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Wong EML, Leung DYP, Wang Q, Leung AYM, Cheung ASP. The effect of a lifestyle intervention program using a mobile application versus the effect of a program using a booklet for adults with metabolic syndrome: A three-arm randomized controlled trial. J Nurs Scholarsh 2023; 55:936-948. [PMID: 36896916 DOI: 10.1111/jnu.12883] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 02/01/2023] [Accepted: 02/14/2023] [Indexed: 03/11/2023]
Abstract
PURPOSE The research aimed to examine the effect of a lifestyle intervention program using mobile application versus booklet for adults with metabolic syndrome in Hong Kong. The outcomes comprised body weight (primary outcome), exercise amount, improvement of cardiometabolic risk factors, cardiovascular endurance, perceived stress scale, and exercise self-efficacy. DESIGN A three-arm randomized controlled trial namely App group, Booklet group, and control group was adopted. METHODS Two hundred sixty-four adults with metabolic syndrome were recruited from community centers from 2019 to December 2021. Inclusion criteria are those adults with metabolic syndrome, able to use a smart phone. All participants received a 30-min health talk. App group additionally received a mobile application, while Booklet group received a booklet, and the control group received a placebo booklet. Data were collected at baseline, Weeks 4, 12, and 24. SPSS and generalized estimating equations (GEE) model were employed for data analysis. FINDINGS Attrition rates were minimal, ranged from 2.65% to 6.44%. Both app and booklet group showed significant improvement in outcomes (exercise amount, waist circumference) when compared to control group. However, statistically significant and superior results were observed in app group, including body weight, exercise amount, waist circumference, body mass index, and systolic blood pressure when compared to booklet group. CONCLUSION The lifestyle intervention supported with app was found to be superior to the booklet support for reducing body weight and maintaining exercise. CLINICAL RELEVANCE The lifestyle intervention program using mobile application support could be used widely for adults with metabolic syndrome in the community. Suggest nurses may incorporate this program in their health promotion strategies focusing on a healthy lifestyle to reduce the risk of progression to metabolic syndrome.
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Affiliation(s)
| | | | - Qun Wang
- School of Nursing, Shenzhen University, Shenzhen, China
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2
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Hartmann-Boyce J, Theodoulou A, Oke JL, Butler AR, Bastounis A, Dunnigan A, Byadya R, Cobiac LJ, Scarborough P, Hobbs FR, Sniehotta FF, Jebb SA, Aveyard P. Long-Term Effect of Weight Regain Following Behavioral Weight Management Programs on Cardiometabolic Disease Incidence and Risk: Systematic Review and Meta-Analysis. Circ Cardiovasc Qual Outcomes 2023; 16:e009348. [PMID: 36974678 PMCID: PMC10106109 DOI: 10.1161/circoutcomes.122.009348] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 01/13/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND Behavioral weight management programs (BWMPs) enhance weight loss in the short term, but longer term cardiometabolic effects are uncertain as weight is commonly regained. We assessed the impact of weight regain after BWMPs on cardiovascular risk factors, diabetes, and cardiovascular disease. METHODS Trial registries, 11 databases, and forward-citation searching (latest search, December 19) were used to identify articles published in English, from any geographical region. Randomized trials of BWMPs in adults with overweight/obesity reporting cardiometabolic outcomes at ≥12 months at and after program end were included. Differences between more intensive interventions and comparator groups were synthesized using mixed-effects, meta-regression, and time-to-event models to assess the impact of weight regain on cardiovascular disease incidence and risk. RESULTS One hundred twenty-four trials reporting on ≥1 cardiometabolic outcomes with a median follow-up of 28 (range, 11-360) months after program end were included. Median baseline participant body mass index was 33 kg/m2; median age was 51 years. Eight and 15 study arms (7889 and 4202 participants, respectively) examined the incidence of cardiovascular disease and type 2 diabetes, respectively, with imprecise evidence of a lower incidence for at least 5 years. Weight regain in BWMPs relative to comparators reduced these differences. One and 5 years after program end, total cholesterol/HDL (high-density lipoprotein) ratio was 1.5 points lower at both times (82 studies; 19 003 participants), systolic blood pressure was 1.5 mm mercury and 0.4 mm lower (84 studies; 30 836 participants), and HbA1c (%) 0.38 lower at both times (94 studies; 28 083 participants). Of the included studies, 22% were judged at high risk of bias; removing these did not meaningfully change results. CONCLUSIONS Despite weight regain, BWMPs reduce cardiometabolic risk factors with effects lasting at least 5 years after program end and dwindling with weight regain. Evidence that they reduce the incidence of cardiovascular disease or diabetes is less certain. Few studies followed participants for ≥5 years. REGISTRATION URL: https://www.crd.york.ac.uk/PROSPERO/; Unique identifier: CRD42018105744.
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Affiliation(s)
- Jamie Hartmann-Boyce
- Nuffield Department of Primary Care Health Sciences (J.H.-B., A.T., A.R.B., A.B., R.B., F.D.R.H., S.A.J., P.A.), University of Oxford, United Kingdom
| | - Annika Theodoulou
- Nuffield Department of Primary Care Health Sciences (J.H.-B., A.T., A.R.B., A.B., R.B., F.D.R.H., S.A.J., P.A.), University of Oxford, United Kingdom
| | - Jason L. Oke
- NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, United Kingdom (J.L.O.)
| | - Ailsa R. Butler
- Nuffield Department of Primary Care Health Sciences (J.H.-B., A.T., A.R.B., A.B., R.B., F.D.R.H., S.A.J., P.A.), University of Oxford, United Kingdom
| | - Anastasios Bastounis
- Nuffield Department of Primary Care Health Sciences (J.H.-B., A.T., A.R.B., A.B., R.B., F.D.R.H., S.A.J., P.A.), University of Oxford, United Kingdom
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, United Kingdom (A.B.)
| | - Anna Dunnigan
- Oxford University Hospitals NHS Foundation Trust, United Kingdom (A.D.)
- Royal Free London NHS Foundation Trust, United Kingdom (A.D.)
| | - Rimu Byadya
- Nuffield Department of Primary Care Health Sciences (J.H.-B., A.T., A.R.B., A.B., R.B., F.D.R.H., S.A.J., P.A.), University of Oxford, United Kingdom
- United Nations World Food Programme, Cox’s Bazar, Bangladesh, India (R.B.)
| | - Linda J. Cobiac
- Nuffield Department of Population Health, Centre on Population Approaches for Non-Communicable Disease Prevention (L.J.C.), University of Oxford, United Kingdom
| | - Peter Scarborough
- Nuffield Department of Population Health, Oxford Biomedical Research Centre (P.S.), University of Oxford, United Kingdom
| | - F.D. Richard Hobbs
- Nuffield Department of Primary Care Health Sciences (J.H.-B., A.T., A.R.B., A.B., R.B., F.D.R.H., S.A.J., P.A.), University of Oxford, United Kingdom
| | - Falko F. Sniehotta
- Faculty of Medical Sciences, Population Health Sciences Institute, Newcastle University, United Kingdom (F.F.S.)
| | - Susan A. Jebb
- Nuffield Department of Primary Care Health Sciences (J.H.-B., A.T., A.R.B., A.B., R.B., F.D.R.H., S.A.J., P.A.), University of Oxford, United Kingdom
| | - Paul Aveyard
- Nuffield Department of Primary Care Health Sciences (J.H.-B., A.T., A.R.B., A.B., R.B., F.D.R.H., S.A.J., P.A.), University of Oxford, United Kingdom
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Relationship between Cardiometabolic Factors and the Response of Blood Pressure to a One-Year Primary Care Lifestyle Intervention in Metabolic Syndrome Patients. Metabolites 2022; 12:metabo12090861. [PMID: 36144265 PMCID: PMC9500796 DOI: 10.3390/metabo12090861] [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: 07/13/2022] [Revised: 09/02/2022] [Accepted: 09/08/2022] [Indexed: 11/17/2022] Open
Abstract
Systemic hypertension has been recognized as a modifiable traditional cardiovascular risk factor and influenced by many factors such as eating habits, physical activity, diabetes, and obesity. The objective of this cross-sectional study was to identify factors that predict changes in blood pressure induced by a one-year lifestyle intervention in primary care settings involving a collaboration between family physicians, dietitians, and exercise specialists. Patients with metabolic syndrome diagnosis were recruited by family physicians participating in primary care lifestyle intervention among several family care clinics across Canada. Participants for whom all cardiometabolic data at the beginning (T0) and the end (T12) of the one-year intervention were available were included in the present analysis (n = 101). Patients visited the dietitian and the exercise specialist weekly for the first three months and monthly for the last nine months. Diet quality, exercise capacity, anthropometric indicators, and cardiometabolic variables were evaluated at T0 and at T12. The intervention induced a statistically significant decrease in waist circumference (WC), systolic (SBP) and diastolic (DBP) blood pressure, and plasma triglycerides, and an increase in cardiorespiratory fitness (estimated VO2max). Body weight (p < 0.001), body mass index (BMI) (p < 0.001), and fasting blood glucose (p = 0.006) reduction, and VO2max increase (p = 0.048) were all related to changes in SBP. WC was the only variable for which changes were significantly correlated with those in both SBP (p < 0.0001) and DBP (p = 0.0004). Variations in DBP were not associated with changes in other cardiometabolic variables to a statistically significant extent. Twelve participants were identified as adverse responders (AR) in both SBP and DBP and displayed less favorable changes in WC. The beneficial effects of the primary care lifestyle intervention on blood pressure were significantly associated with cardiometabolic variables, especially WC. These findings suggest that a structured lifestyle intervention in primary care can help improve cardiometabolic risk factors in patients with metabolic syndrome and that WC should be systematically measured to better stratify the patient’s hypertension risk.
