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Wang D, Benito PJ, Rubio-Arias JÁ, Ramos-Campo DJ, Rojo-Tirado MA. Exploring factors of adherence to weight loss interventions in population with overweight/obesity: an umbrella review. Obes Rev 2024; 25:e13783. [PMID: 38807509 DOI: 10.1111/obr.13783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 07/31/2023] [Accepted: 04/28/2024] [Indexed: 05/30/2024]
Abstract
Adherence is key for achieving the optimal benefits from a weight loss intervention. Despite the number of studies on factors that promote adherence, their findings suggest inconsistent and fragmented evidence. The aim of this study was to review the existing factors of adherence to weight loss interventions and to find factors that facilitate the design of effective intervention programs. Six databases were searched for this umbrella review; after the screening process, 21 studies were included. A total of 47 factors were identified in six groups as relevant for adherence: (i) sociodemographic (n = 7), (ii) physical activity (n = 2), (iii) dietary (n = 8), (iv) behavioral (n = 4), (v) pharmacological (n = 3), and (vi) multi-intervention (n = 23). In addition, a map of adherence factors was created. The main findings are that with respect to demographic factors, the development of personalized intervention strategies based on the characteristics of specific populations is encouraged. Moreover, self-monitoring has been shown to be effective in behavioral, dietary, and multi-interventions, while technology has shown potential in dietary, behavioral, and multi-interventions. In addition, multi-interventions are adherence-promoting strategies, although more evidence is required on adherence to pharmacological interventions. Overall, the factor map can be controlled and modified by researchers and practitioners to improve adherence to weight loss interventions.
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Affiliation(s)
- Deng Wang
- LFE Research Group, Department of Health and Human Performance, Faculty of Physical Activity and Sport Science (INEF), Universidad Politécnica de Madrid (UPM), Madrid, Spain
| | - Pedro J Benito
- LFE Research Group, Department of Health and Human Performance, Faculty of Physical Activity and Sport Science (INEF), Universidad Politécnica de Madrid (UPM), Madrid, Spain
| | - Jacobo Á Rubio-Arias
- Health Research Centre, Department of Education, Faculty of Educational Sciences, University of Almería, Almería, Spain
| | - Domingo J Ramos-Campo
- LFE Research Group, Department of Health and Human Performance, Faculty of Physical Activity and Sport Science (INEF), Universidad Politécnica de Madrid (UPM), Madrid, Spain
| | - Miguel A Rojo-Tirado
- LFE Research Group, Department of Health and Human Performance, Faculty of Physical Activity and Sport Science (INEF), Universidad Politécnica de Madrid (UPM), Madrid, Spain
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2
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Kourpas E, Makrilakis K, Dafoulas G, Iotova V, Tsochev K, Dimova R, Cardon G, González-Gil EM, Moreno L, Kivelä J, Lindström J, Rurik I, Antal E, Timpel P, Schwartz P, Mavrogianni C, Manios Y, Liatis S. Factors affecting continuous participation in follow-up evaluations during a lifestyle intervention programme for type 2 diabetes prevention: The Feel4Diabetes-study. Diabet Med 2024; 41:e15368. [PMID: 38837852 DOI: 10.1111/dme.15368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 05/12/2024] [Accepted: 05/14/2024] [Indexed: 06/07/2024]
Abstract
AIMS Community- and school-based lifestyle interventions are an efficient method of preventing type 2 diabetes in vulnerable populations. Many participants, however, fail to complete the necessary follow-ups. We investigated factors affecting the continuous participation in follow-up evaluations during the Feel4Diabetes-study, a multilevel intervention programme implemented across Europe. METHODS Socioeconomic, sociodemographic and clinical factors were assessed for 2702 participants within six participating countries: Bulgaria and Hungary (low-to-middle-income countries, LMIC), Belgium and Finland (high-income countries, HIC) and Greece and Spain (high-income countries under austerity measures, HICAM). RESULTS Statistically significant differences were detected with respect to sex, control group, education level, employment status, BMI and blood pressure measurements (systolic and diastolic blood pressure). Post hoc analysis revealed significant differences within socioeconomic regions. Higher levels of education were associated with significantly lower attrition in HIC (p < 0.05) and HICAM (p < 0.001), higher employment status was associated with lower attrition in HICAM (p < 0.001) and being female was associated with lower attrition in LMIC (p < 0.001). Surprisingly, the intervention group exhibited higher-than-expected attrition in HIC (p < 0.001) and HICAM (p = 0.003), and lower attrition in LMIC (p = 0.007). When tested together in the same multivariable predictive model, all sociodemographic and socioeconomic variables along with higher BMI retained their statistical significance, while systolic and diastolic blood pressure failed to remain significant. CONCLUSIONS Key socioeconomic and sociodemographic factors along with BMI play a significant role in determining continuous participation in follow-up evaluations during school- and community-based intervention programmes.
