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DeConne TM, Fancher IS, Edwards DG, Trott DW, Martens CR. CD8 + T-cell metabolism is related to cerebrovascular reactivity in middle-aged adults. Am J Physiol Regul Integr Comp Physiol 2024; 326:R416-R426. [PMID: 38406845 DOI: 10.1152/ajpregu.00267.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 02/13/2024] [Accepted: 02/22/2024] [Indexed: 02/27/2024]
Abstract
Cerebrovascular reactivity (CVR) decreases with advancing age, contributing to increased risk of cognitive impairment; however, the mechanisms underlying the age-related decrease in CVR are incompletely understood. Age-related changes to T cells, such as impaired mitochondrial respiration, increased inflammation, likely contribute to peripheral and cerebrovascular dysfunction in animals. However, whether T-cell mitochondrial respiration is related to cerebrovascular function in humans is not known. Therefore, we hypothesized that peripheral T-cell mitochondrial respiration would be positively associated with CVR and that T-cell glycolytic metabolism would be negatively associated with CVR. Twenty middle-aged adults (58 ± 5 yr) were recruited for this study. T cells were separated from peripheral blood mononuclear cells. Cellular oxygen consumption rate (OCR) and extracellular acidification rate (ECAR, a marker of glycolytic activity) were measured using extracellular flux analysis. CVR was quantified using the breath-hold index (BHI), which reflects the change in blood velocity in the middle-cerebral artery (MCAv) during a 30-s breath-hold. In contrast to our hypothesis, we found that basal OCR in CD8+ T cells (β = -0.59, R2 = 0.27, P = 0.019) was negatively associated with BHI. However, in accordance with our hypothesis, we found that basal ECAR (β = -2.20, R2 = 0.29, P = 0.015) and maximum ECAR (β = -50, R2 = 0.24, P = 0.029) were negatively associated with BHI in CD8+ T cells. There were no associations observed in CD4+ T cells. These associations appeared to be primarily mediated by an association with the pressor response to the breath-hold test. Overall, our findings suggest that CD8+ T-cell respiration and glycolytic activity may influence CVR in humans.NEW & NOTEWORTHY Peripheral T-cell metabolism is related to in vivo cerebrovascular reactivity in humans. Higher glycolytic metabolism in CD8+ T cells was associated with lower cerebrovascular reactivity to a breath-hold in middle-aged adults, which is possibly reflective of a more proinflammatory state in midlife.
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Affiliation(s)
- Theodore M DeConne
- Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, United States
| | - Ibra S Fancher
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, Delaware, United States
| | - David G Edwards
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, Delaware, United States
| | - Daniel W Trott
- Department of Kinesiology, University of Texas at Arlington, Arlington, Texas, United States
| | - Christopher R Martens
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, Delaware, United States
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Driver S, McShan E, Swank C, Calhoun S, Douglas M, Suhalka A, Bennett M, Callender L, Ochoa C, Mukkamala S, Kramer K. Results of a 12-Month Randomized Controlled Trial Testing the Efficacy of the Diabetes Prevention Program Group Lifestyle Balance (DPP-GLB) for People Post Stroke (GLB-CVA). Ann Behav Med 2023; 57:1032-1045. [PMID: 37542523 DOI: 10.1093/abm/kaad045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/07/2023] Open
Abstract
BACKGROUND Experience of stroke is associated with an increased risk for diabetes and metabolic syndrome, yet few interventions exist that have been tailored to the population's unique needs. PURPOSE To examine adherence and efficacy of the Diabetes Prevention Program Group Lifestyle Balance program (DPP-GLB) modified for individuals post stroke (GLB-CVA) using a randomized controlled trial. METHODS Adults (18-85 years of age), >12 months post stroke, and body mass index ≥25 kg/m2 were included in this study. Sixty-five individuals were assigned to either the GLB-CVA intervention or a 6-month wait-list control. Participants completed the 12-month GLB-CVA intervention, with attendance and assessment of weight, anthropometric, biomarker, functional, and patient reported outcome data collected at baseline, 3, 6, and 12 months. RESULTS High attendance (90%) and dietary and activity tracking (71%) suggest high adherence to the 12-month GLB-CVA. Six-month randomized controlled trial data indicate significant weight loss (p = .005) in the GLB-CVA group (7.4 ± 13.6 lbs, 3.65%) compared with the wait-list control (0.1 ± 10.1 lbs, 0%), and improvements in arm circumference (p = .04), high-density lipoprotein (HDL) cholesterol (p = .028), 8-year diabetes risk (p = .011), and pain interference (p < .001). Combined 12-month data showed participants lost 10.1 ± 16.8 lbs (4.88%) and improved waist circumference (p = .001), HbA1c (3.6%), diastolic blood pressure (p < .001), pain (p = .001), social participation (p = .025), and eating practices (p = .01) and habits (p < .001). CONCLUSIONS Engagement in the GLB-CVA can result in weight loss and improved health for individuals who are overweight or obese following stroke. Future efforts should examine effectiveness in real-world settings and focus on knowledge translation efforts.
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Affiliation(s)
- Simon Driver
- Baylor Scott & White Research Institute, Dallas, TX, USA
- Baylor Scott & White Institute for Rehabilitation, Dallas, TX, USA
| | - Evan McShan
- Baylor Scott & White Research Institute, Dallas, TX, USA
| | - Chad Swank
- Baylor Scott & White Research Institute, Dallas, TX, USA
- Baylor Scott & White Institute for Rehabilitation, Dallas, TX, USA
| | | | - Megan Douglas
- Baylor Scott & White Research Institute, Dallas, TX, USA
| | | | - Monica Bennett
- Baylor Scott & White Research Institute, Dallas, TX, USA
| | | | - Christa Ochoa
- Baylor Scott & White Research Institute, Dallas, TX, USA
| | | | - Kaye Kramer
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA
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Driver S, McShan EE, Bennett M, Calhoun S, Callender L, Swank C, Dubiel R. A randomized controlled trial protocol for people with traumatic brain injury enrolled in a telehealth delivered diabetes prevention program (tGLB-TBI). Contemp Clin Trials Commun 2023; 35:101191. [PMID: 37520329 PMCID: PMC10382627 DOI: 10.1016/j.conctc.2023.101191] [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: 02/08/2023] [Revised: 07/10/2023] [Accepted: 07/15/2023] [Indexed: 08/01/2023] Open
Abstract
Obesity rates after traumatic brain injury (TBI) are high and are associated with greater risk of morbidity (diabetes, hypertension) and mortality when compared to the general population. Evidence-based interventions for this population are needed and our work modifying and examining the efficacy of the Diabetes Prevention Program Group Lifestyle Balance (GLB-TBI) are promising. Our recent randomized controlled trial included 57 adults with TBI who completed the GLB-TBI in-person and lost 17.8 ± 16.4lbs (7.9% body weight) compared to the attention control (0%). To broaden the accessibility of the intervention we will complete an RCT to assess the efficacy of telehealth delivery (tGLB-TBI) by enrolling 88 participants over a 3 year period. Results will provide a scalable telehealth weight-loss program that clinicians and community workers across the country can use to help people with TBI lose weight and improve health. The long-term goal is to reduce health inequities and broaden program dissemination to people with TBI that lack access due to environmental barriers, including living rurally or lacking transportation.
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Affiliation(s)
- Simon Driver
- North Texas TBI Model System, USA
- Baylor Scott and White Research Institute, 3434 Live Oak Street, Dallas, TX, 75204, USA
- Baylor Scott and White Institute for Rehabilitation, 909 N. Washington, Dallas, TX, 75246, USA
| | - Evan Elizabeth McShan
- North Texas TBI Model System, USA
- Baylor Scott and White Research Institute, 3434 Live Oak Street, Dallas, TX, 75204, USA
| | - Monica Bennett
- North Texas TBI Model System, USA
- Baylor Scott and White Research Institute, 3434 Live Oak Street, Dallas, TX, 75204, USA
| | - Stephanie Calhoun
- North Texas TBI Model System, USA
- Baylor Scott and White Research Institute, 3434 Live Oak Street, Dallas, TX, 75204, USA
| | - Librada Callender
- North Texas TBI Model System, USA
- Baylor Scott and White Research Institute, 3434 Live Oak Street, Dallas, TX, 75204, USA
| | - Chad Swank
- North Texas TBI Model System, USA
- Baylor Scott and White Research Institute, 3434 Live Oak Street, Dallas, TX, 75204, USA
- Baylor Scott and White Institute for Rehabilitation, 909 N. Washington, Dallas, TX, 75246, USA
| | - Rosemary Dubiel
- North Texas TBI Model System, USA
- Baylor Scott and White Research Institute, 3434 Live Oak Street, Dallas, TX, 75204, USA
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Driver S, McShan E, Swank C, Calhoun S, Bennett M, Callender L, Holden A, Juengst S, Bell K, Douglas M, Kramer K, Dubiel R. Efficacy of the Diabetes Prevention Program Group Lifestyle Balance Program Modified for Individuals with TBI (GLB-TBI): Results from a 12-month Randomized Controlled Trial. Ann Behav Med 2023; 57:131-145. [PMID: 35775789 DOI: 10.1093/abm/kaac036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Obesity after traumatic brain injury (TBI) is a public health issue and no evidence-based weight loss interventions exist to meet the unique needs of individuals after TBI. PURPOSE To (a) examine the efficacy of the Diabetes Prevention Program Group Lifestyle Balance for TBI (GLB-TBI) weight-loss intervention compared to an attention control for primary (weight-loss) and secondary health outcomes; (b) determine participant compliance with the GLB-TBI; and (c) determine if compliance is associated with improved outcomes. METHODS Individuals with moderate to severe TBI, age 18-64 years, ≥6 months postinjury, and body mass index of ≥25 kg/m2 were randomized to a 12-month, 22-session GLB-TBI intervention or attention control condition. Weight-loss (lbs.), anthropometric, biomarkers, and patient-reported outcomes were collected at baseline, 3, 6, and 12 months. RESULTS The GLB-TBI group (n = 27) lost 17.8 ± 41.4lbs (7.9%) over the 12-month program and the attention control group (n = 27) lost 0 ± 55.4lbs (0%). The GLB-TBI group had significant improvements in diastolic blood pressure, triglycerides, and HDL cholesterol. GLB-TBI attendance was 89.6% and weekly self-monitoring of diet and activity was 68.8%. Relative to baseline, the GLB-TBI compliant group (≥80% attendance; ≥85% self-monitoring; n = 10) had a statistically significant decrease in weight at each assessment, the noncompliant group had a significant decrease between 6 and 12 months (n = 17), with no change in weight in the attention control group (n = 27). CONCLUSIONS Findings suggest for adults with TBI who are overweight or obese, participation in the GLB-TBI can significantly reduce weight and metabolic risk factors and increase self-reported habits for diet and exercise.
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Affiliation(s)
- Simon Driver
- Department of Physical Medicine and Rehabilitation, Baylor Scott and White Institute for Rehabilitation, Dallas, TX, USA.,Rehabilitation Research Deparment, Baylor Scott and White Research Institute, Dallas, TX, USA.,Research Group, North Texas Traumatic Brain Injury Model System, Dallas, TX, USA
| | - Evan McShan
- Department of Physical Medicine and Rehabilitation, Baylor Scott and White Institute for Rehabilitation, Dallas, TX, USA.,Rehabilitation Research Deparment, Baylor Scott and White Research Institute, Dallas, TX, USA.,Research Group, North Texas Traumatic Brain Injury Model System, Dallas, TX, USA
| | - Chad Swank
- Department of Physical Medicine and Rehabilitation, Baylor Scott and White Institute for Rehabilitation, Dallas, TX, USA.,Rehabilitation Research Deparment, Baylor Scott and White Research Institute, Dallas, TX, USA.,Research Group, North Texas Traumatic Brain Injury Model System, Dallas, TX, USA
| | - Stephanie Calhoun
- Department of Physical Medicine and Rehabilitation, Baylor Scott and White Institute for Rehabilitation, Dallas, TX, USA.,Rehabilitation Research Deparment, Baylor Scott and White Research Institute, Dallas, TX, USA.,Research Group, North Texas Traumatic Brain Injury Model System, Dallas, TX, USA
| | - Monica Bennett
- Rehabilitation Research Deparment, Baylor Scott and White Research Institute, Dallas, TX, USA.,Research Group, North Texas Traumatic Brain Injury Model System, Dallas, TX, USA
| | - Librada Callender
- Department of Physical Medicine and Rehabilitation, Baylor Scott and White Institute for Rehabilitation, Dallas, TX, USA.,Rehabilitation Research Deparment, Baylor Scott and White Research Institute, Dallas, TX, USA.,Research Group, North Texas Traumatic Brain Injury Model System, Dallas, TX, USA
| | - Alexandria Holden
- Department of Physical Medicine and Rehabilitation, Baylor Scott and White Institute for Rehabilitation, Dallas, TX, USA.,Rehabilitation Research Deparment, Baylor Scott and White Research Institute, Dallas, TX, USA.,Research Group, North Texas Traumatic Brain Injury Model System, Dallas, TX, USA
| | - Shannon Juengst
- Research Group, North Texas Traumatic Brain Injury Model System, Dallas, TX, USA.,Department of Physical Medicine and Rehabilitation, University of Texas Southwestern, Dallas, TX, USA
| | - Kathleen Bell
- Research Group, North Texas Traumatic Brain Injury Model System, Dallas, TX, USA.,Department of Physical Medicine and Rehabilitation, University of Texas Southwestern, Dallas, TX, USA
| | - Megan Douglas
- Department of Physical Medicine and Rehabilitation, Baylor Scott and White Institute for Rehabilitation, Dallas, TX, USA.,Rehabilitation Research Deparment, Baylor Scott and White Research Institute, Dallas, TX, USA.,Research Group, North Texas Traumatic Brain Injury Model System, Dallas, TX, USA
| | - Kaye Kramer
- Department of Epidemiology, University of Pittsburgh, PA, USA
| | - Randi Dubiel
- Department of Physical Medicine and Rehabilitation, Baylor Scott and White Institute for Rehabilitation, Dallas, TX, USA.,Rehabilitation Research Deparment, Baylor Scott and White Research Institute, Dallas, TX, USA.,Research Group, North Texas Traumatic Brain Injury Model System, Dallas, TX, USA
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Williams LB, Moser DK, Gustafson A, Waters TM, Rayens MK, Karle ER, Kriska AM. Reaching high-risk Black adults for diabetes prevention programming during a pandemic: The design of Fit & Faithful a randomized controlled community trial. Contemp Clin Trials 2022; 123:106973. [PMID: 36334705 PMCID: PMC10155857 DOI: 10.1016/j.cct.2022.106973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 10/14/2022] [Accepted: 10/20/2022] [Indexed: 11/08/2022]
Abstract
Obesity is a key risk factor for Type 2 diabetes (T2D). Alarmingly, 87% of US adults have overweight or obesity, with non-Hispanic black adults having higher obesity and T2D prevalence than non-Hispanic white. The Diabetes Prevention Program (DPP) demonstrated the clinical benefits of lifestyle intervention (LI). While the DPP LI is effective, some participants don't achieve clinically significant weight loss in the current group-based translation paradigm. Black adults have the lowest adjusted weight loss (3.2%) among all racial/ethnic groups. Early intervention nonresponse defined as ≤1% weight loss at intervention week 4 is linked to lower probability of achieving weight loss goals. This paper describes the design and methods of a cluster randomized controlled trial among black weight loss nonresponders nested in 20 community sites (primarily churches). Descriptions of the adaptations made to transition the program to virtual format during the COVID-19 pandemic are also included. Trained community health workers deliver a group-based, 6-month long DPP over 18 sessions via Zoom. Additionally, nonresponders in the enhanced group receive weekly telephone support to provide individual-level intervention to help overcome weight loss barriers. Outcomes include weight, physical activity level, blood pressure, and dietary behaviors; these are compared between nonresponders in the enhanced intervention group and nonresponders in the active control group. Cost, mediators, and moderators are explored. If found to efficacious, these enhanced strategies could be standardized as a supplement for use with DPP nonresponders.
