Life-style factors associated with changes in serum lipids in a follow-up study of cardiovascular risk factors

Eight-month postprogram completion: change in risk factors for chronic disease amongst participants in a 4-month pedometer-based workplace health program

OBJECTIVE

To evaluate whether participation in a 4-month, pedometer-based, physical activity, workplace health program is associated with long-term sustained improvements in risk factors for type 2 diabetes and cardiovascular disease, 8 months after the completion of the program.

DESIGN AND METHODS

A sample size of 720 was required. 762 Australian adults employed in primarily sedentary occupations and voluntarily enrolled in a workplace program were recruited. Demographic, behavioral, anthropometric and biomedical measurements were completed at baseline, 4 and 12 months.

RESULTS

About 76% of participants returned at 12 months. Sustained improvements at 12 months were observed for self-reported vegetable intake, self-reported sitting time and independently measured blood pressure. Modest improvements from baseline in self-reported physical activity and independently measured waist circumference at 12 months indicated that the significant improvements observed immediately after the health program could not be sustained. Approximately half of those not meeting guidelines for physical activity, waist circumference and blood pressure at baseline, were meeting guidelines at 12 months.

CONCLUSIONS

Participation in this 4-month, pedometer-based, physical activity, workplace health program was associated with sustained improvements in chronic disease risk factors at 12 months. These results indicate that such programs can have a long-term benefit and thus a potential role to play in population prevention of chronic disease.

Depressive symptoms and serum lipid levels in young adult women

Accumulating data suggest that depression is associated with risk factors for cardiovascular disease, but few studies have investigated potential behavioral mediators of such associations, particularly among women. In this study of healthy young adult women (n = 225), we examined associations among depressive symptoms, health behaviors, and serum lipid levels. Depressive symptoms were assessed with the 20-item Center for Epidemiologic Studies-Depression scale, and a fasting blood sample was obtained for serum lipid levels, including total cholesterol, high-density lipoprotein (HDL-C) and low-density lipoprotein (LDL-C). Diet was measured using 24-h recalls, and other health behaviors (physical activity, smoking) were assessed via self-report questionnaire. Results indicated a modest negative association between depressive symptoms and LDL-C levels. Higher levels of depressive symptoms were also associated with lower total and insoluble dietary fiber intake, both of which were associated with HDL-C and LDL-C. Mediational analyses indicated a significant indirect effect of depressive symptoms on LDL-C via total and insoluble dietary fiber in unadjusted analyses, but not in adjusted analyses. The present findings suggest that depressive symptoms are inversely associated with serum LDL-C levels in young adult women, but that these associations are not likely mediated by adverse lifestyle behaviors.

Impact of a pedometer-based workplace health program on cardiovascular and diabetes risk profile

OBJECTIVE

To evaluate whether participation in a four-month, pedometer-based, physical activity, workplace health programme results in an improvement in risk factors for diabetes and cardiovascular disease.

METHODS

Adults employed within Australia in primarily sedentary occupations and voluntarily enrolled in a workplace programme, the Global Corporate Challenge®, aimed at increasing physical activity were recruited. Data included demographic, behavioural, anthropometric and biomedical measurements. Measures were compared between baseline and four-months.

RESULTS

762 participants were recruited in April/May 2008 with 79% returning. Improvements between baseline and four-months amongst programme participants were observed for physical activity (an increase of 6.5% in the proportion meeting guidelines, OR(95%CI): 1.7(1.1, 2.5)), fruit intake (4%, OR: 1.7(1.0, 3.0)), vegetable intake (2%, OR: 1.3(1.0, 1.8)), sitting time (-0.6(-0.9, -0.3) hours/day), blood pressure (systolic: -1.8(-3.1, -.05) mmHg; diastolic: -1.8(-2.4, -1.3) mmHg) and waist circumference (-1.6(-2.4, -0.7) cm). In contrast, an increase was found for fasting total cholesterol (0.3(0.1, 0.4) mmol/L) and triglycerides (0.1(0.0, 0.1) mmol/L).

CONCLUSION

Completion of this four-month, pedometer-based, physical activity, workplace programme was associated with improvements in behavioural and anthropometric risk factors for diabetes and cardiovascular disease. Long-term evaluation is required to evaluate the potential of such programmes to prevent the onset of chronic disease.