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Affiliation(s)
- Elias Kourpas
- Department of Business Administration, Gies College of Business, University of Illinois Urbana-Champaign, Champaign, Illinois, USA
| | - Konstantinos Makrilakis
- First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Diabetes Centre, Laiko General Hospital, Athens, Greece
| | - George Dafoulas
- Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - Violeta Iotova
- Department of Pediatrics, Medical University of Varna, Varna, Bulgaria
| | - Kaloyan Tsochev
- Department of Pediatrics, Medical University of Varna, Varna, Bulgaria
| | - Roumyana Dimova
- Department of Endocrinology, Medical University of Sofia, Sofia, Bulgaria
| | - Greet Cardon
- Department of Movement and Sport Sciences, Ghent University, Ghent, Belgium
| | - Esther M González-Gil
- CIBER Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain
| | - Luis Moreno
- CIBER Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain
- Instituto Agroalimentario de Aragón (IA2), Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, Spain
| | - Jemina Kivelä
- Population Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Jaana Lindström
- Population Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Imre Rurik
- Department of Family and Occupational Medicine, University of Debrecen, Debrecen, Hungary
| | - Emese Antal
- Hungarian Society of Nutrition, Budapest, Hungary
| | - Patrick Timpel
- Department for Prevention and Care of Diabetes, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Peter Schwartz
- Department for Prevention and Care of Diabetes, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Christina Mavrogianni
- Department of Nutrition and Dietetics, Harokopio University of Athens, Athens, Greece
| | - Yannis Manios
- Department of Nutrition and Dietetics, Harokopio University of Athens, Athens, Greece
- Institute of Agri-food and Life Sciences, Hellenic Mediterranean University Research Centre, Heraklion, Greece
| | - Stavros Liatis
- First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Diabetes Centre, Laiko General Hospital, Athens, Greece
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Lee S, Myers ND, Bateman AG, Prilleltensky I, McMahon A, Brincks AM. Baseline self-efficacy predicts subsequent engagement behavior in an online physical activity intervention. Front Sports Act Living 2024; 6:1401206. [PMID: 39022641 PMCID: PMC11251974 DOI: 10.3389/fspor.2024.1401206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 06/07/2024] [Indexed: 07/20/2024] Open
Abstract
Background The purported benefits of online physical activity interventions, in terms of reduced costs, high reach, and easy access, may not be fully realized if participants do not engage with the programs. However, there is a lack of research on modifiable predictors (e.g., beliefs) of engagement with online physical activity interventions. The objective of this brief report was to investigate if self-efficacy to engage at baseline predicted subsequent engagement behavior in an online physical activity intervention at post-baseline. Methods Data (N = 331) from the 2018 Fun For Wellness effectiveness trial (ClinicalTrials.gov, identifier: NCT03194854) were analyzed in this brief report. Multiple logistic regression was fit in Mplus 8 using maximum-likelihood estimation. Results There was evidence that self-efficacy to engage beliefs at baseline positively predicted subsequent engagement behavior in the Fun For Wellness intervention at 30 days post-baseline. Conclusions Some recommendations to increase self-efficacy to engage in future online physical activity intervention studies were provided consistent with self-efficacy theory.
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Affiliation(s)
- Seungmin Lee
- Division of Health and Wellness Studies, Binghamton University, Binghamton, NY, United States
| | - Nicholas D. Myers
- Department of Kinesiology, Michigan State University, East Lansing, MI, United States
| | - André G. Bateman
- Department of Sociology, Psychology and Social Work, The University of the West Indies at Mona, Mona, Kingston, Jamaica
| | - Isaac Prilleltensky
- School of Education and Human Development, University of Miami, Coral Gables, FL, United States
| | - Adam McMahon
- School of Education and Human Development, University of Miami, Coral Gables, FL, United States
| | - Ahnalee M. Brincks
- Human Development and Family Studies, Michigan State University, East Lansing, MI, United States
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Diep C, Lee S, Xue Y, Xiao M, Pivetta B, Daza JF, Jung JJ, Wijeysundera DN, Ladha KS. Preoperative depression and outcomes after metabolic and bariatric surgery: A systematic narrative review. Obes Rev 2024; 25:e13743. [PMID: 38572605 DOI: 10.1111/obr.13743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 02/08/2024] [Accepted: 03/10/2024] [Indexed: 04/05/2024]
Abstract
Preoperative depression is prevalent among patients undergoing metabolic and bariatric surgery (MBS) and is a potentially modifiable risk factor. However, the impact of preoperative depression on MBS outcomes has not been systematically reviewed. A search of MEDLINE, Embase, Cochrane, and PsychINFO (inception to June 2023) was conducted for studies reporting associations between preoperative depression and any clinical or patient-reported outcomes after MBS. Eighteen studies (5 prospective and 13 retrospective) reporting on 5933 participants were included. Most participants underwent gastric bypass or sleeve gastrectomy. Meta-analyses were not conducted due to heterogeneity in reported outcomes; findings were instead synthesized using a narrative and tabular approach. Across 13 studies (n = 3390) the associations between preoperative depression and weight loss outcomes at 6-72 months were mixed overall. This may be related to differences in cohort characteristics, outcome definitions, and instruments used to measure depression. A small number of studies reported that preoperative depression was associated with lower quality of life, worse acute pain, and more perioperative complications after surgery. Most of the included studies were deemed to be at high risk of bias, resulting in low or very low certainty of evidence according to the Risk of Bias In Non-randomized Studies - of Exposure (ROBINS-E) tool. While the impact of preoperative depression on weight loss after MBS remains unclear, there is early evidence that depression has negative consequences on other patient-important outcomes. Adequately powered studies using more sophisticated statistical methods are needed to accurately estimate these associations.