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Rahimi GRM, Yousefabadi HA, Niyazi A, Rahimi NM, Alikhajeh Y. Effects of Lifestyle Intervention on Inflammatory Markers and Waist Circumference in Overweight/Obese Adults With Metabolic Syndrome: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Biol Res Nurs 2021; 24:94-105. [PMID: 34702086 DOI: 10.1177/10998004211044754] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Physical inactivity and an imbalanced diet could lead to some cardio metabolic risk factors. OBJECTIVE The objective of this meta-analysis was to investigate the effects of lifestyle modification on inflammatory indicators and waist circumference (WC) in overweight/obese subjects with metabolic syndrome (MS). DATA SOURCES A systematic search was conducted in PubMed, CINAHL, MEDLINE, Cochrane, Google Scholar, and Web of Science. STUDY SELECTION The selection criteria were randomized controlled trials (RCTs) investigating the effects of lifestyle interventions on inflammation and WC from inception to 20 December 2020. The weighted mean difference (WMD) and 95% confidence interval (CI) between interventions were computed using a random or fixed-effects model. RESULTS Six RCTs (including 1246 MS patients who had, on average, overweight/obesity) met all inclusion criteria. Interventions lasted 6 to 12 months (2-5 sessions per week). Lifestyle intervention significantly reduced C-reactive protein (WMD: -0.52 mg/ml, 95% CI: -0.72, -0.33), IL-6 (WMD: -0.50 pg/ml, 95% CI: -0.56, -0.45), and increased adiponectin (WMD: 0.81 µg/ml, 95% CI, 0.64, 0.98). Moreover, lifestyle modification significantly decreased WC (WMD: -3.12 cm, 95% CI, -4.61, -1.62). CONCLUSION Our findings provide evidence that lifestyle alterations, including physical activity and diet, can lead to significant improvement in abdominal obesity, measured by WC and some inflammation markers among overweight/obese individuals with MS. Further high-quality research is needed to clarify the mechanisms underlying the effect of such interventions on this population's inflammatory markers.
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Affiliation(s)
| | | | - Arghavan Niyazi
- Sanabad Institution of Higher Education Mashhad, Mashhad, Iran
| | | | - Yaser Alikhajeh
- Department of Physical Education and Sports Sciences, Faculty of Educational Science and Psychology, University of Mohaghegh Ardabili, Ardabil, Iran
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Millan-Orge M, Torres-Peña JD, Arenas-Larriva A, Quintana-Navarro GM, Peña-Orihuela P, Alcala-Diaz JF, Luque RM, Rodriguez-Cantalejo F, Katsiki N, Lopez-Miranda J, Perez-Martinez P, Delgado-Lista J. Influence of dietary intervention on microvascular endothelial function in coronary patients and atherothrombotic risk of recurrence. Sci Rep 2021; 11:20301. [PMID: 34645870 PMCID: PMC8514425 DOI: 10.1038/s41598-021-99514-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 09/22/2021] [Indexed: 11/09/2022] Open
Abstract
Endothelial dysfunction is a key player in both the onset and development of atherosclerosis. No study has examined whether healthy dietary patterns can improve microvascular endothelial function in patients with coronary heart disease (CHD) in the long-term and whether this relationship can affect patient's risk of CHD recurrence. In the CORDIOPREV study, a randomized, double-blind, controlled trial, dietary intervention with either the Mediterranean diet or a low-fat diet was implemented in 1,002 CHD patients. A laser-doppler flowmetry was performed at baseline and after 6 years of follow up in 664 patients, evaluating the effects of this dietary intervention on microvascular basal flow and reactive hyperaemia area, as well as on the risk of CHD recurrence, based on the TRS2P risk score. Basal flow (97.78 ± 2.79 vs. 179.31 ± 5.06 arbitrary perfusion units, 83.38% increase, p < 0.001) and reactive hyperaemia area (4233.3 ± 127.73 vs. 9695.9 ± 205.23 arbitrary perfusion units per time, 129.04% increase, p < 0.001) improved after the dietary intervention in the cohort, without finding differences due to the diet (p > 0.05 for the diet-effect). When patients were stratified to low, moderate or high-risk of recurrence, basal flow was similarly increased in all three groups. However, reactive hyperaemia area was improved to a greater extent in patients at the low-risk group compared with those at moderate or high-risk. No differences were observed between diets. Healthy dietary patterns can improve microvascular endothelial function and this improvement persists in the long-term. Patients with a low-risk of CHD recurrence show a greater improvement in reactive vasodilation to ischemia than patients in the moderate or high-risk groups.
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Affiliation(s)
- Marta Millan-Orge
- Lipids and Atherosclerosis Unit, Internal Medicine Unit, Reina Sofia University Hospital, 14004, Cordoba, Spain
| | - Jose D Torres-Peña
- Lipids and Atherosclerosis Unit, Internal Medicine Unit, Reina Sofia University Hospital, 14004, Cordoba, Spain.,Maimonides Biomedical Research Institute of Cordoba (IMIBIC), 14004, Cordoba, Spain.,Department of Medical and Surgical Sciences, University of Cordoba, 14004, Cordoba, Spain.,CIBER Fisiopatologia de La Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III, 28029, Madrid, Spain
| | - Antonio Arenas-Larriva
- Lipids and Atherosclerosis Unit, Internal Medicine Unit, Reina Sofia University Hospital, 14004, Cordoba, Spain.,Maimonides Biomedical Research Institute of Cordoba (IMIBIC), 14004, Cordoba, Spain.,Department of Medical and Surgical Sciences, University of Cordoba, 14004, Cordoba, Spain.,CIBER Fisiopatologia de La Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III, 28029, Madrid, Spain
| | - Gracia M Quintana-Navarro
- Lipids and Atherosclerosis Unit, Internal Medicine Unit, Reina Sofia University Hospital, 14004, Cordoba, Spain.,Maimonides Biomedical Research Institute of Cordoba (IMIBIC), 14004, Cordoba, Spain.,Department of Medical and Surgical Sciences, University of Cordoba, 14004, Cordoba, Spain.,CIBER Fisiopatologia de La Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III, 28029, Madrid, Spain
| | - Patricia Peña-Orihuela
- Lipids and Atherosclerosis Unit, Internal Medicine Unit, Reina Sofia University Hospital, 14004, Cordoba, Spain.,Maimonides Biomedical Research Institute of Cordoba (IMIBIC), 14004, Cordoba, Spain.,Department of Medical and Surgical Sciences, University of Cordoba, 14004, Cordoba, Spain.,CIBER Fisiopatologia de La Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III, 28029, Madrid, Spain
| | - Juan F Alcala-Diaz
- Lipids and Atherosclerosis Unit, Internal Medicine Unit, Reina Sofia University Hospital, 14004, Cordoba, Spain.,Maimonides Biomedical Research Institute of Cordoba (IMIBIC), 14004, Cordoba, Spain.,Department of Medical and Surgical Sciences, University of Cordoba, 14004, Cordoba, Spain.,CIBER Fisiopatologia de La Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III, 28029, Madrid, Spain
| | - Raul M Luque
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), 14004, Cordoba, Spain.,CIBER Fisiopatologia de La Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III, 28029, Madrid, Spain.,Department of Cell Biology, Physiology, and Immunology, University of Cordoba, Agrifood Campus of Internal Excellence (ceiA3), 14071, Cordoba, Spain
| | | | - Niki Katsiki
- First Department of Internal Medicine, Diabetes Center, Division of Endocrinology and Metabolism, AHEPA University Hospital, 1st Stilponos Kyriakidi, 546 21, Thessaloniki, Greece
| | - Jose Lopez-Miranda
- Lipids and Atherosclerosis Unit, Internal Medicine Unit, Reina Sofia University Hospital, 14004, Cordoba, Spain. .,Maimonides Biomedical Research Institute of Cordoba (IMIBIC), 14004, Cordoba, Spain. .,Department of Medical and Surgical Sciences, University of Cordoba, 14004, Cordoba, Spain. .,CIBER Fisiopatologia de La Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III, 28029, Madrid, Spain.
| | - Pablo Perez-Martinez
- Lipids and Atherosclerosis Unit, Internal Medicine Unit, Reina Sofia University Hospital, 14004, Cordoba, Spain.,Maimonides Biomedical Research Institute of Cordoba (IMIBIC), 14004, Cordoba, Spain.,Department of Medical and Surgical Sciences, University of Cordoba, 14004, Cordoba, Spain.,CIBER Fisiopatologia de La Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III, 28029, Madrid, Spain
| | - Javier Delgado-Lista
- Lipids and Atherosclerosis Unit, Internal Medicine Unit, Reina Sofia University Hospital, 14004, Cordoba, Spain. .,Maimonides Biomedical Research Institute of Cordoba (IMIBIC), 14004, Cordoba, Spain. .,Department of Medical and Surgical Sciences, University of Cordoba, 14004, Cordoba, Spain. .,CIBER Fisiopatologia de La Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III, 28029, Madrid, Spain.
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Liao CC, Sheu WHH, Lin SY, Lee WJ, Lee IT. The Relationship Between Abdominal Body Composition and Metabolic Syndrome After a Weight Reduction Program in Adult Men with Obesity. Diabetes Metab Syndr Obes 2020; 13:1-8. [PMID: 32021346 PMCID: PMC6954077 DOI: 10.2147/dmso.s228954] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 12/06/2019] [Indexed: 12/20/2022] Open
Abstract
PURPOSE To assess the relationship between changes in abdominal adipose tissue and metabolic syndrome (MetS) in men with obesity after a weight reduction program (WRP). PATIENTS AND METHODS Adult men with obesity and MetS were recruited for this prospective single-arm intervention study. Participants consumed an energy-restricted diet of 1200 kcal/day and performed 50-mins aerobic exercise daily for 12 weeks. Changes in the components of MetS were recorded. Changes in subcutaneous abdominal fat area (SAFA) and intra-abdominal fat area (IAFA) at the umbilicus level were determined using magnetic resonance imaging. RESULTS A total of 30 men (mean age, 42.3 ± 10.0 years; body mass index, 33.7 ± 4.1 kg/m2) were included in this study. A moderate (8.0%) weight reduction occurred. Reversion of MetS was observed in 15 (50%) participants after the WRP. There was significant reduction in SAFA (68.3 ± 20.2 vs. 51.5 ± 18.6 cm2; P < 0.001) and IAFA (96.3 ± 15.6 vs. 86.0 ± 16.5 cm2; P < 0.001); the magnitude of reduction was greater for SAFA than for IAFA (-16.8 ± 7.7 vs. -10.3 ± 8.3 cm2; P < 0.001). Multivariate logistic regression analysis showed a reduction in IAFA to be an independent factor to decrease the risk of persistent MetS after WRP by adjustment for age, baseline IAFA, and change in SAFA (odds ratio = 0.25, 95% confidence interval: 0.07-0.95, P = 0.041). Reduction in SAFA was not significantly associated with the reversion of MetS (P = 0.411). CONCLUSION Reduction in IAFA via a 12-week WRP may help reverse MetS in men with obesity and MetS.
