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Bletsa E, Oikonomou E, Dimitriadis K, Stampouloglou PK, Fragoulis C, Lontou SP, Korakas E, Beneki E, Kalogeras K, Lambadiari V, Tsioufis K, Vavouranakis M, Siasos G. Exercise Effects on Left Ventricular Remodeling in Patients with Cardiometabolic Risk Factors. Life (Basel) 2023; 13:1742. [PMID: 37629599 PMCID: PMC10456116 DOI: 10.3390/life13081742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 08/08/2023] [Accepted: 08/12/2023] [Indexed: 08/27/2023] Open
Abstract
Left ventricular (LV) remodeling is a dynamic process, which is characterized by changes in ventricular size, shape, and wall thickness, thus altering myocardial geometry and function, and is considered as a negative prognostic factor in patients with heart failure (HF). Hypertension, type 2 diabetes (T2D), and obesity are strongly correlated with the development and the progression of LV remodeling, LV hypertrophy, and LV systolic and/or diastolic dysfunction. Indeed, the beneficial impact of exercise training on primary and secondary prevention of cardiovascular disease (CVD) has been well-established. Recent studies have highlighted that exercise training enhances functional capacity, muscle strength and endurance, cardiac function, and cardiac-related biomarkers among patients with established coronary artery disease (CAD) or HF, thus substantially improving their cardiovascular prognosis, survival rates, and need for rehospitalization. Therefore, in this review article, we discuss the evidence of LV remodeling in patients with cardiometabolic risk factors, such as hypertension, T2D, and obesity, and also highlight the current studies evaluating the effect of exercise training on LV remodeling in these patients.
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Affiliation(s)
- Evanthia Bletsa
- 3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, 11527 Athens, Greece; (E.B.); (P.K.S.); (K.K.); (M.V.); (G.S.)
- Cardiometabolic Disease Unit, 3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, 11527 Athens, Greece; (E.K.); (V.L.)
| | - Evangelos Oikonomou
- 3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, 11527 Athens, Greece; (E.B.); (P.K.S.); (K.K.); (M.V.); (G.S.)
- Cardiometabolic Disease Unit, 3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, 11527 Athens, Greece; (E.K.); (V.L.)
| | - Kyriakos Dimitriadis
- 1st Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Hippokrateion General Hospital, 11527 Athens, Greece; (K.D.); (C.F.); (E.B.); (K.T.)
| | - Panagiota K. Stampouloglou
- 3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, 11527 Athens, Greece; (E.B.); (P.K.S.); (K.K.); (M.V.); (G.S.)
| | - Christos Fragoulis
- 1st Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Hippokrateion General Hospital, 11527 Athens, Greece; (K.D.); (C.F.); (E.B.); (K.T.)
- Heart and Diabetes Center, National and Kapodistrian University of Athens, Medical School, Hippokrateion General Hospital, 11527 Athens, Greece;
| | - Stavroula P. Lontou
- Heart and Diabetes Center, National and Kapodistrian University of Athens, Medical School, Hippokrateion General Hospital, 11527 Athens, Greece;
| | - Emmanouil Korakas
- Cardiometabolic Disease Unit, 3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, 11527 Athens, Greece; (E.K.); (V.L.)
- 2nd Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Attikon University Hospital, 12462 Athens, Greece
| | - Eirini Beneki
- 1st Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Hippokrateion General Hospital, 11527 Athens, Greece; (K.D.); (C.F.); (E.B.); (K.T.)
| | - Konstantinos Kalogeras
- 3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, 11527 Athens, Greece; (E.B.); (P.K.S.); (K.K.); (M.V.); (G.S.)
| | - Vaia Lambadiari
- Cardiometabolic Disease Unit, 3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, 11527 Athens, Greece; (E.K.); (V.L.)
- 2nd Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Attikon University Hospital, 12462 Athens, Greece
| | - Konstantinos Tsioufis
- 1st Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Hippokrateion General Hospital, 11527 Athens, Greece; (K.D.); (C.F.); (E.B.); (K.T.)
- Heart and Diabetes Center, National and Kapodistrian University of Athens, Medical School, Hippokrateion General Hospital, 11527 Athens, Greece;
| | - Manolis Vavouranakis
- 3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, 11527 Athens, Greece; (E.B.); (P.K.S.); (K.K.); (M.V.); (G.S.)
| | - Gerasimos Siasos
- 3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, 11527 Athens, Greece; (E.B.); (P.K.S.); (K.K.); (M.V.); (G.S.)
