.
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Affiliation(s)
- Rodrigo Córdoba García
- Medicina de Familia y Comunitaria, Centro de Salud Delicias Sur. Coordinador del Grupo de Educación Sanitaria y Promoción de la Salud (ESPS), Zaragoza, España.
| | | | - Elena Muñoz Seco
- Medicina de Familia y Comunitaria, Unidad Básica de Salud es Castell, Ibsalut, Es Castell, Menorca, España
| | | | - Joaquín San José Arango
- Medicina de Familia y Comunitaria, Centro de Salud Vilagarcía. Grupo de Trabajo de Alimentación y Nutrición, Pontevedra, España
| | - Jose Ignacio Ramírez Manent
- Medicina de Familia y Comunitaria, Centro de Salud de Calviá, Instituto de Investigación Sanitaria Illes Balears, IdIsBa, Calvià, Mallorca, España
| | - Carlos Martín Cantera
- Medicina de Familia y Comunitaria, Grupo de Investigación Estilos de Vida, IDIAP Jordi Gol, Barcelona, España
| | - María Del Campo Giménez
- Medicina de Familia y Comunitaria, Gerencia de Atención Integrada de Albacete, SESCAM, Albacete, España
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Piernas C, Aveyard P, Lee C, Tsiountsioura M, Noreik M, Astbury NM, Oke J, Madigan C, Jebb SA. Evaluation of an intervention to provide brief support and personalized feedback on food shopping to reduce saturated fat intake (PC-SHOP): A randomized controlled trial. PLoS Med 2020; 17:e1003385. [PMID: 33151934 PMCID: PMC7643942 DOI: 10.1371/journal.pmed.1003385] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 09/18/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Guidelines recommend reducing saturated fat (SFA) intake to decrease cardiovascular disease (CVD) risk, but there is limited evidence on scalable and effective approaches to change dietary intake, given the large proportion of the population exceeding SFA recommendations. We aimed to develop a system to provide monthly personalized feedback and healthier swaps based on nutritional analysis of loyalty card data from the largest United Kingdom grocery store together with brief advice and support from a healthcare professional (HCP) in the primary care practice. Following a hybrid effectiveness-feasibility design, we tested the effects of the intervention on SFA intake and low-density lipoprotein (LDL) cholesterol as well as the feasibility and acceptability of providing nutritional advice using loyalty card data. METHODS AND FINDINGS The Primary Care Shopping Intervention for Cardiovascular Disease Prevention (PC-SHOP) study is a parallel randomized controlled trial with a 3 month follow-up conducted between 21 March 2018 to 16 January2019. Adults ≥18 years with LDL cholesterol >3 mmol/L (n = 113) were recruited from general practitioner (GP) practices in Oxfordshire and randomly allocated to "Brief Support" (BS, n = 48), "Brief Support + Shopping Feedback" (SF, n = 48) or "Control" (n = 17). BS consisted of a 10-minute consultation with an HCP to motivate participants to reduce their SFA intake. Shopping feedback comprised a personalized report on the SFA content of grocery purchases and suggestions for lower SFA swaps. The primary outcome was the between-group difference in change in SFA intake (% total energy intake) at 3 months adjusted for baseline SFA and GP practice using intention-to-treat analysis. Secondary outcomes included %SFA in purchases, LDL cholesterol, and feasibility outcomes. The trial was powered to detect an absolute reduction in SFA of 3% (SD3). Neither participants nor the study team were blinded to group allocation. A total of 106 (94%) participants completed the study: 68% women, 95% white ethnicity, average age 62.4 years (SD 10.8), body mass index (BMI) 27.1 kg/m2 (SD 4.7). There were small decreases in SFA intake at 3 months: control = -0.1% (95% CI -1.8 to 1.7), BS = -0.7% (95% CI -1.8 to 0.3), SF = -0.9% (95% CI -2.0 to 0.2); but no evidence of a significant effect of either intervention compared with control (difference adjusted for GP practice and baseline: BS versus control = -0.33% [95% CI -2.11 to 1.44], p = 0.709; SF versus control = -0.11% [95% CI -1.92 to 1.69], p = 0.901). There were similar trends in %SFA based on supermarket purchases: control = -0.5% (95% CI -2.3 to 1.2), BS = -1.3% (95% CI -2.3 to -0.3), SF = -1.5% (95% CI -2.5 to -0.5) from baseline to follow-up, but these were not significantly different: BS versus control p = 0.379; SF versus control p = 0.411. There were small reductions in LDL from baseline to follow-up (control = -0.14 mmol/L [95% CI -0.48, 0.19), BS: -0.39 mmol/L [95% CI -0.59, -0.19], SF: -0.14 mmol/L [95% CI -0.34, 0.07]), but these were not significantly different: BS versus control p = 0.338; SF versus control p = 0.790. Limitations of this study include the small sample of participants recruited, which limits the power to detect smaller differences, and the low response rate (3%), which may limit the generalisability of these findings. CONCLUSIONS In this study, we have shown it is feasible to deliver brief advice in primary care to encourage reductions in SFA intake and to provide personalized advice to encourage healthier choices using supermarket loyalty card data. There was no evidence of large reductions in SFA, but we are unable to exclude more modest benefits. The feasibility, acceptability, and scalability of these interventions suggest they have potential to encourage small changes in diet, which could be beneficial at the population level. TRIAL REGISTRATION ISRCTN14279335.
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Affiliation(s)
- Carmen Piernas
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
- * E-mail:
| | - Paul Aveyard
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Charlotte Lee
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Melina Tsiountsioura
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Michaela Noreik
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Nerys M. Astbury
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Jason Oke
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Claire Madigan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Susan A. Jebb
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
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Hooper L, Martin N, Jimoh OF, Kirk C, Foster E, Abdelhamid AS. Reduction in saturated fat intake for cardiovascular disease. Cochrane Database Syst Rev 2020; 8:CD011737. [PMID: 32827219 PMCID: PMC8092457 DOI: 10.1002/14651858.cd011737.pub3] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Reducing saturated fat reduces serum cholesterol, but effects on other intermediate outcomes may be less clear. Additionally, it is unclear whether the energy from saturated fats eliminated from the diet are more helpfully replaced by polyunsaturated fats, monounsaturated fats, carbohydrate or protein. OBJECTIVES To assess the effect of reducing saturated fat intake and replacing it with carbohydrate (CHO), polyunsaturated (PUFA), monounsaturated fat (MUFA) and/or protein on mortality and cardiovascular morbidity, using all available randomised clinical trials. SEARCH METHODS We updated our searches of the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (Ovid) and Embase (Ovid) on 15 October 2019, and searched Clinicaltrials.gov and WHO International Clinical Trials Registry Platform (ICTRP) on 17 October 2019. SELECTION CRITERIA Included trials fulfilled the following criteria: 1) randomised; 2) intention to reduce saturated fat intake OR intention to alter dietary fats and achieving a reduction in saturated fat; 3) compared with higher saturated fat intake or usual diet; 4) not multifactorial; 5) in adult humans with or without cardiovascular disease (but not acutely ill, pregnant or breastfeeding); 6) intervention duration at least 24 months; 7) mortality or cardiovascular morbidity data available. DATA COLLECTION AND ANALYSIS Two review authors independently assessed inclusion, extracted study data and assessed risk of bias. We performed random-effects meta-analyses, meta-regression, subgrouping, sensitivity analyses, funnel plots and GRADE assessment. MAIN RESULTS We included 15 randomised controlled trials (RCTs) (16 comparisons, 56,675 participants), that used a variety of interventions from providing all food to advice on reducing saturated fat. The included long-term trials suggested that reducing dietary saturated fat reduced the risk of combined cardiovascular events by 17% (risk ratio (RR) 0.83; 95% confidence interval (CI) 0.70 to 0.98, 12 trials, 53,758 participants of whom 8% had a cardiovascular event, I² = 67%, GRADE moderate-quality evidence). Meta-regression suggested that greater reductions in saturated fat (reflected in greater reductions in serum cholesterol) resulted in greater reductions in risk of CVD events, explaining most heterogeneity between trials. The number needed to treat for an additional beneficial outcome (NNTB) was 56 in primary prevention trials, so 56 people need to reduce their saturated fat intake for ~four years for one person to avoid experiencing a CVD event. In secondary prevention trials, the NNTB was 53. Subgrouping did not suggest significant differences between replacement of saturated fat calories with polyunsaturated fat or carbohydrate, and data on replacement with monounsaturated fat and protein was very limited. We found little or no effect of reducing saturated fat on all-cause mortality (RR 0.96; 95% CI 0.90 to 1.03; 11 trials, 55,858 participants) or cardiovascular mortality (RR 0.95; 95% CI 0.80 to 1.12, 10 trials, 53,421 participants), both with GRADE moderate-quality evidence. There was little or no effect of reducing saturated fats on non-fatal myocardial infarction (RR 0.97, 95% CI 0.87 to 1.07) or CHD mortality (RR 0.97, 95% CI 0.82 to 1.16, both low-quality evidence), but effects on total (fatal or non-fatal) myocardial infarction, stroke and CHD events (fatal or non-fatal) were all unclear as the evidence was of very low quality. There was little or no effect on cancer mortality, cancer diagnoses, diabetes diagnosis, HDL cholesterol, serum triglycerides or blood pressure, and small reductions in weight, serum total cholesterol, LDL cholesterol and BMI. There was no evidence of harmful effects of reducing saturated fat intakes. AUTHORS' CONCLUSIONS The findings of this updated review suggest that reducing saturated fat intake for at least two years causes a potentially important reduction in combined cardiovascular events. Replacing the energy from saturated fat with polyunsaturated fat or carbohydrate appear to be useful strategies, while effects of replacement with monounsaturated fat are unclear. The reduction in combined cardiovascular events resulting from reducing saturated fat did not alter by study duration, sex or baseline level of cardiovascular risk, but greater reduction in saturated fat caused greater reductions in cardiovascular events.
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Affiliation(s)
- Lee Hooper
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Nicole Martin
- Institute of Health Informatics Research, University College London, London, UK
| | - Oluseyi F Jimoh
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Christian Kirk
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Eve Foster
- Norwich Medical School, University of East Anglia, Norwich, UK
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Hooper L, Martin N, Jimoh OF, Kirk C, Foster E, Abdelhamid AS. Reduction in saturated fat intake for cardiovascular disease. Cochrane Database Syst Rev 2020; 5:CD011737. [PMID: 32428300 PMCID: PMC7388853 DOI: 10.1002/14651858.cd011737.pub2] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Reducing saturated fat reduces serum cholesterol, but effects on other intermediate outcomes may be less clear. Additionally, it is unclear whether the energy from saturated fats eliminated from the diet are more helpfully replaced by polyunsaturated fats, monounsaturated fats, carbohydrate or protein. OBJECTIVES To assess the effect of reducing saturated fat intake and replacing it with carbohydrate (CHO), polyunsaturated (PUFA), monounsaturated fat (MUFA) and/or protein on mortality and cardiovascular morbidity, using all available randomised clinical trials. SEARCH METHODS We updated our searches of the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (Ovid) and Embase (Ovid) on 15 October 2019, and searched Clinicaltrials.gov and WHO International Clinical Trials Registry Platform (ICTRP) on 17 October 2019. SELECTION CRITERIA Included trials fulfilled the following criteria: 1) randomised; 2) intention to reduce saturated fat intake OR intention to alter dietary fats and achieving a reduction in saturated fat; 3) compared with higher saturated fat intake or usual diet; 4) not multifactorial; 5) in adult humans with or without cardiovascular disease (but not acutely ill, pregnant or breastfeeding); 6) intervention duration at least 24 months; 7) mortality or cardiovascular morbidity data available. DATA COLLECTION AND ANALYSIS Two review authors independently assessed inclusion, extracted study data and assessed risk of bias. We performed random-effects meta-analyses, meta-regression, subgrouping, sensitivity analyses, funnel plots and GRADE assessment. MAIN RESULTS We included 15 randomised controlled trials (RCTs) (16 comparisons, ~59,000 participants), that used a variety of interventions from providing all food to advice on reducing saturated fat. The included long-term trials suggested that reducing dietary saturated fat reduced the risk of combined cardiovascular events by 21% (risk ratio (RR) 0.79; 95% confidence interval (CI) 0.66 to 0.93, 11 trials, 53,300 participants of whom 8% had a cardiovascular event, I² = 65%, GRADE moderate-quality evidence). Meta-regression suggested that greater reductions in saturated fat (reflected in greater reductions in serum cholesterol) resulted in greater reductions in risk of CVD events, explaining most heterogeneity between trials. The number needed to treat for an additional beneficial outcome (NNTB) was 56 in primary prevention trials, so 56 people need to reduce their saturated fat intake for ~four years for one person to avoid experiencing a CVD event. In secondary prevention trials, the NNTB was 32. Subgrouping did not suggest significant differences between replacement of saturated fat calories with polyunsaturated fat or carbohydrate, and data on replacement with monounsaturated fat and protein was very limited. We found little or no effect of reducing saturated fat on all-cause mortality (RR 0.96; 95% CI 0.90 to 1.03; 11 trials, 55,858 participants) or cardiovascular mortality (RR 0.95; 95% CI 0.80 to 1.12, 10 trials, 53,421 participants), both with GRADE moderate-quality evidence. There was little or no effect of reducing saturated fats on non-fatal myocardial infarction (RR 0.97, 95% CI 0.87 to 1.07) or CHD mortality (RR 0.97, 95% CI 0.82 to 1.16, both low-quality evidence), but effects on total (fatal or non-fatal) myocardial infarction, stroke and CHD events (fatal or non-fatal) were all unclear as the evidence was of very low quality. There was little or no effect on cancer mortality, cancer diagnoses, diabetes diagnosis, HDL cholesterol, serum triglycerides or blood pressure, and small reductions in weight, serum total cholesterol, LDL cholesterol and BMI. There was no evidence of harmful effects of reducing saturated fat intakes. AUTHORS' CONCLUSIONS The findings of this updated review suggest that reducing saturated fat intake for at least two years causes a potentially important reduction in combined cardiovascular events. Replacing the energy from saturated fat with polyunsaturated fat or carbohydrate appear to be useful strategies, while effects of replacement with monounsaturated fat are unclear. The reduction in combined cardiovascular events resulting from reducing saturated fat did not alter by study duration, sex or baseline level of cardiovascular risk, but greater reduction in saturated fat caused greater reductions in cardiovascular events.
