Favorable life-style modification and attenuation of cardiovascular risk factors

Effects of Implementing Personalized Health Education in Ambulatory Care on Cardiovascular Risk Factors, Compliance and Satisfaction with Treatment

Aim and Methods: Data from the CARDIOPLUS study (a prospective, multicenter, non-interventional study, which was conducted among patients and physicians from ambulatory patient care in Poland) were used to assess whether primary care behavioral counseling interventions to improve diet, increase physical activity, stop smoking and reduce alcohol consumption improve outcomes associated with cardiovascular (CVD) risk factors, metabolic parameters, compliance and satisfaction with treatment in adults. The study was carried out throughout Poland in the period from July to December 2019. Results: The study included 8667 patients—49% women and 51% men aged (63 ± 11 years)—and 862 physician-researchers. At the 3-month follow-up, there was a significant reduction in body weight (p = 0.008); reduction of peripheral arterial pressure, both systolic (p < 0.001) and diastolic (p < 0.001); reduction in total cholesterol levels (p < 0.001), triglycerides (p < 0.001), and LDL cholesterol (p < 0.001). The percentage of respondents who fully complied with the doctor’s recommendations increased significantly. The respondents assessed their own satisfaction with the implemented treatment as higher (by about 20%). Conclusions: As a result of pro-health education in the field of lifestyle modifications, a significant reduction of risk factors for cardiovascular diseases, as well as improved compliance and satisfaction with pharmacological treatment, was observed. Thus, appropriate personalized advice on lifestyle habits should be given to each examinee in a positive, systematic way following the periodic health check-ups in order to reduce the person’s risk and improve the effectiveness of the treatment.

Breakfast skipping and the risk of type 2 diabetes: a meta-analysis of observational studies

Objective

Breakfast skipping has been reported to be associated with type 2 diabetes (T2D), but the results are inconsistent. No meta-analyses have applied quantitative techniques to compute summary risk estimates. The present study aimed to conduct a meta-analysis of observational studies summarizing the evidence on the association between breakfast skipping and the risk of T2D.

Design

Systematic review and meta-analysis.

Setting

Relevant studies were identified by a search of PubMed, Embase, Web of Science, China National Knowledge Infrastructure (CNKI) and SINOMED up to 9 August 2014. We also reviewed reference lists from retrieved articles. We included studies that reported risk estimates (including relative risks, odds ratios and hazard ratios) with 95 % confidence intervals for the association between breakfast skipping and the risk of T2D.

Subjects

Eight studies involving 106 935 participants and 7419 patients with T2D were included in the meta-analysis.

Results

A pooled adjusted relative risk for the association between exposure to breakfast skipping and T2D risk was 1·21 (95 % CI 1·12, 1·31; P=0·984; I2=0·0 %) in cohort studies and the pooled OR was 1·15 (95 % CI, 1·05, 1·24; P=0·770; I2=0·0 %) in cross-sectional studies. Visual inspection of a funnel plot and Begg’s test indicated no evidence of publication bias.

Conclusions

Breakfast skipping is associated with a significantly increased risk of T2D. Regular breakfast consumption is potentially important for the prevention of T2D.

Nutrient intake, diet quality, and weight/adiposity parameters in breakfast patterns compared with no breakfast in adults: National Health and Nutrition Examination Survey 2001-2008

BACKGROUND

The effect of different breakfast consumption patterns on nutrient intake, diet quality, and weight/adiposity status is unknown.

OBJECTIVE

To compare nutrient intake, diet quality, and weight/adiposity measures of consumers assigned to different breakfast patterns with breakfast skippers.