- Cardiometabolic Disease Unit, 3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, 11527 Athens, Greece; (E.K.); (V.L.)
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Sit less and move more for cardiovascular health: emerging insights and opportunities. Nat Rev Cardiol 2021; 18:637-648. [PMID: 34017139 DOI: 10.1038/s41569-021-00547-y] [Citation(s) in RCA: 89] [Impact Index Per Article: 29.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/22/2021] [Indexed: 02/01/2023]
Abstract
Sedentary behaviour - put simply, too much sitting, as a distinct concept from too little exercise - is a novel determinant of cardiovascular risk. This definition provides a perspective that is complementary to the well-understood detrimental effects of physical inactivity. Sitting occupies the majority of the daily waking hours in most adults and has become even more pervasive owing to the COVID-19 pandemic. The potential for a broad cardiovascular health benefit exists through an integrated approach that involves 'sitting less and moving more'. In this Review, we first consider observational and experimental evidence on the adverse effects of prolonged, uninterrupted sitting and the evidence identifying the possible mechanisms underlying the associated risk. We summarize the results of randomized controlled trials demonstrating the feasibility of changing sedentary behaviour. We also highlight evidence on the deleterious synergies between sedentary behaviour and physical inactivity as the underpinnings of our case for addressing them jointly in mitigating cardiovascular risk. This integrated approach should not only reduce the specific risks of too much sitting but also have a positive effect on the total amount of physical activity, with the potential to more broadly benefit the health of individuals living with or at risk of developing cardiovascular disease.
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Should we target increased physical activity or less sedentary behavior in the battle against cardiovascular disease risk development? Atherosclerosis 2020; 311:107-115. [PMID: 32773106 DOI: 10.1016/j.atherosclerosis.2020.07.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 06/22/2020] [Accepted: 07/15/2020] [Indexed: 01/09/2023]
Abstract
Physical inactivity is a well-established risk factor for cardiovascular disease (CVD) incidence and mortality. In the last decade, there is also emerging evidence of the role of sedentary behaviors (sitting) as a risk factor for CVD. Therefore, there is increasing interest in understanding the independent and joint effects of physical activity and sedentary behavior on CVD risk. Higher levels of moderate-to-vigorous physical activity and less time spent in sedentary behavior are associated with a decreased risk of CVD. There is also preliminary evidence that higher levels of light-intensity physical activity are associated with lower all-cause mortality rates; however, the cardio-protective effects of light-intensity physical activity are yet to be determined. The results from several studies have demonstrated that the effects of sedentary behavior on CVD risk is more pronounced among individuals who are physically inactive, compared to those who are more active. Further, high levels (60-75 min per day) of moderate-to-vigorous physical activity appear to eliminate the increased risk of CVD associated with excessive sedentary behavior. Replacing sedentary behavior with any intensity of physical activity will produce health benefits; however, the greatest benefits occur when replacing sedentary behavior with moderate-to-vigorous intensity physical activity.
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Luchi TC, Coelho PM, Cordeiro JP, Assis ALEM, Nogueira BV, Marques VB, Dos Santos L, Lima-Leopoldo AP, Lunz W, Leopoldo AS. Chronic aerobic exercise associated to low-dose L-NAME improves contractility without changing calcium handling in rat cardiomyocytes. ACTA ACUST UNITED AC 2020; 53:e8761. [PMID: 32159612 PMCID: PMC7076801 DOI: 10.1590/1414-431x20198761] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Accepted: 12/11/2019] [Indexed: 11/22/2022]
Abstract
Nitric oxide (NO) inhibition by high-dose NG-nitro-L-arginine methyl ester (L-NAME) is associated with several detrimental effects on the cardiovascular system. However, low-dose L-NAME increases NO synthesis, which in turn induces physiological cardiovascular benefits, probably by activating a protective negative feedback mechanism. Aerobic exercise, likewise, improves several cardiovascular functions in healthy hearts, but its effects are not known when chronically associated with low-dose L-NAME. Thus, we tested whether the association between low-dose L-NAME administration and chronic aerobic exercise promotes beneficial effects to the cardiovascular system, evaluating the cardiac remodeling process. Male Wistar rats were randomly assigned to control (C), L-NAME (L), chronic aerobic exercise (Ex), and chronic aerobic exercise associated to L-NAME (ExL). Aerobic training was performed with progressive intensity for 12 weeks; L-NAME (1.5 mg·kg-1·day-1) was administered by orogastric gavage. Low-dose L-NAME alone did not change systolic blood pressure (SBP), but ExL significantly increased SBP at week 8 with normalization after 12 weeks. Furthermore, ExL promoted the elevation of left ventricle (LV) end-diastolic pressure without the presence of cardiac hypertrophy and fibrosis. Time to 50% shortening and relaxation were reduced in ExL, suggesting a cardiomyocyte contractile improvement. In addition, the time to 50% Ca2+ peak was increased without alterations in Ca2+ amplitude and time to 50% Ca2+ decay. In conclusion, the association of chronic aerobic exercise and low-dose L-NAME prevented cardiac pathological remodeling and induced cardiomyocyte contractile function improvement; however, it did not alter myocyte affinity and sensitivity to intracellular Ca2+ handling.