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Affiliation(s)
- Lee Hooper
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Nicole Martin
- Institute of Health Informatics Research, University College London, London, UK
| | - Oluseyi F Jimoh
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Christian Kirk
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Eve Foster
- Norwich Medical School, University of East Anglia, Norwich, UK
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Liu W, Cao Y, Dong L, Zhu Y, Wu Y, Lv Z, Iheozor‐Ejiofor Z, Li C. Periodontal therapy for primary or secondary prevention of cardiovascular disease in people with periodontitis. Cochrane Database Syst Rev 2019; 12:CD009197. [PMID: 31887786 PMCID: PMC6953391 DOI: 10.1002/14651858.cd009197.pub4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND There may be an association between periodontitis and cardiovascular disease (CVD); however, the evidence so far has been uncertain about whether periodontal therapy can help prevent CVD in people diagnosed with chronic periodontitis. This is the second update of a review originally published in 2014, and first updated in 2017. Although there is a new multidimensional staging and grading system for periodontitis, we have retained the label 'chronic periodontitis' in this version of the review since available studies are based on the previous classification system. OBJECTIVES To investigate the effects of periodontal therapy for primary or secondary prevention of CVD in people with chronic periodontitis. SEARCH METHODS Cochrane Oral Health's Information Specialist searched the Cochrane Oral Health's Trials Register, CENTRAL, MEDLINE, Embase, and CINAHL, two trials registries, and the grey literature to September 2019. We placed no restrictions on the language or date of publication. We also searched the Chinese BioMedical Literature Database, the China National Knowledge Infrastructure, the VIP database, and Sciencepaper Online to August 2019. SELECTION CRITERIA We included randomised controlled trials (RCTs) that compared active periodontal therapy to no periodontal treatment or a different periodontal treatment. We included studies of participants with a diagnosis of chronic periodontitis, either with CVD (secondary prevention studies) or without CVD (primary prevention studies). DATA COLLECTION AND ANALYSIS Two review authors carried out the study identification, data extraction, and 'Risk of bias' assessment independently and in duplicate. They resolved any discrepancies by discussion, or with a third review author. We adopted a formal pilot-tested data extraction form, and used the Cochrane tool to assess the risk of bias in the studies. We used GRADE criteria to assess the certainty of the evidence. MAIN RESULTS We included two RCTs in the review. One study focused on the primary prevention of CVD, and the other addressed secondary prevention. We evaluated both as being at high risk of bias. Our primary outcomes of interest were death (all-cause and CVD-related) and all cardiovascular events, measured at one-year follow-up or longer. For primary prevention of CVD in participants with periodontitis and metabolic syndrome, one study (165 participants) provided very low-certainty evidence. There was only one death in the study; we were unable to determine whether scaling and root planning plus amoxicillin and metronidazole could reduce incidence of all-cause death (Peto odds ratio (OR) 7.48, 95% confidence interval (CI) 0.15 to 376.98), or all CVD-related death (Peto OR 7.48, 95% CI 0.15 to 376.98). We could not exclude the possibility that scaling and root planning plus amoxicillin and metronidazole could increase cardiovascular events (Peto OR 7.77, 95% CI 1.07 to 56.1) compared with supragingival scaling measured at 12-month follow-up. For secondary prevention of CVD, one pilot study randomised 303 participants to receive scaling and root planning plus oral hygiene instruction (periodontal treatment) or oral hygiene instruction plus a copy of radiographs and recommendation to follow-up with a dentist (community care). As cardiovascular events had been measured for different time periods of between 6 and 25 months, and only 37 participants were available with at least one-year follow-up, we did not consider the data to be sufficiently robust for inclusion in this review. The study did not evaluate all-cause death and all CVD-related death. We are unable to draw any conclusions about the effects of periodontal therapy on secondary prevention of CVD. AUTHORS' CONCLUSIONS For primary prevention of cardiovascular disease (CVD) in people diagnosed with periodontitis and metabolic syndrome, very low-certainty evidence was inconclusive about the effects of scaling and root planning plus antibiotics compared to supragingival scaling. There is no reliable evidence available regarding secondary prevention of CVD in people diagnosed with chronic periodontitis and CVD. Further trials are needed to reach conclusions about whether treatment for periodontal disease can help prevent occurrence or recurrence of CVD.
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Affiliation(s)
- Wei Liu
- West China Hospital of Stomatology, Sichuan UniversityState Key Laboratory of Oral DiseasesNo. 14, Section Three, Ren Min Nan RoadChengduSichuanChina610041
| | - Yubin Cao
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan UniversityDepartment of Head and Neck OncologyNo. 14, Section Three, Ren Min Nan RoadChengduSichuanChina610041
| | - Li Dong
- Hospital of Traditional Chinese Medicine Affiliated to Southwest Medical UniversityDepartment of Cardiovascular MedicineNo 11, South Jiangyang RoadLuzhouSichuanChina646000
| | - Ye Zhu
- West China Hospital, Sichuan UniversityDepartment of Cardiovascular DiseaseNo 37, Guo Xue XiangChengduSichuanChina610041
| | - Yafei Wu
- West China Hospital of Stomatology, Sichuan University, State Key Laboratory of Oral DiseasesDepartment of PeriodontologyNo. 14, Section Three, Ren Min Nan RoadChengduSichuanChina610041
| | - Zongkai Lv
- Nan Chong Central Hospital, Second Clinical Medical College of Chuan Bei Medical CollegeDepartment of StomatologyNo. 66 , Da Bei Jie RoadNanchongSichuanChina637000
| | | | - Chunjie Li
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan UniversityDepartment of Head and Neck OncologyNo. 14, Section Three, Ren Min Nan RoadChengduSichuanChina610041
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Ismail K, Bayley A, Twist K, Stewart K, Ridge K, Britneff E, Greenough A, Ashworth M, Rundle J, Cook DG, Whincup P, Treasure J, McCrone P, Winkley K, Stahl D. Reducing weight and increasing physical activity in people at high risk of cardiovascular disease: a randomised controlled trial comparing the effectiveness of enhanced motivational interviewing intervention with usual care. Heart 2019; 106:447-454. [PMID: 31831574 PMCID: PMC7057797 DOI: 10.1136/heartjnl-2019-315656] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 10/18/2019] [Accepted: 10/25/2019] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE The epidemic of obesity is contributing to the increasing prevalence of people at high risk of cardiovascular disease (CVD), negating the medical advances in reducing CVD mortality. We compared the clinical and cost-effectiveness of an intensive lifestyle intervention consisting of enhanced motivational interviewing in reducing weight and increasing physical activity for patients at high risk of CVD. METHODS A three-arm, single-blind, parallel-group randomised controlled trial was conducted in consenting primary care centres in south London. We recruited patients aged 40-74 years with a QRisk2 score ≥20.0%, which indicates the probability of having a CVD event in the next 10 years. The intervention was enhanced motivational interviewing which included additional behaviour change techniques and was delivered by health trainers in 10 sessions over 1 year, in either group (n=697) or individual (n=523) format. The third arm received usual care (UC; n=522). The primary outcomes were physical activity (mean steps/day) and weight (kg). Secondary outcomes were changes in low-density lipoprotein cholesterol and CVD risk score. We estimated the relative cost-effectiveness of each intervention. RESULTS At 24 months, the group and individual interventions were not more effective than UC in increasing physical activity (mean difference=70.05 steps, 95% CI -288.00 to 147.90 and mean difference=7.24 steps, 95% CI -224.01 to 238.50, respectively), reducing weight (mean difference=-0.03 kg, 95% CI -0.49 to 0.44 and mean difference=-0.42 kg, 95% CI -0.93 to 0.09, respectively) or improving any secondary outcomes. The group and individual interventions were not cost-effective at conventional thresholds. CONCLUSIONS Enhancing motivational interviewing with additional behaviour change techniques was not effective in reducing weight or increasing physical activity in those at high CVD risk.
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Affiliation(s)
- Khalida Ismail
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Adam Bayley
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Katherine Twist
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Kurtis Stewart
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Katie Ridge
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Emma Britneff
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Anne Greenough
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK.,MRC and Asthma UK Centre in Allergic Mechanisms of Asthma, London, UK
| | - Mark Ashworth
- School of Population Health and Environmental Sciences, King's College London, London, London, UK
| | - Jennifer Rundle
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Derek G Cook
- Division of Population Health Sciences and Education, University of London St George's Molecular and Clinical Sciences Research Institute, London, UK
| | - Peter Whincup
- Division of Population Health Sciences and Education, University of London St George's Molecular and Clinical Sciences Research Institute, London, UK
| | - Janet Treasure
- Department of Health Services and Population Research, Institute of Psychiatry, King's College London, London, UK
| | - Paul McCrone
- Section of Eating Disorders, Institute of Psychiatry, King's College London, London, UK
| | - Kirsty Winkley
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Daniel Stahl
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, King's College London, London, UK
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Senarath U, Katulanda P, Fernando DN, Kalupahana NS, Partheepan K, Jayawardena R, Katulanda G, Dibley MJ. mHealth nutrition and lifestyle intervention (mHENAL) to reduce cardiovascular disease risk in a middle-aged, overweight and obese population in Sri Lanka: Study protocol for a randomized controlled trial. Contemp Clin Trials Commun 2019; 16:100453. [PMID: 31650073 PMCID: PMC6804801 DOI: 10.1016/j.conctc.2019.100453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 09/10/2019] [Accepted: 09/16/2019] [Indexed: 11/28/2022] Open
Abstract
Mobile phone-based health interventions (mHealth) are viewed as an attractive approach to foster behaviour change, and found to be effective in promoting physical activity and healthy diets. The present study aims to investigate whether mHealth with advice for dietary and lifestyle modifications would reduce 10-year cardio vascular disease (CVD) risk among overweight or obese adults aged 35-64 years in Sri Lanka. A two-group parallel-arm randomized controlled trial (RCT) was conducted in Colombo district, recruiting 1200 individuals aged 35-64 years with a body mass index (BMI) of ≥25 kgm-2. Participants were randomly assigned either to mHealth package (intervention arm, n = 600) or usual care (control arm, n = 600). The intervention package contains a series of dietary and lifestyle improvement messages, a mobile application to register participants, and a web application to deliver these messages. Participants in the intervention arm receive 2 voice and 2 text messages per week to their mobile phones for a period of 12 months. The primary outcome (10-year CVD risk) will be assessed according to sex, age, smoking status, blood pressure, serum cholesterol and glycaemic status. Data are collected at enrollment and after 12 months of intervention on: dietary practices, physical activity, smoking, anthropometry, body composition, blood pressure, fasting plasma glucose, HbA1c and lipid profile. Analysis of effect will be performed by intention-to-treat principle, comparing the outcomes between intervention and control arms. The study resulted in a comprehensive mHealth nutrition and lifestyle package (mHENAL) and successfully completed recruitment and baseline assessment of participants. The message delivery is in progress.