DESIGN AND PARTICIPANTS

These associations were assessed in adults 19+ years (N=18,988) participating in the 2001-2008 National Health and Nutrition Examination Survey. Intake was determined from 1-day 24-hour dietary recall. Diet quality was quantified using the Healthy Eating Index-2005. Body mass index (calculated as kg/m(2)) and waist circumferences were determined. Twelve patterns (including No Breakfast [approximately 19% of population]), explaining 58% of the variance in energy from the breakfast meal, were examined. Covariate adjusted general linear models were used to compare nutrient intakes, Healthy Eating Index-2005 scores, and body mass index/waist circumference of consumers of different patterns with breakfast skippers. The P value was Bonferroni corrected (<0.05/12 breakfast patterns <0.0042).

RESULTS

Consumers of the Grain/100% Fruit Juice and Presweetened Ready-to-Eat Cereal (RTEC)/Lower-Fat Milk patterns had lower daily intakes of nutrients to limit (added sugars, saturated fatty acids, solid fats, cholesterol, and sodium) than breakfast skippers. Consumers of the Grain/100% Fruit Juice; Presweetened RTEC/Lower-Fat Milk; and RTEC/Lower-Fat Milk/Whole Fruit/100% Fruit Juice patterns had higher daily intakes of all shortfall nutrients examined (dietary fiber; vitamins A, D, and C; calcium, potassium, folate, iron, and magnesium) than breakfast skippers. Consumers of the Grain/100% Fruit Juice; Grain; Presweetened RTEC/Lower-Fat Milk; RTEC/Lower-Fat Milk/Whole Fruit/100% Fruit Juice; Cooked Cereal; Lower-Fat Milk/Whole Fruit; and Whole Fruit patterns had higher Healthy Eating Index-2005 scores than breakfast skippers. Consumers of the Grain/100% Fruit Juice; Presweetened RTEC/Lower-Fat Milk; RTEC/Lower-Fat Milk/Whole Fruit/100% Fruit Juice; and Cooked Cereal patterns had lower body mass indexes and waist circumferences than breakfast skippers.

CONCLUSIONS

Results suggest dietary and weight advantages of consuming breakfast, especially ones that include grains, cereals, lower-fat milk, and whole fruit/100% fruit juice, in contrast to the potential adverse effects of skipping breakfast.

The effect of quitting smoking on HDL-cholesterol - a review based on within-subject changes

A higher concentration of high density lipoprotein cholesterol (HDL-C) in ex-smokers than smokers has consistently been observed. Better evidence of quitting effects comes from within-subject changes. We extend an earlier meta-analysis to quantify the reduction, and investigate variation by time quit and other factors. We conducted Medline and Cochrane searches for studies measuring HDL-C in subjects while still smoking and later having quit. Using unweighted and inverse-variance weighted regression analysis, we related changes (in mmol/l) to intra-measurement period, and estimated time quit, and to study type, location and start year, age, sex, product smoked, validation of quitting, baseline HDL-C, baseline and change in weight/BMI, and any study constraints on diet or exercise. Forty-five studies were identified (17 Europe, 16 North America, 11 Asia, 1 Australia). Thirteen were observational, giving changes over at least 12 months, with most involving >1000 subjects. Others were smoking cessation trials, 12 randomized and 20 non-randomized. These were often small (18 of <100 subjects) and short (14 of <10 weeks, the longest a year). Thirty studies provided results for only one time interval. From 94 estimates of HDL-C change, the unweighted mean was 0.107 (95% CI 0.085-0.128). The weighted mean 0.060 (0.044 to 0.075) was lower, due to smaller estimates in longer term studies. Weighted means varied by time quit (0.083, 0.112, 0.111, 0.072, 0.058 and 0.040 for <3, 3 to <6, 6 to <13, 13 to <27, 27 to <52 and 52+ weeks, p=0.006). After adjustment for time quit, estimates varied by study constraint on diet/exercise (p=0.003), being higher in studies requiring subjects to maintain their pre-quitting habits, but no other clear differences were seen, with significant (p<0.05) increases following quitting being evident in all subgroups studied, except where data were very limited. For both continuing and never smokers, the data are (except for two large studies atypically showing significant HDL-C declines in both groups, and a smaller decline in quitters) consistent with no change, and contrast markedly with the data for quitters. We conclude that quitting smoking increases HDL-C, and that this increase occurs rapidly after quitting, with no clear pattern of change thereafter.