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Affiliation(s)
- Chun-Cheng Liao
- Department of Family Medicine, Taichung Armed Forces General Hospital, Taichung, Taiwan
- School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Wayne Huey-Herng Sheu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Rong Hsing Research Center for Translational Medicine, College of Life Sciences, National Chung Hsing University, Taichung, Taiwan
| | - Shih-Yi Lin
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Center for Geriatrics and Gerontology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Wen-Jane Lee
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
| | - I-Te Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- College of Science, Tunghai University, Taichung City, Taiwan
- Correspondence: I-Te Lee Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, 1650 Taiwan Boulevard, Sect. 4, Taichung40705, TaiwanTel +886-4-23741300Fax +886-4-23593662 Email
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Wong EML, Leung DYP, Wang Q, Leung AYM. A nurse-led lifestyle intervention using mobile application versus booklet for adults with metabolic syndrome-Protocol for a randomized controlled trial. J Adv Nurs 2019; 76:364-372. [PMID: 31642088 DOI: 10.1111/jan.14241] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 09/21/2019] [Accepted: 10/14/2019] [Indexed: 11/30/2022]
Abstract
AIMS To compare the effect of a lifestyle intervention programme using mobile application versus booklet for adults with metabolic syndrome (MetS) living in the community. DESIGN A multisite randomized controlled trial with three parallel arms, namely metabolic syndrome app group, booklet group, and control group. METHODS The research study has been supported by the Health and Medical Research fund in Hong Kong in 2019. The protocol was approved by the study university and the selected community centres. Three hundred and sixty subjects will be recruited from community centres and randomized into either one arm. Inclusion criteria are those adult with MetS, able to use a smart phone. All participants received a 30-min health educational session. App group participants will receive a mobile application while booklet group participants will receive a specific booklet of MetS care and the control group receive a placebo booklet only. The primary outcomes comprises of body weight. The secondary outcomes include total physical exercise, cardiometablolic risk factors, cardiovascular endurance, self-efficacy for exercise, and stress level. Data will be collected at baseline, weeks 4, 12, and 24. SPSS and generalized estimating equations model will be employed for data analysis. DISCUSSION Metabolic syndrome is a common health problem associated with the heightened risk of cardiovascular disease and the risks are potentially amenable to lifestyle intervention. The results will compare the relative effectiveness of a lifestyle intervention using an app versus a booklet on physical and psychological outcomes for adults with MetS. IMPACT What problem will the study address? The results will inform the healthcare professional and nurses about the effective way for health promotion, to enhance patient's lifestyle modification and exercise sustainability that will be beneficial to the clients' health.
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Affiliation(s)
- Eliza Mi-Ling Wong
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, SAR, China
| | - Doris Y P Leung
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, SAR, China
| | - Qun Wang
- School of Nursing, Shenzhen University, Shenzhen, China
| | - Angela Y M Leung
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, SAR, China
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8
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Albert Pérez E, Poveda González M, Martínez-Espinosa RM, Molina Vila MD, Reig García-Galbis M. Practical Guidance for Interventions in Adults with Metabolic Syndrome: Diet and Exercise vs. Changes in Body Composition. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E3481. [PMID: 31540536 PMCID: PMC6765968 DOI: 10.3390/ijerph16183481] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 08/29/2019] [Accepted: 09/02/2019] [Indexed: 12/12/2022]
Abstract
(1) Objective: to establish practical guidance for the design of future clinical trials in MS (metabolic syndrome) patients aged 18 and older, based on a systematic review of randomized clinical trials connecting diet, physical exercise and changes in body composition. (2) Method: this systematic review of randomized clinical trials (RCT) is based on the guidelines recommended by PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses). Criteria of selection: ≥18 years of age; patients diagnosed with MS; intervention programs including diet, physical exercise and/or modifications in the style of life as treatment, as well as the magnitude of changes in body composition (BC); randomized clinical trial published between 2004 and 2018. (3) Results: the multidisciplinary interventions describe major changes in BC, and the recurring pattern in these clinical trials is an energy reduction and control in the percentage of intake of macronutrients along with the performance of regularly structured exercise; the most analyzed parameter was waist circumference (88.9% of the trials), followed by body weight (85.2%), BMI (77.8%) and body fat (55.6%). (4) Conclusions: The analysis of the information here reported sheds light for the design of future clinical trials in adults with MS. The best anthropometric parameters and units of measurement to monitor the interventions are related to dietary and physical exercise interventions. A list of practical advice that is easy to implement in daily practice in consultation is here proposed in order to guarantee the best results in changes of body composition.
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Affiliation(s)
- Enrique Albert Pérez
- Faculty of Health Sciences, University of Alicante, 03690 Alicante, Spain; (E.A.P.); (M.P.G.)
| | - Marina Poveda González
- Faculty of Health Sciences, University of Alicante, 03690 Alicante, Spain; (E.A.P.); (M.P.G.)
| | - Rosa María Martínez-Espinosa
- Division of Biochemistry and Molecular Biology, Department of Agrochemistry and Biochemistry, Faculty of Sciences. University of Alicante, 03690 Alicante, Spain;
| | - Mariola D Molina Vila
- Department of Mathematics, Faculty of Sciences, University of Alicante, 03690 Alicante, Spain;
| | - Manuel Reig García-Galbis
- Department of Nutrition and Dietetics, Faculty of Health Sciences, University of Atacama, Avda. Copayapu 2862, III Region, Copiapó 1530000, Chile
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Wagner J, Knaier R, Infanger D, Arbeev K, Briel M, Dieterle T, Hanssen H, Faude O, Roth R, Hinrichs T, Schmidt-Trucksäss A. Functional aging in health and heart failure: the COmPLETE Study. BMC Cardiovasc Disord 2019; 19:180. [PMID: 31362698 PMCID: PMC6664502 DOI: 10.1186/s12872-019-1164-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 07/18/2019] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Cardiovascular (CV) diseases including heart failure are the leading causes of morbidity, with age being the primary risk factor. The combination of age-related organic functional impairment and reduced physical fitness can drastically impact an individual's healthspan. One's lifespan can potentially be prolonged by the preservation or improvement of physical fitness. However, it remains unclear as to which biomarkers are most suitable for distinguishing between healthy aging and the impaired organ function associated with heart failure. Therefore, a comprehensive assessment of the components of physical fitness and CV function will be performed to identify the most important factors contributing to aging in relation to both health and disease. METHODS This cross-sectional investigation will consist of two parts: COmPLETE-Health (C-Health) and COmPLETE-Heart (C-Heart). C-Health will examine the aging trajectories of physical fitness components and CV properties in a healthy population sample aged between 20 and 100 years (n = 490). Separately, C-Heart will assess the same markers in patients at different stages of chronic heart failure (n = 80). The primary outcome to determine the difference between C-Health and C-Heart will be cardiorespiratory fitness as measured by cardiopulmonary exercise testing on a bicycle ergometer. Secondary outcomes will include walking speed, balance, isometric strength, peak power, and handgrip strength. Physical activity as a behavioural component will be assessed objectively via accelerometry. Further, CV assessments will include pulse wave velocity; retinal, arterial, and venous diameters; brachial and retinal arterial endothelial function; carotid intima-media thickness; and systolic and diastolic function. The health distances for C-Health and C-Heart will be calculated using the methodology based on statistical (Mahalanobis) distance applied to measurements of quantitative biomarkers. DISCUSSION This research seeks to identify physical fitness and CV biomarkers that best resemble underlying CV risk with age. Further, it will examine which physical fitness markers are impaired most in heart failure. The presented integrative approach could define new recommendations for diagnostic guidance in aging. Ultimately, this study is expected to offer a better understanding of which functional characteristics should be specifically targeted in primary and secondary prevention to achieve an optimal healthspan.
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Affiliation(s)
- Jonathan Wagner
- Department of Sport, Exercise and Health, University of Basel, Birsstrasse 320 B, 4052 Basel, Switzerland
| | - Raphael Knaier
- Department of Sport, Exercise and Health, University of Basel, Birsstrasse 320 B, 4052 Basel, Switzerland
| | - Denis Infanger
- Department of Sport, Exercise and Health, University of Basel, Birsstrasse 320 B, 4052 Basel, Switzerland
| | - Konstantin Arbeev
- Biodemography of Aging Research Unit (BARU), Social Science Research Institute, Duke University, Durham, NC 27705 USA
| | - Matthias Briel
- Department of Clinical Research, Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Spitalstrasse 12, 4056 Basel, Switzerland
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street, Hamilton, ONL8S4K1 Canada
| | - Thomas Dieterle
- University Clinic of Medicine, Cantonal Hospital Baselland, University of Basel, Rheinstrasse 26, 4410 Liestal, Switzerland
| | - Henner Hanssen
- Department of Sport, Exercise and Health, University of Basel, Birsstrasse 320 B, 4052 Basel, Switzerland
| | - Oliver Faude
- Department of Sport, Exercise and Health, University of Basel, Birsstrasse 320 B, 4052 Basel, Switzerland
| | - Ralf Roth
- Department of Sport, Exercise and Health, University of Basel, Birsstrasse 320 B, 4052 Basel, Switzerland
| | - Timo Hinrichs
- Department of Sport, Exercise and Health, University of Basel, Birsstrasse 320 B, 4052 Basel, Switzerland
| | - Arno Schmidt-Trucksäss
- Department of Sport, Exercise and Health, University of Basel, Birsstrasse 320 B, 4052 Basel, Switzerland
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10
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Marini E, Mariani PG, Ministrini S, Pippi R, Aiello C, Reginato E, Siepi D, Innocente S, Lombardini R, Paltriccia R, Kararoudi MN, Lupattelli G, De Feo P, Pasqualini L. Combined aerobic and resistance training improves microcirculation in metabolic syndrome. J Sports Med Phys Fitness 2018; 59:1571-1576. [PMID: 30421869 DOI: 10.23736/s0022-4707.18.09077-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Exercise intervention improves macrovascular function in metabolic syndrome (MeS) patients, but few studies have evaluated the effect of exercise on microcirculatory dysfunction, which plays a key role in the development of MeS and its correlated organ damage. We carried out this intervention study to evaluate the influence of an aerobic and resistance training on skin microvascular reactivity in MeS patients. METHODS Postocclusive reactive hyperemia (PORH) of the forearm skin was evaluated, by laser-Doppler flowmetry, before and after a 12-week program of aerobic and resistance training in 15 MeS patients referring to our Lipid Metabolism Outpatients Clinic, together with anthropometric, fitness and metabolic parameters; 15 matched MeS patients who did not exercise, served as a control group. The exercise training consisted of 2 sessions/week of aerobic and resistant exercise. RESULTS Following exercise program, we observed a significant reduction in body weight, fat mass, fasting blood glucose, serum HbA1c and triglycerides, while HDL-cholesterol significantly increased. The exercise-treated group experienced a significant improvement in the area of hyperemia (AH) after PORH, and in all fitness parameters: VO2max, strength on the pulldown lat machine, chest press, leg press and leg extension. A significant correlation emerged between the increase in AH and the reduction in HbA1c and between increase in AH and strength at the chest press, and at the leg extension. CONCLUSIONS Our study showed that a short-term combined aerobic-resistance training positively affects microvascular reactivity in MeS patients. This improvement is correlated with the reduction of HbA1c and fitness parameters, and particularly with increased muscle strength at the upper and lower limbs.