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Affiliation(s)
- Lovoria B Williams
- University of Kentucky, College of Nursing, 751 Rose Street, Lexington, KY 40536, United States.
| | - Debra K Moser
- University of Kentucky, College of Nursing, 751 Rose Street, Lexington, KY 40536, United States
| | - Alison Gustafson
- University of Kentucky, College of Agriculture, Department of Dietetics and Human Nutrition, 206g Funkhouser, Lexington, KY 40536, United States
| | - Teresa M Waters
- University of Kentucky, College of Public Health Department of Health Management and Policy, 111 Washington Avenue, Lexington, KY 40536, United States
| | - Mary Kay Rayens
- University of Kentucky, College of Nursing, 751 Rose Street, Lexington, KY 40536, United States; University of Kentucky, College of Public Health Department of Health Management and Policy, 111 Washington Avenue, Lexington, KY 40536, United States
| | - Erika R Karle
- University of Kentucky, College of Nursing, 751 Rose Street, Lexington, KY 40536, United States
| | - Andrea M Kriska
- University of Pittsburgh, Graduate School of Public Health, Department of Epidemiology, 130 Desoto Street, Pittsburgh, PA 15261, United States
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Chopra S, Ranjan P, Malhotra A, Sarkar S, Kumari A, Kaloiya GS, Dwivedi SN, Siddhu A, Vikram NK. Identification of instruments for evaluation of behavioural and psychological parameters associated with obesity management: A systematic review with narrative synthesis of the findings. Diabetes Metab Syndr 2022; 16:102350. [PMID: 34920204 DOI: 10.1016/j.dsx.2021.102350] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 10/31/2021] [Accepted: 11/21/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND AIMS To identify instruments used to evaluate the predictors of successful weight loss across weight loss trials. METHODS We searched PubMed, PsychInfo, Cochrane Reviews and Scopus for weight loss trials reporting instruments published in the last 16 years. RESULTS A total of 46 significant behavioral and psychological predictors were identified, of which 32 instruments were finally selected. SF-36 questionnaire and Obesity Related Problem Scale for psychosocial health, TREMORE scale for motivation, Social Support Scale for support, Weight Efficacy Lifestyle Scale for self-efficacy and Body Shape Questionnaire for body image had moderate quality. Barriers to healthy eating questionnaire scale and Dutch Eating Behavior also had moderate quality. CONCLUSION Use of uniform instruments with optimum quality can benefit clinical and community-based researchers to generate reliable datasets.
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Affiliation(s)
- Sakshi Chopra
- University of Delhi, Department of Home Science, New Delhi, India
| | - Piyush Ranjan
- All India Institute of Medical Sciences, Department of Medicine, New Delhi, India.
| | - Anita Malhotra
- Lakshmibai College, University of Delhi, Department of Home Science, New Delhi, India
| | - Siddharth Sarkar
- All India Institute of Medical Sciences, Department of Psychiatry, New Delhi, India
| | - Archana Kumari
- All India Institute of Medical Sciences, Department of Obstetrics and Gynaecology, New Delhi, India
| | | | - S N Dwivedi
- All India Institute of Medical Sciences, Department of Biostatistics, New Delhi, India
| | - Anupa Siddhu
- University of Delhi, Department of Home Science, New Delhi, India
| | - Naval K Vikram
- All India Institute of Medical Sciences, Department of Medicine, New Delhi, India
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Hazuda HP, Pan Q, Florez H, Luchsinger JA, Crandall JP, Venditti EM, Golden SH, Kriska AM, Bray GA. Association of Intensive Lifestyle and Metformin Interventions With Frailty in the Diabetes Prevention Program Outcomes Study. J Gerontol A Biol Sci Med Sci 2021; 76:929-936. [PMID: 33428709 DOI: 10.1093/gerona/glaa295] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Frailty is a geriatric syndrome of decreased physiologic reserve and resistance to stressors that results in increased vulnerability to adverse health outcomes with aging. Diabetes and hyperglycemia are established risk factors for frailty. We sought to examine whether the odds of frailty among individuals at high risk of diabetes randomized to treatment with intensive lifestyle (ILS), metformin, or placebo differed after long-term follow-up. METHOD The sample comprised participants in the Diabetes Prevention Program (DPP) clinical trial, who continued follow-up in the DPP Outcomes Study (DPPOS) and completed frailty assessments in DPPOS Years 8 (n = 2385) and 10 (n = 2289), approximately 12 and 14 years after DPP randomization. Frailty was classified using Fried Frailty Phenotype criteria. GEE models adjusting for visit year with repeated measures pooled for Years 8 and 10 were used to estimate pairwise odds ratios (ORs) between ILS, metformin, and placebo for the outcomes of frail and prefrail versus nonfrail. RESULTS Frailty prevalence by treatment group was ILS = 3.0%, metformin = 5.4%, placebo = 5.7% at Year 8, and ILS = 3.6%, metformin = 5.3%, placebo = 5.4% at Year 10. Odds ratios (95% CI) estimated with GEE models were ILS versus placebo, 0.62 (0.42-0.93), p = .022; metformin versus placebo, 0.99 (0.69-1.42), p = .976; and ILS versus metformin, 0.63 (0.42-0.94), p = .022. Odds of being frail versus nonfrail were 37% lower for ILS compared to metformin and placebo. CONCLUSIONS Early ILS intervention, at an average age of about 50 years, in persons at high risk of diabetes may reduce frailty prevalence in later life. Metformin may be ineffective in reducing frailty prevalence. CLINICAL TRIALS REGISTRATION NUMBERS NCT00004992 (DPP) and NCT00038727 (DPPOS).
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Affiliation(s)
- Helen P Hazuda
- University of Texas Health Science Center at San Antonio
| | - Qing Pan
- Biostatistics Center, The George Washington University
| | | | | | | | | | | | | | - George A Bray
- Pennington Biomedical Research Center, Baton Rouge, Louisiana
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Napoleone JM, Miller RG, Devaraj SM, Rockette-Wagner B, Arena VC, Venditti EM, Kramer K, Strotmeyer ES, Kriska AM. Impact of Maintenance Session Attendance and Early Weight Loss Goal Achievement on Weight Loss Success in a Community-Based Diabetes Prevention Program Intervention. Sci Diabetes Self Manag Care 2021; 47:279-289. [PMID: 34167389 DOI: 10.1177/26350106211023990] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this study was to examine how maintenance session attendance and 6-month weight loss (WL) goal achievement impacted 12-month 5% WL success in older adults participating in a community-based Diabetes Prevention Program (DPP) lifestyle intervention. METHODS Data were combined from 2 community trials that delivered the 12-month DPP-based Group Lifestyle Balance (GLB) to overweight/obese adults (mean age = 62 years, 76% women) with prediabetes and/or metabolic syndrome. Included participants (n = 238) attended ≥4 core sessions (months 0-6) and had complete data on maintenance attendance (≥4 of 6 sessions during months 7-12) and 6- and 12-month WL (5% WL goal, yes/no). Multivariate logistic regression was used to estimate the odds of 12-month 5% WL associated with maintenance attendance and 6-month WL. Associations between age (Medicare-eligible ≥65 vs <65 years) and WL and attendance were examined. RESULTS Both attending ≥4 maintenance sessions and meeting the 6-month 5% WL goal increased the odds of meeting the 12-month 5% WL goal. For those not meeting the 6-month WL goal, maintenance session attendance did not improve odds of 12-month WL success. Medicare-eligible adults ≥65 years were more likely to meet the 12-month WL goal (odds ratio = 3.03, 95% CI, 1.58-5.81) versus <65 years. CONCLUSIONS The results of this study provide important information regarding participant attendance and WL for providers offering DPP-based lifestyle intervention programs across the country who are seeking Medicare reimbursement. Understanding Medicare reimbursement-defined success will allow these providers to focus on and develop strategies to enhance program effectiveness and sustainability.
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Affiliation(s)
- Jenna M Napoleone
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - Rachel G Miller
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - Susan M Devaraj
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - Bonny Rockette-Wagner
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - Vincent C Arena
- Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - Elizabeth M Venditti
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | | | - Elsa S Strotmeyer
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - Andrea M Kriska
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
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9
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A clinical diabetes risk prediction model for prediabetic women with prior gestational diabetes. PLoS One 2021; 16:e0252501. [PMID: 34170930 PMCID: PMC8232404 DOI: 10.1371/journal.pone.0252501] [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: 11/01/2020] [Accepted: 05/18/2021] [Indexed: 12/23/2022] Open
Abstract
Introduction Without treatment, prediabetic women with a history of gestational diabetes mellitus (GDM) are at greater risk for developing type 2 diabetes compared with women without a history of GDM. Both intensive lifestyle intervention and metformin can reduce risk. To predict risk and treatment response, we developed a risk prediction model specifically for women with prior GDM. Methods The Diabetes Prevention Program was a randomized controlled trial to evaluate the effectiveness of intensive lifestyle intervention, metformin (850mg twice daily), and placebo in preventing diabetes. Data from the Diabetes Prevention Program (DPP) was used to conduct a secondary analysis to evaluate 11 baseline clinical variables of 317 women with prediabetes and a self-reported history of GDM to develop a 3-year diabetes risk prediction model using Cox proportional hazards regression. Reduced models were explored and compared with the main model. Results Within three years, 82 (25.9%) women developed diabetes. In our parsimonious model using 4 of 11 clinical variables, higher fasting glucose and hemoglobin A1C were each associated with greater risk for diabetes (each hazard ratio approximately 1.4), and there was an interaction between treatment arm and BMI suggesting that metformin was more effective relative to no treatment for BMI ≥ 35kg/m2 than BMI < 30kg/m2. The model had fair discrimination (bias corrected C index = 0.68) and was not significantly different from our main model using 11 clinical variables. The estimated incidence of diabetes without treatment was 37.4%, compared to 20.0% with intensive lifestyle intervention or metformin treatment for women with a prior GDM. Conclusions A clinical prediction model was developed for individualized decision making for prediabetes treatment in women with prior GDM.
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10
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Fourny N, Beauloye C, Bernard M, Horman S, Desrois M, Bertrand L. Sex Differences of the Diabetic Heart. Front Physiol 2021; 12:661297. [PMID: 34122133 PMCID: PMC8192974 DOI: 10.3389/fphys.2021.661297] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 04/12/2021] [Indexed: 12/24/2022] Open
Abstract
Type 2 diabetes is a chronic disease associated with micro- and macro-vascular complications, including myocardial ischemia, and also with a specific and intrinsic cardiac dysfunction called diabetic cardiomyopathy (DCM). Both clinical and animal studies demonstrate significant sex differences in prevalence, pathophysiology, and outcomes of cardiovascular diseases (CVDs), including those associated with diabetes. The increased risk of CVDs with diabetes is higher in women compared to men with 50% higher risk of coronary artery diseases and increased mortality when exposed to acute myocardial infarction. Clinical studies also reveal a sexual dimorphism in the incidence and outcomes of DCM. Based on these clinical findings, growing experimental research was initiated to understand the impact of sex on CVDs associated with diabetes and to identify the molecular mechanisms involved. Endothelial dysfunction, atherosclerosis, coagulation, and fibrosis are mechanisms found to be sex-differentially modulated in the diabetic cardiovascular system. Recently, impairment of energy metabolism also emerged as a determinant of multiple CVDs associated with diabetes. Therefore, future studies should thoroughly analyze the sex-specific metabolic determinants to propose new therapeutic targets. With current medicine tending toward more personalized care of patients, we finally propose to discuss the importance of sex as determinant in the treatment of diabetes-associated cardiac diseases to promote a more systemic inclusion of both males and females in clinical and preclinical studies.