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Affiliation(s)
- Upul Senarath
- Faculty of Medicine, University of Colombo, 25 Kynsey Road, Colombo, 00800, Sri Lanka
| | - Prasad Katulanda
- Faculty of Medicine, University of Colombo, 25 Kynsey Road, Colombo, 00800, Sri Lanka
| | - Dulitha N. Fernando
- Faculty of Medicine, University of Colombo, 25 Kynsey Road, Colombo, 00800, Sri Lanka
| | | | | | - Ranil Jayawardena
- Faculty of Medicine, University of Colombo, 25 Kynsey Road, Colombo, 00800, Sri Lanka
| | - Gaya Katulanda
- Department of Chemical Pathology, National Hospital of Sri Lanka, Regent Street, Colombo, 01000, Sri Lanka
| | - Michael J. Dibley
- The University of Sydney School of Public Health, Faculty of Medicine and Health, Edward Ford Building (A27), The University of Sydney, NSW, 2006, Australia
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Gluba-Brzozka A, Franczyk B, Rysz J. Cholesterol Disturbances and the Role of Proper Nutrition in CKD Patients. Nutrients 2019; 11:E2820. [PMID: 31752189 PMCID: PMC6893650 DOI: 10.3390/nu11112820] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Accepted: 11/10/2019] [Indexed: 12/21/2022] Open
Abstract
Chronic kidney disease (CKD) is a widespread disease with increasing prevalence in the modern society. Lipid disturbances are common in this group of patients. In most patients with CKD atherogenic dyslipidemia is observed. Dyslipidemia in patients with renal diseases increases the risk of cardiovascular diseases and it accelerates the progression of chronic kidney disease to its end stage. The amelioration of dyslipidemia and the lowering of oxidative stress, inflammatory processes, insulin sensitivity and remnant lipoproteins levels may lead to the reduction in cardiovascular burden. Nutritional interventions can strengthen the beneficial effect of treatment and they play an important role in the preservation of overall well-being of the patients with CKD since the aim of appropriate diet is to reduce the risk of cardiovascular events, prevent malnutrition, and hamper the progression of kidney disease. The management of dyslipidemia, regardless of the presence of chronic kidney disease, should be initiated by the introduction of therapeutic lifestyle changes. The introduction of diet change was shown to exert beneficial effect on the lipid level lowering that reaches beyond pharmacological therapy. Currently available evidence give the impression that data on dietary interventions in CKD patients is not sufficient to make any clinical practice guidelines and is of low quality.
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Affiliation(s)
- Anna Gluba-Brzozka
- Department of Nephrology, Hypertension and Family Medicine, Medical University of Lodz, 90-549 Lodz, Poland; (B.F.); (J.R.)
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Fontaine G, Cossette S, Maheu-Cadotte MA, Mailhot T, Heppell S, Roussy C, Côté J, Gagnon MP, Dubé V. Behavior change counseling training programs for nurses and nursing students: A systematic descriptive review. NURSE EDUCATION TODAY 2019; 82:37-50. [PMID: 31425931 DOI: 10.1016/j.nedt.2019.08.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Revised: 07/02/2019] [Accepted: 08/04/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES (1) To systematically review the literature on behavior change counseling (BCC) training programs targeting nurses and nursing students; (2) to characterize these training programs according to their content (i.e., targeted health behavior[s], BCC approaches taught, BCC techniques taught), structure, and modes of delivery. DESIGN A systematic, descriptive literature review. DATA SOURCES PubMed, CINAHL and Embase were searched with no time limitation in August 2018. REVIEW METHODS A systematic, descriptive literature review structured according to Paré et al.'s methodology and the PRISMA guidelines. Primary studies were included if they evaluated a BCC training program with nurses or nursing students. Review authors screened studies, extracted data, and assessed study quality using the MERSQI. Data was synthesized through narrative synthesis, descriptive statistics, and content analysis. RESULTS From a pool of 267 articles, we included 25 articles published between 2003 and 2018. Two studies scored as low quality (8%), 18 as moderate quality (72%), and 5 as high quality (20%). Physical activity (n = 14; 56%) and smoking (n = 11; 44%) were the most frequently targeted health behaviors. Eleven BCC approaches were cited (e.g., motivational interviewing), and 48 BCC techniques were identified (e.g., eliciting and scaling change talk). The median number of training sessions was 3 (interquartile range [IQR] 5), the median training program duration was 3 h (IQR 6.25 h), and median training period was 24.5 days (IQR 110 days). Programs were most often delivered as seminars and workshops. CONCLUSIONS High-quality studies reporting the assessment of BCC training programs with nurses and nursing students are scarce. There was significant heterogeneity in terms of the BCC approaches and techniques taught. Current evidence suggests nurses and nursing students learn BCC mainly through active, realistic practice. However, computer-based training programs are rapidly gaining ground. Further research emphasizing theory-based BCC training programs is warranted.
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Affiliation(s)
- Guillaume Fontaine
- Faculty of Nursing, University of Montreal, Montreal, Quebec, Canada; Montreal Heart Institute Research Center, 5000 Belanger Street, S-2490, Montreal H1T 1C8, Quebec, Canada.
| | - Sylvie Cossette
- Faculty of Nursing, University of Montreal, Montreal, Quebec, Canada; Montreal Heart Institute Research Center, Montreal, Quebec, Canada
| | - Marc-André Maheu-Cadotte
- Faculty of Nursing, University of Montreal, Montreal, Quebec, Canada; Montreal Heart Institute Research Center, Montreal, Quebec, Canada; University of Montreal Hospital Research Center, Montreal, Quebec, Canada
| | - Tanya Mailhot
- Montreal Heart Institute Research Center, Montreal, Quebec, Canada; Department of Pharmacy and Health Systems Sciences, Bouvé College of Health Sciences, Northeastern University, United States of America
| | - Sonia Heppell
- Faculty of Nursing, University of Montreal, Montreal, Quebec, Canada; Montreal Heart Institute, Montreal, Quebec, Canada
| | | | - José Côté
- Faculty of Nursing, University of Montreal, Montreal, Quebec, Canada; University of Montreal Hospital Research Center, Montreal, Quebec, Canada
| | - Marie-Pierre Gagnon
- Faculty of Nursing, Laval University, Quebec, Quebec, Canada; CHU de Québec Research Center, Quebec, Quebec, Canada
| | - Véronique Dubé
- Faculty of Nursing, University of Montreal, Montreal, Quebec, Canada
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29
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Weber B, Bersch-Ferreira ÂC, Torreglosa CR, Marcadenti A, Lara ES, da Silva JT, Costa RP, Santos RHN, Berwanger O, Bosquetti R, Pagano R, Mota LGS, de Oliveira JD, Soares RM, Galante AP, da Silva SA, Zampieri FG, Kovacs C, Amparo FC, Moreira P, da Silva RA, Dos Santos KG, Monteiro AS, Paiva CCJ, Magnoni CD, Moreira ASB, Peçanha DO, Missias KCS, de Paula LS, Marotto D, Souza P, Martins PRT, Dos Santos EM, Santos MR, Silva LP, Torres RS, Barbosa SNAA, de Pinho PM, de Araujo SHA, Veríssimo AOL, Guterres AS, Cardoso AFR, Palmeira MM, de Ataíde BRB, Costa LPS, Marinho HA, de Araújo CBP, Carvalho HMS, Maquiné RO, Caiado AC, de Matos CH, Barretta C, Specht CM, Onofrei M, Bertacco RTA, Borges LR, Bertoldi EG, Longo A, Ribas BLP, Dobke F, Pretto ADB, Bachettini NP, Gastaud A, Necchi R, Souza GC, Zuchinali P, Fracasso BM, Bobadra S, Sangali TD, Salamoni J, Garlini LM, Shirmann GS, de Los Santos MLP, Bortonili VMS, Dos Santos CP, Bragança GCM, Ambrózio CL, E Lima SB, Schiavini J, Napparo AS, Boemo JL, Nagano FEZ, Modanese PVG, Cunha NM, Frehner C, da Silva LF, Formentini FS, Ramos MEM, Ramos SS, Lucas MCS, Machado BG, Ruschel KB, Beiersdorf JR, Nunes CE, Rech RL, Damiani M, Berbigier M, Poloni S, Vian I, Russo DS, Rodrigues JA, de Moraes MAP, da Costa LM, Boklis M, El Kik RM, Adorne EF, Teixeira JM, Trescastro EP, Chiesa FL, Telles CT, Pellegrini LA, Reis LF, Cardoso RGM, Closs VE, Feres NH, da Silva NF, Silva NE, Dutra ES, Ito MK, Lima MEP, Carvalho APPF, Taboada MIS, Machado MMA, David MM, Júnior DGS, Dourado C, Fagundes VCFO, Uehara RM, Sasso S, Vieira JSO, de Oliveira BAS, Pereira JL, Rodrigues IG, Pinho CPS, Sousa ACS, Almeida AS, de Jesus MT, da Silva GB, Alves LVS, Nascimento VOG, Vieira SA, Coura AGL, Dantas CF, Leda NMFS, Medeiros AL, Andrade ACL, Pinheiro JMF, de Lima LRM, Sabino LS, de Souza CVS, Vasconcelos SML, Costa FA, Ferreira RC, Cardoso IB, Navarro LNP, Ferreira RB, Júnior AES, Silva MBG, Almeida KMM, Penafort AM, de Queirós APO, Farias GMN, Carlos DMO, Cordeiro CGNC, Vasconcelos VB, de Araújo EMVMC, Sahade V, Ribeiro CSA, Araujo GA, Gonçalves LB, Teixeira CS, Silva LMAJ, da Costa LB, Souza TS, de Jesus SO, Luna AB, da Rocha BRS, Santos MA, Neto JAF, Dias LPP, Cantanhede RCA, Morais JM, Duarte RCL, Barbosa ECB, Barbosa JMA, de Sousa RML, Dos Santos AF, Teixeira AF, Moriguchi EH, Bruscato NM, Kesties J, Vivian L, de Carli W, Shumacher M, Izar MCO, Asoo MT, Kato JT, Martins CM, Machado VA, Bittencourt CRO, de Freitas TT, Sant'Anna VAR, Lopes JD, Fischer SCPM, Pinto SL, Silva KC, Gratão LHA, Holzbach LC, Backes LM, Rodrigues MP, Deucher KLAL, Cantarelli M, Bertoni VM, Rampazzo D, Bressan J, Hermsdorff HHM, Caldas APS, Felício MB, Honório CR, da Silva A, Souza SR, Rodrigues PA, de Meneses TMX, Kumbier MCC, Barreto AL, Cavalcanti AB. Implementation of a Brazilian Cardioprotective Nutritional (BALANCE) Program for improvement on quality of diet and secondary prevention of cardiovascular events: A randomized, multicenter trial. Am Heart J 2019; 215:187-197. [PMID: 31349110 DOI: 10.1016/j.ahj.2019.06.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 06/14/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Appropriate dietary recommendations represent a key part of secondary prevention in cardiovascular disease (CVD). We evaluated the effectiveness of the implementation of a nutritional program on quality of diet, cardiovascular events, and death in patients with established CVD. METHODS In this open-label, multicenter trial conducted in 35 sites in Brazil, we randomly assigned (1:1) patients aged 45 years or older to receive either the BALANCE Program (experimental group) or conventional nutrition advice (control group). The BALANCE Program included a unique nutritional education strategy to implement recommendations from guidelines, adapted to the use of affordable and regional foods. Adherence to diet was evaluated by the modified Alternative Healthy Eating Index. The primary end point was a composite of all-cause mortality, cardiovascular death, cardiac arrest, myocardial infarction, stroke, myocardial revascularization, amputation, or hospitalization for unstable angina. Secondary end points included biochemical and anthropometric data, and blood pressure levels. RESULTS From March 5, 2013, to Abril 7, 2015, a total of 2534 eligible patients were randomly assigned to either the BALANCE Program group (n = 1,266) or the control group (n = 1,268) and were followed up for a median of 3.5 years. In total, 235 (9.3%) participants had been lost to follow-up. After 3 years of follow-up, mean modified Alternative Healthy Eating Index (scale 0-70) was only slightly higher in the BALANCE group versus the control group (26.2 ± 8.4 vs 24.7 ± 8.6, P < .01), mainly due to a 0.5-serving/d greater intake of fruits and of vegetables in the BALANCE group. Primary end point events occurred in 236 participants (18.8%) in the BALANCE group and in 207 participants (16.4%) in the control group (hazard ratio, 1.15; 95% CI 0.95-1.38; P = .15). Secondary end points did not differ between groups after follow-up. CONCLUSIONS The BALANCE Program only slightly improved adherence to a healthy diet in patients with established CVD and had no significant effect on the incidence of cardiovascular events or death.