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Affiliation(s)
- Ettore Marini
- Unit of Internal Medicine, Department of Medicine, University of Perugia, Perugia, Italy -
| | - Pietro G Mariani
- Unit of Internal Medicine, Department of Medicine, University of Perugia, Perugia, Italy
| | - Stefano Ministrini
- Unit of Internal Medicine, Department of Medicine, University of Perugia, Perugia, Italy
| | - Roberto Pippi
- Department of Medicine, Healthy Lifestyle Institute CURIAMO, University of Perugia, Perugia, Italy
| | - Cristina Aiello
- Department of Medicine, Healthy Lifestyle Institute CURIAMO, University of Perugia, Perugia, Italy
| | - Elisa Reginato
- Department of Medicine, Healthy Lifestyle Institute CURIAMO, University of Perugia, Perugia, Italy
| | - Donatella Siepi
- Unit of Internal Medicine, Department of Medicine, University of Perugia, Perugia, Italy
| | - Salvatore Innocente
- Unit of Internal Medicine, Department of Medicine, University of Perugia, Perugia, Italy
| | - Rita Lombardini
- Unit of Internal Medicine, Department of Medicine, University of Perugia, Perugia, Italy
| | - Rita Paltriccia
- Unit of Internal Medicine, Department of Medicine, University of Perugia, Perugia, Italy
| | - Meisam N Kararoudi
- The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Graziana Lupattelli
- Unit of Internal Medicine, Department of Medicine, University of Perugia, Perugia, Italy
| | - Pierpaolo De Feo
- Department of Medicine, Healthy Lifestyle Institute CURIAMO, University of Perugia, Perugia, Italy
| | - Leonella Pasqualini
- Unit of Internal Medicine, Department of Medicine, University of Perugia, Perugia, Italy
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11
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Paley CA, Johnson MI. Abdominal obesity and metabolic syndrome: exercise as medicine? BMC Sports Sci Med Rehabil 2018; 10:7. [PMID: 29755739 PMCID: PMC5935926 DOI: 10.1186/s13102-018-0097-1] [Citation(s) in RCA: 88] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 04/26/2018] [Indexed: 12/18/2022]
Abstract
Background Metabolic syndrome is defined as a cluster of at least three out of five clinical risk factors: abdominal (visceral) obesity, hypertension, elevated serum triglycerides, low serum high-density lipoprotein (HDL) and insulin resistance. It is estimated to affect over 20% of the global adult population. Abdominal (visceral) obesity is thought to be the predominant risk factor for metabolic syndrome and as predictions estimate that 50% of adults will be classified as obese by 2030 it is likely that metabolic syndrome will be a significant problem for health services and a drain on health economies. Evidence shows that regular and consistent exercise reduces abdominal obesity and results in favourable changes in body composition. It has therefore been suggested that exercise is a medicine in its own right and should be prescribed as such. Purpose of this review This review provides a summary of the current evidence on the pathophysiology of dysfunctional adipose tissue (adiposopathy). It describes the relationship of adiposopathy to metabolic syndrome and how exercise may mediate these processes, and evaluates current evidence on the clinical efficacy of exercise in the management of abdominal obesity. The review also discusses the type and dose of exercise needed for optimal improvements in health status in relation to the available evidence and considers the difficulty in achieving adherence to exercise programmes. Conclusion There is moderate evidence supporting the use of programmes of exercise to reverse metabolic syndrome although at present the optimal dose and type of exercise is unknown. The main challenge for health care professionals is how to motivate individuals to participate and adherence to programmes of exercise used prophylactically and as a treatment for metabolic syndrome.
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Affiliation(s)
- Carole A Paley
- 1Research & Development (Ward 12), Airedale NHS Foundation Trust, Skipton Road, Steeton, Keighley, West Yorkshire BD20 6TD UK.,2School of Clinical and Applied Sciences, Leeds Beckett University, Portland Building, City Campus, Leeds, LS1 3HE UK
| | - Mark I Johnson
- 2School of Clinical and Applied Sciences, Leeds Beckett University, Portland Building, City Campus, Leeds, LS1 3HE UK
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12
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Torres-Peña JD, Garcia-Rios A, Delgado-Casado N, Gomez-Luna P, Alcala-Diaz JF, Yubero-Serrano EM, Gomez-Delgado F, Leon-Acuña A, Lopez-Moreno J, Camargo A, Tinahones FJ, Delgado-Lista J, Ordovas JM, Perez-Martinez P, Lopez-Miranda J. Mediterranean diet improves endothelial function in patients with diabetes and prediabetes: A report from the CORDIOPREV study. Atherosclerosis 2017; 269:50-56. [PMID: 29274507 DOI: 10.1016/j.atherosclerosis.2017.12.012] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 12/05/2017] [Accepted: 12/07/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND AND AIMS Endothelial dysfunction (ED) plays a key role in the development of atherosclerotic cardiovascular disease (ASCVD). Likewise, type 2 diabetes (T2D) is a major CVD risk factor. Therefore, our objective was to explore whether long-term consumption of a Mediterranean diet (MedDiet) rich in olive oil or a low-fat diet (LF diet) was associated with an improvement in ED and whether the potential benefits were similar in patients with or without T2D in the CORDIOPREV clinical trial (NCT00924937). METHODS Endothelial function was measured in 805 participants who had completed follow-up ultrasound image studies, using ultrasonography of brachial artery to calculate flow mediated vasodilatation (FMD) before and after 1.5 years of intervention with a MedDiet [35% of calories from fat (22% monounsaturated) and 50% from carbohydrates] and LF diet [28% fat (12% monounsaturated) and 55% of calories from carbohydrates]. We categorized participants as patients with T2D, prediabetes, and without T2D according to the American Diabetes Association (ADA) criteria. RESULTS MedDiet increased FMD in patients with T2D [5.2 ± 0.4 at 1.5 years vs. 3.8 ± 0.4 at baseline; p=0.04] and prediabetes [4.9 ± 0.4 vs. 3.8 ± 0.4; p=0.04] and induced an improvement in FMD compared to LF diet in patients with diabetes [5.2 ± 0.4 (MedDiet) vs.3.7 ± 0.4 (LF diet); p=0.01]; whereas both diets maintained FMD stable in patients without diabetes. CONCLUSIONS Habitual consumption of a MedDiet rich in extra virgin olive oil improves endothelial function in patients with prediabetes and diabetes. This takes great importance given that diet must be the cornerstone of treatment of patients with diabetes at high cardiovascular risk.
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Affiliation(s)
- Jose D Torres-Peña
- Lipid and Atherosclerosis Unit, Department of Internal Medicine / IMIBIC/Reina Sofia University Hospital/University of Cordoba, Spain; CIBER Fisiopatologia Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III, Spain
| | - Antonio Garcia-Rios
- Lipid and Atherosclerosis Unit, Department of Internal Medicine / IMIBIC/Reina Sofia University Hospital/University of Cordoba, Spain; CIBER Fisiopatologia Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III, Spain
| | - Nieves Delgado-Casado
- Lipid and Atherosclerosis Unit, Department of Internal Medicine / IMIBIC/Reina Sofia University Hospital/University of Cordoba, Spain; CIBER Fisiopatologia Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III, Spain
| | - Purificacion Gomez-Luna
- Lipid and Atherosclerosis Unit, Department of Internal Medicine / IMIBIC/Reina Sofia University Hospital/University of Cordoba, Spain; CIBER Fisiopatologia Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III, Spain
| | - Juan F Alcala-Diaz
- Lipid and Atherosclerosis Unit, Department of Internal Medicine / IMIBIC/Reina Sofia University Hospital/University of Cordoba, Spain; CIBER Fisiopatologia Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III, Spain
| | - Elena M Yubero-Serrano
- Lipid and Atherosclerosis Unit, Department of Internal Medicine / IMIBIC/Reina Sofia University Hospital/University of Cordoba, Spain; CIBER Fisiopatologia Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III, Spain
| | - Francisco Gomez-Delgado
- Lipid and Atherosclerosis Unit, Department of Internal Medicine / IMIBIC/Reina Sofia University Hospital/University of Cordoba, Spain; CIBER Fisiopatologia Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III, Spain
| | - Ana Leon-Acuña
- Lipid and Atherosclerosis Unit, Department of Internal Medicine / IMIBIC/Reina Sofia University Hospital/University of Cordoba, Spain; CIBER Fisiopatologia Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III, Spain
| | - Javier Lopez-Moreno
- Lipid and Atherosclerosis Unit, Department of Internal Medicine / IMIBIC/Reina Sofia University Hospital/University of Cordoba, Spain; CIBER Fisiopatologia Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III, Spain
| | - Antonio Camargo
- Lipid and Atherosclerosis Unit, Department of Internal Medicine / IMIBIC/Reina Sofia University Hospital/University of Cordoba, Spain; CIBER Fisiopatologia Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III, Spain
| | - Francisco J Tinahones
- CIBER Fisiopatologia Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III, Spain; Biomedical Research Institute of Malaga (IBIMA), Virgen de la Victoria Hospital, University of Malaga, Malaga, Spain
| | - Javier Delgado-Lista
- Lipid and Atherosclerosis Unit, Department of Internal Medicine / IMIBIC/Reina Sofia University Hospital/University of Cordoba, Spain; CIBER Fisiopatologia Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III, Spain
| | - Jose M Ordovas
- Jean Mayer U.S. Department of Agriculture Human Nutrition Research Center on Aging, Tufts University School of Medicine, Boston, MA, USA; Madrid Institute of Advanced Studies-Food, Madrid, Spain; National Centre of Cardiovascular Research (CNIC), Madrid, Spain
| | - Pablo Perez-Martinez
- Lipid and Atherosclerosis Unit, Department of Internal Medicine / IMIBIC/Reina Sofia University Hospital/University of Cordoba, Spain; CIBER Fisiopatologia Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III, Spain.