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Affiliation(s)
- Natacha Fourny
- Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium
| | - Christophe Beauloye
- Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium.,Division of Cardiology, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | | | - Sandrine Horman
- Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium
| | | | - Luc Bertrand
- Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium
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Leisure Sedentary Behavior Levels and Meeting Program Goals in a Community Lifestyle Intervention for Diabetes Prevention. J Phys Act Health 2020; 18:44-51. [PMID: 33361473 DOI: 10.1123/jpah.2020-0052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 10/05/2020] [Accepted: 10/11/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND The importance of leisure sedentary behavior (LSB) change in diabetes prevention efforts is not well known. This study examines the relationships between changes in self-reported LSB and the primary intervention goals (weight and moderate-intensity to vigorous-intensity physical activity [MVPA]) during a community-based translation of the Diabetes Prevention Program (the Group Lifestyle Balance Program). METHODS A total of 322 adults at risk for type 2 diabetes were recruited from 3 community centers, a worksite, and military site. Community and worksite participants were randomized to immediate or delayed-delivery (control) intervention. All military site participants (n = 99) received immediate intervention. Logistic and linear generalized estimating equations were used to determine associations between LSB changes and weight-related outcomes and MVPA. RESULTS Results were obtained for 259 (80.4%) participants. The LSB decreased after 6 and 12 months (mean [95% confidence interval]: -25.7 [-38.6 to -12.8] and -16.1 [-28.2 to -3.9] min/d; both P < .05). Each 20-minute reduction in LSB was associated with a 5% increase in odds of meeting the weight-loss goal (6 mo: odds ratio = 1.05 [1.002 to 1.102]; P = .042; adjusted model including MVPA), but LSB was not related to changes in reported MVPA minutes or MVPA goal achievement. CONCLUSION Within the context of existing lifestyle intervention programs, reducing sedentary behavior has the potential to contribute to weight loss separately from reported MVPA improvement.
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Azar KMJ, Nasrallah C, Szwerinski NK, Petersen JJ, Halley MC, Greenwood D, Romanelli RJ. Implementation of a group-based diabetes prevention program within a healthcare delivery system. BMC Health Serv Res 2019; 19:694. [PMID: 31615525 PMCID: PMC6792249 DOI: 10.1186/s12913-019-4569-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 09/30/2019] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Group-based Diabetes Prevention Programs (DPP), aligned with recommendations from the Centers for Disease Control and Prevention, promote clinically significant weight loss and reduce cardio-metabolic risks. Studies have examined implementation of the DPP in community settings, but less is known about its integration in healthcare systems. In 2010, a group-based DPP known as the Group Lifestyle Balance (GLB) was implemented within a large healthcare delivery system in Northern California, across three geographically distinct regional administration divisions of the organization within 12 state counties, with varying underlying socio-demographics. The regional divisions implemented the program independently, allowing for natural variation in its real-world integration. We leveraged this natural experiment to qualitatively assess the implementation of a DPP in this healthcare system and, especially, its fidelity to the original GLB curriculum and potential heterogeneity in implementation across clinics and regional divisions. METHODS Using purposive sampling, we conducted semi-structured interviews with DPP lifestyle coaches. Data were analyzed using mixed-method techniques, guided by an implementation outcomes framework consisting of eight constructs: acceptability, adoption, appropriateness, cost, feasibility, fidelity, penetration, and sustainability. RESULTS We conducted 33 interviews at 20 clinics across the three regional administrative divisions. Consistencies in implementation of the program were found across regions in terms of satisfaction with the evidence base (acceptability), referral methods (adoption), eligibility criteria (fidelity), and strategies to increase retention and effectiveness (sustainability). Heterogeneity in implementation across regions were found in all categories, including: the number and frequency of sessions (fidelity); program branding (adoption); lifestyle coach training (adoption), and patient-facing cost (cost). Lifestyle coaches expressed differing attitudes about curriculum content (acceptability) and suitability of educational level (appropriateness). While difficulties with recruitment were common across regions (feasibility), strategies used to address these challenges differed (sustainability). CONCLUSIONS Variation exists in the implementation of the DPP within a large multi-site healthcare system, revealing a dynamic and important tension between retaining fidelity to the original program and tailoring the program to meet the local needs. Moreover, certain challenges across sites may represent opportunities for considering alternative implementation to anticipate these barriers. Further research is needed to explore how differences in implementation domains impact program effectiveness.
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Affiliation(s)
- Kristen M J Azar
- Palo Alto Medical Foundation Research Institute, 795 El Camino Real, Ames Building, Palo Alto, CA, 94301, USA.
| | - Catherine Nasrallah
- Palo Alto Medical Foundation Research Institute, 795 El Camino Real, Ames Building, Palo Alto, CA, 94301, USA
| | - Nina K Szwerinski
- Palo Alto Medical Foundation Research Institute, 795 El Camino Real, Ames Building, Palo Alto, CA, 94301, USA
| | - John J Petersen
- Palo Alto Medical Foundation Research Institute, 795 El Camino Real, Ames Building, Palo Alto, CA, 94301, USA
| | - Meghan C Halley
- Palo Alto Medical Foundation Research Institute, 795 El Camino Real, Ames Building, Palo Alto, CA, 94301, USA
| | - Deborah Greenwood
- Palo Alto Medical Foundation Research Institute, 795 El Camino Real, Ames Building, Palo Alto, CA, 94301, USA
| | - Robert J Romanelli
- Palo Alto Medical Foundation Research Institute, 795 El Camino Real, Ames Building, Palo Alto, CA, 94301, USA
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Temple KA, Tjaden AH, Atkinson KM, Barengolts E, Hannon TS, Mather KJ, Utzschneider KM, Edelstein SL, Ehrmann DA, Mokhlesi B. Association of Habitual Daily Physical Activity With Glucose Tolerance and β-Cell Function in Adults With Impaired Glucose Tolerance or Recently Diagnosed Type 2 Diabetes From the Restoring Insulin Secretion (RISE) Study. Diabetes Care 2019; 42:1521-1529. [PMID: 31177181 PMCID: PMC6647043 DOI: 10.2337/dc19-0538] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Accepted: 04/28/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE We examined the relationship between habitual daily physical activity and measures of glucose tolerance, insulin sensitivity, and β-cell responses in adults with impaired glucose tolerance (IGT) or drug-naive, recently diagnosed type 2 diabetes. RESEARCH DESIGN AND METHODS Participants included 230 adults (mean ± SD age 54.5 ± 8.5 years, BMI 35 ± 5.5 kg/m2; 42.6% women) who underwent a 3-h oral glucose tolerance test (OGTT) and hyperglycemic clamp. Wrist accelerometers worn for 7 consecutive days measured total physical activity counts (TAC) (daily mean 233,460 [∼50th percentile for age]). We evaluated whether TAC was associated with fasting plasma glucose, OGTT 2-h plasma glucose or glucose incremental area under the curve (G-iAUC), hyperglycemic clamp measures of insulin sensitivity (steady-state glucose infusion rate/insulin [M/I]) and β-cell responses (acute C-peptide response to glucose, steady-state C-peptide, and maximal β-cell response), and OGTT C-peptide index (ΔC-peptide0-30/Δglucose0-30). RESULTS After adjustments for confounders, there was no association of TAC with fasting plasma glucose, 2-h glucose, or G-iAUC. Higher TAC was associated with higher insulin sensitivity (M/I). After adjusting for M/I, higher TAC was not associated with measures of β-cell response. CONCLUSIONS In adults with IGT or drug-naive, recently diagnosed type 2 diabetes, higher levels of habitual physical activity are associated with higher insulin sensitivity. Further studies are needed to understand why higher levels of physical activity are not associated with better β-cell response.
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Affiliation(s)
| | - Ashley H Tjaden
- George Washington University Biostatistics Center, Rockville, MD
| | - Karen M Atkinson
- VA Puget Sound Health Care System and University of Washington, Seattle, WA
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Driver S, Juengst S, McShan EE, Bennett M, Bell K, Dubiel R. A randomized controlled trial protocol for people with traumatic brain injury enrolled in a healthy lifestyle program (GLB-TBI). Contemp Clin Trials Commun 2019; 14:100328. [PMID: 30775611 PMCID: PMC6365803 DOI: 10.1016/j.conctc.2019.100328] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 01/10/2019] [Accepted: 01/18/2019] [Indexed: 01/07/2023] Open
Abstract
Weight gain is prevalent among people with traumatic brain injury (TBI) and may be attributable to environmental or injury-specific factors such as mobility impairment, endocrine dysfunction, behavioral and emotional disorders, and sensory loss. Few weight management programs exist to meet the unique needs of this population. Researchers modified a nationally recognized, evidence-based weight-loss program, Group Lifestyle Balance™ (GLB), to address the needs of over-weight and obese people post TBI (GLB-TBI). This current randomized controlled trial (RCT) examines the efficacy of the GLB-TBI on weight and secondary outcomes compared to an attention control educational support group. Furthermore, researchers have developed a mobile technology app to further engage participants in the program. This RCT will enroll and randomize 66 participants over a two-year period. It is anticipated that findings from this current RCT will contribute to the knowledge and evidence for an effective weight-loss intervention among this underserved population, with a goal of achieving full recognition by the Centers for Disease Control and Prevention-National Diabetes Prevention Program and subsequent Center for Medicare and Medicaid Services reimbursement for participation.
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Affiliation(s)
- Simon Driver
- North Texas Traumatic Brain Injury Model System, USA
- Baylor Scott and White Institute for Rehabilitation, 909 N. Washington, Dallas, TX, 75246, USA
| | - Shannon Juengst
- North Texas Traumatic Brain Injury Model System, USA
- University of Texas at Southwestern, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
| | - Evan Elizabeth McShan
- North Texas Traumatic Brain Injury Model System, USA
- Baylor Scott and White Institute for Rehabilitation, 909 N. Washington, Dallas, TX, 75246, USA
| | - Monica Bennett
- North Texas Traumatic Brain Injury Model System, USA
- Baylor Scott and White Health, 8080 N. Central Expy, Dallas, TX, 75206, USA
| | - Kathleen Bell
- North Texas Traumatic Brain Injury Model System, USA
- University of Texas at Southwestern, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
| | - Rosemary Dubiel
- North Texas Traumatic Brain Injury Model System, USA
- Baylor Scott and White Institute for Rehabilitation, 909 N. Washington, Dallas, TX, 75246, USA
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15
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Ritchie ND, Carroll JK, Holtrop JS, Havranek EP. Effects of physical activity goal attainment on engagement and outcomes in the National Diabetes Prevention Program. Transl Behav Med 2019; 8:932-937. [PMID: 29669050 DOI: 10.1093/tbm/ibx021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The National Diabetes Prevention Program (NDPP) is the most widely available behavioral intervention to prevent diabetes, but attrition is a concern and strategies are needed to make the program more engaging. Previous evidence suggests that the 150-min weekly physical activity goal in NDPP is hard for many to achieve. Further study of the impact of this protocol recommendation may improve understanding for NDPP reach and effectiveness in reducing diabetes risk. We conducted an observational study of relationships between physical activity goal attainment and retention and weight loss among 391 NDPP participants between March 2013 and May 2016. Average percent of self-reported weekly physical activity goal attainment was 52.7% (SD = 35.1). Goal attainment was related to percent of sessions attended, β = 0.21 (p < .01) and program completion (OR 0.47; p < .05; 95% CI 0.24-0.90). Each occurrence of goal failure was associated with a 25% lower likelihood of attending the next session (OR 0.75; p < .001; 95% CI 0.64-0.87). Goal attainment was also related to total percent weight loss, β = -0.14 (p < .05) and achieving ≥5% weight loss (OR 0.39; p < .01; 95% CI 0.19-0.76), but there was no effect of goal attainment on weight change per session attended. Failing to attain physical activity goals may deter retention in the NDPP. Yet, goal attainment did not affect the rate of weight loss per session attended. It may be important to encourage continued engagement among individuals who struggle to achieve physical activity goals. Moreover, it may be necessary to modify physical activity recommendations to meet individual needs.
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Affiliation(s)
- Natalie D Ritchie
- Denver Health and Hospital Authority, Denver, CO, USA.,University of Colorado School of Medicine, Aurora, CO, USA
| | | | | | - Edward P Havranek
- Denver Health and Hospital Authority, Denver, CO, USA.,University of Colorado School of Medicine, Aurora, CO, USA
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16
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Doma K, Speyer R, Parsons LA, Cordier R. Comparison of psychometric properties between recall methods of interview-based physical activity questionnaires: a systematic review. BMC Med Res Methodol 2019; 19:43. [PMID: 30823873 PMCID: PMC6396466 DOI: 10.1186/s12874-019-0684-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 02/14/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND This systematic review examined the methodological quality of studies and assessed the psychometric qualities of interview-administered Past-week and Usual-week Physical Activity Questionnaires (PAQs). Pubmed and Embase were used to retrieve data sources. METHODS The studies were selected using the following eligibility criteria: 1) psychometric properties of PAQs were assessed in adults; 2) the PAQs either consisted of recall periods of usual 7-days (Usual-week PAQs) within the past 12 months or during the past 7-days (Past-week PAQs); and 3) PAQs were interview-administered. The COSMIN taxonomy was utilised to critically appraise study quality and a previously established psychometric criteria employed to evaluate the overall psychometric qualities. RESULTS Following screening, 42 studies were examined to determine the psychometric properties of 20 PAQs, with the majority of studies demonstrating good to excellent ratings for methodological quality. For convergent validity (i.e., the relationship between PAQs and other measures), similar overall associations were found between Past-week PAQs and Usual-week PAQs. However, PAQs were more strongly associated with direct measures of physical activity (e.g., accelerometer) than indirect measures of physical activity (i.e., physical fitness), irrespective of recall methods. Very few psychometric properties were examined for each PAQ, with the majority exhibiting poor ratings in psychometric quality. Only a few interview-administered PAQs exhibited positive ratings for a single psychometric property, although the other properties were either rated as poor or questionable, demonstrating the limitations of current PAQs. CONCLUSION Accordingly, further research is necessary to explore a greater number of psychometric properties, or to develop new PAQs by addressing the psychometric limitations identified in the current review.