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Affiliation(s)
| | | | - Camila R Torreglosa
- Research Institute-HCor, São Paulo, Brazil; Research Institute-HCor, São Paulo, Brazil and to PhD studant at Graduation Program in Global Health and Sustainability, University of São Paulo, São Paulo-SP, Brazil
| | - Aline Marcadenti
- Research Institute-HCor, São Paulo, Brazil; Research Institute-HCor, São Paulo, Brazil and to Graduate Program in Health Sciences (Cardiology), Institute of Cardiology of Rio Grande do Sul/University Foundation of Cardiology (IC/FUC), Porto Alegre-RS, Brazil
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Annie S B Moreira
- Hospital Universitário Pedro Ernesto, Rio de Janeiro-RJ, Brazil; Instituto Nacional de Cardiologia, Rio de Janeiro-RJ, Brazil
| | | | | | - Lais S de Paula
- Hospital Universitário Pedro Ernesto, Rio de Janeiro-RJ, Brazil
| | - Deborah Marotto
- Hospital Universitário Pedro Ernesto, Rio de Janeiro-RJ, Brazil
| | - Paula Souza
- Instituto Nacional de Cardiologia, Rio de Janeiro-RJ, Brazil
| | | | | | | | - Luisa P Silva
- Instituto Nacional de Cardiologia, Rio de Janeiro-RJ, Brazil
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Aline Longo
- Universidade Federal de Pelotas, Pelotas-RS, Brazil
| | | | | | | | | | | | | | | | | | | | - Sara Bobadra
- Hospital de Clínicas de Porto Alegre, Porto Alegre-RS, Brazil
| | | | - Joyce Salamoni
- Hospital de Clínicas de Porto Alegre, Porto Alegre-RS, Brazil
| | - Luíza M Garlini
- Hospital de Clínicas de Porto Alegre, Porto Alegre-RS, Brazil
| | | | | | | | | | | | | | | | | | | | | | | | - Paulo V G Modanese
- Hospital de Clínicas da Universidade Federal do Paraná, Curitiba-PR, Brazil
| | - Natalia M Cunha
- Hospital de Clínicas da Universidade Federal do Paraná, Curitiba-PR, Brazil
| | - Caroline Frehner
- Hospital de Clínicas da Universidade Federal do Paraná, Curitiba-PR, Brazil
| | - Lannay F da Silva
- Hospital de Clínicas da Universidade Federal do Paraná, Curitiba-PR, Brazil
| | | | - Maria E M Ramos
- Hospital Universitário Associação Educadora São Carlos, Canoas-RS, Brazil
| | - Salvador S Ramos
- Hospital Universitário Associação Educadora São Carlos, Canoas-RS, Brazil
| | - Marilia C S Lucas
- Hospital Universitário Associação Educadora São Carlos, Canoas-RS, Brazil
| | - Bruna G Machado
- Hospital Universitário Associação Educadora São Carlos, Canoas-RS, Brazil
| | - Karen B Ruschel
- Hospital Universitário Associação Educadora São Carlos, Canoas-RS, Brazil
| | | | - Cristine E Nunes
- Hospital Universitário Associação Educadora São Carlos, Canoas-RS, Brazil
| | - Rafael L Rech
- Hospital Universitário Associação Educadora São Carlos, Canoas-RS, Brazil
| | - Mônica Damiani
- Hospital Universitário Associação Educadora São Carlos, Canoas-RS, Brazil
| | - Marina Berbigier
- Hospital Universitário Associação Educadora São Carlos, Canoas-RS, Brazil
| | - Soraia Poloni
- Instituto de Cardiologia do Rio Grande do Sul, Porto Alegre-RS, Brazil
| | - Izabele Vian
- Instituto de Cardiologia do Rio Grande do Sul, Porto Alegre-RS, Brazil
| | - Diana S Russo
- Instituto de Cardiologia do Rio Grande do Sul, Porto Alegre-RS, Brazil
| | | | | | - Laura M da Costa
- Instituto de Cardiologia do Rio Grande do Sul, Porto Alegre-RS, Brazil
| | - Mirena Boklis
- Instituto de Cardiologia do Rio Grande do Sul, Porto Alegre-RS, Brazil
| | - Raquel M El Kik
- Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre-RS, Brazil
| | - Elaine F Adorne
- Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre-RS, Brazil
| | - Joise M Teixeira
- Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre-RS, Brazil
| | - Eduardo P Trescastro
- Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre-RS, Brazil
| | - Fernanda L Chiesa
- Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre-RS, Brazil
| | - Cristina T Telles
- Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre-RS, Brazil
| | - Livia A Pellegrini
- Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre-RS, Brazil
| | - Luisa F Reis
- Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre-RS, Brazil
| | - Roberta G M Cardoso
- Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre-RS, Brazil
| | - Vera E Closs
- Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre-RS, Brazil
| | - Naoel H Feres
- Universidade Federal do Mato Grosso, Cuiabá-MT, Brazil
| | | | - Neyla E Silva
- Universidade Federal do Mato Grosso, Cuiabá-MT, Brazil
| | | | - Marina K Ito
- Hospital Universitário de Brasília, Brasília-DF, Brazil
| | | | | | | | | | - Marta M David
- Hospital Universitário Maria Aparecida Pedrossian, Campo Grande-MS, Brazil
| | - Délcio G S Júnior
- Hospital Universitário Maria Aparecida Pedrossian, Campo Grande-MS, Brazil
| | - Camila Dourado
- Hospital Universitário Maria Aparecida Pedrossian, Campo Grande-MS, Brazil
| | | | - Rose M Uehara
- Hospital Universitário Maria Aparecida Pedrossian, Campo Grande-MS, Brazil
| | - Sandramara Sasso
- Hospital Universitário Maria Aparecida Pedrossian, Campo Grande-MS, Brazil
| | | | | | - Juliana L Pereira
- Hospital Universitário Maria Aparecida Pedrossian, Campo Grande-MS, Brazil
| | - Isa G Rodrigues
- Pronto Socorro Cardiológico Universitário de Pernambuco, Recife-PE, Brazil
| | - Claudia P S Pinho
- Pronto Socorro Cardiológico Universitário de Pernambuco, Recife-PE, Brazil
| | | | | | | | | | | | | | | | - Amanda G L Coura
- Hospital Universitário Alcides Carneiro, Campina Grande-PB, Brazil
| | - Clenise F Dantas
- Hospital Universitário Alcides Carneiro, Campina Grande-PB, Brazil
| | - Neuma M F S Leda
- Hospital Universitário Alcides Carneiro, Campina Grande-PB, Brazil
| | | | - Ana C L Andrade
- Hospital Universitário Alcides Carneiro, Campina Grande-PB, Brazil
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Viviane Sahade
- Hospital Universitário Professor Edgard Santos, Salvador-BA, Brazil
| | | | - Givaldo A Araujo
- Hospital Universitário Professor Edgard Santos, Salvador-BA, Brazil
| | | | | | | | - Laís B da Costa
- Hospital Universitário Professor Edgard Santos, Salvador-BA, Brazil
| | - Tainah S Souza
- Hospital Universitário Professor Edgard Santos, Salvador-BA, Brazil
| | - Sende O de Jesus
- Hospital Universitário Professor Edgard Santos, Salvador-BA, Brazil
| | - Adriana B Luna
- Hospital Universitário da Universidade Federal de Sergipe, Aracaju-SE, Brazil
| | | | - Maria A Santos
- Hospital Universitário da Universidade Federal de Sergipe, Aracaju-SE, Brazil
| | - José A F Neto
- Hospital Universitário da Universidade Federal do Maranhão, São Luís-MA, Brazil
| | - Luciana P P Dias
- Hospital Universitário da Universidade Federal do Maranhão, São Luís-MA, Brazil
| | | | - Jadson M Morais
- Hospital Universitário da Universidade Federal do Maranhão, São Luís-MA, Brazil
| | - Rita C L Duarte
- Hospital Universitário da Universidade Federal do Maranhão, São Luís-MA, Brazil
| | - Elza C B Barbosa
- Hospital Universitário da Universidade Federal do Maranhão, São Luís-MA, Brazil
| | - Janaina M A Barbosa
- Hospital Universitário da Universidade Federal do Maranhão, São Luís-MA, Brazil
| | | | | | - Adriana F Teixeira
- Hospital Universitário da Universidade Federal do Maranhão, São Luís-MA, Brazil
| | | | - Neide M Bruscato
- Associação Veranense de Assistência em Saúde, Veranópolis-RS, Brazil
| | - Josiele Kesties
- Associação Veranense de Assistência em Saúde, Veranópolis-RS, Brazil
| | - Lilian Vivian
- Associação Veranense de Assistência em Saúde, Veranópolis-RS, Brazil
| | - Waldemar de Carli
- Associação Veranense de Assistência em Saúde, Veranópolis-RS, Brazil
| | - Marina Shumacher
- Associação Veranense de Assistência em Saúde, Veranópolis-RS, Brazil
| | | | - Marina T Asoo
- Universidade Federal de São Paulo, São Paulo-SP, Brazil
| | | | | | | | | | | | | | - Júlia D Lopes
- Universidade Federal de São Paulo, São Paulo-SP, Brazil
| | | | - Sônia L Pinto
- Universidade Federal de Tocantins, Palmas-TO, Brazil
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Simone R Souza
- Instituto Estadual de Cardiologia Aloysio de Castro, Rio de Janeiro-RJ, Brazil
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Rhee EJ, Kim HC, Kim JH, Lee EY, Kim BJ, Kim EM, Song Y, Lim JH, Kim HJ, Choi S, Moon MK, Na JO, Park KY, Oh MS, Han SY, Noh J, Yi KH, Lee SH, Hong SC, Jeong IK. 2018 Guidelines for the Management of Dyslipidemia in Korea. J Lipid Atheroscler 2019; 8:78-131. [PMID: 32821702 PMCID: PMC7379116 DOI: 10.12997/jla.2019.8.2.78] [Citation(s) in RCA: 88] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Accepted: 06/19/2019] [Indexed: 12/29/2022] Open
Affiliation(s)
- Eun-Jung Rhee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyeon Chang Kim
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Jae Hyeon Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eun Young Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Byung Jin Kim
- Division of Cardiology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eun Mi Kim
- Department of Nutrition and Dietetics, Kangbuk Samsung Hospital, Seoul, Korea
| | - YoonJu Song
- Department of Food Science and Nutrition, The Catholic University of Korea, Bucheon, Korea
| | - Jeong Hyun Lim
- Department of Food Service and Nutrition Care, Seoul National University Hospital, Seoul, Korea
| | - Hae Jin Kim
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, Korea
| | - Seonghoon Choi
- Division of Cardiology, Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea
| | - Min Kyong Moon
- Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
| | - Jin Oh Na
- Cardiovascular Center, Division of Cardiology, Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Kwang-Yeol Park
- Department of Neurology, Chung-Ang University College of Medicine, Seoul, Korea
| | - Mi Sun Oh
- Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Sang Youb Han
- Division of Nephrology, Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Junghyun Noh
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Kyung Hee Yi
- Department of Pediatrics, Wonkwang University Sanbon Medical Center, Gunpo, Korea
| | - Sang-Hak Lee
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Soon-Cheol Hong
- Department of Obstetrics and Gynecology, Korea University Medical Center, Seoul, Korea
| | - In-Kyung Jeong
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
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31
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Rhee EJ, Kim HC, Kim JH, Lee EY, Kim BJ, Kim EM, Song Y, Lim JH, Kim HJ, Choi S, Moon MK, Na JO, Park KY, Oh MS, Han SY, Noh J, Yi KH, Lee SH, Hong SC, Jeong IK. 2018 Guidelines for the management of dyslipidemia. Korean J Intern Med 2019; 34:723-771. [PMID: 31272142 PMCID: PMC6610190 DOI: 10.3904/kjim.2019.188] [Citation(s) in RCA: 128] [Impact Index Per Article: 25.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Accepted: 06/19/2019] [Indexed: 02/07/2023] Open
Affiliation(s)
- Eun-Jung Rhee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyeon Chang Kim
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Jae Hyeon Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eun Young Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
| | - Byung Jin Kim
- Division of Cardiology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eun Mi Kim
- Department of Nutrition and Dietetics, Kangbuk Samsung Hospital, Seoul, Korea
| | - YoonJu Song
- Department of Food Science and Nutrition, The Catholic University of Korea, Bucheon, Korea
| | - Jeong Hyun Lim
- Department of Food Service and Nutrition Care, Seoul National University Hospital, Seoul, Korea
| | - Hae Jin Kim
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, Korea
| | - Seonghoon Choi
- Division of Cardiology, Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea
| | - Min Kyong Moon
- Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
| | - Jin Oh Na
- Cardiovascular Center, Division of Cardiology, Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Kwang-Yeol Park
- Department of Neurology, Chung-Ang University College of Medicine, Seoul, Korea
| | - Mi Sun Oh
- Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Sang Youb Han
- Divisions of Nephrology, Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Junghyun Noh
- Divisions of Endocrinology and Metabolism, Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Kyung Hee Yi
- Department of Pediatrics, Wonkwang University Sanbon Medical Center, Gunpo, Korea
| | - Sang-Hak Lee
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Soon-Cheol Hong
- Department of Obstetrics and Gynecology, Korea University Medical Center, Seoul, Korea
| | - In-Kyung Jeong
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Korea
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Leszczak J, Czenczek-Lewandowska E, Przysada G, Wyszyńska J, Weres A, Baran J, Kwolek A, Mazur A. Diet after Stroke and Its Impact on the Components of Body Mass and Functional Fitness-A 4-Month Observation. Nutrients 2019; 11:nu11061227. [PMID: 31146478 PMCID: PMC6627133 DOI: 10.3390/nu11061227] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 05/27/2019] [Accepted: 05/28/2019] [Indexed: 12/14/2022] Open
Abstract
The aim of the study was to assess the effect of various diets on BMI and selected components of body mass, i.e., fat mass (FAT%), visceral fat (VFAT level), muscle mass (PMM %), body water (TBW %), and functional fitness during a 4-month observation period. Examinations were conducted three times in a group of 100 people after a stroke. The study group was divided into four subgroups according to the type of diet applied. The components of body mass were assessed using the electrical bioimpedance method, and functional fitness using the Barthel scale, the Brunnström scale, and the modified Ashworth scale. Despite the fact that there were no significant differences among the diets applied, it was observed that each of them had a positive effect on the reduction of the mean BMI, FAT%, VFAT level, and the increase in TBW% and PMM%. At the same time, there was a significant improvement in the functional fitness of the hand and upper limb. Weight control and a change in eating habits after a stroke incident is extremely important as it promotes faster recovery and improved functional fitness.