| | - Jose Lopez-Miranda
- Lipid and Atherosclerosis Unit, Department of Internal Medicine / IMIBIC/Reina Sofia University Hospital/University of Cordoba, Spain; CIBER Fisiopatologia Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III, Spain
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13
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Medical Nutrition Therapy and Weight Loss Questions for the Evidence Analysis Library Prevention of Type 2 Diabetes Project: Systematic Reviews. J Acad Nutr Diet 2017; 117:1578-1611. [DOI: 10.1016/j.jand.2017.06.361] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 06/20/2017] [Indexed: 01/03/2023]
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14
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Lee IT, Wang JS, Fu CP, Lin SY, Sheu WHH. Relationship between body weight and the increment in serum brain-derived neurotrophic factor after oral glucose challenge in men with obesity and metabolic syndrome: A prospective study. Medicine (Baltimore) 2016; 95:e5260. [PMID: 27787389 PMCID: PMC5089118 DOI: 10.1097/md.0000000000005260] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Brain-derived neurotrophic factor (BDNF) plays a role in energy homeostasis. However, the postprandial BDNF change has not been well investigated. We hypothesized that the BDNF increment after oral glucose challenge is associated with body weight.To address this possibility, man adults with obesity in conjunction with metabolic syndrome were compared with normal weight controls at baseline in the initial cross-sectional protocol. The obese subjects then underwent a 12-week program for body-weight reduction in the prospective protocol. The area under the curve (AUC) of serum BDNF was recorded during a 75 g oral glucose tolerant test and the BDNF AUC index was defined as [(AUC of BDNF) - (fasting BDNF2 hours)]/(fasting BDNF2 hours).A total of 25 controls and 36 obese subjects completed the study assessments. In the cross-sectional protocol, the BDNF AUC index was significantly higher in the obese subjects than in the controls (9.0 ± 16.5% vs. - 8.0 ± 22.5%, P = 0.001). After weight reduction (from 97.0 ± 12.5 kg to 88.6 ± 12.9 kg, P < 0.001), the percentage change of body weight was significantly associated with the BDNF AUC index after the study (95% CI between 0.21 and 1.82, P = 0.015). Using 6% weight reduction as a cut-off value, a larger weight reduction was able to reliably predict a negative BDNF AUC index.In conclusion, a high BDNF AUC index was observed for obese men in this study, whereas the index value significantly decreased after body-weight reduction. These findings suggest that postprandial BDNF increment may be associated with obesity.
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Affiliation(s)
- I-Te Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung
- School of Medicine, National Yang-Ming University, Taipei
- School of Medicine, Chung Shan Medical University
| | - Jun-Sing Wang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung
- School of Medicine, National Yang-Ming University, Taipei
| | - Chia-Po Fu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung
| | - Shih-Yi Lin
- School of Medicine, National Yang-Ming University, Taipei
- Center for Geriatrics and Gerontology, Taichung Veterans General Hospital
| | - Wayne Huey-Herng Sheu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung
- School of Medicine, National Yang-Ming University, Taipei
- Institute of Medical Technology, National Chung-Hsing University, Taichung, Taiwan
- Correspondence: Wayne Huey-Herng Sheu, Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan (e-mail: )
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Uthman OA, Hartley L, Rees K, Taylor F, Ebrahim S, Clarke A. Multiple Risk Factor Interventions for Primary Prevention of CVD in LMIC: A Cochrane Review. Glob Heart 2016; 12:199-208.e8. [PMID: 27452771 DOI: 10.1016/j.gheart.2016.03.639] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 03/03/2016] [Indexed: 10/21/2022] Open
Abstract
This study sought to determine the effectiveness of multiple risk factor interventions aimed at modifying major cardiovascular risk factors for the primary prevention of cardiovascular disease in low- and middle-income countries (LMIC). We searched electronic databases for randomized controlled trials of health promotion interventions to achieve behavior change. The pooled effect indicated a reduction in systolic blood pressure (-6.72 mm Hg; 95% confidence interval [CI]: -9.82 to -3.61; I2 = 91%), diastolic blood pressure (-4.40 mm Hg; 95% CI: -6.47 to -2.34; I2 = 92%), body mass index (-0.76 kg/m2; 95% CI: -1.29 to -0.22; I2 = 80%), and waist circumference (-3.31 cm; 95% CI: -4.77 to -1.86; I2 = 55%) in favor of multiple risk factor interventions. There is some evidence that multiple risk factor interventions may lower blood pressure levels and anthropometrics in populations in LMIC settings at high risk of hypertension and diabetes.
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Affiliation(s)
- Olalekan A Uthman
- Warwick Centre for Applied Health Research and Delivery, Division of Health Sciences, Warwick Medical School, The University of Warwick, Warwick, United Kingdom.
| | - Louise Hartley
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Karen Rees
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Fiona Taylor
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Shah Ebrahim
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Aileen Clarke
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom
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Lee G, Choi HY, Yang SJ. [Effects of Dietary and Physical Activity Interventions on Metabolic Syndrome: A Meta-analysis]. J Korean Acad Nurs 2016; 45:483-94. [PMID: 26364523 DOI: 10.4040/jkan.2015.45.4.483] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Revised: 01/31/2015] [Accepted: 05/26/2015] [Indexed: 11/09/2022]
Abstract
PURPOSE This study identified effects of dietary and physical activity interventions including dietary interventions or physical activity interventions alone or combined dietary-physical activity interventions to improve symptoms in metabolic syndrome including abdominal obesity, high triglycerides, low high density lipoprotein cholesterol, elevated blood pressure, and elevated fasting glucose through meta-analysis. METHODS Articles on metabolic syndrome X published from 1988 to 2013 were searched through electronic databases, Google Scholar, and reference reviews. Methodological quality was assessed by the checklist, SIGN (Scottish Intercollegiate Guidelines Network). RESULTS In the meta-analysis, there were 9 articles reporting 13 interventions with 736 participants. Using random effect models, the dietary and/or physical activity interventions showed a lower mean difference in waist circumference (-1.30 cm, 95% CI:-2.44~-0.15, p=.027). The combined dietary-physical activity interventions showed a lower mean difference in waist circumference (-2.77 cm, 95% CI:-4.77~-0.76, p=.007) and systolic blood pressure (-5.44 mmHg, 95% CI:-10.76~-0.12, p=.044). Additionally, interventions of over 24 weeks yielded a lower mean difference in waist circumference (-2.78 cm, 95% CI:-4.69~-0.87, p=.004) and diastolic blood pressure (-1.93 mmHg, 95% CI:-3.63~-0.22, p=.026). CONCLUSION The findings indicate that dietary and/or physical activity interventions for metabolic syndrome reduce central obesity with no adverse effects. This finding provides objective evidences for dietary and physical activity management on metabolic syndrome as an efficient intervention.
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Affiliation(s)
- Guna Lee
- Division of Nursing Science, Ewha Womans University, Seoul, Korea
| | - Hye Young Choi
- Department of Nursing, Tongmyong University, Busan, Korea
| | - Sook Ja Yang
- Department of Nursing, Tongmyong University, Busan, Korea.
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Effect of weight loss induced by energy restriction on measures of arterial compliance: A systematic review and meta-analysis. Atherosclerosis 2016; 247:7-20. [DOI: 10.1016/j.atherosclerosis.2016.01.042] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2015] [Revised: 01/13/2016] [Accepted: 01/26/2016] [Indexed: 12/16/2022]
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18
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Pedralli ML, Waclawovsky G, Camacho A, Markoski MM, Castro I, Lehnen AM. Study of endothelial function response to exercise training in hypertensive individuals (SEFRET): study protocol for a randomized controlled trial. Trials 2016; 17:84. [PMID: 26873336 PMCID: PMC4752791 DOI: 10.1186/s13063-016-1210-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 02/03/2016] [Indexed: 02/06/2023] Open
Abstract
Background Endothelial dysfunction is a hallmark of diabetes mellitus and systemic arterial hypertension (SAH) and an early maker for atherosclerosis. Aerobic exercise training is known to enhance endothelial function, but little is understood about the effects of resistance or combined exercise training on endothelial function. The aim of this study is to investigate the effect of a 12-week aerobic (AT), resistance (RT), or combined (aerobic and resistance, CT) training program on endothelial function and assess associated effects on blood pressure in individuals with SAH. Methods/design Eighty-one subjects with SAH aged 18 to 70 years will be selected and randomly assigned to three types of exercise training: AT, RT or CT. The study will involve the following procedures and tests: anamnesis, anthropometric assessment, echocardiography, blood pressure measurements through ambulatory blood pressure monitoring, flow-mediated dilation, ergospirometry, one repetition maximum test (1-RM), and blood collection (number of circulating endothelial progenitor cells, number of circulating endothelial microparticles, lipid profile, glucose, glycated hemoglobin, and creatinine). The AT intervention will consist of a 40-min exercise session with progressive intensities ranging from 50 to 75 % of heart rate reserve. The RT intervention will consist of a 40-minute session with four sets of six to 12 repetitions with a rest period of 60 to 90 seconds between each set and each type of exercise. Weight loads will be adjusted to 60 to 80 % of 1-RM for six types of exercise. The CT intervention will consist of a 20-min aerobic exercise session, followed by an additional 20-min resistance exercise session; each resistance exercise will have two sets less to match the total training volume. Discussion The study results are expected evidence of cardiovascular protective effects of different types of exercise training through the modulation of endothelial function in hypertensive individuals. Knowing the magnitude of improvement of endothelium-dependent vasodilation for the different types of exercise training can provide scientific evidence for the prescription of exercise programs for vascular protection targeting hypertensive individuals. Trial registration The Brazilian Clinical Trials Registry (http://www.ensaiosclinicos.gov.br/) under RBR-9ygmdn and dated 1 March 2015.