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Affiliation(s)
- Kenji Doma
- College of Healthcare Sciences, James Cook University, Townsville, Queensland, Australia.
| | - Renée Speyer
- Department Special needs Education, University of Oslo, Oslo, Norway.,School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Perth, Western Australia.,Department of Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Lauren Alese Parsons
- School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Perth, Western Australia
| | - Reinie Cordier
- School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Perth, Western Australia
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17
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de Ritter R, Sep SJS, van der Kallen CJH, Schram MT, Koster A, Kroon AA, van Greevenbroek MMJ, Eussen SJPM, Dagnelie PC, de Jong M, Vos RC, Woodward M, Bots ML, Peters SAE, Stehouwer CDA. Adverse differences in cardiometabolic risk factor levels between individuals with pre-diabetes and normal glucose metabolism are more pronounced in women than in men: the Maastricht Study. BMJ Open Diabetes Res Care 2019; 7:e000787. [PMID: 31798903 PMCID: PMC6861068 DOI: 10.1136/bmjdrc-2019-000787] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Revised: 09/20/2019] [Accepted: 10/14/2019] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To investigate whether adverse differences in levels of cardiovascular risk factors in women than men, already established when comparing individuals with and without diabetes, are also present before type 2 diabetes onset. RESEARCH DESIGN AND METHODS In a population-based cohort study of individuals aged 40-75 years (n=3410; 49% women, 29% type 2 diabetes (oversampled by design)), we estimated associations with cardiometabolic and lifestyle risk factors of (1) pre-diabetes and type 2 diabetes (reference category: normal glucose metabolism) and (2) among non-diabetic individuals, of continuous levels of hemoglobin A1c (HbA1c). Age-adjusted sex differences were analyzed using linear and logistic regression models with sex interaction terms. RESULTS In pre-diabetes, adverse differences in cardiometabolic risk factors were greater in women than men for systolic blood pressure (difference, 3.02 mm Hg; 95% CI:-0.26 to 6.30), high-density lipoprotein (HDL) cholesterol (difference, -0.10 mmol/L; 95% CI: -0.18 to -0.02), total-to-HDL cholesterol ratio (difference, 0.22; 95% CI: -0.01 to 0.44), triglycerides (ratio: 1.11; 95% CI: 1.01 to 1.22), and inflammation markers Z-score (ratio: 1.18; 95% CI: 0.98 to 1.41). In type 2 diabetes, these sex differences were similar in direction, and of greater magnitude. Additionally, HbA1c among non-diabetic individuals was more strongly associated with several cardiometabolic risk factors in women than men: per one per cent point increase, systolic blood pressure (difference, 3.58 mm Hg; 95% CI: -0.03 to 7.19), diastolic blood pressure (difference, 2.10 mm Hg; 95% CI: -0.02 to 4.23), HDL cholesterol (difference, -0.09 mmol/L; 95% CI: -0.19 to 0.00), and low-density lipoprotein cholesterol (difference, 0.26 mmol/L; 95% CI: 0.05 to 0.47). With regard to lifestyle risk factors, no consistent pattern was observed. CONCLUSION Our results are consistent with the concept that the more adverse changes in cardiometabolic risk factors in women (than men) arise as a continuous process before the onset of type 2 diabetes.
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Affiliation(s)
- Rianneke de Ritter
- Department of Internal Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands
- CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
| | - Simone J S Sep
- Department of Internal Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands
- CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
- Adelante, Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, The Netherlands
| | - Carla J H van der Kallen
- Department of Internal Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands
- CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
| | - Miranda T Schram
- Department of Internal Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands
- CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
- Heart and Vascular Centre, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Annemarie Koster
- Department of Social Medicine, Maastricht University, Maastricht, The Netherlands
- CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Abraham A Kroon
- Department of Internal Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands
- CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
| | - Marleen M J van Greevenbroek
- Department of Internal Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands
- CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
| | - Simone J P M Eussen
- CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
- Department of Epidemiology, Maastricht University, Maastricht, The Netherlands
| | - Pieter C Dagnelie
- Department of Internal Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands
- CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
| | - Marit de Jong
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Rimke C Vos
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Public Health and Primary Care / LUMC-Campus, Leiden University Medical Center, The Hague, The Netherlands
| | - Mark Woodward
- The George Institute for Global Health, University of Oxford, Oxford, United Kingdom
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Michiel L Bots
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Sanne A E Peters
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
- The George Institute for Global Health, University of Oxford, Oxford, United Kingdom
| | - Coen D A Stehouwer
- Department of Internal Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands
- CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
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Beneficial effects of Apple Cider Vinegar on weight management, Visceral Adiposity Index and lipid profile in overweight or obese subjects receiving restricted calorie diet: A randomized clinical trial. J Funct Foods 2018. [DOI: 10.1016/j.jff.2018.02.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Betts AC, Froehlich-Grobe K, Driver S, Carlton D, Kramer MK. Reducing barriers to healthy weight: Planned and responsive adaptations to a lifestyle intervention to serve people with impaired mobility. Disabil Health J 2018; 11:315-323. [PMID: 29129715 PMCID: PMC5869071 DOI: 10.1016/j.dhjo.2017.10.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 08/31/2017] [Accepted: 10/16/2017] [Indexed: 01/05/2023]
Abstract
BACKGROUND People with impaired mobility (IM) disabilities have a higher prevalence of obesity and obesity-related chronic conditions; however, lifestyle interventions that address the unique needs of people with IM are lacking. OBJECTIVE This paper describes an adapted evidence-based lifestyle intervention developed through community-based participatory research (CBPR). METHODS Individuals with IM, health professionals, disability group representatives, and researchers formed an advisory board to guide the process of thoroughly adapting the Diabetes Prevention Program Group Lifestyle Balance (DPP GLB) intervention after a successful pilot in people with IM. The process involved two phases: 1) planned adaptations to DPP GLB content and delivery, and 2) responsive adaptations to address issues that emerged during intervention delivery. RESULTS Planned adaptations included combining in-person sessions with conference calls, providing arm-based activity trackers, and adding content on adaptive cooking, adaptive physical activity, injury prevention, unique health considerations, self-advocacy, and caregiver support. During the intervention, participants encountered numerous barriers, including health and mental health issues, transportation, caregivers, employment, adjusting to disability, and functional limitations. We addressed barriers with responsive adaptations, such as supporting electronic self-monitoring, offering make up sessions, and adding content and activities on goal setting, problem solving, planning, peer support, reflection, and motivation. CONCLUSIONS Given the lack of evidence on lifestyle change in people with disabilities, it is critical to involve the community in intervention planning and respond to real-time barriers as participants engage in change. A randomized controlled trial (RCT) is underway to examine the usability, feasibility, and preliminary effectiveness of the adapted intervention.
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Affiliation(s)
- Andrea C Betts
- UTHealth School of Public Health, 5323 Harry Hines Blvd., Dallas, TX 75390-9066, USA
| | | | - Simon Driver
- Baylor Institute for Rehabilitation, 909 N. Washington Ave. Ste. 232, Dallas, TX 75246, USA
| | - Danielle Carlton
- Baylor Institute for Rehabilitation, 909 N. Washington Ave. Ste. 232, Dallas, TX 75246, USA.
| | - M Kaye Kramer
- University of Pittsburgh, 130 De Soto St., Pittsburgh, PA 15261, USA
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20
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Bazargan-Hejazi S, Arroyo JS, Hsia S, Brojeni NR, Pan D. A Racial Comparison of Differences between Self-Reported and Objectively Measured Physical Activity among US Adults with Diabetes. Ethn Dis 2017; 27:403-410. [PMID: 29225441 DOI: 10.18865/ed.27.4.403] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Objective To investigate: 1) the racial/ethnic disparities in meeting the recommended physical activity as measured by subjective vs objective measures in a national sample of individuals with type 2 diabetes mellitus; and 2) the racial/ethnic differences with respect to the magnitude of the discrepancy between self-reported and objectively measured moderate-to-vigorous intensity aerobic physical activity (MVPA). Methods We used data from the National Health and Nutrition Examination Survey (NHANES) 2003-06 to calculate and compare the percentage of individuals with diabetes who achieved the recommended levels of physical activity as measured by subjective self-report (500 metabolic equivalents (MET)-minutes/week) and objective accelerometer measurement (150 minutes per week of MVPA) across racial/ethnic groups. Results 71.2%, 15.7%, and 13.1% of participants were White, African American, and Hispanic, respectively. Based on self-report, 67.1%, 39.2%, and 55.1% of Whites, African Americans, and Hispanics, respectively, met the 500 MET-minutes/week threshold of physical activity (P<.0001). Objective measurement by accelerometer showed that 44.2%, 42.6%, and 65.1% of Whites, African Americans, and Hispanics, respectively, met the threshold (P<.0003). Conclusions Many individuals with type 2 diabetes mellitus did not meet the recommended physical activity thresholds. African Americans had the lowest proportion of meeting both the self-reported and objectively measured thresholds. White patients with diabetes overestimated frequency of their physical activity, while their Hispanic counterparts significantly underestimated it. Also, the gap between the two measures of MVPA was largest among Hispanics.
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Affiliation(s)
| | - Jeffrey S Arroyo
- College of Medicine, Charles R. Drew University of Medicine & Science, Los Angeles, CA
| | - Stanley Hsia
- Department of Internal Medicine, Charles R. Drew University of Medicine & Science, Los Angeles, CA
| | - Neda Rouhi Brojeni
- Department of Internal Medicine, St. Vincent Charity Medical Center, Cleveland, OH
| | - Deyu Pan
- Department of Internal Medicine, Charles R. Drew University of Medicine & Science, Los Angeles, CA
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Eaglehouse YL, Venditti EM, Kramer MK, Arena VC, Vanderwood KK, Rockette-Wagner B, Kriska AM. Factors related to lifestyle goal achievement in a diabetes prevention program dissemination study. Transl Behav Med 2017; 7:873-880. [PMID: 28397158 PMCID: PMC5634908 DOI: 10.1007/s13142-017-0494-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
The U.S. Diabetes Prevention Program (DPP) showed that lifestyle participants who achieved ≥7% weight loss and ≥150 min/week physical activity experienced the greatest reduction in type 2 diabetes incidence. Demographic, clinical, and program factors that are related to achieving both these lifestyle goals have seldom been explored in community-delivered DPP programs. The purpose of this investigation is to examine factors associated with concurrent achievement of weight loss and physical activity goals in a 12-month community DPP lifestyle intervention. Adults [n = 223; age = 58.4 (SD = 11.5); BMI = 33.8 (SD = 6.0)] with glucose or HbA1c values in the pre-diabetes range and/or metabolic syndrome risk factors enrolled from one worksite and three community centers in the Pittsburgh, PA metropolitan area between January 2011 and January 2014. Logistic regression analyses determined the demographic, clinical and program adherence factors related to goal achievement at 6, 12, and 18 months. Participants achieving both intervention goals at 6 months (n = 57) were more likely to attend sessions [Adjusted Odds Ratio (AOR) =1.48], self-weigh (AOR = 1.19), and self-monitor behaviors (AOR = 1.18) than those meeting neither goal (n = 35; all p < 0.05). Baseline BMI (AOR = 0.87, p < 0.01), elevated glycemic status (AOR = 0.49, p < 0.05), and female sex (AOR = 0.52, p < 0.05) were inversely related to goal achievement at 6 months. Meeting either lifestyle goal at 6 months had the strongest association with meeting both goals at 12 and 18 months. Our study supports the importance of early engagement, regular attendance, self-monitoring, and self-weighing for goal achievement. Dissemination efforts should consider alternative approaches for those not meeting goals by 6 months to enhance long-term success.
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Affiliation(s)
- Yvonne L Eaglehouse
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, 130 De Soto Street, Pittsburgh, PA, 15261, USA.
- Division of Cancer Prevention and Population Sciences, University of Pittsburgh Cancer Institute, 5150 Centre Avenue, Pittsburgh, PA, 15232, USA.
- , 11300 Rockville Pike, Suite 1120, Rockville, MD, 20852, USA.
| | - Elizabeth M Venditti
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, 130 De Soto Street, Pittsburgh, PA, 15261, USA
- Department of Psychiatry, University of Pittsburgh School of Medicine, 3550 Terrace Street, Pittsburgh, PA, 15261, USA
| | - M Kaye Kramer
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, 130 De Soto Street, Pittsburgh, PA, 15261, USA
| | - Vincent C Arena
- Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, 130 De Soto Street, Pittsburgh, PA, 15261, USA
| | - Karl K Vanderwood
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, 130 De Soto Street, Pittsburgh, PA, 15261, USA
- Montana Department of Public Health and Human Services, 111 North Sanders, Helena, MT, 59601, USA
| | - Bonny Rockette-Wagner
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, 130 De Soto Street, Pittsburgh, PA, 15261, USA
| | - Andrea M Kriska
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, 130 De Soto Street, Pittsburgh, PA, 15261, USA
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22
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Driver S, Reynolds M, Kramer K. Modifying an evidence-based lifestyle programme for individuals with traumatic brain injury. Brain Inj 2017; 31:1612-1616. [DOI: 10.1080/02699052.2017.1346286] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- Simon Driver
- Department of Physical Medicine and Rehabilitation, Baylor Institute for Rehabilitation, Baylor University Medical Center, Dallas, TX, USA
| | - Megan Reynolds
- Department of Physical Medicine and Rehabilitation, Baylor Institute for Rehabilitation, Baylor University Medical Center, Dallas, TX, USA
| | - Kaye Kramer
- Innovative Wellness Solutions, LLC, Pittsburgh, PA, USA
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Kwak MS, Kim D, Chung GE, Kim W, Kim JS. The preventive effect of sustained physical activity on incident nonalcoholic fatty liver disease. Liver Int 2017; 37:919-926. [PMID: 27917585 DOI: 10.1111/liv.13332] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 11/22/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND & AIMS Physical activity (PA) is inversely associated with nonalcoholic fatty liver disease (NAFLD) prevalence. However, few studies evaluated the effect of PA on NAFLD incidence in regard to visceral adipose tissue (VAT) and insulin resistance (IR). We investigated whether PA at baseline and change in PA during follow-up have any effect on incident NAFLD. METHODS We enrolled subjects who underwent health screenings between 2007 and 2008 and participated in voluntary follow-up between 2011 and 2013 (median 4.42 years). Incident NAFLD was defined as NAFLD absence at baseline and presence at follow-up by ultrasonography. PA was measured using a detailed questionnaire-based metabolic equivalent at baseline and follow-up; the difference during follow-up was calculated. RESULTS Of the 1373 subjects enrolled, 288 (21.0%) developed NAFLD. Both total and leisure-time PA at baseline were inversely associated with incident NAFLD (P for trend=.005 and .003 respectively). Decreased PA at follow-up was associated with increased incident NAFLD risk after adjusting for age, gender, body mass index, smoking, hypertension, diabetes and diet [hazard ratio (HR) 1.45, 95% confidence interval (CI) 1.04-2.02, 4th (most decreased PA) vs 1st quartile (increased PA), P=.028]. This relationship was attenuated but remained statistically significant after adjustment for VAT(HR 1.48, 95% CI 1.06-2.06, 4th vs 1st quartile) and IR(HR 1.59, 95% CI 1.11-2.27, 4th vs 1st quartile). CONCLUSIONS This study shows an independent protective effect of PA at baseline on incident NAFLD after 4-year follow-up. Furthermore, sustained or increased PA had a preventive effect on incident NAFLD independent of VAT and IR.