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Affiliation(s)
- Calvin Diep
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Sandra Lee
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Yuanxin Xue
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Maggie Xiao
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Canada
| | - Bianca Pivetta
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Canada
| | - Julian F Daza
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Department of Surgery, Division of General Surgery, University of Toronto, Toronto, Canada
| | - James J Jung
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Department of Surgery, Division of General Surgery, University of Toronto, Toronto, Canada
- Department of Surgery, St. Michael's Hospital, Toronto, Canada
| | - Duminda N Wijeysundera
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Department of Anesthesia, St. Michael's Hospital, Toronto, Canada
| | - Karim S Ladha
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Department of Anesthesia, St. Michael's Hospital, Toronto, Canada
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Kataoka J, Olsson M, Lindgren E, Larsson I, Schmidt J, Benrick A, Stener-Victorin E. Effects of weight loss intervention on anxiety, depression and quality of life in women with severe obesity and polycystic ovary syndrome. Sci Rep 2024; 14:13495. [PMID: 38866860 PMCID: PMC11169487 DOI: 10.1038/s41598-024-63166-w] [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: 12/14/2023] [Accepted: 05/26/2024] [Indexed: 06/14/2024] Open
Abstract
Polycystic ovary syndrome (PCOS) is a common endocrine disorder in women that is associated with an increased risk of anxiety and depression and with a lower health-related quality of life (HRQoL). PCOS is closely associated with obesity, which per se can lead to symptoms of anxiety and depression and lower HRQoL. The first-line treatment for PCOS is weight loss through lifestyle intervention, which has been shown to improve all symptoms of the syndrome. The aim of this study was to investigate symptoms of anxiety and depression and HRQoL in women with severe obesity (BMI ≥ 35) with and without PCOS, and to evaluate the effect of a one-year structured weight loss intervention. A total of 246 women with severe obesity (PCOS n = 63, non-PCOS n = 183) were included. The comprehensive psychopathological rating scale self-rating scale for affective symptoms (CPRS-S-A) and the short form-36 (SF-36) were used to assess symptoms of anxiety and depression and HRQoL. In total 72 women of the 246 women with severe obesity completed a one-year weight loss programme and were followed up and compared with baseline data. In women with severe obesity, there were no differences in symptoms of anxiety and depression and HRQoL between women with and without PCOS at baseline. Clinically relevant anxiety symptoms were present in 71.3% (PCOS) and 65.6% (non-PCOS), and depression symptoms were present in 56.4% (PCOS) and 52.2% (non-PCOS). Significant weight loss improved physical HRQoL in all women, but reduced symptoms of anxiety and depression only in women without PCOS. There were no differences when comparing the changes between the groups. Women with severe obesity are severely affected by symptoms of anxiety and depression, independent of PCOS. Weight loss improved symptoms of anxiety and depression in women without PCOS, but there were no differences between groups in change from baseline to follow-up.Trial registration number: Clinical trial.gov: NCT01319162, March 18, 2011. Date of registration and enrolment of the first subject September 2011.
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Affiliation(s)
- Josefin Kataoka
- Department of Physiology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 430, 405 30, Gothenburg, Sweden
- Department of Obstetrics and Gynaecology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Marie Olsson
- Department of Physiology and Pharmacology, Karolinska Institute, Biomedicum, B5, 171 77, Stockholm, Sweden
| | - Eva Lindgren
- Department of Physiology and Pharmacology, Karolinska Institute, Biomedicum, B5, 171 77, Stockholm, Sweden
| | - Ingrid Larsson
- Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
- Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Box 428, 405 30, Gothenburg, Sweden
| | - Johanna Schmidt
- Department of Obstetrics and Gynaecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 416 85, Gothenburg, Sweden
| | - Anna Benrick
- Department of Physiology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 430, 405 30, Gothenburg, Sweden
- Institute of Health Sciences, University of Skövde, Box 408, 541 28, Skövde, Sweden
| | - Elisabet Stener-Victorin
- Department of Physiology and Pharmacology, Karolinska Institute, Biomedicum, B5, 171 77, Stockholm, Sweden.
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Hossaini J, Osmani V, Klug SJ. Behavioral weight loss interventions for people with physical disabilities: A systematic review. Obes Rev 2024; 25:e13722. [PMID: 38332472 DOI: 10.1111/obr.13722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 10/26/2023] [Accepted: 01/17/2024] [Indexed: 02/10/2024]
Abstract
AIM The aim of this study is to examine which interventions lead to clinically significant weight loss among people with physical disabilities. METHODS We systematically searched three electronic databases (PubMed, Scopus, and CENTRAL) including studies until May 2022 to find randomized controlled trials on behavioral interventions and weight-related outcomes in people with physical disabilities. Pharmacological or surgical interventions were excluded. Study quality was evaluated using the Cochrane Risk of Bias Tool. Interventions were grouped as dietary, physical activity, education/coaching, or multi-component. Mean weight changes, standard deviations, confidence intervals, and effect sizes were extracted or calculated for assessment of the intervention effect. RESULTS Sixty studies involving 6,511 participants were included in the qualitative synthesis. Most studies (n = 32) included multi-component interventions, incorporating dietary and physical activity components. Limited evidence suggests that extensive dietary interventions or long-term multi-component interventions might lead to a clinically relevant weight reduction of at least 5% for older individuals (age > 50) with mild-to-moderate mobility impairments. DISCUSSION Due to the high heterogeneity of studies and low study quality, it can be assumed that the range of applicability of the findings is questionable. Further research should examine younger age groups (i.e., children, adolescents, and adults under 40 years) and compare different settings such as schools, clinics, nursing homes, and assisted living facilities.