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Affiliation(s)
- T C Luchi
- Departamento de Desportos, Centro de Educação Física e Desportos, Universidade Federal do Espírito Santo, Vitória, ES, Brasil
| | - P M Coelho
- Programa de Pós-Graduação em Nutrição e Saúde, Centro de Ciências da Saúde, Universidade Federal do Espírito Santo, Vitória, ES, Brasil
| | - J P Cordeiro
- Departamento de Desportos, Centro de Educação Física e Desportos, Universidade Federal do Espírito Santo, Vitória, ES, Brasil
| | - A L E M Assis
- Departamento de Morfologia, Centro de Ciências da Saúde, Universidade Federal do Espírito Santo, Vitória, ES, Brasil
| | - B V Nogueira
- Departamento de Morfologia, Centro de Ciências da Saúde, Universidade Federal do Espírito Santo, Vitória, ES, Brasil
| | - V B Marques
- Departamento de Ciências Fisiológicas, Centro de Ciências da Saúde, Universidade Federal do Espírito Santo, Vitória, ES, Brasil
| | - L Dos Santos
- Departamento de Ciências Fisiológicas, Centro de Ciências da Saúde, Universidade Federal do Espírito Santo, Vitória, ES, Brasil
| | - A P Lima-Leopoldo
- Departamento de Desportos, Centro de Educação Física e Desportos, Universidade Federal do Espírito Santo, Vitória, ES, Brasil.,Programa de Pós-Graduação em Nutrição e Saúde, Centro de Ciências da Saúde, Universidade Federal do Espírito Santo, Vitória, ES, Brasil
| | - W Lunz
- Departamento de Desportos, Centro de Educação Física e Desportos, Universidade Federal do Espírito Santo, Vitória, ES, Brasil
| | - A S Leopoldo
- Departamento de Desportos, Centro de Educação Física e Desportos, Universidade Federal do Espírito Santo, Vitória, ES, Brasil.,Programa de Pós-Graduação em Nutrição e Saúde, Centro de Ciências da Saúde, Universidade Federal do Espírito Santo, Vitória, ES, Brasil
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Abstract
More than 30% of U.S. adults are obese or overweight. A program of regular physical activity is recommended as part of an effective lifestyle intervention for weight loss and weight management. However, more than 40% of adults do not engage in sufficient physical activity to realize these beneficial effects on body weight. Physicians may encounter many barriers to counseling physical activity, such as lack of knowledge or self-efficacy for counseling patients about physical activity. Obese individuals may be reluctant to exercise because of weight stigma, physique anxiety, and other factors; therefore, referral to a weight management specialist or clinical exercise physiologist can be helpful in facilitating exercise and assisting in achieving a clinically meaningful weight loss. Exercise has many benefits on physical and mental health and well-being that go well beyond weight loss, and it is for these reasons that exercise is particularly important for overweight and obese individuals.
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Affiliation(s)
- Carol Ewing Garber
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY
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Messerli-Bürgy N, Horsch A, Schindler C, Boichat A, Kriemler S, Munsch S, Crottet B, Marquez-Vidal PM, Borghini A, Puder JJ. Influence of Acute Physical Activity on Stress Reactivity in Obese and Normal Weight Children: A Randomized Controlled Trial. Obes Facts 2019; 12:115-130. [PMID: 30844804 PMCID: PMC6465711 DOI: 10.1159/000494294] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 10/05/2018] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVE Physical activity (PA) may influence acute stress reactivity in children differently depending on their weight. This randomized controlled trial investigated the impact of acute PA and of BMI status (overweight/obese (OB/OW) and normal weight (NW) on stress reactivity. METHOD 50 prepubertal children (24 OW/OB and 26 NW) were randomly assigned to the PA or sedentary arm (SED) for 30 min followed by a stress task. Salivary cortisol, blood pressure (BP), and heart rate (HR) were measured. RESULTS An interaction effect between the randomization arms and weight status on salivary cortisol was found after the stress task (p = 0.04). Cortisol increased in the SED, but not in the PA arm (p = 0.004 for differences in time course) of NW children. Time course did not differ between both arms in OW/OB children (p = 0.7). OW/OB SED children had a flat cortisol course, and levels were reduced compared to the NW SED or the OW/OB PA children (p ≤ 0.03). Systolic BP increased only in the SED arm (p = 0.01). HR was higher in the PA than in the SED arm during stress (p < 0.001) and showed different time courses (p = 0.006). CONCLUSION PA impacted on acute stress reactivity and influenced stress reactivity differently in NW and OW/OB children.