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Affiliation(s)
- Marinei Lopes Pedralli
- Laboratório de Investigação Clínica, Instituto de Cardiologia / Fundação Universitária de Cardiologia - ICFUC, Av. Princesa Isabel, 395. Bairro Santana, 90620 001, Porto Alegre, RS, Brazil. .,Universidade Luterana do Brasil - ULBRA, Torres, Rio Grande do Sul, Brazil.
| | - Gustavo Waclawovsky
- Laboratório de Investigação Clínica, Instituto de Cardiologia / Fundação Universitária de Cardiologia - ICFUC, Av. Princesa Isabel, 395. Bairro Santana, 90620 001, Porto Alegre, RS, Brazil.
| | - Augusto Camacho
- Laboratório de Investigação Clínica, Instituto de Cardiologia / Fundação Universitária de Cardiologia - ICFUC, Av. Princesa Isabel, 395. Bairro Santana, 90620 001, Porto Alegre, RS, Brazil.
| | - Melissa Medeiros Markoski
- Laboratório de Investigação Clínica, Instituto de Cardiologia / Fundação Universitária de Cardiologia - ICFUC, Av. Princesa Isabel, 395. Bairro Santana, 90620 001, Porto Alegre, RS, Brazil.
| | - Iran Castro
- Laboratório de Investigação Clínica, Instituto de Cardiologia / Fundação Universitária de Cardiologia - ICFUC, Av. Princesa Isabel, 395. Bairro Santana, 90620 001, Porto Alegre, RS, Brazil.
| | - Alexandre Machado Lehnen
- Laboratório de Investigação Clínica, Instituto de Cardiologia / Fundação Universitária de Cardiologia - ICFUC, Av. Princesa Isabel, 395. Bairro Santana, 90620 001, Porto Alegre, RS, Brazil. .,Faculdade Sogipa de Educação Física, Porto Alegre, Rio Grande do Sul, Brazil.
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Dirajlal-Fargo S, Webel AR, Longenecker CT, Kinley B, Labbato D, Sattar A, McComsey GA. The effect of physical activity on cardiometabolic health and inflammation in treated HIV infection. Antivir Ther 2015; 21:237-45. [PMID: 26455521 DOI: 10.3851/imp2998] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2015] [Indexed: 12/17/2022]
Abstract
BACKGROUND In HIV-uninfected populations, physical activity decreases mortality and inflammation. Inflammation is a potential cause of comorbidities in HIV+ adults, the evidence examining the effect of physical activity on cardiometabolic health is limited. This analysis examines the relationship between physical activity, cardiometabolic health and inflammation. METHODS We conducted a nested study within the SATURN-HIV trial in which 147 HIV+ adults were randomized to 10 mg daily rosuvastatin or placebo. Measures of physical activity, cardiometabolic health, inflammation and vascular disease (carotid artery intima media thickness and computed tomography-acquired measures pericardial fat volume) were assessed at baseline and through 96 weeks. Spearman correlations and multivariable analyses were used to explore relationships between physical activity, cardiometabolic health and inflammation. RESULTS Median age (Q1, Q3) was 46 (40.4, 52.7) years, 80% were male, 69% were African American and 46% were on protease inhibitors. Baseline median physical activity was 44 min per week (0, 150), 24% of participants performed greater than 150 min per week. At baseline, physical activity correlated with several markers of cardiometabolic health and inflammation (all P≤0.05). Over all time points median physical activity was independently associated with carotid distensibility (β=2.53; P=0.008), pericardial fat volume (β=-6.13; P=0.001) and interleukin-6 (β=-0.468; P<0.001). CONCLUSIONS Physical activity is associated with vascular disease, endothelial function, and may be an adjuvant to decreasing comorbidities in HIV+ adults. Further studies should examine long-term effects of physical activity on cardiometabolic health and inflammation in this population. Clinicaltrials.gov NCT01218802.
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Uthman OA, Hartley L, Rees K, Taylor F, Ebrahim S, Clarke A. Multiple risk factor interventions for primary prevention of cardiovascular disease in low- and middle-income countries. Cochrane Database Syst Rev 2015; 2015:CD011163. [PMID: 26272648 PMCID: PMC6999125 DOI: 10.1002/14651858.cd011163.pub2] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND In many low- and middle-income countries (LMICs) morbidity and mortality associated with cardiovascular diseases (CVDs) have grown exponentially over recent years. It is estimated that about 80% of CVD deaths occur in LMICs. People in LMICs are more exposed to cardiovascular risk factors such as tobacco, and often do not have access to effective and equitable healthcare services (including early detection services). Evidence from high-income countries indicates that multiple risk factor intervention programmes do not result in reductions in CVD events. Given the increasing incidence of CVDs and lower CVD health awareness in LMICs it is possible that such programmes may have beneficial effects. OBJECTIVES To determine the effectiveness of multiple risk factor interventions (with or without pharmacological treatment) aimed at modifying major cardiovascular risk factors for the primary prevention of CVD in LMICs. SEARCH METHODS We searched (from inception to 27 June 2014) the Cochrane Library (CENTRAL, HTA, DARE, EED), MEDLINE, EMBASE, Global Health and three other databases on 27 June 2014. We also searched two clinical trial registers and conducted reference checking to identify additional studies. We applied no language limits. SELECTION CRITERIA We included randomised controlled trials (RCTs) of health promotion interventions to achieve behaviour change (i.e. smoking cessation, dietary advice, increasing activity levels) with or without pharmacological treatments, which aim to alter more than one cardiovascular risk factor (i.e. diet, reduce blood pressure, smoking, total blood cholesterol or increase physical activity) of at least six months duration of follow-up conducted in LMICs. DATA COLLECTION AND ANALYSIS Two authors independently assessed trial eligibility and risk of bias, and extracted data. We combined dichotomous data using risk ratios (RRs) and continuous data using mean differences (MDs), and presented all results with a 95% confidence interval (CI). The primary outcome was combined fatal and non-fatal cardiovascular disease events. MAIN RESULTS Thirteen trials met the inclusion criteria and are included in the review. All studies had at least one domain with unclear risk of bias. Some studies were at high risk of bias for random sequence generation (two trials), allocation concealment (two trials), blinding of outcome assessors (one trial) and incomplete outcome data (one trial). Duration and content of multiple risk factor interventions varied across the trials. Two trials recruited healthy participants and the other 11 trials recruited people with varying risks of CVD, such as participants with known hypertension and type 2 diabetes. Only one study reported CVD outcomes and multiple risk factor interventions did not reduce the incidence of cardiovascular events (RR 0.57, 95% CI 0.11 to 3.07, 232 participants, low-quality evidence); the result is imprecise (a wide confidence interval and small sample size) and makes it difficult to draw a reliable conclusion. None of the included trials reported all-cause mortality. The pooled effect indicated a reduction in systolic blood pressure (MD -6.72 mmHg, 95% CI -9.82 to -3.61, I² = 91%, 4868 participants, low-quality evidence), diastolic blood pressure (MD -4.40 mmHg, 95% CI -6.47 to -2.34, I² = 92%, 4701 participants, low-quality evidence), body mass index (MD -0.76 kg/m², 95% CI -1.29 to -0.22, I² = 80%, 2984 participants, low-quality evidence) and waist circumference (MD -3.31, 95% CI -4.77 to -1.86, I² = 55%, 393 participants, moderate-quality evidence) in favour of multiple risk factor interventions, but there was substantial heterogeneity. There was insufficient evidence to determine the effect of these interventions on consumption of fruit or vegetables, smoking cessation, glycated haemoglobin, fasting blood sugar, high density lipoprotein (HDL) cholesterol, low density lipoprotein (LDL) cholesterol and total cholesterol. None of the included trials reported on adverse events. AUTHORS' CONCLUSIONS Due to the limited evidence currently available, we can draw no conclusions as to the effectiveness of multiple risk factor interventions on combined CVD events and mortality. There is some evidence that multiple risk factor interventions may lower blood pressure levels, body mass index and waist circumference in populations in LMIC settings at high risk of hypertension and diabetes. There was considerable heterogeneity between the trials, the trials were small, and at some risk of bias. Larger studies with longer follow-up periods are required to confirm whether multiple risk factor interventions lead to reduced CVD events and mortality in LMIC settings.
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Affiliation(s)
- Olalekan A Uthman
- Division of Health Sciences, Warwick Medical School, The University of WarwickWarwick Centre for Applied Health Research and Delivery (WCAHRD)WarwickUK
| | - Louise Hartley
- Warwick Medical School, University of WarwickDivision of Health SciencesCoventryWarwickshireUKCV4 7AL
| | - Karen Rees
- Warwick Medical School, University of WarwickDivision of Health SciencesCoventryWarwickshireUKCV4 7AL
| | - Fiona Taylor
- London School of Hygiene & Tropical MedicineDepartment of Non‐communicable Disease EpidemiologyKeppel StreetLondonUKWC1E 7HT
| | - Shah Ebrahim
- London School of Hygiene & Tropical MedicineDepartment of Non‐communicable Disease EpidemiologyKeppel StreetLondonUKWC1E 7HT
| | - Aileen Clarke
- Warwick Medical School, University of WarwickDivision of Health SciencesCoventryWarwickshireUKCV4 7AL
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Joris PJ, Zeegers MP, Mensink RP. Weight loss improves fasting flow-mediated vasodilation in adults: a meta-analysis of intervention studies. Atherosclerosis 2014; 239:21-30. [PMID: 25568949 DOI: 10.1016/j.atherosclerosis.2014.12.056] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 11/07/2014] [Accepted: 12/09/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND Obesity is associated with vascular endothelial dysfunction. Effects of weight loss on endothelial function are however not clear. Therefore, we performed a meta-analysis to quantify effects of weight loss on flow-mediated vasodilation (FMD) of the brachial artery, a measurement of endothelial function. METHODS Studies with experimental (RCTs) and quasi-experimental designs published before June 2014 were identified by a systematic search. Changes in FMD were defined as the difference between measurements before and after the study. For RCTs, changes were corrected for those in the no-weight loss control group. Summary estimates of weighted mean differences (WMDs) in FMD and 95% confidence intervals (CIs) were calculated using random-effect meta-analyses. The impact of subject characteristics, type of weight-loss treatment, and dietary composition on changes in FMD was also investigated. RESULTS Four RCTs involving 265 subjects were included. Weight loss increased FMD vs. control by 3.29% (95% CI: 0.98-5.59%; P = 0.005; mean weight loss: 8.6 kg). A total of 1517 subjects participated in 33 studies with 49 relevant study arms. It was estimated that each 10 kg decrease in body weight increased fasting FMD by 1.11% (95% CI: 0.47-1.76%; P = 0.001). Effects were more pronounced when participants had coexisting obesity-related morbidities. Also, effects may be larger when subjects received low-fat diets or weight-reduction regimens including exercise therapy or weight-loss medication. CONCLUSION Weight loss significantly improves fasting FMD in adults, which is a risk marker for cardiovascular disease. Effects may depend on subject characteristics, type of weight-loss treatment, and dietary composition.
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Affiliation(s)
- Peter J Joris
- Department of Human Biology, NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands; Top Institute of Food and Nutrition (TIFN), Wageningen, The Netherlands.
| | - Maurice P Zeegers
- Department of Complex Genetics, NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands.
| | - Ronald P Mensink
- Department of Human Biology, NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands; Top Institute of Food and Nutrition (TIFN), Wageningen, The Netherlands.