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Affiliation(s)
- Justyna Leszczak
- Faculty of Medicine, University of Rzeszów, 35-959 Rzeszów, Poland.
| | | | - Grzegorz Przysada
- Faculty of Medicine, University of Rzeszów, 35-959 Rzeszów, Poland.
- Clinical Regional Hospital No. 2 in Rzeszów, Lwowska Street 60, 35-301 Rzeszów, Poland.
| | | | - Aneta Weres
- Faculty of Medicine, University of Rzeszów, 35-959 Rzeszów, Poland.
| | - Joanna Baran
- Faculty of Medicine, University of Rzeszów, 35-959 Rzeszów, Poland.
| | - Andrzej Kwolek
- Faculty of Medicine, University of Rzeszów, 35-959 Rzeszów, Poland.
| | - Artur Mazur
- Faculty of Medicine, University of Rzeszów, 35-959 Rzeszów, Poland.
- Clinical Regional Hospital No. 2 in Rzeszów, Lwowska Street 60, 35-301 Rzeszów, Poland.
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Piernas C, Tsiountsioura M, Astbury NM, Madigan C, Aveyard P, Jebb SA. Primary Care SHOPping intervention for cardiovascular disease prevention (PC-SHOP): protocol for a randomised controlled trial to reduce saturated fat intake. BMJ Open 2019; 9:e027035. [PMID: 30992293 PMCID: PMC6500228 DOI: 10.1136/bmjopen-2018-027035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION A diet high in saturated fat (SFA) increases the risk of cardiovascular disease (CVD) and intakes in the UK exceed dietary recommendations. The Primary Care Shopping Intervention for Cardiovascular Disease Prevention (PC-SHOP) study aims to test the effect of an intervention for people with raised low-density lipoprotein (LDL) cholesterol involving health professional (HP) advice alone, or in combination with personalised feedback based on nutritional analysis of grocery store loyalty card data, on SFA intake and blood lipids in comparison with no intervention. METHODS AND ANALYSIS PC-SHOP is a three-arm parallel randomised controlled trial with an allocation ratio of 1:3:3 ('no intervention': n=16, 'brief support': n=48, 'brief support plus shopping feedback': n=48, respectively). Participants with raised LDL will be recruited from general practitioner (GP) practices for a 3-month intervention period. In brief support, an HP will deliver a behaviourally informed 10 min consultation and provide a written self-help guide to inform and motivate people to reduce their SFA intake. In brief support plus shopping feedback, the participants will receive the same HP-led behavioural support and, based on data from their grocery store loyalty card, personalised feedback on the SFA content of their grocery shopping, identifying high SFA purchases and suggesting swaps to similar but lower SFA items.Measurements for the primary and secondary outcomes will be collected at baseline and at follow-up (3 months). The primary outcome measure will be the between-group difference in the reduction of SFA intake between baseline and follow-up. Secondary outcomes include changes in blood lipids and SFA content of food purchases, with process measures to consider the feasibility and acceptability of the intervention. ETHICS AND DISSEMINATION This study has been reviewed and approved by the National Health Service Health Research Authority Research Ethics Committee (Ref: 17/SC/0168). The trial findings will be disseminated to academic and HPs through presentations at meetings and peer-reviewed journals and to the public through the media. If the intervention is effective, the results will be communicated to relevant stakeholders, including policymakers and retailers. TRIAL REGISTRATION NUMBER ISRCTN14279335; Pre-results.
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Affiliation(s)
- Carmen Piernas
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Melina Tsiountsioura
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Nerys M Astbury
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Claire Madigan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Paul Aveyard
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Susan A Jebb
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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34
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Haas K, Hayoz S, Maurer-Wiesner S. Effectiveness and Feasibility of a Remote Lifestyle Intervention by Dietitians for Overweight and Obese Adults: Pilot Study. JMIR Mhealth Uhealth 2019; 7:e12289. [PMID: 30973338 PMCID: PMC6482396 DOI: 10.2196/12289] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 02/10/2019] [Accepted: 02/12/2019] [Indexed: 12/24/2022] Open
Abstract
Background To tackle the problem of obesity and related diseases in Switzerland, cost-efficient, effective, and innovative primary health care interventions for weight management are required. In this context, Oviva has developed a scalable technology for registered dietitians to counsel overweight and obese patients via a mobile phone app. Objective The aim of this study was to evaluate the effectiveness and feasibility of weight loss counseling by dietitians using a mobile phone app for patients with overweight and obesity. Methods In this pre- and posttest pilot study, overweight and obese adults participated in a 1-year behavioral intervention to lose weight through remote counseling by dietitians in the German-speaking part of Switzerland. The study started in April 2016 and finished in May 2018. Participants received individual counseling through the app and the exchange with the dietitian focused on regular feedback on photo-based food log, motivation, and education. The contents were tailored to the individual lifestyle goal set. The predefined intensity of remote counseling decreased during the year. Group chat could be used. The outcomes examined were changes in weight (primary outcome), hemoglobin A1c, fasting glucose, fasting insulin, triglyceride, high-density lipoprotein cholesterol, blood pressure (BP), body mass index (BMI), waist circumference, body fat, and responses to a self-administered questionnaire with questions regarding participants’ physical activity, dietary assessment, and health-related quality of life. Changes were tested at baseline, after 3 months, and after 12 months, as well as between the third and the 12th month. Results In total, 36 women and 7 men, with a mean age of 40.6 years, participated and 36 participants completed the study. Median weight change after the first 12 weeks was −3.8 kg (range: −15 to 2.4 and P<.001), between week 12 and week 52 it was −1.1 kg (range: −9.7 to 7 and P=.08), and the median change during the entire period of intervention was −4.9 kg (range: −21.9 to 7.5 and P<.001). Furthermore, changes in BMI, waist circumference, body fat, and BP between baseline and 12 weeks and between baseline and 52 weeks were also significant. Significant changes in certain eating habits were also demonstrated (higher frequency of vegetable, fruit, and breakfast consumption and lower frequency of alcohol, sweet, and fat consumption). Conclusions In addition to the professional skills of a dietitian, a profession-specific app such as Oviva can provide effective support that meets the needs of dietitians and clients on the long path of behavioral change and sustainable weight reduction. Trial Registration ClinicalTrials.gov NCT02694614; https://clinicaltrials.gov/ct2/show/NCT02694614 (Archived by WebCite at http://www.webcitation.org/76gYkGOIc)
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Affiliation(s)
- Karin Haas
- Applied Research & Development Nutrition and Dietetics, Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
| | - Stefanie Hayoz
- Applied Research & Development Nutrition and Dietetics, Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
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35
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Busnelli M, Manzini S, Sirtori CR, Chiesa G, Parolini C. Effects of Vegetable Proteins on Hypercholesterolemia and Gut Microbiota Modulation. Nutrients 2018; 10:E1249. [PMID: 30200592 PMCID: PMC6164761 DOI: 10.3390/nu10091249] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 08/30/2018] [Accepted: 09/03/2018] [Indexed: 12/19/2022] Open
Abstract
Risk assessment tools, i.e., validated risk prediction algorithms, to estimate the patient's 10-year risk of developing cardiovascular disease (CVD) should be used to identify high-risk people for primary prevention. Current evidence confirms that appropriate monitoring and control of risk factors either reduces the likelihood of CVD or slows down its progression. It is thus crucial that all health professionals make appropriate use of all the available intervention strategies to control risk factors: from dietary improvement and adequate physical activity to the use of functional foods, food supplements, and drugs. The gut microbiota, which encompasses 1 × 1014 resident microorganisms, has been recently recognized as a contributing factor in the development of human disease. This review examines the effect of both some vegetable food components belong to the "protein food group" and the underexploited protein-rich hempseed on cholesterolemia and gut microbiota composition.
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Affiliation(s)
- Marco Busnelli
- Department of Pharmacological and Biomolecular Sciences, Università degli Studi di Milano, 20133 Milano, Italy.
| | - Stefano Manzini
- Department of Pharmacological and Biomolecular Sciences, Università degli Studi di Milano, 20133 Milano, Italy.
| | - Cesare R Sirtori
- Centro Dislipidemie, A.S.S.T. Grande Ospedale Metropolitano Niguarda, 220162 Milano, Italy.
| | - Giulia Chiesa
- Department of Pharmacological and Biomolecular Sciences, Università degli Studi di Milano, 20133 Milano, Italy.
| | - Cinzia Parolini
- Department of Pharmacological and Biomolecular Sciences, Università degli Studi di Milano, 20133 Milano, Italy.
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Leyvraz M, Mizéhoun-Adissoda C, Houinato D, Moussa Baldé N, Damasceno A, Viswanathan B, Amyunzu-Nyamongo M, Owuor J, Chiolero A, Bovet P. Food Consumption, Knowledge, Attitudes, and Practices Related to Salt in Urban Areas in Five Sub-Saharan African Countries. Nutrients 2018; 10:E1028. [PMID: 30087242 PMCID: PMC6116014 DOI: 10.3390/nu10081028] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 07/30/2018] [Accepted: 08/03/2018] [Indexed: 01/02/2023] Open
Abstract
High salt intake is a major risk factor of hypertension and cardiovascular disease. Improving knowledge, attitudes, and practices (KAP) related to salt intake in the general population is a key component of salt reduction strategies. The objective of this study was to describe and compare the KAP of adults related to salt in urban areas of five countries in sub-Saharan Africa. The survey included 588 participants aged 25 to 65 years who were selected using convenience samples in the urban areas of Benin, Guinea, Kenya, Mozambique, and Seychelles. Socio-demographic and food consumption were assessed using a structured closed-ended questionnaire administered by survey officers. Height, weight, and blood pressure were measured. Food consumption varied largely between countries. Processed foods high in salt, such as processed meat, cheese, pizzas, and savory snacks were consumed rather infrequently in all the countries, but salt-rich foods, such as soups or bread and salty condiments, were consumed frequently in all countries. The majority of the participants knew that high salt intake can cause health problems (85%) and thought that it is important to limit salt intake (91%). However, slightly over half (56%) of the respondents regularly tried to limit their salt intake while only 8% of the respondents thought that they consumed too much salt. Salt and salty condiments were added most of the time during cooking (92% and 64%, respectively) but rarely at the table (11%). These findings support the need for education campaigns to reduce salt added during cooking and for strategies to reduce salt content in selected manufactured foods in the region.