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Affiliation(s)
- Jihad Hossaini
- Chair of Social Determinants of Health, School of Medicine and Health, Department Health and Sport Sciences, Technical University of Munich, Munich, Germany
| | - Vanesa Osmani
- Chair of Epidemiology, School of Medicine and Health, Department Health and Sport Sciences, Technical University of Munich, Munich, Germany
| | - Stefanie J Klug
- Chair of Epidemiology, School of Medicine and Health, Department Health and Sport Sciences, Technical University of Munich, Munich, Germany
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7
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Harfoush A, Chatterjee K, Deery E, Hamdallah H. Exploring different stroke populations' information needs: a cross-sectional study in England. Arch Public Health 2024; 82:63. [PMID: 38711113 DOI: 10.1186/s13690-024-01289-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 04/15/2024] [Indexed: 05/08/2024] Open
Abstract
BACKGROUND While tailored information might have the potential to motivate stroke survivors to make essential lifestyle changes and improve long-term outcomes, how this varies among different stroke populations is not yet fully understood. METHOD From November 2022 to May 2023, stroke survivors in the UK, who were clinically stable, participated in a community-based, descriptive cross-sectional study. Participants rated several information themes on a Likert scale from one to five, indicating the relevance of each information group to them. Data were analysed using Wilcoxon and chi-squared tests on SPSS. Descriptive statistics were employed for examining the preferred information delivery method, timing, personnel, and frequency. RESULTS Seventy survivors, with an average age of 67 ± 19 (61% males), were recruited. Survivors emphasised the importance of symptoms, risk factors, and recovery information during hospital stay, while medication and lifestyle change information were more significant in the community. Subgroup analysis revealed distinct patterns: First-time stroke survivors highlighted the importance of social and financial support (acute phase median Likert score 3, chronic phase median Likert score 4; p < 0.01), while those with prior strokes emphasised information on driving and working after stroke (acute phase median Likert score 4, chronic phase median Likert score 3; p < 0.05). Survivors recruited after six months of stroke prioritised knowledge of carer support in the community (acute phase median Likert score 3.5, chronic phase median Likert score 4; p < 0.01). CONCLUSION Survivors' information needs differ depending on factors such as the recovery phase, type of stroke, time since diagnosis, and the presence of a previous stroke. Considering these factors is essential when developing or providing information to stroke survivors.
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Affiliation(s)
- Allam Harfoush
- Chester Medical School, The Faculty of Medicine and Life Sciences, University of Chester, Chester, UK.
| | - Kausik Chatterjee
- Chester Medical School, The Faculty of Medicine and Life Sciences, University of Chester, Chester, UK
- The Countess of Chester Hospital, Liverpool Road, Chester, UK
| | - Elizabeth Deery
- The School of Sport, Ulster University, York St, Belfast, UK
| | - Hanady Hamdallah
- Chester Medical School, The Faculty of Medicine and Life Sciences, University of Chester, Chester, UK
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Krishnan A, Schneider CV, Hadi Y, Mukherjee D, AlShehri B, Alqahtani SA. Cardiovascular and mortality outcomes with GLP-1 receptor agonists vs other glucose-lowering drugs in individuals with NAFLD and type 2 diabetes: a large population-based matched cohort study. Diabetologia 2024; 67:483-493. [PMID: 38117293 PMCID: PMC10844347 DOI: 10.1007/s00125-023-06057-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 10/11/2023] [Indexed: 12/21/2023]
Abstract
AIMS/HYPOTHESIS We aimed to determine whether the use of glucagon-like peptide-1 receptor agonists (GLP-1RA) in individuals with non-alcoholic fatty liver disease (NAFLD) and type 2 diabetes mellitus decreases the risk of new-onset adverse cardiovascular events (CVEs) and mortality rate compared with other glucose-lowering drugs in a real setting at a population level. METHODS We conducted a population-based propensity-matched retrospective cohort study using TriNetX. The cohort comprised patients over 20 years old who were newly treated with glucose-lowering drugs between 1 January 2013 and 31 December 2021, and followed until 30 September 2022. New users of GLP-1RAs were matched based on age, demographics, comorbidities and medication use by using 1:1 propensity matching with other glucose-lowering drugs. The primary outcome was the new onset of adverse CVEs, including heart failure, composite incidence of major adverse cardiovascular events (MACE; defined as unstable angina, myocardial infarction, or coronary artery procedures or surgeries) and composite cerebrovascular events (defined as the first occurrence of stroke, transient ischaemic attack, cerebral infarction, carotid intervention or surgery), and the secondary outcome was all-cause mortality. Cox proportional hazards models were used to estimate HRs. RESULTS The study involved 2,835,398 patients with both NAFLD and type 2 diabetes. When compared with the sodium-glucose cotransporter 2 (SGLT2) inhibitors group, the GLP-1RAs group showed no evidence of a difference in terms of new-onset heart failure (HR 0.97; 95% CI 0.93, 1.01), MACE (HR 0.95; 95% CI 0.90, 1.01) and cerebrovascular events (HR 0.99; 95% CI 0.94, 1.03). Furthermore, the two groups had no evidence of a difference in mortality rate (HR 1.06; 95% CI 0.97, 1.15). Similar results were observed across sensitivity analyses. Compared with other second- or third-line glucose-lowering medications, the GLP-1RAs demonstrated a lower rate of adverse CVEs, including heart failure (HR 0.88; 95% CI 0.85, 0.92), MACE (HR 0.89; 95% CI 0.85, 0.94), cerebrovascular events (HR 0.93; 95% CI 0.89, 0.96) and all-cause mortality rate (HR 0.70; 95% CI 0.66, 0.75). CONCLUSIONS/INTERPRETATION In individuals with NAFLD and type 2 diabetes, GLP-1RAs are associated with lower incidences of adverse CVEs and all-cause mortality compared with metformin or other second- and third-line glucose-lowering medications. However, there was no significant difference in adverse CVEs or all-cause mortality when compared with those taking SGLT2 inhibitors.