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Phillips SA, Mahmoud AM, Brown MD, Haus JM. Exercise interventions and peripheral arterial function: implications for cardio-metabolic disease. Prog Cardiovasc Dis 2014; 57:521-34. [PMID: 25529367 DOI: 10.1016/j.pcad.2014.12.005] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Physical inactivity is a major risk factor for the development of obesity and other cardiovascular (CV) disease (CVD). Vascular endothelial dysfunction is a key event in the development of CVD and is associated with a sedentary lifestyle in otherwise healthy adults. In addition, vascular endothelial dysfunction may be exacerbated in sedentary individuals who are obese and insulin resistant, since excess body fat is associated with elevated levels of pro-atherogenic inflammatory adipokines and cytokines that reduce the nitric oxide (NO) and other upstream paracrine signaling substances which reduces vascular health. Since blood flow-related shear stress is a major stimulus to NO release from the endothelium, disturbed flow or low shear stress is the likely mechanism by which vascular endothelial function is altered with inactivity. Evidence shows that regular physical exercise has beneficial effects on CVD and the risk factors that promote peripheral arterial function and health. Both aerobic and resistance exercise training are generally believed to improve endothelial function and are commonly recommended for CV health, including the management of obesity, hypertension, and insulin resistance. However, many factors including age, disease status, and race appear to influence these outcomes. Although evidence supporting the health benefits of exercise is compelling, the optimum prescription (volume and intensity) and the exact mechanism underlying the effects of exercise training on arterial function and cardiometabolic risk has yet to be identified. The focus of this review will be on the evidence supporting exercise interventions for peripheral arterial function.
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Affiliation(s)
- Shane A Phillips
- Department of Physical Therapy, University of Illinois at Chicago, Chicago, IL; Integrative Physiology Laboratory, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL.
| | - Abeer M Mahmoud
- Integrative Physiology Laboratory, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL; Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, IL
| | - Michael D Brown
- Integrative Physiology Laboratory, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL; Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, IL
| | - Jacob M Haus
- Integrative Physiology Laboratory, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL; Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, IL
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Hartmann-Boyce J, Johns DJ, Jebb SA, Aveyard P. Effect of behavioural techniques and delivery mode on effectiveness of weight management: systematic review, meta-analysis and meta-regression. Obes Rev 2014; 15:598-609. [PMID: 24636238 PMCID: PMC4237119 DOI: 10.1111/obr.12165] [Citation(s) in RCA: 152] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Revised: 01/25/2014] [Accepted: 02/09/2014] [Indexed: 12/20/2022]
Abstract
A systematic review, meta-analysis and meta-regression were conducted to evaluate the effectiveness of behavioural weight management programmes and examine how programme characteristics affect mean weight loss. Randomized controlled trials of multicomponent behavioural weight management programmes in overweight and obese adults were included. References were obtained through systematic searches of electronic databases (conducted November 2012), screening reference lists and contacting experts. Two reviewers extracted data and evaluated risk of bias. Thirty-seven studies, representing over 16,000 participants, were included. The pooled mean difference in weight loss at 12 months was -2.8 kg (95% confidence interval [CI] -3.6 to -2.1, P < 0.001). I(2) indicated that 93% of the variability in outcome was due to differences in programme effectiveness. Meta-analysis showed no evidence that supervised physical activity sessions (mean difference 1.1 kg, 95% CI -2.65 to 4.79, P = 0.08), more frequent contact (mean difference -0.3 kg, 95% CI -0.7 to 0.2, P = 0.25) or in-person contact (mean difference 0.0 kg, 95% CI -1.8 to 1.8, P = 0.06) were related to programme effectiveness at 12 months. In meta-regression, calorie counting (-3.3 kg, 95% CI -4.6 to -2.0, P = 0.027), contact with a dietitian (-1.5 kg, 95% CI -2.9 to -0.2, P < 0.001) and use of behaviour change techniques that compare participants' behaviour with others (-1.5 kg, 95% CI -2.9 to -0.1, P = 0.032) were associated with greater weight loss. There was no evidence that other programme characteristics were associated with programme effectiveness. Most but not all behavioural weight management programmes are effective. Programmes that support participants to count calories or include a dietitian may be more effective, but the programme characteristics explaining success are mainly unknown.
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Affiliation(s)
- J Hartmann-Boyce
- Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, University of Oxford, Oxford, UK
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Silver HJ, Kang H, Keil CD, Muldowney JA, Kocalis H, Fazio S, Vaughan DE, Niswender KD. Consuming a balanced high fat diet for 16 weeks improves body composition, inflammation and vascular function parameters in obese premenopausal women. Metabolism 2014; 63:562-73. [PMID: 24559846 PMCID: PMC4306330 DOI: 10.1016/j.metabol.2014.01.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Revised: 01/10/2014] [Accepted: 01/12/2014] [Indexed: 01/24/2023]
Abstract
OBJECTIVE Inflammation, insulin resistance and vascular dysfunction characterize obesity and predict development of cardiovascular disease (CVD). Although women experience CVD events at an older age, vascular dysfunction is evident 10years prior to coronary artery disease. Questions remain whether replacing SFA entirely with MUFA or PUFA is the optimal approach for cardiometabolic benefits. This study tested the hypotheses that: a) body composition, inflammation and vascular function would improve with a high fat diet (HFD) when type of fat is balanced as 1/3 SFA, 1/3 MUFA and 1/3 PUFA; and b) body composition, inflammation and vascular function would improve more when balanced HFD is supplemented with 18C fatty acids, in proportion to the degree of 18C unsaturation. METHODS Obese premenopausal women were stabilized on balanced HFD and randomized to consume 9g/d of encapsulated stearate (18:0), oleate (18:1), linoleate (18:2) or placebo. RESULTS Significant improvements occurred in fat oxidation rate (↑6%), body composition (%fat: ↓2.5±2.1%; %lean: ↑2.5±2.1%), inflammation (↓ IL-1α, IL-1β, 1L-12, Il-17, IFNγ, TNFα, TNFβ) and vascular function (↓BP, ↓PAI-1, ↑tPA activity). When compared to HFD+placebo, HFD+stearate had the greatest effect on reducing IFNγ (↓74%) and HFD+linoleate had the greatest effect on reducing PAI-1 (↓31%). CONCLUSIONS Balancing the type of dietary fat consumed (SFA/MUFA/PUFA) is a feasible strategy to positively affect markers of CVD risk. Moreover, reductions in inflammatory molecules involved in vascular function might be enhanced when intake of certain 18C fatty acids is supplemented. Long term effects need to be determined for this approach.
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Affiliation(s)
- Heidi J Silver
- Vanderbilt University, Department of Medicine, Nashville, TN, USA.
| | - Hakmook Kang
- Vanderbilt University, Department of Biostatistics, Nashville, TN, USA
| | - Charles D Keil
- Vanderbilt University, Department of Medicine, Nashville, TN, USA
| | | | - Heidi Kocalis
- Vanderbilt University, Department of Medicine, Nashville, TN, USA
| | - Sergio Fazio
- Vanderbilt University, Department of Cardiology, Nashville, TN, USA
| | | | - Kevin D Niswender
- Vanderbilt University, Department of Medicine, Nashville, TN, USA; Tennessee Valley Healthcare System, Nashville, TN, USA
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Roque FR, Hernanz R, Salaices M, Briones AM. Exercise training and cardiometabolic diseases: focus on the vascular system. Curr Hypertens Rep 2013; 15:204-14. [PMID: 23519745 DOI: 10.1007/s11906-013-0336-5] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The regular practice of physical activity is a well-recommended strategy for the prevention and treatment of several cardiovascular and metabolic diseases. Physical exercise prevents the progression of vascular diseases and reduces cardiovascular morbidity and mortality. Exercise training also ameliorates vascular changes including endothelial dysfunction and arterial remodeling and stiffness, usually present in type 2 diabetes, obesity, hypertension and metabolic syndrome. Common to these diseases is excessive oxidative stress, which plays an important role in the processes underlying vascular changes. At the vascular level, exercise training improves the redox state and consequently NO availability. Moreover, growing evidence indicates that other mediators such as prostanoids might be involved in the beneficial effects of exercise. The purpose of this review is to update recent findings describing the adaptation response induced by exercise in cardiovascular and metabolic diseases, focusing more specifically on the beneficial effects of exercise in the vasculature and the underlying mechanisms.
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Affiliation(s)
- Fernanda R Roque
- Departamento de Farmacología, Facultad de Medicina, Universidad Autónoma de Madrid, Instituto de Investigación Hospital Universitario La Paz (IdiPAZ), Madrid, Spain
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Bolignano D, Zoccali C. Effects of weight loss on renal function in obese CKD patients: a systematic review. Nephrol Dial Transplant 2013; 28 Suppl 4:iv82-98. [PMID: 24092846 DOI: 10.1093/ndt/gft302] [Citation(s) in RCA: 149] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Obesity is an independent risk factor for the development and progression of chronic kidney disease (CKD). We conducted a systematic review to assess the benefits of intentional weight loss in obese subjects with altered glomerular filtration rate (GFR), proteinuria or albuminuria. MEDLINE, EMBASE and CENTRAL databases were searched for articles reporting longitudinal data on the effect of weight loss on renal parameters in obese patients with altered kidney function. Thirty-one (2013 subjects) were included. In the 13 studies where weight loss was achieved by bariatric surgery, body mass index (BMI) significantly decreased in all studies; GFR decreased in six studies on hyperfiltration patients and increased in one study on patients with CKD Stage 3-4. Albuminuria decreased in six studies and proteinuria decreased in five studies. In six studies, weight loss was achieved by antiobesity agents: BMI decreased in all studies; GFR decreased in four studies and albuminuria in three. Eleven studies analysed the effects of diet, alone or in combination with lifestyle modifications. A significant decrease in BMI was reported in all studies; GFR increased in two studies, remained stable in four studies and decreased in two studies on hyperfiltration patients. Albuminuria decreased in six studies and remained stable in one study. Proteinuria decreased in five studies. In obese patients with altered renal function, weight loss, particularly if achieved by surgical interventions, improves proteinuria, albuminuria and normalizes GFR. Larger, long-term studies are needed to analyse the durability of this improvement and the effects on renal outcomes, such as CKD progression and the development of ESKD.