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Affiliation(s)
- Magali Leyvraz
- Institute of Social and Preventive Medicine (IUMSP), Canton University Hospital (CHUV), 1010 Lausanne, Switzerland.
| | - Carmelle Mizéhoun-Adissoda
- School of Nutrition and Dietetics, Faculty of Health Science, University of Abomey-Calavi, Cotonou 01 BP 526, Benin.
| | - Dismand Houinato
- Laboratory of Noncommunicable and Neurologic Diseases Epidemiology, Faculty of Health Science, University of Abomey-Calavi, Cotonou 01 BP 526, Benin.
| | - Naby Moussa Baldé
- Department of Endocrinology and Diabetes, Donka University Hospital, Conakry, Guinea.
| | | | | | | | - Jared Owuor
- African Institute for Health and Development (AIHD), Nairobi 00100, Kenya.
| | - Arnaud Chiolero
- Institute of Social and Preventive Medicine (IUMSP), Canton University Hospital (CHUV), 1010 Lausanne, Switzerland.
- Institute of Primary Health Care (BIHAM), University of Bern, 3012 Bern, Switzerland.
| | - Pascal Bovet
- Institute of Social and Preventive Medicine (IUMSP), Canton University Hospital (CHUV), 1010 Lausanne, Switzerland.
- Ministry of Health, Victoria, Republic of Seychelles.
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37
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Götz A, Lehti M, Donelan E, Striese C, Cucuruz S, Sachs S, Yi CX, Woods SC, Wright SD, Müller TD, Tschöp MH, Gao Y, Hofmann SM. Circulating HDL levels control hypothalamic astrogliosis via apoA-I. J Lipid Res 2018; 59:1649-1659. [PMID: 29991652 DOI: 10.1194/jlr.m085456] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 07/09/2018] [Indexed: 01/09/2023] Open
Abstract
Meta-inflammation of hypothalamic areas governing energy homeostasis has recently emerged as a process of potential pathophysiological relevance for the development of obesity and its metabolic sequelae. The current model suggests that diet-induced neuronal injury triggers microgliosis and astrocytosis, conditions which ultimately may induce functional impairment of hypothalamic circuits governing feeding behavior, systemic metabolism, and body weight. Epidemiological data indicate that low circulating HDL levels, besides conveying cardiovascular risk, also correlate strongly with obesity. We simulated that condition by using a genetic loss of function mouse model (apoA-I-/-) with markedly reduced HDL levels to investigate whether HDL may directly modulate hypothalamic inflammation. Astrogliosis was significantly enhanced in the hypothalami of apoA-I-/- compared with apoA-I+/+ mice and was associated with compromised mitochondrial function. apoA-I-/- mice exhibited key components of metabolic disease, like increased fat mass, fasting glucose levels, hepatic triglyceride content, and hepatic glucose output compared with apoA-I+/+ controls. Administration of reconstituted HDL (CSL-111) normalized hypothalamic inflammation and mitochondrial function markers in apoA-I-/- mice. Treatment of primary astrocytes with apoA-I resulted in enhanced mitochondrial activity, implying that circulating HDL levels are likely important for astrocyte function. HDL-based therapies may consequently avert reactive gliosis in hypothalamic astrocytes by improving mitochondrial bioenergetics and thereby offering potential treatment and prevention for obesity and metabolic disease.
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Affiliation(s)
- Anna Götz
- Institutes for Diabetes and Obesity Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany; Department of Internal Medicine I, University Hospital RWTH Aachen, Aachen, Germany
| | - Maarit Lehti
- LIKES Research Centre for Physical Activity and Health, Jyväskylä, Finland
| | - Elizabeth Donelan
- Metabolic Disease Institute, Department of Internal Medicine, University of Cincinnati, Cincinnati, OH
| | - Cynthia Striese
- Diabetes and Regeneration Research, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany
| | - Sebastian Cucuruz
- Diabetes and Regeneration Research, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany
| | - Stephan Sachs
- Diabetes and Regeneration Research, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany
| | - Chun-Xia Yi
- Department of Endocrinology and Metabolism, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Stephen C Woods
- Metabolic Disease Institute, Department of Internal Medicine, University of Cincinnati, Cincinnati, OH
| | | | - Timo D Müller
- Institutes for Diabetes and Obesity Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany; German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Matthias H Tschöp
- Institutes for Diabetes and Obesity Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany; German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Yuanqing Gao
- Nanjing Medical University, College of Pharmacy, Nanjing, China.
| | - Susanna M Hofmann
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany; Medizinische Klinik und Poliklinik IV, Klinikum der Ludwig Maximilian Universität, Munich, Germany.
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Córdoba García R, Camarelles Guillem F, Muñoz Seco E, Gómez Puente JM, José Arango JS, Ramírez Manent JI, Martín Cantera C, Campo Giménez MD, Revenga Frauca J. Recomendaciones sobre el estilo de vida. Actualizacón PAPPS 2018. Aten Primaria 2018; 50 Suppl 1:29-40. [PMID: 29866355 PMCID: PMC6836940 DOI: 10.1016/s0212-6567(18)30361-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Affiliation(s)
- Rodrigo Córdoba García
- Especialista en Medicina Familiar y Comunitaria, Centro de Salud Delicias Sur, Zaragoza, y coordinador del Grupo ESPS
| | | | - Elena Muñoz Seco
- Especialista en Medicina Familiar y Comunitaria, Unidad Básica de Salud es Castell, Menorca, Ibsalut
| | | | - Joaquín San José Arango
- Especialista en Medicina Familiar y Comunitaria, Centro de Salud Vilagarcía, Pontevedra, y miembro del Grupo de Trabajo de Alimentación y Nutrición
| | - José Ignacio Ramírez Manent
- Especialista en Medicina Familiar y Comunitaria, Centro de Salud de Calvià, Instituto de Investigación Sanitaria Illes Balears, IdISBa
| | - Carlos Martín Cantera
- Especialista en Medicina Familiar y Comunitaria, Grupo de Investigación Estilos de Vida, IDIAP Jordi Gol, Barcelona
| | - M Del Campo Giménez
- Médico residente de Medicina de Familia y Comunitaria, Centro de Salud la Roda, Unidad Docente de Albacete
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Druss BG, Singh M, von Esenwein SA, Glick GE, Tapscott S, Tucker SJ, Lally CA, Sterling EW. Peer-Led Self-Management of General Medical Conditions for Patients With Serious Mental Illnesses: A Randomized Trial. Psychiatr Serv 2018; 69:529-535. [PMID: 29385952 PMCID: PMC5930018 DOI: 10.1176/appi.ps.201700352] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Individuals with serious mental illnesses have high rates of general medical comorbidity and challenges in managing these conditions. A growing workforce of certified peer specialists is available to help these individuals more effectively manage their health and health care. However, few studies have examined the effectiveness of peer-led programs for self-management of general medical conditions for this population. METHODS This randomized study enrolled 400 participants with a serious mental illness and one or more chronic general medical conditions across three community mental health clinics. Participants were randomly assigned to the Health and Recovery Peer (HARP) program, a self-management program for general medical conditions led by certified peer specialists (N=198), or to usual care (N=202). Assessments were conducted at baseline and three and six months. RESULTS At six months, participants in the intervention group demonstrated a significant differential improvement in the primary study outcome, health-related quality of life. Specifically, compared with the usual care group, intervention participants had greater improvement in the Short-Form Health Survey physical component summary (an increase of 2.7 versus 1.4 points, p=.046) and mental component summary (4.6 versus 2.5 points, p=.039). Significantly greater six-month improvements in mental health recovery were seen for the intervention group (p=.02), but no other between-group differences in secondary outcome measures were significant. CONCLUSIONS The HARP program was associated with improved physical health- and mental health-related quality of life among individuals with serious mental illness and comorbid general medical conditions, suggesting the potential benefits of more widespread dissemination of peer-led disease self-management in this population.
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Affiliation(s)
- Benjamin G Druss
- Dr. Druss, Ms. Singh, Dr. von Esenwein, Ms. Tapscott, and Ms. Lally are with the Department of Health Policy and Management, Emory University, Atlanta. Ms. Glick is with J. Michael Consulting, Atlanta. Ms. Tucker is with the Georgia Mental Health Consumer Network, Atlanta. Dr. Sterling is with the Department of Sociology, Kennesaw State University, Kennesaw, Georgia
| | - Manasvini Singh
- Dr. Druss, Ms. Singh, Dr. von Esenwein, Ms. Tapscott, and Ms. Lally are with the Department of Health Policy and Management, Emory University, Atlanta. Ms. Glick is with J. Michael Consulting, Atlanta. Ms. Tucker is with the Georgia Mental Health Consumer Network, Atlanta. Dr. Sterling is with the Department of Sociology, Kennesaw State University, Kennesaw, Georgia
| | - Silke A von Esenwein
- Dr. Druss, Ms. Singh, Dr. von Esenwein, Ms. Tapscott, and Ms. Lally are with the Department of Health Policy and Management, Emory University, Atlanta. Ms. Glick is with J. Michael Consulting, Atlanta. Ms. Tucker is with the Georgia Mental Health Consumer Network, Atlanta. Dr. Sterling is with the Department of Sociology, Kennesaw State University, Kennesaw, Georgia
| | - Gretl E Glick
- Dr. Druss, Ms. Singh, Dr. von Esenwein, Ms. Tapscott, and Ms. Lally are with the Department of Health Policy and Management, Emory University, Atlanta. Ms. Glick is with J. Michael Consulting, Atlanta. Ms. Tucker is with the Georgia Mental Health Consumer Network, Atlanta. Dr. Sterling is with the Department of Sociology, Kennesaw State University, Kennesaw, Georgia
| | - Stephanie Tapscott
- Dr. Druss, Ms. Singh, Dr. von Esenwein, Ms. Tapscott, and Ms. Lally are with the Department of Health Policy and Management, Emory University, Atlanta. Ms. Glick is with J. Michael Consulting, Atlanta. Ms. Tucker is with the Georgia Mental Health Consumer Network, Atlanta. Dr. Sterling is with the Department of Sociology, Kennesaw State University, Kennesaw, Georgia
| | - Sherry Jenkins Tucker
- Dr. Druss, Ms. Singh, Dr. von Esenwein, Ms. Tapscott, and Ms. Lally are with the Department of Health Policy and Management, Emory University, Atlanta. Ms. Glick is with J. Michael Consulting, Atlanta. Ms. Tucker is with the Georgia Mental Health Consumer Network, Atlanta. Dr. Sterling is with the Department of Sociology, Kennesaw State University, Kennesaw, Georgia
| | - Cathy A Lally
- Dr. Druss, Ms. Singh, Dr. von Esenwein, Ms. Tapscott, and Ms. Lally are with the Department of Health Policy and Management, Emory University, Atlanta. Ms. Glick is with J. Michael Consulting, Atlanta. Ms. Tucker is with the Georgia Mental Health Consumer Network, Atlanta. Dr. Sterling is with the Department of Sociology, Kennesaw State University, Kennesaw, Georgia
| | - Evelina W Sterling
- Dr. Druss, Ms. Singh, Dr. von Esenwein, Ms. Tapscott, and Ms. Lally are with the Department of Health Policy and Management, Emory University, Atlanta. Ms. Glick is with J. Michael Consulting, Atlanta. Ms. Tucker is with the Georgia Mental Health Consumer Network, Atlanta. Dr. Sterling is with the Department of Sociology, Kennesaw State University, Kennesaw, Georgia
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Bokslag A, Kroeze W, de Groot CJM, Teunissen PW. Cardiovascular risk after preeclampsia: The effect of communicating risk factors on intended healthy behavior. Hypertens Pregnancy 2018; 37:98-103. [PMID: 29694251 DOI: 10.1080/10641955.2018.1460668] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE We studied the effect of communicating cardiovascular risk factors on intended healthy behavior in women with a history of preeclampsia or uncomplicated pregnancy. METHODS Intention for healthy behavior was assessed before and after cardiovascular risk assessment. Changes were calculated for women with and without cardiovascular risk factors. RESULTS In women with cardiovascular risk factors, the intention to quit smoking increased; whereas, intended healthy diet and sufficient exercise did not change. In participants without risk factors, none of the healthy behaviors changed. CONCLUSION Communicating risk factors alone does not seem to be effective as an intervention to achieve lifestyle changes.