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Affiliation(s)
- Min-Sun Kwak
- Department of Internal Medicine, Healthcare Research Institute, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Korea
| | - Donghee Kim
- Department of Internal Medicine, Healthcare Research Institute, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Korea.,Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA, USA
| | - Goh Eun Chung
- Department of Internal Medicine, Healthcare Research Institute, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Korea
| | - Won Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul Metropolitan Government Boramae Medical Center, Seoul, Korea
| | - Joo Sung Kim
- Department of Internal Medicine, Healthcare Research Institute, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Korea
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24
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Strauss SM, McCarthy M. Arthritis-Related Limitations Predict Insufficient Physical Activity in Adults With Prediabetes Identified in the NHANES 2011-2014. DIABETES EDUCATOR 2017; 43:163-170. [PMID: 28169593 DOI: 10.1177/0145721717691849] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Purpose The purpose of the study was to determine the extent to which arthritis-related limitations are salient in predicting less than the recommended amount of time for adults with prediabetes to spend on moderate or vigorous physical activity. Methods Data from the 2011-2014 National Health and Nutrition Examination Survey (NHANES) in the United States were used to identify the predictors of insufficient physical activity in a large sample of adults with prediabetes 20 years of age and older (n = 2536). Results When extrapolated to more than 45 million adults in the United States at least 20 years of age with prediabetes, 42.7% had insufficient physical activity. Having arthritis-related functional limitations was a significant predictor of insufficient physical activity, even after accounting for the statistically significant contributions of female sex, older age, lower education level, higher body mass index, and depression. Conclusion When educating and counseling adults with prediabetes, diabetes educators should assess for arthritis-related functional limitations when examining factors that may affect prediabetes progression. Recommendations for physical activity for those with mobility and other limitations need to be individualized within a tailored exercise program to accommodate their specific limitations.
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Affiliation(s)
- Shiela M Strauss
- New York University Rory Meyers College of Nursing, New York, NY, USA (Dr Strauss, Dr McCarthy)
| | - Margaret McCarthy
- New York University Rory Meyers College of Nursing, New York, NY, USA (Dr Strauss, Dr McCarthy)
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Ahn S, Lee J, Bartlett-Prescott J, Carson L, Post L, Ward KD. Evaluation of a Behavioral Intervention With Multiple Components Among Low-Income and Uninsured Adults With Obesity and Diabetes. Am J Health Promot 2017; 32:409-422. [DOI: 10.1177/0890117117696250] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: To examine the effects of a community-based behavioral intervention with multiple components on health outcomes among low-income and uninsured adults who were obese and had diabetes and treated in a “real-world” setting. Design: A longitudinal design with a retrospective comparison group was used to examine the ability of a health promotion program to improve body mass index (BMI) and hemoglobin A1c (HbA1c) among 87 treatment group and 62 comparison group participants. Setting: Urban/metropolitan city in the United States. Intervention: A community-based behavioral intervention with 3 components including health-coach visits, registered dietitian visits, and exercise consultations delivered over 12 months. Measures: Biometric measurements were collected at baseline, 3, 6, 9, 12, and 18 months, whereas self-reported measurements were collected at baseline, 6 months, and 12 months. Analysis: Linear mixed models with participant-level random intercepts were fitted for BMI and HbA1c. Results: The treatment group demonstrated reductions in BMI (percentage change = −2.1%, P < .001) and HbA1c (−0.6%, P < .001) as well as improvement in diabetes knowledge (+5.4%, P = .025), whereas the comparison group did not show any improvements in biometric measures. Dietitian visits were the most effective treatment component to reduce HbA1c (coefficient = −0.08, P = .025). Conclusion: Multiple component behavioral intervention in community settings, particularly when delivered by registered dietitians, shows promise to combat the dual epidemic of obesity and diabetes among low-income and uninsured patients.
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Affiliation(s)
- SangNam Ahn
- Division of Health Systems Management and Policy, The University of Memphis School of Public Health, Memphis, TN, USA
| | - Joonhyung Lee
- Fogelman College of Business and Economics, The University of Memphis, Memphis, TN, USA
| | | | - Lisa Carson
- Methodist Le Bonheur Healthcare Hospital, Memphis, TN, USA
| | - Lindsey Post
- Division of Health Systems Management and Policy, The University of Memphis School of Public Health, Memphis, TN, USA
| | - Kenneth D. Ward
- Division of Social and Behavioral Sciences, The University of Memphis School of Public Health, Memphis, TN, USA
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26
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Rockette-Wagner B, Storti KL, Dabelea D, Edelstein S, Florez H, Franks PW, Montez MG, Pomeroy J, Kriska AM. Activity and Sedentary Time 10 Years After a Successful Lifestyle Intervention: The Diabetes Prevention Program. Am J Prev Med 2017; 52:292-299. [PMID: 27887769 PMCID: PMC5318249 DOI: 10.1016/j.amepre.2016.10.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 08/31/2016] [Accepted: 10/05/2016] [Indexed: 12/30/2022]
Abstract
INTRODUCTION This study aims to determine if evidence exists for a lasting effect of the Diabetes Prevention Program (DPP) lifestyle intervention on activity levels by comparing objectively collected activity data between the DPP Outcome Study (DPPOS) cohort and adults from the National Health and Nutrition Examination Survey (NHANES; 2003-2006). METHODS Average minutes/day of light and moderate to vigorous physical activity (MVPA) and sedentary behavior from ActiGraph accelerometers (collected 2010-2012) were examined (2013-2014) for comparable DPPOS and NHANES subgroups by age, sex, and diabetes status. Longitudinal questionnaire data on leisure activity, collected yearly from DPP baseline to the time of accelerometer measurement (1996-2010; 11.9-year mean follow-up), were also examined to provide support for a long-term intervention effect. RESULTS Average minutes/day of accelerometer-derived MVPA was higher in all DPPOS subgroups versus NHANES subgroups of similar age/sex/diabetes status; with values as much as twice as high in some DPPOS subgroups. Longitudinal questionnaire data from DPP/DPPOS showed a maintained increase of 1.24 MET hours/week (p=0.026) of leisure activity in DPPOS participants from all original study arms between DPP baseline and accelerometer recording. There were no consistent differences between comparable DPPOS and NHANES subgroups for accelerometer-derived sedentary or light-intensity activity minutes/day. CONCLUSIONS More than 10 years after the start of DPP, DPPOS participants performed more accelerometer-measured MVPA than similar adults from NHANES. Longitudinal questionnaire data support the accelerometer-based findings by suggesting that leisure activity levels at the time of accelerometer recording remained higher than DPP baseline levels.
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Affiliation(s)
| | - Kristi L Storti
- Department of Kinesiology, Health, and Sport Science, Indiana University of Pennsylvania, Indiana, Pennsylvania
| | - Dana Dabelea
- Department of Epidemiology, University of Colorado, Denver, Colorado
| | - Sharon Edelstein
- George Washington University Biostatistics Center, Rockville, Maryland
| | - Hermes Florez
- Department of Medicine, University of Miami, Miami, Florida
| | - Paul W Franks
- Department of Clinical Science, Genetic and Molecular Epidemiology Unit, Lund University, Malmö, Sweden; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Maria G Montez
- University of Texas Health Science Center, San Antonio, Texas
| | - Jeremy Pomeroy
- Diabetes Epidemiology and Clinical Research Section, U.S. NIH, Phoenix, Arizona; Center for Clinical Epidemiology and Population Health, Marshfield Clinic Research Foundation, Marshfield, Wisconsin
| | - Andrea M Kriska
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania
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Leisure-Time Physical Activity and Sedentary Behavior and Their Cross-Sectional Associations with Excessive Daytime Sleepiness in the French SU.VI.MAX-2 Study. Int J Behav Med 2016; 23:143-52. [PMID: 26249724 DOI: 10.1007/s12529-015-9501-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND The potential benefit of physical activity in terms of decreasing excessive daytime sleepiness (EDS) prevalence is unclear, especially in aging adults. PURPOSE We aimed to elucidate the associations among physical activity, sedentariness, and EDS in middle-aged and older adults. METHODS We conducted a cross-sectional analysis using data from a subsample of participants in the SU.VI.MAX-2 observational study (2007-2009; N = 4179; mean age = 61.9 years). EDS was defined as a score >10 on the Epworth Sleepiness Scale. Leisure-time physical activity and different types of sedentary behavior were assessed with the Modifiable Activity Questionnaire. The associations were examined with multivariable logistic regression models. RESULTS In the adjusted multivariable model, total leisure-time physical activity (modeled in quartiles, Q) was significantly, inversely associated with EDS (odds ratios (OR)Q4 vs Q1 = 0.70, 95 % confidence interval (CI) = 0.54-0.89). The association persisted in analyses restricted to individuals not taking sleep medication (ORQ4 vs Q1 = 0.72, 95 % CI = 0.54-0.95). In turn, time spent watching television and time spent reading appeared protective against EDS (ORQ4 vs Q1 = 0.73, 95 % CI = 0.57-0.94; ORQ4 vs Q1 = 0.76, 95 % CI = 0.60-0.97, respectively), whereas time spent on a computer appeared to confer an increased risk for EDS (ORQ4 vs Q1 = 1.30, 95 % CI = 1.05-1.62). When physical activity and sedentariness were modeled jointly, using WHO recommendation-based cutoffs for high/low levels, no significant associations were observed in the fully adjusted models. CONCLUSIONS The findings reinforce public health recommendations promoting behavior modification and specifically moderate-intensity exercise in middle-aged and older adults. The association of high physical activity/low sedentariness with EDS, which was not supported by the data, merits further investigation before firm conclusions could be drawn.
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Zarkesh M, Asghari G, Amiri P, Hosseinzadeh N, Hedayati M, Ghanbarian A, Azizi F. Familial Aggregation of Metabolic Syndrome With Different Socio-Behavioral Characteristics: The Fourth Phase of Tehran Lipid and Glucose Study. IRANIAN RED CRESCENT MEDICAL JOURNAL 2016; 18:e30104. [PMID: 27781113 PMCID: PMC5065923 DOI: 10.5812/ircmj.30104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 07/09/2015] [Accepted: 08/15/2015] [Indexed: 01/12/2023]
Abstract
BACKGROUND Since genetic and most environmental factors shape the context of families, some studies have been initiated to investigate the role of familial relationships in metabolic syndrome (MetS). OBJECTIVES To estimate the familial aggregation of MetS and its components by identifying both case and control probands among Tehranian adults with different socio-behavioral and reproductive characteristics. PATIENTS AND METHODS This case-controlled/family-based study was conducted on 1,777 families (635 case probands) who participated in the Tehran Lipid and Glucose Study (TLGS). Socio-demographic and reproductive information including levels of education, marital status, occupation status, age at menarche, number of abortions, number of children, and lifestyle habits such as smoking, physical activity and regular diet were obtained from the TLGS data bank. Metabolic syndrome was defined according to the joint interim statement (JIS) criteria. To estimate the regression co-efficient for familial aggregation and environmental factors, the generalized estimation equation method was used. RESULTS The risk of having MetS among family members for case versus control probands was 2.19 (95% CI: 1.68 - 2.84), which, after adjusting for potential confounders including age, sex, educational level, marital status, occupation, age at menarche and energy, soft drink and starchy vegetable intake, increased to 2.31 (95% CI: 1.81 - 2.94; P < 0.05). Compared to control probands, the risk of having MetS components increased significantly from OR = 1.28 for both high waist circumference (WC) and blood pressure (BP) to OR = 1.72 for high triglycerides in cases. Familial aggregation inherited from the father was significantly observed in all MetS components, from adjusted OR = 1.63 for hyperglycemia to adjusted OR = 2.69 for high WC, except for low HDL, after controlling for potential confounders. CONCLUSIONS Considering spouses and siblings, there was a higher risk for MetS components among families whose fathers and offspring had MetS components, implying the pivotal role of genetic inheritance in the incidence of the syndrome and its components.