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Affiliation(s)
- Arunkumar Krishnan
- Department of Supportive Oncology, Levine Cancer Institute, Atrium Health, Charlotte, NC, USA.
- Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
- Department of Medicine, Section of Gastroenterology and Hepatology, West Virginia University School of Medicine, Morgantown, WV, USA.
| | - Carolin V Schneider
- Department of Medicine III, Gastroenterology, Metabolic Diseases, and Intensive Care, University Hospital RWTH Aachen, Aachen, Germany
| | - Yousaf Hadi
- Department of Medicine, Section of Gastroenterology and Hepatology, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Diptasree Mukherjee
- Department of Medicine, Apex Institute of Medical Science, Kolkata, West Bengal, India
| | - Bandar AlShehri
- Diabetes and Endocrinology, Faculty of Medicine, University of Jeddah, Jeddah, Saudi Arabia
| | - Saleh A Alqahtani
- Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Liver Transplant Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
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Vega C, Barnafi E, Sánchez C, Acevedo F, Walbaum B, Parada A, Rivas N, Merino T. Calorie Restriction and Time-Restricted Feeding: Effective Interventions in Overweight or Obese Patients Undergoing Radiotherapy Treatment with Curative Intent for Cancer. Nutrients 2024; 16:477. [PMID: 38398802 PMCID: PMC10892811 DOI: 10.3390/nu16040477] [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: 12/26/2023] [Revised: 01/14/2024] [Accepted: 01/30/2024] [Indexed: 02/25/2024] Open
Abstract
This study assesses the feasibility of calorie restriction (CR) and time-restricted feeding (TRF) in overweight and obese cancer patients who realized little to no physical activity undergoing curative radiotherapy, structured as a prospective, interventional, non-randomized open-label clinical trial. Of the 27 participants initially enrolled, 21 patients with breast cancer were selected for analysis. The participants self-selected into two dietary interventions: TRF, comprising a sugar and saturated fat-free diet calibrated to individual energy needs consumed within an 8 h eating window followed by a 16 h fast, or CR, involving a 25% reduction in total caloric intake from energy expenditure distributed across 4 meals and 1 snack with 55% carbohydrates, 15% protein, and 30% fats, excluding sugars and saturated fats. The primary goal was to evaluate the feasibility of these diets in the specific patient group. The results indicate that both interventions are effective and statistically significant for weight loss and reducing one's waist circumference, with TRF showing a potentially stronger impact and better adherence. Changes in the LDL, HDL, total cholesterol, triglycerides, glucose and insulin were not statistically significant.
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Affiliation(s)
- Carmen Vega
- Cancer Center UC, Red de Salud Christus-UC, Santiago 8330032, Chile;
| | - Esteban Barnafi
- Faculty of Medicine, School of Medicine, Pontificia Universidad Católica de Chile, Santiago 8331150, Chile; (E.B.); (N.R.)
| | - César Sánchez
- Department of Hematology-Oncology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago 8330077, Chile; (C.S.); (F.A.); (B.W.)
| | - Francisco Acevedo
- Department of Hematology-Oncology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago 8330077, Chile; (C.S.); (F.A.); (B.W.)
| | - Benjamin Walbaum
- Department of Hematology-Oncology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago 8330077, Chile; (C.S.); (F.A.); (B.W.)
| | - Alejandra Parada
- Department of Health Sciences, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago 7820436, Chile;
| | - Nicolás Rivas
- Faculty of Medicine, School of Medicine, Pontificia Universidad Católica de Chile, Santiago 8331150, Chile; (E.B.); (N.R.)