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Affiliation(s)
- Anouk Bokslag
- a Department of Obstetrics & Gynecology , VU University Medical Center , Amsterdam , The Netherlands
| | - Willemieke Kroeze
- b Department of Health Sciences, Prevention and Public Health section, Faculty of Earth and Life Sciences , VU University , Amsterdam , The Netherlands
| | - Christianne J M de Groot
- a Department of Obstetrics & Gynecology , VU University Medical Center , Amsterdam , The Netherlands
| | - Pim W Teunissen
- a Department of Obstetrics & Gynecology , VU University Medical Center , Amsterdam , The Netherlands.,c Department of Educational Development and Research, School of Health Professions Education, Faculty of Health, Medicine and Life Sciences , Maastricht University , Maastricht , The Netherlands
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Abstract
OBJECTIVE FFQ are often used to estimate food and nutrient intakes to rank individuals by their level of intake. We evaluated the relative validity of a semi-quantitative FFQ created for use in Tanzania by comparing it with two 24 h diet recalls. DESIGN We measured relative validity of the FFQ with deattenuated energy-adjusted rank correlations for nutrients, deattenuated rank correlations for food groups, and performed a cross-classification analysis of energy-adjusted nutrient quartiles using percentage of agreement and Bland-Altman analysis. SETTING Interviews were conducted in 2014 in participants' homes in Ukonga, Dar es Salaam, Tanzania. SUBJECTS We surveyed 317 adults aged 40 years or older from the general public. RESULTS Deattenuated energy-adjusted rank correlation coefficients of nutrients ranged from -0·03 for riboflavin to 0·41 for percentage of energy from carbohydrates, with a median correlation of 0·21. Coefficients for food groups ranged from 0·00 for root vegetables to 0·51 for alcohol, with a median of 0·35. Relative to the average of the two 24 h diet recalls, the FFQ overestimated energy intake and intakes of all nutrients and food groups, other than tea, with ratios among nutrients ranging from 1·34 for SFA to 7·08 for vitamin A; and among food groups from 0·92 for tea to 9·00 for fruit. The percentage of participants classified into the same nutrient intake quartile ranged from 23 % for SFA to 32 % for both niacin and pantothenic acid, with a median of 28 %. CONCLUSIONS The FFQ performed moderately well in urban Tanzanian adults.
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Williams AS, Patel PM, Beucke NL, Koopman RJ. Community-Based Medical Student Nutrition Counseling Training for Low-Income Families. PRIMER (LEAWOOD, KAN.) 2018; 2:5. [PMID: 32818179 PMCID: PMC7426123 DOI: 10.22454/primer.2018.809708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND AND OBJECTIVES Physician nutrition counseling has become increasingly important due to increases in child and adult obesity. However, medical student education on nutrition counseling, especially for low-income families, is insufficient. METHODS Eat Healthy, Stay Active! (EHSA) is a community-based child obesity program that provided experiential learning for medical students to counsel low-income Head Start families about nutrition. The authors conducted a focus group to explore medical students' opinions about the proficiency of their nutrition education skills, especially in low-income families, and the role of EHSA. The authors also surveyed students about their self-confidence in providing low-income families with nutrition counseling. RESULTS Most students reported a favorable overall impression of EHSA with a mean score of 7 on a 10-point scale (1=poor experience, 10=very positive experience) and 70% reporting they would recommend EHSA to their classmates. They also reported a significant (80%, P< 0.0001) increase in their confidence of counseling patients about child obesity after participating in EHSA. In focus groups, students felt that EHSA improved their nutrition knowledge and helped them to understand barriers of low-income families for healthy nutrition. CONCLUSIONS Students participating in EHSA, a novel, community-based, experiential learning project, gained self-confidence in providing nutrition counseling to low-income families. The program also positively impacted medical student personal opinions of low-income families by providing a personal reference for low-income struggles.
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Affiliation(s)
- Amy S Williams
- Department of Family and Community Medicine, University of Missouri in Columbia, MO
| | - Pooja M Patel
- Providence St. Peter Hospital, University of Washington in Olympia, WA
| | - Nathan L Beucke
- Department of Child Health, University of Missouri School of Medicine, Columbia, MO
| | - Richelle J Koopman
- Department of Family and Community Medicine, University of Missouri, Columbia, MO
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Riegel B, Moser DK, Buck HG, Dickson VV, Dunbar SB, Lee CS, Lennie TA, Lindenfeld J, Mitchell JE, Treat-Jacobson DJ, Webber DE. Self-Care for the Prevention and Management of Cardiovascular Disease and Stroke: A Scientific Statement for Healthcare Professionals From the American Heart Association. J Am Heart Assoc 2017; 6:e006997. [PMID: 28860232 PMCID: PMC5634314 DOI: 10.1161/jaha.117.006997] [Citation(s) in RCA: 269] [Impact Index Per Article: 38.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Self-care is defined as a naturalistic decision-making process addressing both the prevention and management of chronic illness, with core elements of self-care maintenance, self-care monitoring, and self-care management. In this scientific statement, we describe the importance of self-care in the American Heart Association mission and vision of building healthier lives, free of cardiovascular diseases and stroke. The evidence supporting specific self-care behaviors such as diet and exercise, barriers to self-care, and the effectiveness of self-care in improving outcomes is reviewed, as is the evidence supporting various individual, family-based, and community-based approaches to improving self-care. Although there are many nuances to the relationships between self-care and outcomes, there is strong evidence that self-care is effective in achieving the goals of the treatment plan and cannot be ignored. As such, greater emphasis should be placed on self-care in evidence-based guidelines.
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Wiggers J, McElwaine K, Freund M, Campbell L, Bowman J, Wye P, Wolfenden L, Tremain D, Barker D, Slattery C, Gillham K, Bartlem K. Increasing the provision of preventive care by community healthcare services: a stepped wedge implementation trial. Implement Sci 2017; 12:105. [PMID: 28830568 PMCID: PMC5567434 DOI: 10.1186/s13012-017-0636-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Accepted: 08/14/2017] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Although clinical guidelines recommend the provision of care to reduce client chronic disease risk behaviours, such care is provided sub-optimally by primary healthcare providers. A study was undertaken to determine the effectiveness of an intervention in increasing community-based clinician implementation of multiple elements of recommended preventive care for four risk behaviours. METHODS A three-group stepped-wedge trial was undertaken with all 56 community-based primary healthcare facilities in one health district in New South Wales, Australia. A 12-month implementation intervention was delivered sequentially in each of three geographically and administratively defined groups of facilities. The intervention consisted of six key strategies: leadership and consensus processes, enabling systems, educational meetings and training, audit and feedback, practice change support, and practice change information and resources. Client-reported receipt of three elements of preventive care: assessment; brief advice; referral for four behavioural risks: smoking, inadequate fruit and/or vegetable consumption, alcohol overconsumption, and physical inactivity, individually, and for all such risks combined were collected for 56 months (October 2009-May 2014). Segmented logistic regression models were developed to assess intervention effectiveness. RESULTS A total of 5369 clients participated in data collection. Significant increases were found for receipt of four of five assessment outcomes (smoking OR 1.53; fruit and/or vegetable intake OR 2.18; alcohol consumption OR 1.69; all risks combined OR 1.78) and two of five brief advice outcomes (fruit and/or vegetable intake OR 2.05 and alcohol consumption OR 2.64). No significant increases in care delivery were observed for referral for any risk behaviour, or for physical inactivity. CONCLUSIONS The implementation intervention was effective in enhancing assessment of client risk status but less so for elements of care that could reduce client risk: provision of brief advice and referral. The intervention was ineffective in increasing care addressing physical inactivity. Further research is required to identify barriers to the provision of preventive care and the effectiveness of practice change interventions in increasing its provision. TRIAL REGISTRATION Australian Clinical Trials Registry ACTRN12611001284954 . Registered 15 December 2011. Retrospectively registered.
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Affiliation(s)
- John Wiggers
- School of Medicine and Public Health, The University of Newcastle, Callaghan, Australia
- Hunter New England Population Health, Wallsend, Australia
- Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Kathleen McElwaine
- School of Medicine and Public Health, The University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Megan Freund
- School of Medicine and Public Health, The University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Libby Campbell
- School of Medicine and Public Health, The University of Newcastle, Callaghan, Australia
- Hunter New England Population Health, Wallsend, Australia
- Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Jenny Bowman
- School of Psychology, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Paula Wye
- School of Psychology, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Luke Wolfenden
- School of Medicine and Public Health, The University of Newcastle, Callaghan, Australia
- Hunter New England Population Health, Wallsend, Australia
- Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Danika Tremain
- School of Medicine and Public Health, The University of Newcastle, Callaghan, Australia
- Hunter New England Population Health, Wallsend, Australia
- Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Daniel Barker
- School of Medicine and Public Health, The University of Newcastle, Callaghan, Australia
| | | | - Karen Gillham
- Hunter New England Population Health, Wallsend, Australia
| | - Kate Bartlem
- Hunter New England Population Health, Wallsend, Australia
- School of Psychology, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton Heights, Australia
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Ravishankar D, Salamah M, Attina A, Pothi R, Vallance TM, Javed M, Williams HF, Alzahrani EMS, Kabova E, Vaiyapuri R, Shankland K, Gibbins J, Strohfeldt K, Greco F, Osborn HMI, Vaiyapuri S. Ruthenium-conjugated chrysin analogues modulate platelet activity, thrombus formation and haemostasis with enhanced efficacy. Sci Rep 2017; 7:5738. [PMID: 28720875 PMCID: PMC5515887 DOI: 10.1038/s41598-017-05936-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 06/06/2017] [Indexed: 01/28/2023] Open
Abstract
The constant increase in cardiovascular disease rate coupled with significant drawbacks of existing therapies emphasise the necessity to improve therapeutic strategies. Natural flavonoids exert innumerable pharmacological effects in humans. Here, we demonstrate the effects of chrysin, a natural flavonoid found largely in honey and passionflower on the modulation of platelet function, haemostasis and thrombosis. Chrysin displayed significant inhibitory effects on isolated platelets, however, its activity was substantially reduced under physiological conditions. In order to increase the efficacy of chrysin, a sulfur derivative (thio-chrysin), and ruthenium-complexes (Ru-chrysin and Ru-thio-chrysin) were synthesised and their effects on the modulation of platelet function were evaluated. Indeed, Ru-thio-chrysin displayed a 4-fold greater inhibition of platelet function and thrombus formation in vitro than chrysin under physiologically relevant conditions such as in platelet-rich plasma and whole blood. Notably, Ru-thio-chrysin exhibited similar efficacy to chrysin in the modulation of haemostasis in mice. Increased bioavailability and cell permeability of Ru-thio-chrysin compared to chrysin were found to be the basis for its enhanced activity. Together, these results demonstrate that Ru-thio-coupled natural compounds such as chrysin may serve as promising templates for the development of novel anti-thrombotic agents.
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Affiliation(s)
| | | | - Alda Attina
- School of Pharmacy, University of Reading, Reading, UK
| | - Radhika Pothi
- School of Pharmacy, University of Reading, Reading, UK
| | | | | | | | | | - Elena Kabova
- School of Pharmacy, University of Reading, Reading, UK
| | | | | | - Jonathan Gibbins
- Institute for Cardiovascular and Metabolic Research, School of Biological Sciences, University of Reading, Reading, UK
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Quader ZS, Cogswell ME, Fang J, Coleman King SM, Merritt RK. Changes in primary healthcare providers' attitudes and counseling behaviors related to dietary sodium reduction, DocStyles 2010 and 2015. PLoS One 2017; 12:e0177693. [PMID: 28531232 PMCID: PMC5439686 DOI: 10.1371/journal.pone.0177693] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 05/02/2017] [Indexed: 11/30/2022] Open
Abstract
High blood pressure is a major risk factor for cardiovascular disease. The 2013 ACC/AHA Lifestyle Management Guideline recommends counseling pre-hypertensive and hypertensive patients to reduce sodium intake. Population sodium reduction efforts have been introduced in recent years, and dietary guidelines continued to emphasize sodium reduction in 2010 and 2015. The objective of this analysis was to determine changes in primary health care providers' sodium-reduction attitudes and counseling between 2010 and 2015. Primary care internists, family/general practitioners, and nurse practitioners answered questions about sodium-related attitudes and counseling behaviors in DocStyles, a repeated cross-sectional web-based survey in the United States. Differences in responses between years were examined. In 2015, the majority (78%) of participants (n = 1,251) agreed that most of their patients should reduce sodium intake, and reported advising hypertensive (85%), and chronic kidney disease patients (71%), but not diabetic patients (48%) and African-American patients (43%) to consume less salt. Since 2010, the proportion of participants agreeing their patients should reduce sodium intake decreased while the proportion advising patients with these characteristics to consume less salt increased and the prevalence of specific types of advice declined. Changes in behaviors between surveys remained significant after adjusting for provider and practice characteristics. More providers are advising patients to consume less salt in 2015 compared to 2010; however, fewer agree their patients should reduce intake and counseling is not universally applied across patient groups at risk for hypertension. Further efforts and educational resources may be required to enable patient counseling about sodium reduction strategies.