Effects of lifestyle interventions and long-term weight loss on lipid outcomes - a systematic review

Weight and lipids are critical components of the metabolic syndrome, diabetes and cardiovascular disease. Past reviews considering weight loss on lipid profiles have been for ≤1 year follow-up and/or were for very overweight, obese or morbidly obese participants. This systematic review includes lifestyle interventions for adults (18-65 years), with a mean baseline BMI< 35 kg/m(2) , with weight and lipid differences over 2 years. Between 1990 and 2010, 14 studies were identified. Mean differences for weight and lipids were modest. However, weight loss at 2-3 years follow-up, produced significant beneficial lipid profile changes. These were similar to previous reviews conducted on heavier target groups and/or over shorter follow-up periods; cholesterol (1.3% decrease per kg lost) and triglycerides (1.6% fall per kg). Weight loss sustained longer than 3 years was not associated with beneficial lipid changes, suggesting that other lifestyle changes not just weight loss needs maintaining. Evidence linking lifestyle induced sustained weight loss with lipid profile changes in the long-term for this group is limited. Probable within-group differences (treatment vs prevention), would make further group separation prudent. Individual patient data analysis would facilitate this, uncover baseline, medication and confounding effects, and may identify successful program components enabling more effective obesity prevention and treatment strategies.

Long-term weight loss from lifestyle intervention benefits blood pressure?: a systematic review

Weight gain may increase blood pressure. Weight loss may reduce this. Reviews have considered the long-term effects of weight loss but are related mainly to more obese participants often on obesity medication and/or undergoing obesity surgery. This systematic review, based on lifestyle interventions for adults (18 to 65 years) with mean baseline BMI of <35 kg/m(2), links weight change to blood pressure difference. A systematic review of studies reporting weight differences and blood pressure outcomes, published between 1990 and 2008 with follow-up of > or =2 years identified 8 clinical trials or controlled before and after studies (represented by 9 articles) and 8 cohort studies. Differences ranged from -11 to +4kg for weight, -7 to +2.2 mm Hg for diastolic blood pressure and -13 to +6.1 mm Hg for systolic blood pressure. For this population group, no quantifiable relationship between weight and diastolic blood pressure difference was found, possibly because of small weight losses, differing weight status responses, or because pharmacologically controlled hypertension masked weight loss influences. Systolic differences were in line with previous reviews of 1 kg:1 mm Hg relationship, but only for follow-up periods of 2 to 3 years, possibly reflecting the fact that regardless of maintained weight loss, blood pressure often reverts back to higher levels. Lifestyle interventions for weight and blood pressure are limited in this target group, and there has been no exploration of successful intervention components. An individual patient data analysis may uncover baseline and medication effects, explore differences between weight groups, and may identify successful components. Such an analysis would enable effective development of preventative interventions for both hypertension and obesity.

Lipid profile in men and women with different levels of sports participation and physical activity

Objective

The purpose of the present study was to analyse the lipid profile in men and women differentiated according to energy expenditure during sports participation (EESPORT), energy expenditure during active leisure time (EEALT) and overall energy expenditure (EETOTAL).

Design

The subjects were grouped by sex, age, EESPORT, EEALT and EETOTAL. Group differences were analysed using analyses of covariance with BMI and alcohol consumption as covariates.

Setting

Physical activity was assessed using the Flemish Physical Activity Computerised Questionnaire. Fasting blood samples were taken to measure total cholesterol (TC), TAG, HDL-cholesterol (HDL-C), LDL-cholesterol (LDL-C) and the ratio TC:HDL-C.

Subjects

The study sample consisted of 1170 Flemish men and women between 18 and 75 years of age.

Results

Differences in lipid profile were observed in the younger age group (<45 years), all in favour of the most active group. More specifically, when differentiating by EEALT and EETOTAL, men had a healthier lipid profile for TAG, HDL-C and TC:HDL-C. Differentiation according to EESPORT revealed the same significant results except for TAG. In women significant results for HDL-C, LDL-C and TC:HDL-C were found when differentiated by EESPORT.