| | - Tomás Merino
- Cancer Center UC, Red de Salud Christus-UC, Santiago 8330032, Chile;
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Fila M, Chojnacki J, Pawlowska E, Sobczuk P, Chojnacki C, Blasiak J. The Ketogenic Diet in the Prevention of Migraines in the Elderly. Nutrients 2023; 15:4998. [PMID: 38068855 PMCID: PMC10707997 DOI: 10.3390/nu15234998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 11/23/2023] [Accepted: 11/30/2023] [Indexed: 12/18/2023] Open
Abstract
Migraines display atypical age dependence, as the peak of their prevalence occurs between the ages of 20-40 years. With age, headache attacks occur less frequently and are characterized by a lower amplitude. However, both diagnosis and therapy of migraines in the elderly are challenging due to multiple comorbidities and polypharmacy. Dietary components and eating habits are migraine triggers; therefore, nutrition is a main target in migraine prevention. Several kinds of diets were proposed to prevent migraines, but none are commonly accepted due to inconsistent results obtained in different studies. The ketogenic diet is featured by very low-carbohydrate and high-fat contents. It may replace glucose with ketone bodies as the primary source of energy production. The ketogenic diet and the actions of ketone bodies are considered beneficial in several aspects of health, including migraine prevention, but studies on the ketogenic diet in migraines are not standardized and poorly evidenced. Apart from papers claiming beneficial effects of the ketogenic diet in migraines, several studies have reported that increased levels of ketone bodies may be associated with all-cause and incident heart failure mortality in older adults and are supported by research on mice showing that the ketogenic diets and diet supplementation with a human ketone body precursor may cause life span shortening. Therefore, despite reports showing a beneficial effect of the ketogenic diet in migraines, such a diet requires further studies, including clinical trials, to verify whether it should be recommended in older adults with migraines.
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Affiliation(s)
- Michal Fila
- Department of Developmental Neurology and Epileptology, Polish Mother’s Memorial Hospital—Research Institute, 93-338 Lodz, Poland;
| | - Jan Chojnacki
- Department of Clinical Nutrition and Gastroenterological Diagnostics, Medical University of Lodz, 90-647 Lodz, Poland; (J.C.), (C.C.)
| | - Elzbieta Pawlowska
- Department of Pediatric Dentistry, Medical University of Lodz, 92-217 Lodz, Poland;
| | - Piotr Sobczuk
- Emergency Medicine and Disaster Medicine Department, Medical University of Lodz, 92-209 Lodz, Poland;
- Department of Orthopaedics and Traumatology, Polish Mother’s Memorial Hospital—Research Institute, Rzgowska 281, 93-338 Lodz, Poland
| | - Cezary Chojnacki
- Department of Clinical Nutrition and Gastroenterological Diagnostics, Medical University of Lodz, 90-647 Lodz, Poland; (J.C.), (C.C.)
| | - Janusz Blasiak
- Faculty of Medicine, Collegium Medicum, The Mazovian Academy in Plock, 09-402 Plock, Poland
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11
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Goldstein SP, Olson KL, Thomas JG. Association of weight and shape concern with weight change and weight-related behaviors in behavioral weight loss treatment. J Behav Med 2023; 46:1049-1056. [PMID: 37740874 PMCID: PMC10577101 DOI: 10.1007/s10865-023-00451-5] [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: 04/11/2023] [Accepted: 09/13/2023] [Indexed: 09/25/2023]
Abstract
Weight and shape concern (WSC) is a facet of negative body image that is common among individuals with overweight/obesity seeking behavioral weight loss treatment (BWL), but remains understudied. This secondary analysis evaluates associations between WSC, weight change, and weight-related behaviors among individuals in a 24-week BWL. Adults (n = 32) with body mass index 25-50 kg/m2 completed a baseline WSC questionnaire, measured weight at 12 and 24 weeks, measured physical activity via accelerometer, and completed 24-hour dietary recalls. Adherence to self-monitoring dietary intake and weight were assessed. A series of linear mixed models were used to evaluate associations between baseline WSC and weight change, as well as weight-related behaviors. Results revealed no significant effect of WSC on weight change. There were significant WSC x time interactions, such that those rating WSC "very important" decreased self-weighing and the "low importance" group decreased their caloric intake during treatment. The "pretty important" group had greater minutes of activity than the "low importance" group. Findings indicated that WSC may impact weight-related behaviors that contribute to BWL success. This trial was pre-registered on ClinicalTrials.gov (NCT03739151).
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Affiliation(s)
- Stephanie P Goldstein
- Department of Psychiatry and Human Behavior, The Miriam Hospital/Weight Control and Diabetes Research Center, Warren Alpert Medical School of Brown University, 196 Richmond St, Providence, RI, 02903, USA.