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Affiliation(s)
- Nadine Messerli-Bürgy
- Clinical Child Psychology & Biological Psychology, Department of Psychology, University of Fribourg, Fribourg, Switzerland,
- Obstetric Service, Department Women-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland,
| | - Antje Horsch
- Institute of Higher Education and Research in Healthcare, University of Lausanne and Lausanne University Hospital, Lausanne, Switzerland
- Neonatology Service, Department Women-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
| | - Christian Schindler
- Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland
| | - Anaëlle Boichat
- Institute of Sport Studies, University of Lausanne, Lausanne, Switzerland
| | - Susi Kriemler
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Simone Munsch
- Department of Clinical Psychology and Psychotherapy, University of Fribourg, Fribourg, Switzerland
| | - Bertrand Crottet
- Service of Pediatric Endocrinology, Diabetology and Obesity, Lausanne University Hospital, Lausanne, Switzerland
| | - Pedro M Marquez-Vidal
- Department of Medicine, Internal Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Ayala Borghini
- University Service of Child and Adolescent Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
| | - Jardena J Puder
- Obstetric Service, Department Women-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
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Yu Y, Gao Q, Xia W, Zhang L, Hu Z, Wu X, Jia X. Association between Physical Exercise and Biomarkers of Oxidative Stress among Middle-Aged and Elderly Community Residents with Essential Hypertension in China. BIOMED RESEARCH INTERNATIONAL 2018; 2018:4135104. [PMID: 30065938 PMCID: PMC6051290 DOI: 10.1155/2018/4135104] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 05/20/2018] [Accepted: 06/06/2018] [Indexed: 02/08/2023]
Abstract
This study aimed to investigate the role of different types and frequencies of physical exercise in biomarkers of oxidative stress among middle-aged and elderly community residents with essential hypertension in China. A community-based cross-sectional survey was undertaken in 7 subdistricts. Individuals, 45-79 years old, with essential hypertension (n = 402) and without cardiovascular disease (n = 1047) were included. Superoxide dismutase (SOD) activities and plasma levels of malondialdehyde (MDA) and 4-hydroxynonenal (4-HNE) were determined. Multilevel linear regression was used to estimate the associations between various types of physical exercise and oxidative stress biomarker levels. Participants engaged in high frequency walking/square dancing or taiji/yoga demonstrated decreased systolic blood pressure in both groups; however, diastolic blood pressure decreased only among individuals with hypertension participating in walking/square dancing. In individuals with hypertension, MDA levels decreased in those participating in walking/square dancing, SOD activity increased in those participating in walking/square dancing, and 4-HNE levels decreased in those involved in taiji/yoga. In individuals without cardiovascular disease, MDA levels decreased in those involved in walking/square dancing or taiji/yoga, SOD activity increased in those performing walking/square dancing, and 4-HNE levels decreased in those involved in taiji/yoga. Oxidative stress marker levels also improved in those involved in walking/square dancing or taiji/yoga groups as the exercise frequency increased. Thus, frequent participation in walking/square dancing or taiji/yoga effectively decreases hypertension-related oxidative stress biomarker levels.