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Affiliation(s)
- Maryam Zarkesh
- Cellular and Molecular Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Golaleh Asghari
- Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Parisa Amiri
- Research Center for Social Determinants of Endocrine Health and Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
- Corresponding Author: Parisa Amiri, Research Center for Social Determinants of Endocrine Health and Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, P. O. Box: 19395-4763, Tehran, IR Iran. Tel: +98-212409309, Fax: +98-212402463, E-mail:
| | - Nima Hosseinzadeh
- Cellular and Molecular Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Mehdi Hedayati
- Cellular and Molecular Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Arash Ghanbarian
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
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Yuzbashian E, Asghari G, Mirmiran P, Zadeh-Vakili A, Azizi F. Sugar-sweetened beverage consumption and risk of incident chronic kidney disease: Tehran lipid and glucose study. Nephrology (Carlton) 2016; 21:608-16. [DOI: 10.1111/nep.12646] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 09/17/2015] [Accepted: 10/02/2015] [Indexed: 12/18/2022]
Affiliation(s)
- Emad Yuzbashian
- Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences; Shahid Beheshti University of Medical Sciences; Tehran Iran
| | - Golaleh Asghari
- Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences; Shahid Beheshti University of Medical Sciences; Tehran Iran
| | - Parvin Mirmiran
- Department of Clinical Nutrition and Dietetics, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute; Shahid Beheshti University of Medical Sciences; Tehran Iran
| | - Azita Zadeh-Vakili
- Cellular and Molecular Endocrine Research Center, Obesity Research Center, Research Institute for Endocrine Sciences; Shahid Beheshti University of Medical Sciences; Tehran Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences; Shahid Beheshti University of Medical Sciences; Tehran Iran
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Betts AC, Froehlich-Grobe K. Accessible weight loss: Adapting a lifestyle intervention for adults with impaired mobility. Disabil Health J 2016; 10:139-144. [PMID: 27431768 DOI: 10.1016/j.dhjo.2016.06.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 06/03/2016] [Accepted: 06/12/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Despite disparities in obesity between those with and without disability, there is limited evidence to guide weight loss intervention in people with impaired mobility (IM), particularly those with severe impairments. OBJECTIVE Examine the usability, feasibility, and effectiveness of adapting an existing evidence-based weight loss program for people with IM. METHODS In this single-group pre-test post-test pilot study, 10 overweight or obese individuals with permanent IM (e.g. spinal cord injury, spina bifida, osteoarthritis) participated in a 20-week modification of the DPP Group Lifestyle Balance™ (DPP GLB) program, a group-based adaptation of the Diabetes Prevention Program (DPP). Fifteen conference calls encouraged reducing calorie and fat intake and increasing exercise through self-monitoring and problem solving. We defined feasibility as retention and engagement, usability as participants' program satisfaction ratings, and effectiveness as physiological and psychosocial change measured on three occasions over 20 weeks. Analytic methods included basic descriptive statistics (feasibility and usability) and repeated measures ANOVA (effectiveness). RESULTS The program retained 70% of participants. These individuals attended an average of 79.3% of conference calls and self-monitored more than half of the weeks. Participants rated the program highly, with mean overall scores of 6.3 ± 0.3 and 6.2 ± 0.6 out of 7 on helpfulness and satisfaction scales, respectively. Program completers experienced a significant mean weight loss of 8.86 ± 8.37 kg (p = 0.024), or 7.4% of their start weight, and significantly reduced their BMI. CONCLUSIONS An adapted version of the DPP GLB is a feasible, usable, and potentially effective intervention for promoting weight loss among persons with IM.
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Affiliation(s)
- Andrea C Betts
- Baylor Institute for Rehabilitation, Dallas, TX, USA; Division of Health Promotion and Behavioral Sciences, University of Texas School of Public Health, Dallas Regional Campus, USA
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Kandula NR, Dave S, De Chavez PJ, Marquez DX, Bharucha H, Mammen S, Dunaif A, Ackermann RT, Kumar S, Siddique J. An Exercise Intervention for South Asian Mothers with Risk Factors for Diabetes. TRANSLATIONAL JOURNAL OF THE AMERICAN COLLEGE OF SPORTS MEDICINE 2016; 1:52-59. [PMID: 27617303 PMCID: PMC5015884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
PURPOSE South Asians (Indians, Pakistanis, Bangladeshis, Sri Lankans, Nepalis, and Bhutanese) in the United States have a very high prevalence of type 2 diabetes mellitus (DM). This pilot study evaluated a culturally-tailored exercise intervention among South Asian immigrant mothers with DM risk factors. METHODS Through an academic-community partnership, South Asian women with risk factors for DM and who had at least one child between 6-14 years were enrolled into this single-arm study. The intervention for the mothers included 16-weeks of twice weekly exercise classes, self-monitoring with activity trackers, goal-setting, and classes on healthy eating. Based on prior community-based participatory research, children were offered exercise classes during the mothers' classes. The primary efficacy outcomes were change in mothers' moderate/vigorous physical activity and body weight pre- and post-intervention (16-weeks). Program adherence, clinical, and psychosocial outcomes were measured. A qualitative process evaluation was conducted to understand participant perspectives. RESULTS Participants' (n=30) average age was 40 (SD=5) years., 57% had a high school education or less, and all were overweight/obese.. At baseline, women were not meeting recommended physical activity guidelines. Overall, participants attended 75% of exercise classes. Compared to baseline, participants' weight decreased by 3.2 lbs. (95% CI: -5.5, -1.0) post-intervention. Among women who attended at least 80% of classes (n=17), weight change was -4.8 lbs, (95% CI: -7.7, -1.9). Change in accelerometer-measured physical activity was not significant; however exercise-related confidence increased from baseline (p-value <0.01). Women described multiple physical and psychosocial benefits from the intervention. CONCLUSION This pilot study suggests that a culturally-tailored exercise intervention that included exercise classes for children was feasible and had physical and psychosocial benefits in South Asian mothers with risk factors for DM.
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Affiliation(s)
- Namratha R Kandula
- Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, IL; Department of Preventive Medicine, Northwestern University, Chicago, IL
| | - Swapna Dave
- Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | - David X Marquez
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, IL
| | | | - Shinu Mammen
- Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Andrea Dunaif
- Department of Medicine, Division of Endocrinology, Metabolism and Molecular Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Ronald T Ackermann
- Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | - Juned Siddique
- Department of Preventive Medicine, Northwestern University, Chicago, IL
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Kautzky-Willer A, Harreiter J, Pacini G. Sex and Gender Differences in Risk, Pathophysiology and Complications of Type 2 Diabetes Mellitus. Endocr Rev 2016; 37:278-316. [PMID: 27159875 PMCID: PMC4890267 DOI: 10.1210/er.2015-1137] [Citation(s) in RCA: 1031] [Impact Index Per Article: 128.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The steep rise of type 2 diabetes mellitus (T2DM) and associated complications go along with mounting evidence of clinically important sex and gender differences. T2DM is more frequently diagnosed at lower age and body mass index in men; however, the most prominent risk factor, which is obesity, is more common in women. Generally, large sex-ratio differences across countries are observed. Diversities in biology, culture, lifestyle, environment, and socioeconomic status impact differences between males and females in predisposition, development, and clinical presentation. Genetic effects and epigenetic mechanisms, nutritional factors and sedentary lifestyle affect risk and complications differently in both sexes. Furthermore, sex hormones have a great impact on energy metabolism, body composition, vascular function, and inflammatory responses. Thus, endocrine imbalances relate to unfavorable cardiometabolic traits, observable in women with androgen excess or men with hypogonadism. Both biological and psychosocial factors are responsible for sex and gender differences in diabetes risk and outcome. Overall, psychosocial stress appears to have greater impact on women rather than on men. In addition, women have greater increases of cardiovascular risk, myocardial infarction, and stroke mortality than men, compared with nondiabetic subjects. However, when dialysis therapy is initiated, mortality is comparable in both males and females. Diabetes appears to attenuate the protective effect of the female sex in the development of cardiac diseases and nephropathy. Endocrine and behavioral factors are involved in gender inequalities and affect the outcome. More research regarding sex-dimorphic pathophysiological mechanisms of T2DM and its complications could contribute to more personalized diabetes care in the future and would thus promote more awareness in terms of sex- and gender-specific risk factors.
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Affiliation(s)
- Alexandra Kautzky-Willer
- Gender Medicine Unit (A.K.-W., J.H.), Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, 1090 Vienna, Austria; and Metabolic Unit (G.P.), Institute of Neuroscience, National Research Council, 35127 Padua, Italy
| | - Jürgen Harreiter
- Gender Medicine Unit (A.K.-W., J.H.), Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, 1090 Vienna, Austria; and Metabolic Unit (G.P.), Institute of Neuroscience, National Research Council, 35127 Padua, Italy
| | - Giovanni Pacini
- Gender Medicine Unit (A.K.-W., J.H.), Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, 1090 Vienna, Austria; and Metabolic Unit (G.P.), Institute of Neuroscience, National Research Council, 35127 Padua, Italy
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Farhadnejad H, Asghari G, Mirmiran P, Yuzbashian E, Azizi F. Micronutrient Intakes and Incidence of Chronic Kidney Disease in Adults: Tehran Lipid and Glucose Study. Nutrients 2016; 8:217. [PMID: 27104561 PMCID: PMC4848686 DOI: 10.3390/nu8040217] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Revised: 03/13/2016] [Accepted: 03/28/2016] [Indexed: 12/16/2022] Open
Abstract
The aim of this study was to investigate the associations between micronutrient intakes and the 3.6-year incidence of chronic kidney disease (CKD) in adults. This cohort study was conducted, within the framework of the Tehran Lipid and Glucose Study, on 1692 subjects, aged ≥30 years, without CKD at the baseline. Dietary intakes were collected using a valid and reliable food-frequency questionnaire. Anthropometrics and biochemical measurements were taken. Chronic kidney disease was defined as eGFR < 60 mL/min/1.73 m2. The mean age of participants was 43.3 ± 11.4 years. In the fully adjusted model, individuals in the top quintile of folate (OR: 0.44, 95% CI: 0.24–0.80), cobalamin (OR: 0.57, 95% CI: 0.34–0.93), vitamin C (OR: 0.38, 95% CI: 0.21–0.69), vitamin E (OR: 0.45, 95% CI: 0.22–0.92), vitamin D (OR: 0.39, 95% CI: 0.21–0.70), potassium (OR: 0.47, 95% CI: 0.23–0.97) and magnesium (OR: 0.41, 95% CI: 0.22–0.76) had decreased risk of CKD, and in the top quintile of sodium (OR: 1.64, 95% CI: 1.03–2.61), subjects had increased risk of CKD, in comparison to the bottom quintile. No significant associations were found between the intakes of other micronutrients. High intake of several micronutrients including vitamins C, E, D, cobalamin, folate, magnesium, and potassium was associated with a decreased risk, while sodium was associated with an increased risk of incident CKD.
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Affiliation(s)
- Hossein Farhadnejad
- Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran 19395-4763, Iran.
| | - Golaleh Asghari
- Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran 19395-4763, Iran.
| | - Parvin Mirmiran
- Department of Clinical Nutrition and Dietetics, National Nutrition and Food Technology Research Institute, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran 19395-4741, Iran.
| | - Emad Yuzbashian
- Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran 19395-4763, Iran.
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran 19395-4763, Iran.
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Cha E, Akazawa MK, Kim KH, Dawkins CR, Lerner HM, Umpierrez G, Dunbar SB. Lifestyle habits and obesity progression in overweight and obese American young adults: Lessons for promoting cardiometabolic health. Nurs Health Sci 2015; 17:467-75. [PMID: 26086402 PMCID: PMC4609221 DOI: 10.1111/nhs.12218] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Revised: 02/13/2015] [Accepted: 02/17/2015] [Indexed: 02/04/2023]
Abstract
Obesity among young adults is a growing problem in the United States and is related to unhealthy lifestyle habits, such as high caloric intake and inadequate exercise. Accurate assessment of lifestyle habits across obesity stages is important for informing age-specific intervention strategies to prevent and reduce obesity progression. Using a modified version of the Edmonton Obesity Staging System (mEOSS), a new scale for defining obesity risk and predicting obesity morbidity and mortality, this cross-sectional study assessed the prevalence of overweight/obese conditions in 105 young adults and compared their lifestyle habits across the mEOSS stages. Descriptive statistics, chi-square tests, and one-way analyses of variance were performed. Eighty percent of participants (n = 83) fell into the mEOSS-2 group and had obesity-related chronic disorders, such as diabetes, hypertension, and/or dyslipidemia. There were significant differences in dietary quality and patterns across the mEOSS stages. Findings highlighted the significance of prevention and early treatment for overweight and obese young adults to prevent and cease obesity progression.
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Affiliation(s)
- EunSeok Cha
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Margeaux K Akazawa
- Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Kevin H Kim
- Posthumous, University of Pittsburgh, School of Education, Pittsburgh, Pennsylvania, USA
| | - Colleen R Dawkins
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Hannah M Lerner
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | | | - Sandra B Dunbar
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
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Cha E, Braxter BJ, Kim KH, Lee H, Akazawa MK, Talman MS, Pinto MD, Faulkner MS. Preventive strategies to reduce depressive symptoms in overweight and obese young adults. Arch Psychiatr Nurs 2015; 29:258-64. [PMID: 26397427 PMCID: PMC4580911 DOI: 10.1016/j.apnu.2015.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Revised: 11/23/2014] [Accepted: 04/11/2015] [Indexed: 11/17/2022]
Abstract
This study examined the relationships among problem-solving, physical activity self-efficacy, leisure-time physical activity, and depressive symptoms in overweight/obese young adults vulnerable to many health risks. Data from 96 young adults were used. The mean age and body mass index were 24.0±3.3 years old, and 36.9±7.9, respectively. There was a positive association between physical activity self-efficacy and leisure-time physical activity in African Americans, but not in non-African Americans. Better problem solving was associated with fewer depressive symptoms regardless of gender and race.