| | - KayLoni L Olson
- Department of Psychiatry and Human Behavior, The Miriam Hospital/Weight Control and Diabetes Research Center, Warren Alpert Medical School of Brown University, 196 Richmond St, Providence, RI, 02903, USA
| | - J Graham Thomas
- Department of Psychiatry and Human Behavior, The Miriam Hospital/Weight Control and Diabetes Research Center, Warren Alpert Medical School of Brown University, 196 Richmond St, Providence, RI, 02903, USA
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12
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Worthington A, Gillies N, Hannaford R, Roy R, Braakhuis A. Implementing multicomponent, eHealth-based behaviour change support within a dietary intervention trial improves adherence to study-related behaviours in healthy young adults. BMC Nutr 2023; 9:134. [PMID: 37990250 PMCID: PMC10664496 DOI: 10.1186/s40795-023-00798-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 11/14/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND Behaviour change science is proposed to improve participant retention and enhance the validity of trials. However, researchers seldom systematically consider and implement behaviour change strategies within trials for this purpose. The objective of this article is to evaluate how an eHealth behaviour change support (BCS) program enhances young adults' adherence to behaviours required within a dietary intervention. METHODS The Nine Principles framework was used to develop BCS to implement across both arms of a 10-week randomised parallel-group intervention to enhance adherence to (i) eating healthily and (ii) reporting dietary intake. Key components of the BCS included access to a dietitian-led Facebook group, text reminders, and food delivery. Effectiveness was measured using the following analyses of the 78 participants who completed the study; pre-post change in targeted dietary habits over time using a subscore of the Healthy Diet Habits Index, questionnaire to assess change in perception of barriers to eating healthily over time, Facebook group engagement, and impact evaluation of the BCS. Participants received a dietary reporting score out of 100 to assess adherence across the 10 weeks. RESULTS The total Healthy Diet Habits Index subscore out of 16 significantly increased from baseline to week 10 (10.6 ± 2.6 to 11.2 ± 2.6, p value < 0.05), driven primarily by an increase in vegetable consumption. Overall adherence to reporting was high across the 10 weeks, with the total population mean reporting score 90.4 ± 14.6 out of 100. Relatively low Facebook engagement was observed. Adding objects to the environment, prompts/cues and removing reward appeared to be effective components of the BCS for enhancing adherence to the target behaviours. CONCLUSION Using a behaviour change framework to support the design of randomised trials is a promising way to enhance participant adherence to study requirements that are typically considered burdensome, such as dietary reporting. It also enables researchers to identify and replicate effective components of BCS, including behaviour change techniques and modes of delivery. Further research into the use of different behaviour change frameworks for this purpose is warranted. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04869163; https://clinicaltrials.gov/ct2/show/NCT04869163 . (03/05/2021).
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Affiliation(s)
- Anna Worthington
- Discipline of Nutrition, School of Medical Sciences, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand.
| | - Nicola Gillies
- Discipline of Nutrition, School of Medical Sciences, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Rina Hannaford
- Bioinformatics & Statistics Team, AgResearch Ltd, Palmerston North, New Zealand
| | - Rajshri Roy
- Discipline of Nutrition, School of Medical Sciences, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Andrea Braakhuis
- Discipline of Nutrition, School of Medical Sciences, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
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13
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Moradi Tuchayi S, Khachatryan Y, Wang Y, Rox Anderson R, Wang JS, Wein MN, Garibyan L. Selective reduction of visceral adipose tissue with injectable ice slurry. Sci Rep 2023; 13:16350. [PMID: 37770553 PMCID: PMC10539385 DOI: 10.1038/s41598-023-43220-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 09/21/2023] [Indexed: 09/30/2023] Open
Abstract
Reduction in visceral adipose tissue (VAT) mass reduces body weight and metabolic disease risk in obese patients. However surgical removal of VAT is highly invasive and thus not clinically feasible. We developed an injectable ice slurry for selective reduction of adipose tissue through cryolipolysis. The aim of this study was to investigate safety, feasibility and mechanism of ice slurry-induced cryolipolysis of VAT. Perigonadal VAT in diet-induced obese mice and rats was subjected to slurry or sham treatment. Body weight and blood chemistry were monitored for 56 days post-treatment. Histological analysis and molecular studies were performed to elucidate mechanisms of fat reduction. Treatment of VAT was well tolerated in all animals. Slurry induced adipocyte cell death via selective cryolipolysis; significant weight loss was noted at day 21 post-treatment. RNA sequencing from treated VAT samples showed increased expression of genes involved in inflammation, immune response, collagen biosynthesis and wound healing, and decreased expression of adipokines. This study demonstrates that slurry treatment is safe and effective in inducing cryolipolysis of VAT and subsequent weight loss in mice. Ice slurry is promising as a minimally-invasive treatment to reduce visceral adipose tissue.
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Affiliation(s)
- Sara Moradi Tuchayi
- Wellman Center for Photomedicine, Massachusetts General Hospital, 50 Blossom Street-Thier 2, Boston, MA, 02114, USA
- Department of Dermatology, Harvard Medical School, Boston, USA
| | - Yeva Khachatryan
- Wellman Center for Photomedicine, Massachusetts General Hospital, 50 Blossom Street-Thier 2, Boston, MA, 02114, USA
| | - Ying Wang
- Wellman Center for Photomedicine, Massachusetts General Hospital, 50 Blossom Street-Thier 2, Boston, MA, 02114, USA
- Department of Dermatology, Harvard Medical School, Boston, USA
| | - R Rox Anderson
- Wellman Center for Photomedicine, Massachusetts General Hospital, 50 Blossom Street-Thier 2, Boston, MA, 02114, USA
- Department of Dermatology, Harvard Medical School, Boston, USA
| | - Jialiang S Wang
- Endocrine Unit, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Marc N Wein
- Endocrine Unit, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Lilit Garibyan
- Wellman Center for Photomedicine, Massachusetts General Hospital, 50 Blossom Street-Thier 2, Boston, MA, 02114, USA.