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Affiliation(s)
- Zerleen S. Quader
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- IHRC, Inc., Atlanta, Georgia, United States of America
| | - Mary E. Cogswell
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Jing Fang
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Sallyann M. Coleman King
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Robert K. Merritt
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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Schwingshackl L, Chaimani A, Hoffmann G, Schwedhelm C, Boeing H. Impact of different dietary approaches on blood pressure in hypertensive and prehypertensive patients: protocol for a systematic review and network meta-analysis. BMJ Open 2017; 7:e014736. [PMID: 28446526 PMCID: PMC5566592 DOI: 10.1136/bmjopen-2016-014736] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Lifestyle modification is one of the cornerstones in the management of hypertension. According to the most recent guidelines by the American Heart Association, all patients with hypertension should adopt the following dietary advices: increased consumption of fresh fruits, vegetables, low-fat dairy products and sodium reduction. The aim of the present study is to assess the efficacy of different dietary approaches on systolic and diastolic blood pressure in patients with hypertension and high normal blood pressure in a systematic review including a pairwise and network meta-analysis of randomised trials. METHODS AND ANALYSIS We conducted searches in Cochrane Central Register of Controlled Trials in the Cochrane Library, PubMed and Google Scholar until November 2016. Citations, abstracts and relevant papers were screened for eligibility by two reviewers independently. Randomised trials were included if they met the following criteria: (1) hypertension (as mean values ≥140 mm Hg systolic blood pressure and/or ≥90 mm Hg diastolic blood pressure) or high normal blood pressure (mean systolic blood pressure ≥130 mm Hg and/or mean diastolic blood pressure ≥85 mm Hg), (2) age ≥18 years, (3) intervention diets (different type of dietary approaches, eg, dietary approach to stop hypertension diet; Mediterranean diet, vegetarian diet, palaeolithic diet, low sodium diet) either hypocaloric, isocaloric or ad libitum diets, (4) intervention period ≥12 weeks. For each outcome measure of interest, random effects pairwise and network meta-analyses were performed in order to determine the pooled relative effect of each intervention relative to every other intervention in terms of the postintervention values (or change scores). Subgroup analyses were planned for hypertensive status, study length, sample size, age and sex. ETHICS AND DISSEMINATION As this study is based solely on the published literature, no ethics approval was required. We published our network meta-analysis in a peer-reviewed scientific journal. SYSTEMATIC REVIEW REGISTRATION PROSPERO: CRD42016049243.
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Affiliation(s)
- Lukas Schwingshackl
- Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE), Nuthetal, Germany
| | - Anna Chaimani
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Medical School Campus, University of Ioannina, Ioannina, Greece
| | - Georg Hoffmann
- Department of Nutritional Sciences, University of Vienna, Vienna, Austria
| | - Carolina Schwedhelm
- Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE), Nuthetal, Germany
| | - Heiner Boeing
- Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE), Nuthetal, Germany
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Palmer SC, Maggo JK, Campbell KL, Craig JC, Johnson DW, Sutanto B, Ruospo M, Tong A, Strippoli GFM. Dietary interventions for adults with chronic kidney disease. Cochrane Database Syst Rev 2017; 4:CD011998. [PMID: 28434208 PMCID: PMC6478277 DOI: 10.1002/14651858.cd011998.pub2] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Dietary changes are routinely recommended in people with chronic kidney disease (CKD) on the basis of randomised evidence in the general population and non-randomised studies in CKD that suggest certain healthy eating patterns may prevent cardiovascular events and lower mortality. People who have kidney disease have prioritised dietary modifications as an important treatment uncertainty. OBJECTIVES This review evaluated the benefits and harms of dietary interventions among adults with CKD including people with end-stage kidney disease (ESKD) treated with dialysis or kidney transplantation. SEARCH METHODS We searched the Cochrane Kidney and Transplant Specialised Register (up to 31 January 2017) through contact with the Information Specialist using search terms relevant to this review. Studies contained in the Specialised Register are identified through search strategies specifically designed for CENTRAL, MEDLINE, and EMBASE; handsearching conference proceedings; and searching the International Clinical Trials Register (ICTRP) Search Portal and ClinicalTrials.gov. SELECTION CRITERIA Randomised controlled trials (RCTs) or quasi-randomised RCTs of dietary interventions versus other dietary interventions, lifestyle advice, or standard care assessing mortality, cardiovascular events, health-related quality of life, and biochemical, anthropomorphic, and nutritional outcomes among people with CKD. DATA COLLECTION AND ANALYSIS Two authors independently screened studies for inclusion and extracted data. Results were summarised as risk ratios (RR) for dichotomous outcomes or mean differences (MD) or standardised MD (SMD) for continuous outcomes, with 95% confidence intervals (CI) or in descriptive format when meta-analysis was not possible. Confidence in the evidence was assessed using GRADE. MAIN RESULTS We included 17 studies involving 1639 people with CKD. Three studies enrolled 341 people treated with dialysis, four studies enrolled 168 kidney transplant recipients, and 10 studies enrolled 1130 people with CKD stages 1 to 5. Eleven studies (900 people) evaluated dietary counselling with or without lifestyle advice and six evaluated dietary patterns (739 people), including one study (191 people) of a carbohydrate-restricted low-iron, polyphenol enriched diet, two studies (181 people) of increased fruit and vegetable intake, two studies (355 people) of a Mediterranean diet and one study (12 people) of a high protein/low carbohydrate diet. Risks of bias in the included studies were generally high or unclear, lowering confidence in the results. Participants were followed up for a median of 12 months (range 1 to 46.8 months).Studies were not designed to examine all-cause mortality or cardiovascular events. In very-low quality evidence, dietary interventions had uncertain effects on all-cause mortality or ESKD. In absolute terms, dietary interventions may prevent one person in every 3000 treated for one year avoiding ESKD, although the certainty in this effect was very low. Across all 17 studies, outcome data for cardiovascular events were sparse. Dietary interventions in low quality evidence were associated with a higher health-related quality of life (2 studies, 119 people: MD in SF-36 score 11.46, 95% CI 7.73 to 15.18; I2 = 0%). Adverse events were generally not reported.Dietary interventions lowered systolic blood pressure (3 studies, 167 people: MD -9.26 mm Hg, 95% CI -13.48 to -5.04; I2 = 80%) and diastolic blood pressure (2 studies, 95 people: MD -8.95, 95% CI -10.69 to -7.21; I2 = 0%) compared to a control diet. Dietary interventions were associated with a higher estimated glomerular filtration rate (eGFR) (5 studies, 219 people: SMD 1.08; 95% CI 0.26 to 1.97; I2 = 88%) and serum albumin levels (6 studies, 541 people: MD 0.16 g/dL, 95% CI 0.07 to 0.24; I2 = 26%). A Mediterranean diet lowered serum LDL cholesterol levels (1 study, 40 people: MD -1.00 mmol/L, 95% CI -1.56 to -0.44). AUTHORS' CONCLUSIONS Dietary interventions have uncertain effects on mortality, cardiovascular events and ESKD among people with CKD as these outcomes were rarely measured or reported. Dietary interventions may increase health-related quality of life, eGFR, and serum albumin, and lower blood pressure and serum cholesterol levels.Based on stakeholder prioritisation of dietary research in the setting of CKD and preliminary evidence of beneficial effects on risks factors for clinical outcomes, large-scale pragmatic RCTs to test the effects of dietary interventions on patient outcomes are required.
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Affiliation(s)
- Suetonia C Palmer
- University of Otago ChristchurchDepartment of Medicine2 Riccarton AvePO Box 4345ChristchurchNew Zealand8140
| | - Jasjot K Maggo
- University of Otago ChristchurchDepartment of Medicine2 Riccarton AvePO Box 4345ChristchurchNew Zealand8140
| | - Katrina L Campbell
- Bond UniversityFaculty of Health Science and Medicine2 Promenthean WayRobinaQueenslandAustralia4226
| | - Jonathan C Craig
- The University of SydneySydney School of Public HealthEdward Ford Building A27SydneyNSWAustralia2006
- The Children's Hospital at WestmeadCochrane Kidney and Transplant, Centre for Kidney ResearchWestmeadNSWAustralia2145
| | - David W Johnson
- Princess Alexandra HospitalDepartment of Nephrology199 Ipswich RdWoolloongabbaQueenslandAustralia4102
| | - Bernadet Sutanto
- The Children's Hospital at WestmeadCentre for Kidney ResearchWestmeadNSWAustralia2145
| | - Marinella Ruospo
- DiaverumMedical Scientific OfficeLundSweden
- Amedeo Avogadro University of Eastern PiedmontDivision of Nephrology and Transplantation, Department of Translational MedicineVia Solaroli 17NovaraItaly28100
| | - Allison Tong
- The University of SydneySydney School of Public HealthEdward Ford Building A27SydneyNSWAustralia2006
- The Children's Hospital at WestmeadCentre for Kidney ResearchWestmeadNSWAustralia2145
| | - Giovanni FM Strippoli
- The University of SydneySydney School of Public HealthEdward Ford Building A27SydneyNSWAustralia2006
- The Children's Hospital at WestmeadCochrane Kidney and Transplant, Centre for Kidney ResearchWestmeadNSWAustralia2145
- DiaverumMedical Scientific OfficeLundSweden
- University of BariDepartment of Emergency and Organ TransplantationBariItaly
- Diaverum AcademyBariItaly
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Boehme AK, Esenwa C, Elkind MSV. Stroke Risk Factors, Genetics, and Prevention. Circ Res 2017; 120:472-495. [PMID: 28154098 PMCID: PMC5321635 DOI: 10.1161/circresaha.116.308398] [Citation(s) in RCA: 795] [Impact Index Per Article: 113.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 01/05/2017] [Accepted: 01/05/2017] [Indexed: 12/18/2022]
Abstract
Stroke is a heterogeneous syndrome, and determining risk factors and treatment depends on the specific pathogenesis of stroke. Risk factors for stroke can be categorized as modifiable and nonmodifiable. Age, sex, and race/ethnicity are nonmodifiable risk factors for both ischemic and hemorrhagic stroke, while hypertension, smoking, diet, and physical inactivity are among some of the more commonly reported modifiable risk factors. More recently described risk factors and triggers of stroke include inflammatory disorders, infection, pollution, and cardiac atrial disorders independent of atrial fibrillation. Single-gene disorders may cause rare, hereditary disorders for which stroke is a primary manifestation. Recent research also suggests that common and rare genetic polymorphisms can influence risk of more common causes of stroke, due to both other risk factors and specific stroke mechanisms, such as atrial fibrillation. Genetic factors, particularly those with environmental interactions, may be more modifiable than previously recognized. Stroke prevention has generally focused on modifiable risk factors. Lifestyle and behavioral modification, such as dietary changes or smoking cessation, not only reduces stroke risk, but also reduces the risk of other cardiovascular diseases. Other prevention strategies include identifying and treating medical conditions, such as hypertension and diabetes, that increase stroke risk. Recent research into risk factors and genetics of stroke has not only identified those at risk for stroke but also identified ways to target at-risk populations for stroke prevention.
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Affiliation(s)
- Amelia K Boehme
- From the Department of Epidemiology, Mailman School of Public Health (A.K.B., M.S.V.E.) and Department of Neurology, College of Physicians and Surgeons (A.K.B., C.E., M.S.V.E.), Columbia University, New York, NY
| | - Charles Esenwa
- From the Department of Epidemiology, Mailman School of Public Health (A.K.B., M.S.V.E.) and Department of Neurology, College of Physicians and Surgeons (A.K.B., C.E., M.S.V.E.), Columbia University, New York, NY
| | - Mitchell S V Elkind
- From the Department of Epidemiology, Mailman School of Public Health (A.K.B., M.S.V.E.) and Department of Neurology, College of Physicians and Surgeons (A.K.B., C.E., M.S.V.E.), Columbia University, New York, NY.
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2015 Korean Guidelines for the Management of Dyslipidemia: Executive Summary (English Translation). Korean Circ J 2016; 46:275-306. [PMID: 27275165 PMCID: PMC4891593 DOI: 10.4070/kcj.2016.46.3.275] [Citation(s) in RCA: 90] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 04/06/2016] [Accepted: 04/12/2016] [Indexed: 11/23/2022] Open
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