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Affiliation(s)
- EunSeok Cha
- Emory University Nell Hodgson Woodruff School of Nursing, Atlanta, GA.
| | | | - Kevin H Kim
- University of Pittsburgh School of Education, Pittsburgh, PA
| | - Heeyoung Lee
- University of Pittsburgh School of Nursing, Pittsburgh, PA
| | | | | | - Melissa D Pinto
- Emory University Nell Hodgson Woodruff School of Nursing, Atlanta, GA
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Boucher AB, Adesanya EAO, Owei I, Gilles AK, Ebenibo S, Wan J, Edeoga C, Dagogo-Jack S. Dietary habits and leisure-time physical activity in relation to adiposity, dyslipidemia, and incident dysglycemia in the pathobiology of prediabetes in a biracial cohort study. Metabolism 2015; 64:1060-7. [PMID: 26116207 PMCID: PMC4828921 DOI: 10.1016/j.metabol.2015.05.015] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Revised: 05/28/2015] [Accepted: 05/29/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Dietary and exercise data are frequently recorded in clinical research, but their correlation with metabolic measures needs further evaluation. OBJECTIVE We examined the association of food and exercise habits with body size, lipid profile, and glycemia in a prospective biracial cohort. METHODS The Pathobiology of Prediabetes in A Biracial Cohort study followed initially normoglycemic offspring of parents with type 2 diabetes (T2DM) for the occurrence of incident prediabetes, defined as impaired fasting glucose (IFG) and/or impaired glucose tolerance (IGT). At enrollment, participants underwent a 75-gram OGTT, anthropometry, measurement of fasting lipids, insulin, and body fat (DEXA), and completed the Food Habits Questionnaire (FHQ), and Modifiable Activity Questionnaire (MAQ). We assessed the relationship between FHQ and MAQ scores and adiposity, cardiometabolic measures, and incident dysglycemia. RESULTS Among our cohort of 338 subjects (188 black, 150 white; mean age {±SD} 45.2±10.2 years, BMI 30.3±7.2 kg/m(2)), FHQ and MAQ scores were individually correlated with BMI (r=0.14, -0.12; P=0.01, 0.03) and waist circumference (r=0.19, -0.11; P=0.004, 0.05). Diet-adjusted leisure activity (MAQ/FHQ) was significantly correlated with total body fat (r=-0.20, P=0.0007), trunk fat (r=-0.20, P=0.0006), and serum triglycerides (r=-0.17, P=0.003) and HDL cholesterol (r=0.11, P=0.04) levels. During 5.5 years of follow-up, 111 subjects (Progressors) developed prediabetes (n=101) or diabetes (n=10) and 227 remained normoglycemic (Non-progressors). Age, BMI, MAQ and MAQ/FHQ values were significant predictors of incident prediabetes/diabetes. Progressors reported similar dietary habits (FHQ score 2.57±0.49 vs. 2.57±0.53) but 30% lower physical activity (MAQ score 15.2±20.5 vs. 22.3±30.5 MET-hr/wk, P=0.015) compared with non-progressors. CONCLUSIONS Among African-American and Caucasian offspring of parents with T2DM, self-reported dietary and exercise habits correlated with measures of adiposity and dyslipidemia; however, physical activity, but not dietary recall, significantly predicted incident dysglycemia during 5.5 years of follow-up.
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Affiliation(s)
- Andrew B Boucher
- Division of Endocrinology, Diabetes and Metabolism, University of Tennessee Health Science Center, Memphis, TN, USA
| | - E A Omoluyi Adesanya
- The Division of Biological Sciences, The University of Chicago, Chicago, IL, USA
| | - Ibiye Owei
- Division of Endocrinology, Diabetes and Metabolism, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Ashley K Gilles
- Division of Endocrinology, Diabetes and Metabolism, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Sotonte Ebenibo
- Division of Endocrinology, Diabetes and Metabolism, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Jim Wan
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Chimaroke Edeoga
- Division of Endocrinology, Diabetes and Metabolism, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Samuel Dagogo-Jack
- Division of Endocrinology, Diabetes and Metabolism, University of Tennessee Health Science Center, Memphis, TN, USA.
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Mirmiran P, Yuzbashian E, Asghari G, Hosseinpour-Niazi S, Azizi F. Consumption of sugar sweetened beverage is associated with incidence of metabolic syndrome in Tehranian children and adolescents. Nutr Metab (Lond) 2015. [PMID: 26225136 PMCID: PMC4518610 DOI: 10.1186/s12986-015-0021-6] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background Intakes of high sugar-sweetened beverages (SSBs) in adults can escalate risk of metabolic syndrome (MetS); however, data of longitudinal studies in children and adolescents are lacking. In this study we assessed consumption of SSBs in relation to incidence of MetS among children and adolescents during a 3.6 year follow-up. Methods This study was a population-based longitudinal study, in which 424 subjects, aged 6–18 years, from the Tehran Lipid and Glucose Study with complete data on dietary intake, blood pressure, anthropometry, and biochemical indices were followed for 3.6 years. Dietary intake was collected using a valid and reliable food frequency questionnaire. MetS was defined according to the Cook criteria. Sugar sweetened beverages included all kinds of sugar sweetened carbonated soft drinks (SSSDs) and fruit juice drinks. Results Average daily intakes of SSSD and fruit juice drinks were 38.5 ± 75.0 and 32.3 ± 60.1 g, respectively. After adjustment for confounders, compared to the first quartile, the odds ratio of incident MetS in the highest quartile of SSB and SSSD was 3.20 (95 % CI: 1.06–9.90) and 3.01 (95 % CI: 1.17–7.74), respectively. Regarding incidence of MetS components, compared with the lowest quartile, the highest quartile of SSSDs showed odds ratios of 2.49 (95 % CI: 1.00–6.53) for abdominal obesity and 2.79 (95 % CI: 1.02–7.64) for hypertension. No significant association was found between consumption of fruit juice drink and SSSD with other components of MetS. Conclusions Children and adolescents with high intakes of carbonated beverages could be at increased risk of MetS, abdominal obesity, and hypertension.
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Affiliation(s)
- Parvin Mirmiran
- Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Emad Yuzbashian
- Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Golaleh Asghari
- Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Somayeh Hosseinpour-Niazi
- Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Association between thyroid hormones, thyroid antibodies and insulin resistance in euthyroid individuals: A population-based cohort. DIABETES & METABOLISM 2015; 41:480-8. [PMID: 26049821 DOI: 10.1016/j.diabet.2015.04.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 04/26/2015] [Accepted: 04/27/2015] [Indexed: 02/08/2023]
Abstract
AIM The association between insulin resistance and thyroid function in euthyroid subjects has not yet been clarified. This study aimed to investigate the association between thyroid function within the normal reference range and insulin resistance in participants of the Tehran Thyroid Study (TTS). METHODS This cross-sectional study was conducted within the framework of the TTS. Of 5786 subjects aged ≥ 20 years, 2758 euthyroid subjects free of thyroid disorders, diabetes, chronic kidney disease and cardiovascular disease, and not taking steroids and lipid-lowering agents, were included. Serum concentrations of free thyroxine (FT4) and TSH were measured. The homoeostasis model assessment index for insulin resistance (HOMA-IR) was used to evaluate IR. RESULTS On linear regression analysis, a negative association was found between serum FT4 levels and HOMA-IR in the model with age, smoking and physical activity (B = -0.09, P < 0.001) and in the WC-adjusted model with age, smoking and physical activity for men (B = -0.06, P < 0.01). In addition, there was a positive association between serum TSH levels and HOMA-IR in both models [with age, smoking and physical activity (B = 0.07, P = 0.006), and age, smoking, physical activity and adjusted for WC (B = 0.05, P = 0.01)] that was not more significant on logistic regression analysis. In women, neither serum FT4 nor TSH levels were associated with HOMA-IR; the prevalence of IR decreased from 27.2 to 19.1 with increasing tertiles of FT4 only in men (P = 0.01). No significant differences were observed in HOMA-IR and its components between thyroid peroxidase antibody (TPOAb)-negative and -positive groups. Also, it was found that metabolically healthy but obese (MHO) subjects had higher levels of TSH than individuals who were MONW (metabolically obese but normal weight; P < 0.01). CONCLUSION Low FT4 was independently associated with IR in healthy euthyroid Iranian men.
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Kwak MS, Kim D, Chung GE, Kim W, Kim YJ, Yoon JH. Role of physical activity in nonalcoholic fatty liver disease in terms of visceral obesity and insulin resistance. Liver Int 2015; 35:944-52. [PMID: 24684289 DOI: 10.1111/liv.12552] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Accepted: 03/23/2014] [Indexed: 02/13/2023]
Abstract
BACKGROUND & AIMS Limited evidence supports a role for physical activity (PA) in nonalcoholic fatty liver disease (NAFLD) independent of visceral obesity or/and insulin resistance. We investigated the association between PA and NAFLD while considering visceral adipose tissue (VAT) and insulin resistance in a large general population. METHODS Nonalcoholic fatty liver disease was diagnosed based on typical ultrasonographic findings. A detailed PA questionnaire included type, frequency, duration and length of time that the subject engaged in PA. PA was determined by a metabolic equivalent. VAT was evaluated by computed tomography taken at the umbilicus level. RESULTS A total of 3718 subjects were enrolled in the analysis. After adjusting for age, gender, body mass index, smoking, hypertension, diabetes, soft drink and coffee consumption, the total PA was inversely associated with NAFLD [4th quartile (highest activities), odds ratio (OR) 0.68, 95% confidence interval (CI) 0.54-0.85; 3rd quartile, OR 0.74, 95% CI 0.59-0.93 vs. 1st quartile (lowest activities), P for trend <0.001]. After further adjusting for VAT or insulin resistance or both (P for trend = 0.027, 0.001 and 0.040 respectively), this relationship was slightly attenuated but remained statistically significant. The leisure-time PA and weighted PA also had inverse associations with NAFLD independent of the VAT or insulin resistance or both. CONCLUSIONS This study showed an inverse association between various types of PA and the prevalence of NAFLD in a dose-dependent manner that was independent of visceral obesity and insulin resistance. This finding suggests a beneficial association between PA and NAFLD.
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Affiliation(s)
- Min-Sun Kwak
- Department of Internal Medicine, Healthcare Research Institute, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Korea
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Prevention of Diabetes Through the Lifestyle Intervention: Lessons Learned from the Diabetes Prevention Program and Outcomes Study and its Translation to Practice. Curr Nutr Rep 2014; 3:364-378. [PMID: 25383256 DOI: 10.1007/s13668-014-0094-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
A number of strategies have been used to delay or prevent the development of type 2 diabetes mellitus (T2D) in high-risk adults. Among them were diet, exercise, medications and surgery. This report focuses on the nutritional lessons learned from implementation of the Intensive Lifestyle Intervention (ILI) in the DPP and its follow-up DPPOS that looked at weight loss through modification of diet and exercise. The Diabetes Prevention Program (DPP) is a large clinical trial, sponsored by the National Institutes of Health, designed to look at several strategies to prevent conversion to type 2 diabetes (T2D) by adults with prediabetes (IGT/IFG) including an Intensive Lifestyle Intervention (ILI). The ∼3800 ethnically diverse participants (46% reported non-white race) were overweight, had impaired glucose tolerance (IGT) and impaired fasting glucose (IFG). Treatments were assigned randomly. The Diabetes Prevention Program Outcomes Study (DPPOS) is a follow up study evaluating the long-term outcomes of the clinical trial.
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Cha E, Kim KH, Umpierrez G, Dawkins CR, Bello MK, Lerner HM, Narayan KMV, Dunbar SB. A feasibility study to develop a diabetes prevention program for young adults with prediabetes by using digital platforms and a handheld device. DIABETES EDUCATOR 2014; 40:626-37. [PMID: 24950683 DOI: 10.1177/0145721714539736] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this pilot study was to examine the feasibility and preliminary efficacy of an age-specific diabetes prevention program in young adults with prediabetes. METHODS A one-group pretest-posttest design was used. The inclusion criteria were age 18 to 29 years and the presence of prediabetes (either impaired fasting glucose of 100-125 mg/dL [5.55-6.94 mmol/L] or A1C of 5.7%-6.4%). Fifteen participants were enrolled in the study. A technology-based lifestyle coaching program focused on diet and physical activity and incorporating a handheld device and digital platforms was developed and tested. Psychosocial factors (health literacy, illness perception, self-efficacy, therapeutic efficacy) based on social cognitive theory, changes in diet and physical activity, and cardiometabolic risk factors were assessed at baseline and week 12 after the intervention. A paired-samples t test was performed to examine changes between baseline and postintervention on each psychosocial and physical variable. RESULTS Participants' (n = 13 completers) mean age was 24.4 ± 2.2 years, 23.1% were male, and 53.8% were African American. Overall, the participants were satisfied with the intervention (mean score, 4.15 on a 5-point, Likert-type scale). Between pre- and posttesting, mean body mass index and mean A1C decreased from 41.0 ± 7.3 kg/m(2) and 6.0 ± 0.5% to 40.1 ± 7.0 kg/m(2) and 5.6 ± 0.5%, respectively, whereas mean fasting glucose did not significantly change (from 92.6 ± 11 to 97.6 ± 14.3 mg/dL [5.14 ± 0.61 to 5.42 ± 0.79 mmol/L]). CONCLUSIONS The intervention resulted in reduced A1C and a trend toward decreased body mass index in obese sedentary young adults with prediabetes after 12 weeks. Further study through a randomized clinical trial with a longer intervention period is warranted.
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Affiliation(s)
- EunSeok Cha
- Emory University, Atlanta, Georgia (Dr Cha, Dr Umpierrez, Ms Dawkins, Ms Bello, Dr Venkat Narayan, Dr Dunbar)
| | - Kevin H Kim
- University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Kim)
| | - Guillermo Umpierrez
- Emory University, Atlanta, Georgia (Dr Cha, Dr Umpierrez, Ms Dawkins, Ms Bello, Dr Venkat Narayan, Dr Dunbar)
| | - Colleen R Dawkins
- Emory University, Atlanta, Georgia (Dr Cha, Dr Umpierrez, Ms Dawkins, Ms Bello, Dr Venkat Narayan, Dr Dunbar)
| | - Morenike K Bello
- Emory University, Atlanta, Georgia (Dr Cha, Dr Umpierrez, Ms Dawkins, Ms Bello, Dr Venkat Narayan, Dr Dunbar)
| | | | - K M Venkat Narayan
- Emory University, Atlanta, Georgia (Dr Cha, Dr Umpierrez, Ms Dawkins, Ms Bello, Dr Venkat Narayan, Dr Dunbar)
| | - Sandra B Dunbar
- Emory University, Atlanta, Georgia (Dr Cha, Dr Umpierrez, Ms Dawkins, Ms Bello, Dr Venkat Narayan, Dr Dunbar)
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Davis NJ, Ma Y, Delahanty LM, Hoffman HJ, Mayer-Davis E, Franks PW, Brown-Friday J, Isonaga M, Kriska AM, Venditti EM, Wylie-Rosett J. Predictors of sustained reduction in energy and fat intake in the Diabetes Prevention Program Outcomes Study intensive lifestyle intervention. J Acad Nutr Diet 2013; 113:1455-1464. [PMID: 24144073 DOI: 10.1016/j.jand.2013.07.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Accepted: 06/23/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Few lifestyle intervention studies examine long-term sustainability of dietary changes. OBJECTIVE To describe sustainability of dietary changes over 9 years in the Diabetes Prevention Program and its outcomes study, the Diabetes Prevention Program Outcomes Study, among participants receiving the intensive lifestyle intervention. DESIGN One thousand seventy-nine participants were enrolled in the intensive lifestyle intervention arm of the Diabetes Prevention Program; 910 continued participation in the Diabetes Prevention Program Outcomes Study. Fat and energy intake derived from food frequency questionnaires at baseline and post-randomization Years 1 and 9 were examined. Parsimonious models determined whether baseline characteristics and intensive lifestyle intervention session participation predicted sustainability. RESULTS Self-reported energy intake was reduced from a median of 1,876 kcal/day (interquartile range [IQR]=1,452 to 2,549 kcal/day) at baseline to 1,520 kcal/day (IQR=1,192 to 1,986 kcal/day) at Year 1, and 1,560 kcal/day (IQR=1,223 to 2,026 kcal/day) at Year 9. Dietary fat was reduced from a median of 70.4 g (IQR=49.3 to 102.5 g) to 45 g (IQR=32.2 to 63.8 g) at Year 1 and increased to 61.0 g (IQR=44.6 to 82.7 g) at Year 9. Percent energy from fat was reduced from a median of 34.4% (IQR=29.6% to 38.5%) to 27.1% (IQR=23.1% to 31.5%) at Year 1 but increased to 35.3% (IQR=29.7% to 40.2%) at Year 9. Lower baseline energy intake and Year 1 dietary reduction predicted lower energy and fat gram intake at Year 9. Higher leisure physical activity predicted lower fat gram intake but not energy intake. CONCLUSIONS Intensive lifestyle intervention can result in reductions in total energy intake for up to 9 years. Initial success in achieving reductions in fat and energy intake and success in attaining activity goals appear to predict long-term success at maintaining changes.