Conclusions

Men and women <45 years of age with higher levels of energy expenditure due to sport show a better lipid profile than their sedentary counterparts. When differentiating subjects according to energy expenditure during active leisure time or overall energy expenditure, only in men was a healthier lipid profile observed in favour of the most active subjects.

Depressive symptoms and serum lipid fractions in middle-aged men: physiologic and health behavior links

OBJECTIVE

To investigate alternative hypothetical models that could clarify the relationship between depressive symptoms and serum cholesterol fractions, i.e., high-density lipoprotein (HDL) and low-density lipoprotein (LDL). It was hypothesized that the impact of the depressive symptoms on cholesterol fractions is mediated through health behavior and body mass index, and at the same time there would be a direct link from depression to cholesterol.

METHODS

The study sample consisted of 893 middle-age men who participated in a trial aimed at preventing the metabolic syndrome, Type 2 diabetes and cardiovascular diseases. Serum cholesterol was measured by the enzymatic method. Participants completed self-report questionnaires assessing health behavior and depressive symptoms.

RESULTS

Depressive symptoms consistently correlated statistically significantly with adverse lifestyle factors and, as hypothesized, positively with HDL. Path analyses supported the parallel existence of two main pathways: from depression through adverse health behavior to unfavorable cholesterol fraction balance, and a direct physiological link indicative of beneficial effect of depression on cholesterol levels.

CONCLUSIONS

It is concluded that, among a sample of men, depressive symptoms are linked to cholesterol fractions through two different pathways. An adverse relationship of depression with serum lipids HDL-LDL balance is partly mediated through harmful health behaviors. At the same time, the results indicate a direct, physiological link between depressive symptoms and cholesterol that has a beneficial influence on the HDL-LDL balance.

Effect of a 4-year workplace-based physical activity intervention program on the blood lipid profiles of participating employees: The high-risk and population strategy for occupational health promotion (HIPOP-OHP) study

Individuals who are physically fit or engage in regular physical activity have a lower incidence of cardiovascular disease and risk of mortality. We conducted a large-scale controlled trial of interventions to decrease cardiovascular risk factors, during which we assessed the effect of a workplace-based intervention program, which was part of a population strategy for promoting long-term increases in physical activity, on the blood lipid profiles of participating employees. Data were collected from 2929 participants and this report presents the results of a survey conducted in five factories for the intervention group and five factories for the control group at baseline and year 5. The absolute/proportional changes in HDL-cholesterol were 2.7 mg/dL (4.8%) in the intervention group and -0.6 mg/dL (-1.0%) in the control group. The differences between the two groups in the change in serum levels of HDL-cholesterol were highly significant (p<0.001) in each analysis of covariance, in which the number of cigarettes smoked was included or excluded. In the intervention group, the daily walking time increased significantly (p<0.001) when compared between baseline and year 5, whereas no significant difference was observed in daily walking time in the control group over the identical period. Our results show that an intervention program promoting physical activity raises serum HDL-cholesterol levels of middle-aged employees. Increased awareness of the benefits of physical activity, using environmental rearrangement and health promotion campaigns, which especially target walking, may have contributed to a beneficial change in serum HDL-cholesterol levels in the participants.

Relationship between lifestyle and change of cardiovascular risk factors based on a five-year follow-up of employees in Japan

The purpose of this study is to determine the relationship between lifestyle and change of cardiovascular risk factors based on a five-year follow up. The subjects were 307 employees participating in annual health check-ups in Tokyo, Japan from 1998 to 2003. Personal health check-up data were collected on their systolic/diastolic blood pressure (SBP/DBP), serum total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), fasting serum glucose (FSG), uric acid (UA), body mass index (BMI), questionnaire on medication history and Breslow's lifestyle. Over five years, cardiovascular risk factors such as SBP/DBP, TC, TG, FBG, UA and BMI have become worse; however, some of these risk factors were significantly different after 5 yr among lifestyle groups. TG in the poor lifestyle group was significantly higher than in good or moderate lifestyle groups after adjusting for age in men. In women, SBP and BMI in poor lifestyle group were significantly higher than those in good or moderate lifestyle groups after adjusting for age and baseline values. These results show that aging is the major influencing factor of cardiovascular risk factor deterioration. At the same time, lifestyle conditions are related to changes in some cardiovascular risk factors among Japanese employees.