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Affiliation(s)
- Davide Bolignano
- Clinical Epidemiology and Pathophysiology of Renal Diseases and Hypertension of Reggio Calabria, CNR-IBIM, Reggio Calabria, Italy
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27
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Dutheil F, Lac G, Lesourd B, Chapier R, Walther G, Vinet A, Sapin V, Verney J, Ouchchane L, Duclos M, Obert P, Courteix D. Different modalities of exercise to reduce visceral fat mass and cardiovascular risk in metabolic syndrome: the RESOLVE* randomized trial. Int J Cardiol 2013; 168:3634-42. [DOI: 10.1016/j.ijcard.2013.05.012] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Revised: 04/15/2013] [Accepted: 05/04/2013] [Indexed: 10/26/2022]
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Santos ABS, Junges M, Silvello D, Macari A, de Araújo BS, Seligman BG, Duncan BB, Rohde LEP, Clausell N, Foppa M. Early change of extracellular matrix and diastolic parameters in metabolic syndrome. Arq Bras Cardiol 2013; 101:311-6. [PMID: 24008653 PMCID: PMC4062367 DOI: 10.5935/abc.20130182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2012] [Accepted: 06/07/2013] [Indexed: 11/29/2022] Open
Abstract
Background Metabolic syndrome (MS) is associated with increased cardiovascular risk. It
is not clear whether myocardial changes showed in this syndrome, such as
diastolic dysfunction, are due to the systemic effects of the syndrome, or
to specific myocardial effects. Objectives Compare diastolic function, biomarkers representing extracellular matrix
activity (ECM), inflammation and cardiac hemodynamic stress in patients with
the MS and healthy controls. Methods MS patients (n = 76) and healthy controls (n=30) were submitted to a clinical
assessment, echocardiographic study, and measurement of plasma levels of
metalloproteinase-9 (MMP9), tissue inhibitor of metalloproteinase-1 (TIMP1),
ultrasensitive-reactive-C-Protein (us-CRP), insulin resistance (HOMA-IR) and
natriuretic peptide (NT-proBNP). Results MS group showed lower E' wave (10.1 ± 3.0 cm/s vs 11.9 ± 2.6 cm/s, p =
0.005), increased A wave (63.4 ± 14.1 cm/s vs. 53.1 ± 8.9 cm/s; p <
0.001), E/E' ratio (8.0 ± 2.2 vs. 6.3 ± 1.2; p < 0.001), MMP9 (502.9 ±
237.1 ng / mL vs. 330.4±162.7 ng/mL; p < 0.001), us-CRP (p = 0.001) and
HOMA-IR (p < 0.001), but no difference for TIMP1 or NT-proBNP levels. In
a multivariable analysis, only MMP9 was independently associated with MS.
Conclusion MS patients showed differences for echocardiographic measures of diastolic
function, ECM activity, us-CRP and HOMA-IR when compared to controls.
However, only MMP9 was independently associated with the MS. These findings
suggest that there are early effects on ECM activity, which cannot be
tracked by routine echocardiographic measures of diastolic function.
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Affiliation(s)
- Angela B. S. Santos
- Hospital de Clínicas de Porto Alegre, Porto Alegre, RS -
Brazil
- Universidade Federal do Rio Grande do Sul, Porto Alegre, RS -
Brazil
- Mailing Address: Angela Barreto Santiago Santos, Hospital de
Clinicas de Porto Alegre - Divisão Cardiovascular, Rua Ramiro Barcelos, 2350,
Sala 2061. Postal Code 90035-903, Porto Alegre, RS - Brazil. E-mail:
| | - Mauricio Junges
- Universidade Federal do Rio Grande do Sul, Porto Alegre, RS -
Brazil
| | - Daiane Silvello
- Universidade Federal do Rio Grande do Sul, Porto Alegre, RS -
Brazil
| | - Adriana Macari
- Universidade Federal do Rio Grande do Sul, Porto Alegre, RS -
Brazil
| | | | - Beatriz G. Seligman
- Hospital de Clínicas de Porto Alegre, Porto Alegre, RS -
Brazil
- Universidade Federal do Rio Grande do Sul, Porto Alegre, RS -
Brazil
| | - Bruce B. Duncan
- Universidade Federal do Rio Grande do Sul, Porto Alegre, RS -
Brazil
| | - Luis Eduardo P. Rohde
- Hospital de Clínicas de Porto Alegre, Porto Alegre, RS -
Brazil
- Universidade Federal do Rio Grande do Sul, Porto Alegre, RS -
Brazil
| | - Nadine Clausell
- Hospital de Clínicas de Porto Alegre, Porto Alegre, RS -
Brazil
- Universidade Federal do Rio Grande do Sul, Porto Alegre, RS -
Brazil
| | - Murilo Foppa
- Hospital de Clínicas de Porto Alegre, Porto Alegre, RS -
Brazil
- Universidade Federal do Rio Grande do Sul, Porto Alegre, RS -
Brazil
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Aronis KN, Chamberland JP, Mantzoros CS. GLP-1 promotes angiogenesis in human endothelial cells in a dose-dependent manner, through the Akt, Src and PKC pathways. Metabolism 2013; 62:1279-86. [PMID: 23684008 PMCID: PMC3755020 DOI: 10.1016/j.metabol.2013.04.010] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Revised: 04/10/2013] [Accepted: 04/11/2013] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Novel anti-diabetic medications that mimic or augment the physiological actions of GLP-1 improve cardiovascular risk factors in diabetics and GLP-1 has been proposed to have a beneficial role in the cardiovascular system. GLP-1 may have a direct cardioprotective role by decreasing infarct size and protecting from ischemia-reperfusion injury while prolonging survival in rodent models. The mechanisms underlying these observations remain largely unknown. In vitro studies suggest that GLP-1 may promote endothelial cell proliferation, but no study to date has evaluated a potential direct effect of GLP-1 on angiogenesis. SPECIFIC AIM To evaluate whether GLP-1 affects angiogenesis in humans and to elucidate underlying molecular mechanisms. MATERIAL AND METHODS We utilized a 3D culture system where spherules of human umbilical vein endothelial cells (HUVECs) embedded in a collagen scaffold were treated with escalating doses of human recombinant GLP-1 (50-2000 nmol/L) and the formation of new vessels was observed and quantified. Signaling inhibitors were utilized to identify molecular pathways through which GLP-1 promotes angiogenesis. RESULTS We demonstrate that GLP-1 promotes angiogenesis in a dose-dependent manner. The maximum effect on angiogenesis was observed at a GLP-1 dose of 500 nmol/L, while increased angiogenesis occurred in response to doses ranging from 200 nmol/L to 1000 nmol/L. Pre-treatment of the system with Akt inhibitor IV, Bisindolylmaleimide (PKC inhibitor) and src inhibitor I resulted in a significant decrease of the GLP-1 induced angiogenesis. CONCLUSIONS This is the first study to demonstrate that GLP-1 promotes angiogenesis in a HUVEC three dimensional in vitro model. This effect requires pharmacological doses and is mediated through the Akt, PKC and src pathways.
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Affiliation(s)
- Konstantinos N Aronis
- Division of Endocrinology, Diabetes & Metabolism, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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Abstract
Functional integrity of endothelial cells is an indicator and a prerequisite for vascular health and counteracts the development of atherosclerosis. This concept of 'endothelial therapy' was developed in the late 1990s as an approach to preserve or restore endothelial cell health given that 'the knowledge of the mechanisms involved in 'endothelial dysfunction' allows us to interfere specifically with pathogenic pathways at very early time points and to slow down the progression of disease'. In the present review, the principles underlying endothelial cell health will be discussed as well as the role of endothelial therapy as a preventive measure to reduce the prevalence of coronary artery disease or to delay disease progression in patients with chronic coronary artery disease. This article also highlights the importance of active participation, the need to reduce the number of future patients in view of the rising prevalence of childhood obesity, and the potential of endothelial therapy to improve survival, reduce disability and health costs, and to improve overall quality of life in patients at risk for or already diagnosed with coronary artery disease. The preventive and therapeutic approaches and considerations described herein can be applied by physicians, patients, parents, educators, health agencies, and political decision makers to help reducing the global cardiovascular disease burden in the decades to come.
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Affiliation(s)
- Matthias Barton
- Molecular Internal Medicine, University of Zürich, LTK Y44 G22, Winterthurerstrasse 190, 8057 Zürich, Switzerland.
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Neuhouser ML, Howard B, Lu J, Tinker LF, Van Horn L, Caan B, Rohan T, Stefanick ML, Thomson CA. A low-fat dietary pattern and risk of metabolic syndrome in postmenopausal women: the Women's Health Initiative. Metabolism 2012; 61:1572-81. [PMID: 22633601 PMCID: PMC3430820 DOI: 10.1016/j.metabol.2012.04.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2011] [Revised: 04/04/2012] [Accepted: 04/04/2012] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Nutrition plays an important role in metabolic syndrome etiology. We examined whether the Women's Health Initiative (WHI) Dietary Modification Trial influenced metabolic syndrome risk. MATERIALS/METHODS 48,835 postmenopausal women aged 50-79 years were randomized to a low-fat (20% energy from fat) diet (intervention) or usual diet (comparison) for a mean of 8.1 years. Blood pressure, waist circumference and fasting blood measures of glucose, HDL-cholesterol and triglycerides were measured on a subsample (n=2816) at baseline and years 1, 3 and 6 post-randomization. Logistic regression estimated associations of the intervention with metabolic syndrome risk and use of cholesterol-lowering and hypertension medications. Multivariate linear regression tested associations between the intervention and metabolic syndrome components. RESULTS At year 3, but not years 1 or 6, women in the intervention group (vs. comparison) had a non-statistically significant lower risk of metabolic syndrome (OR=0.83, 95%CI 0.59-1.18). Linear regression models simultaneously modeling the five metabolic syndrome components revealed significant associations of the intervention with metabolic syndrome at year 1 (p<0.0001), but not years 3 (p=0.19) and 6 (p=0.17). Analyses restricted to intervention-adherent participants strengthened associations at years 3 (p=0.05) and 6 (p=0.06). Cholesterol-lowering and hypertension medication use was 19% lower at year 1 for intervention vs. comparison group women (OR=0.81, 95% CI 0.60-1.09).Over the entire trial, fewer intervention vs. comparison participants used these medications (26.0% vs. 29.9%), although results were not statistically significant (p=0.89). CONCLUSIONS The WHI low-fat diet may influence metabolic syndrome risk and decrease use of hypertension and cholesterol-lowering medications. Findings have potential for meaningful clinical translation.
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Affiliation(s)
- Marian L Neuhouser
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA 98109-1024, USA.
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