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Strath SJ, Kaminsky LA, Ainsworth BE, Ekelund U, Freedson PS, Gary RA, Richardson CR, Smith DT, Swartz AM. Guide to the Assessment of Physical Activity: Clinical and Research Applications. Circulation 2013; 128:2259-79. [DOI: 10.1161/01.cir.0000435708.67487.da] [Citation(s) in RCA: 584] [Impact Index Per Article: 53.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Faam B, Hosseinpanah F, Amouzegar A, Ghanbarian A, Asghari G, Azizi F. Leisure-time physical activity and its association with metabolic risk factors in Iranian adults: Tehran Lipid and Glucose Study, 2005-2008. Prev Chronic Dis 2013; 10:E36. [PMID: 23489641 PMCID: PMC3600871 DOI: 10.5888/pcd10.120194] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
We examined the association between leisure-time physical activity (LTPA) and metabolic syndrome (MetS) among 4,665 randomly selected adults who participated in the Tehran Lipid and Glucose Study, 2005-2008. Normal-weight participants with light LTPA had higher risk of low high-density lipoprotein cholesterol and elevated levels of triglycerides than those with vigorous LTPA. Overweight adults with moderate LTPA had higher risk of having elevated levels of fasting blood glucose than adults with vigorous LTPA and, in the same group, we found an inverse association between light LTPA and MetS after adjustment for sex, age, education levels, smoking, and calorie intake. Although participants in the normal-weight and obese groups with vigorous LTPA had higher risk of high systolic blood pressure than participants with moderate LTPA, this finding had no clinical significance. Increased LTPA is associated with decreased risk of any damaging changes in the markers of MetS.
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Affiliation(s)
- Bita Faam
- Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Smith HA, Storti KL, Arena VC, Kriska AM, Gabriel KKP, Sutton-Tyrrell K, Hames KC, Conroy MB. Associations between accelerometer-derived physical activity and regional adiposity in young men and women. Obesity (Silver Spring) 2013; 21:1299-305. [PMID: 23408709 PMCID: PMC3716839 DOI: 10.1002/oby.20308] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Empirical evidence supports an inverse relationship between physical activity (PA) and adiposity, but studies using detailed measures of both are scarce. The relationship between regional adiposity and accelerometer-derived PA in men and women are described. DESIGN AND METHODS Cross-sectional analysis included 253 participants from a weight loss study limited to ages 20-45 years and BMI 25-39.9 kg m(-2) . PA data were collected with accelerometers and expressed as total accelerometer counts and average amount of time per day accumulated in different intensity levels [sedentary, light-, and moderate-to-vigorous intensity PA (MVPA)]. Accumulation of time spent above 100 counts was expressed as total active time. Computed tomography (CT) was used to measure abdominal and adipose tissue (AT). Multivariate linear regression analyses were used to assess the relationship between regional adiposity (dependent variable) and the various PA levels (independent variable), and were executed separately for men and women, adjusting for wear time, age, race, education, and BMI. RESULTS Among males, light activity was inversely associated with total AT (β = -0.19; P = 0.02) as well as visceral AT (VAT) (β = -0.30; P = 0.03). Among females sedentary time was positively associated with VAT (β = 0.11; P = 0.04) and total active time was inversely associated with VAT (β = -0.12; P = 0.04). CONCLUSIONS Findings from this study suggest that PA intensity level may influence regional adiposity differently in men and women. Additional research is needed in larger samples to clarify the difference in these associations by sex, create recommendations for the frequency, duration and intensity of PA needed to target fat deposits, and determine if these recommendations should differ by sex.
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Affiliation(s)
- H A Smith
- Department of Enterprise Informatics, Highmark, Pittsburgh, Pennsylvania, USA
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Cha E, Umpierrez G, Kim KH, Bello MK, Dunbar SB. Characteristics of American young adults with increased risk for type 2 diabetes: a pilot study. DIABETES EDUCATOR 2013; 39:454-63. [PMID: 23640300 DOI: 10.1177/0145721713486199] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The purpose of the study was to examine the characteristics of American young adults with increased risk for type 2 diabetes (T2D). METHODS Participants ages 18 to 29, overweight/obese, and sedentary were recruited from the metro Atlanta area in the United States. Variables included demographics, anthropometric and clinical variables, and physical activity. Of 107 participants, 3 participants had undiagnosed diabetes and 1 participant did not complete the modifiable activity questionnaire. Thus, 103 young adults remained for the final data analysis. RESULTS Most participants were females and African Americans. About 30% of participants had prediabetes, either impaired fasting glucose, an A1C of 5.7% to 6.4%, or both. Overall, prediabetes young adults were heavier and did less physical activity than Diabetes Prevention Program (DPP) trial participants. In addition, these young adults had a higher prevalence of parental T2D history and lower level of physical activity compared to young adults with normoglycemia. CONCLUSIONS Physical activity and parent T2D history are key risk factors for identifying young adults with prediabetes. Multilevel strategies are necessary to raise awareness of diabetes risk and to prevent T2D in young adults.
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Affiliation(s)
- Eunseok Cha
- Emory University, Atlanta, Georgia (Drs Cha, Umpierrez, Dunbar, Ms Bello)
| | | | - Kevin H Kim
- University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Kim)
| | - Morenike K Bello
- Emory University, Atlanta, Georgia (Drs Cha, Umpierrez, Dunbar, Ms Bello)
| | - Sandra B Dunbar
- Emory University, Atlanta, Georgia (Drs Cha, Umpierrez, Dunbar, Ms Bello)
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Kriska A, Delahanty L, Edelstein S, Amodei N, Chadwick J, Copeland K, Galvin B, El ghormli L, Haymond M, Kelsey M, Lassiter C, Mayer-Davis E, Milaszewski K, Syme A. Sedentary behavior and physical activity in youth with recent onset of type 2 diabetes. Pediatrics 2013; 131:e850-6. [PMID: 23400602 PMCID: PMC3581838 DOI: 10.1542/peds.2012-0620] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE With the rise of type 2 diabetes in youth, it is critical to investigate factors such as physical activity (PA) and time spent sedentary that may be contributing to this public health problem. This article describes PA and sedentary time in a large cohort of youth with type 2 diabetes and compares these levels with other large-scale investigations. METHODS The Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) trial is a study in 699 youth, recruited from 15 US clinical centers, aged 10 to 17 years with <2 years of type 2 diabetes and a BMI ≥85th percentile. RESULTS In comparison with the subset of the NHANES cohort who were obese (BMI ≥95th percentile), TODAY youth spent significantly more time being sedentary (difference averaging 56 minutes per day; P < .001) as assessed by accelerometry. Although moderate to vigorous activity levels in both obese cohorts for all age groups were exceptionally low, younger TODAY boys were still significantly less active than similarly aged NHANES youth. Comparisons between the TODAY girls and other investigations suggest that the TODAY girls also had relatively lower PA and fitness levels. CONCLUSIONS Adolescents with type 2 diabetes from the large TODAY cohort appear to be less physically active and tend to spend more time being sedentary than similarly aged youth without diabetes identified from other large national investigations. Treatment efforts in adolescents with type 2 diabetes should include decreasing sitting along with efforts to increase PA levels.
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Affiliation(s)
- Andrea Kriska
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Linda Delahanty
- Diabetes Research Center, Massachusetts General Hospital, Boston, Massachusetts
| | - Sharon Edelstein
- Biostatistics Center, George Washington University, Rockville, Maryland
| | - Nancy Amodei
- Department of Pediatrics, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Jennifer Chadwick
- University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Kenneth Copeland
- University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Bryan Galvin
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Laure El ghormli
- Biostatistics Center, George Washington University, Rockville, Maryland
| | - Morey Haymond
- Children’s Nutrition Research Center, Baylor College of Medicine, Houston, Texas
| | - Megan Kelsey
- Children’s Hospital Colorado, University of Colorado Denver, Aurora, Colorado
| | - Chad Lassiter
- Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Elizabeth Mayer-Davis
- Department of Nutrition, University of North Carolina Chapel Hill, Chapel Hill, North Carolina
| | | | - Amy Syme
- Department of Pediatric Endocrinology, Yale University School of Medicine, New Haven, Connecticut
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Delahanty LM, Peyrot M, Shrader PJ, Williamson DA, Meigs JB, Nathan DM. Pretreatment, psychological, and behavioral predictors of weight outcomes among lifestyle intervention participants in the Diabetes Prevention Program (DPP). Diabetes Care 2013; 36:34-40. [PMID: 23129133 PMCID: PMC3526204 DOI: 10.2337/dc12-0733] [Citation(s) in RCA: 92] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To identify the most important pretreatment characteristics and changes in psychological and behavioral factors that predict weight outcomes in the Diabetes Prevention Program (DPP). RESEARCH DESIGN AND METHODS Approximately 25% of DPP lifestyle intervention participants (n = 274) completed questionnaires to assess weight history and psychological and behavioral factors at baseline and 6 months after completion of the 16-session core curriculum. The change in variables from baseline to 6 months was assessed with t tests. Multivariate models using hierarchical logistic regression assessed the association of weight outcomes at end of study with each demographic, weight loss history, psychological, and behavioral factor. RESULTS At end of study, 40.5% had achieved the DPP 7% weight loss goal. Several baseline measures (older age, race, older age when first overweight, fewer self-implemented weight loss attempts, greater exercise self-efficacy, greater dietary restraint, fewer fat-related dietary behaviors, more sedentary activity level) were independent predictors of successful end-of-study weight loss with the DPP lifestyle program. The DPP core curriculum resulted in significant improvements in many psychological and behavioral targets. Changes in low-fat diet self-efficacy and dietary restraint skills predicted better long-term weight loss, and the association of low-fat diet self-efficacy with weight outcomes was explained by dietary behaviors. CONCLUSIONS Health care providers who translate the DPP lifestyle intervention should be aware of pretreatment characteristics that may hamper or enhance weight loss, consider prioritizing strategies to improve low-fat diet self-efficacy and dietary restraint skills, and examine whether taking these actions improves weight loss outcomes.
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Affiliation(s)
- Linda M Delahanty
- Department of Medicine, Massachusetts General Hospital Diabetes Center, Boston, MA, USA.
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Macananey O, O'Shea D, Warmington SA, Green S, Egaña M. Gymnasium-based unsupervised exercise maintains benefits in oxygen uptake kinetics obtained following supervised training in type 2 diabetes. Appl Physiol Nutr Metab 2012; 37:599-609. [PMID: 22563745 DOI: 10.1139/h2012-012] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Supervised exercise (SE) in patients with type 2 diabetes improves oxygen uptake kinetics at the onset of exercise. Maintenance of these improvements, however, has not been examined when supervision is removed. We explored if potential improvements in oxygen uptake kinetics following a 12-week SE that combined aerobic and resistance training were maintained after a subsequent 12-week unsupervised exercise (UE). The involvement of cardiac output (CO) in these improvements was also tested. Nineteen volunteers with type 2 diabetes were recruited. Oxygen uptake kinetics and CO (inert gas rebreathing) responses to constant-load cycling at 50% ventilatory threshold (V(T)), 80% V(T), and mid-point between V(T) and peak workload (50% Δ) were examined at baseline (on 2 occasions) and following each 12-week training period. Participants decided to exercise at a local gymnasium during the UE. Thirteen subjects completed all the interventions. The time constant of phase 2 of oxygen uptake was significantly faster (p < 0.05) post-SE and post-UE compared with baseline at 50% V(T) (17.3 ± 10.7 s and 17.5 ± 5.9 s vs. 29.9 ± 10.7 s), 80% V(T) (18.9 ± 4.7 and 20.9 ± 8.4 vs. 34.3 ± 12.7s), and 50% Δ (20.4 ± 8.2 s and 20.2 ± 6.0 s vs. 27.6 ± 3.7 s). SE also induced faster heart rate kinetics at all 3 intensities and a larger increase in CO at 30 s in relation to 240 s at 80% V(T); and these responses were maintained post-UE. Unsupervised exercise maintained benefits in oxygen uptake kinetics obtained during a supervised exercise in subjects with diabetes, and these benefits were associated with a faster dynamic response of heart rate after training.
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Affiliation(s)
- Oscar Macananey
- Department of Physiology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin 2, Ireland
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Vol S, Bedouet M, Gusto G, Leglu C, Beslin E, Decou P, Nègre E, Planage B, Chazelle E, Mercier F, Lantieri O, Tichet J. Evaluating physical activity: The AQAP questionnaire and its interpretation software. Ann Phys Rehabil Med 2011; 54:478-95. [DOI: 10.1016/j.rehab.2011.09.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2010] [Revised: 09/06/2011] [Accepted: 09/08/2011] [Indexed: 12/01/2022]
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