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Affiliation(s)
- Ying Yu
- Department of Physiology, Bengbu Medical College, 2600 Dong Hai Avenue, Bengbu 233030, China
- Science Research Center, Bengbu Medical College, 2600 Dong Hai Avenue, Bengbu 233030, China
| | - Qin Gao
- Department of Physiology, Bengbu Medical College, 2600 Dong Hai Avenue, Bengbu 233030, China
- Science Research Center, Bengbu Medical College, 2600 Dong Hai Avenue, Bengbu 233030, China
| | - Wanning Xia
- Department of Epidemiology and Statistics, Bengbu Medical College, 2600 Dong Hai Avenue, Bengbu 233030, China
| | - Lina Zhang
- Department of Neurology, First Affiliated Hospital of Bengbu Medical College, Bengbu 233004, China
| | - Zhiyuan Hu
- Science Research Center, Bengbu Medical College, 2600 Dong Hai Avenue, Bengbu 233030, China
| | - Xuesen Wu
- Department of Epidemiology and Statistics, Bengbu Medical College, 2600 Dong Hai Avenue, Bengbu 233030, China
| | - Xianjie Jia
- Department of Epidemiology and Statistics, Bengbu Medical College, 2600 Dong Hai Avenue, Bengbu 233030, China
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Gant CM, Binnenmars SH, Harmelink M, Soedamah-Muthu SS, Bakker SJL, Navis G, Laverman GD. Real-life achievement of lipid-lowering treatment targets in the DIAbetes and LifEstyle Cohort Twente: systemic assessment of pharmacological and nutritional factors. Nutr Diabetes 2018; 8:24. [PMID: 29695715 PMCID: PMC5917033 DOI: 10.1038/s41387-018-0028-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 02/01/2018] [Accepted: 02/20/2018] [Indexed: 01/05/2023] Open
Abstract
Background/Objectives Lowering low-density lipoprotein cholesterol (LDLc) in type 2 diabetes mellitus is of paramount importance in preventing cardiovascular disease. However, treatment targets for LDLc are often not reached. We studied the prevalence of LDLc target achievement in a real-life population of type 2 diabetes mellitus patients in secondary care, and investigated whether in those not on target, there is room for intensifying pharmacological and lifestyle management according to current treatment guidelines. Subjects/Methods We performed a cross-sectional analysis in the DIAbetes and LifEstyle Cohort Twente-1 (DIALECT-1; n = 450, age 63 ± 9 years, 58% men, diabetes duration 11 (7–18) years). At baseline, we determined plasma LDLc concentration, pharmacological treatment (i.e., statin use), and lifestyle (physical activity and dietary intake). Patients were divided according to LDLc < 1.8, LDLc 1.8–2.5, and LDLc > 2.5 mmol/l. Dietary intake was collected from a validated Food Frequency Questionnaire (177 items) and we determined guideline adherence for different food groups. Physical activity was assessed with the Short Questionnaire to ASsess Health enhancing behavior. Results LDLc data were available in 428 type 2 diabetes mellitus patients. LDLc ≤ 2.5 mmol/l was achieved in 317 patients (76%). In total, 76% of patients used statins, in those with LDLc > 2.5 mmol/l, this was 44%. Adherence to lifestyle guidelines was not different between the LDLc groups and was as follows: body mass index 6%, physical activity 59%, vegetables 7%, fruit 28%, legumes 59%, nuts 14%, dairy 19%, fish 36%, tea 8%, fats 66%, red meat 12%, processed meat 2%, alcohol 71%, sweetened beverages 34%, and sodium 12%. Conclusions In type 2 diabetes mellitus patients in secondary health care, the target LDLc is achieved by three quarters of patients. Increasing statin treatment could be a first step to improve LDLc. In addition, there are ample opportunities for lifestyle management through increasing adherence to lifestyle guidelines.
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Affiliation(s)
- Christina M Gant
- Department of Internal Medicine/Nephrology, ZGT Hospital, Almelo and Hengelo, Hengelo, The Netherlands. .,Division of Nephrology, Department of Internal Medicine, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.
| | - S Heleen Binnenmars
- Department of Internal Medicine/Nephrology, ZGT Hospital, Almelo and Hengelo, Hengelo, The Netherlands.,Division of Nephrology, Department of Internal Medicine, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Manon Harmelink
- Department of Internal Medicine/Nephrology, ZGT Hospital, Almelo and Hengelo, Hengelo, The Netherlands
| | - Sabita S Soedamah-Muthu
- Centre of Research on Psychology in Somatic Diseases (CORPS), Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands.,Institute for Food, Nutrition and Health, University of Reading, Reading, UK
| | - Stephan J L Bakker
- Division of Nephrology, Department of Internal Medicine, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Gerjan Navis
- Division of Nephrology, Department of Internal Medicine, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Gozewijn D Laverman
- Department of Internal Medicine/Nephrology, ZGT Hospital, Almelo and Hengelo, Hengelo, The Netherlands.,Division of Nephrology, Department of Internal Medicine, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
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