Eating patterns and type 2 diabetes risk in men: breakfast omission, eating frequency, and snacking

BACKGROUND

Little is known about the association between eating patterns and type 2 diabetes (T2D) risk.

OBJECTIVE

The objective of this study was to prospectively examine associations between breakfast omission, eating frequency, snacking, and T2D risk in men.

DESIGN

Eating patterns were assessed in 1992 in a cohort of 29,206 US men in the Health Professionals Follow-Up Study who were free of T2D, cardiovascular disease, and cancer and were followed for 16 y. We used Cox proportional hazards analysis to evaluate associations with incident T2D.

RESULTS

We documented 1944 T2D cases during follow-up. After adjustment for known risk factors for T2D, including BMI, men who skipped breakfast had 21% higher risk of T2D than did men who consumed breakfast (RR: 1.21; 95% CI: 1.07, 1.35). Compared with men who ate 3 times/d, men who ate 1-2 times/d had a higher risk of T2D (RR: 1.25; 95% CI: 1.08, 1.45). These findings persisted after stratification by BMI or diet quality. Additional snacks beyond the 3 main meals (breakfast, lunch, and dinner) were associated with increased T2D risk, but these associations were attenuated after adjustment for BMI.

CONCLUSIONS

Breakfast omission was associated with an increased risk of T2D in men even after adjustment for BMI. A direct association between snacking between meals and T2D risk was mediated by BMI.

Breakfast frequency and quality may affect glycemia and appetite in adults and children

Observational studies of breakfast frequency in children and adults suggest an inverse (protective) association between the frequency of eating breakfast and the risk for obesity and chronic diseases such as type 2 diabetes. More prospective studies with stronger designs are needed, as are experimental studies on this topic. In addition, above and beyond breakfast frequency, the roles of dietary quality and composition need to be studied in the context of eating or skipping breakfast. Experimental studies are also necessary to rigorously test causality and biological mechanisms. Therefore, we conducted 2 pilot experimental studies to examine some of the effects of breakfast skipping and breakfast composition on blood glucose and appetite in children and adults. Our results suggest that breakfast frequency and quality may be related in causal ways to appetite controls and blood sugar control, supporting the hypothesis that the breakfast meal and its quality may have important causal implications for the risk of obesity and type 2 diabetes.

Serum fatty acid composition as a marker of eating habits in normal and diabetic subjects

It is known that the Japanese people have had healthy eating habits, which may explain their low incidence of non-insulin-dependent diabetes mellitus (NIDDM). In the present study, in order to examine dietary habits such as fish consumption, the serum fatty acids from 190 normal people in their 30s and 50s living in Tokyo were surveyed. Furthermore, the fatty acid composition of 44 patients with DM was studied to clarify the difference in eating habits between normal and diabetic patients. The n-3:n-6 ratio of polyunsaturated fatty acids was 0.19 +/- 0.05 for the group in their 30s and 0.27 +/- 0.08 for the group in their 50s (P < 0.01). In patients with DM, the n-3:n-6 ratio was 0.23 +/- 0.05 and glycosylated haemoglobin (HbA1c) was 6.52 +/- 0.55%. After 4 months of dietary education, the n-3:n-6 ratio had increased to 0.27 +/- 0.06 (P < 0.01) and HbA1c had decreased significantly to 6.16 +/- 0.35% (P < 0.01). These findings indicated that people in their 50s tend to eat a traditional diet, which is abundant in fish oil, whereas people in their 30s, as well as patients with NIDDM in their 50s, appear to eat a diet that includes less fish than the traditional diet. Benefits of fish oil have been reported to be limited due to adverse effects in the glycemic controls in patients with NIDDM. Early instruction of newly diagnosed patients to encourage them to change their eating habits to a more traditional diet, which is abundant in fish, proved to be one of the safe methods for interventions in patients with DM.