- Department of Dermatology, Harvard Medical School, Boston, USA.
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14
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Cava E, Spadaccini D, Aimaretti G, Marzullo P, Cavigiolo B, Farinelli D, Gennari A, Saggia C, Carbonelli MG, Riso S, Prodam F. Weight Management Effectiveness and Predictors of Dropout in Breast Cancer Survivors: A Retrospective Study. Cancers (Basel) 2023; 15:4401. [PMID: 37686676 PMCID: PMC10486561 DOI: 10.3390/cancers15174401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 08/24/2023] [Accepted: 08/31/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND Reducing obesity and weight gain, which often occurs during breast cancer treatment, may represent an efficient secondary or tertiary prevention against cancer. PURPOSE This retrospective observational cohort study aimed to assess the impact of a Mediterranean diet on weight and anthropometric changes in women completing active breast cancer treatment. Additionally, we sought to identify factors associated with study dropout within one year. METHODS A total of 182 female patients (20 normal weight, 59 overweight, 103 obese) received personalized Mediterranean diet interventions and underwent monthly outpatient visits. RESULTS Dropout rates were 42.3% at 6 months and 64.1% at 12 months. Among the obese subgroup, BMI (p < 0.001) and fat mass (p < 0.05) decreased after 6 months. At 12 months, the obese subgroup showed a borderline significant further reduction in BMI (p = 0.062). BMI or weight loss did not predict dropout at any time point. However, age (OR = 0.91) and diastolic blood pressure (OR = 1.07) were significant predictors of dropout at 12 months. CONCLUSION Implementing a Mediterranean diet can lead to weight and anthropometric improvements in breast cancer survivors. Further research is necessary to explore the long-term effects of weight loss on these individuals, identify effective dietary approaches, and consider specific predictors of dropout.
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Affiliation(s)
- Edda Cava
- Unit of Dietetic and Clinical Nutrition, San Camillo-Forlanini Hospital, 00149 Rome, Italy; (E.C.); (M.G.C.)
| | - Daniele Spadaccini
- Department of Health Sciences, University of Piemonte Orientale, Via Solaroli 17, 28100 Novara, Italy; (D.S.); (G.A.); (P.M.)
| | - Gianluca Aimaretti
- Department of Health Sciences, University of Piemonte Orientale, Via Solaroli 17, 28100 Novara, Italy; (D.S.); (G.A.); (P.M.)
- SCDU Endocrinology, University Hospital “Maggiore della Carità”, Department of Translational Medicine, University of Piemonte Orientale, Via Solaroli 17, 28100 Novara, Italy;
| | - Paolo Marzullo
- Department of Health Sciences, University of Piemonte Orientale, Via Solaroli 17, 28100 Novara, Italy; (D.S.); (G.A.); (P.M.)
- SCDU Endocrinology, University Hospital “Maggiore della Carità”, Department of Translational Medicine, University of Piemonte Orientale, Via Solaroli 17, 28100 Novara, Italy;
| | - Beatrice Cavigiolo
- SCDU Endocrinology, University Hospital “Maggiore della Carità”, Department of Translational Medicine, University of Piemonte Orientale, Via Solaroli 17, 28100 Novara, Italy;
| | - Deborah Farinelli
- Unit of Dietetic and Clinical Nutrition, University Hospital “Maggiore della Carità”, 28100 Novara, Italy; (D.F.); (S.R.)
| | - Alessandra Gennari
- Division of Oncology, University Hospital “Maggiore della Carità”, Department of Translational Medicine, University of Eastern Piedmont, Via Solaroli 17, 28100 Novara, Italy; (A.G.)
| | - Chiara Saggia
- Division of Oncology, University Hospital “Maggiore della Carità”, Department of Translational Medicine, University of Eastern Piedmont, Via Solaroli 17, 28100 Novara, Italy; (A.G.)
| | - Maria Grazia Carbonelli
- Unit of Dietetic and Clinical Nutrition, San Camillo-Forlanini Hospital, 00149 Rome, Italy; (E.C.); (M.G.C.)
| | - Sergio Riso
- Unit of Dietetic and Clinical Nutrition, University Hospital “Maggiore della Carità”, 28100 Novara, Italy; (D.F.); (S.R.)
| | - Flavia Prodam
- Department of Health Sciences, University of Piemonte Orientale, Via Solaroli 17, 28100 Novara, Italy; (D.S.); (G.A.); (P.M.)
- SCDU Endocrinology, University Hospital “Maggiore della Carità”, Department of Translational Medicine, University of Piemonte Orientale, Via Solaroli 17, 28100 Novara, Italy;
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15
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Shuhaiber J, Moradi Tuchayi S, Bijari FJ, Guehl NJ, Wang Y, Farinelli WA, Arkun K, El Fakhri G, Anderson RR, Garibyan L. Injectable ice slurry for reducing pericardial adipose tissue. Lasers Surg Med 2023; 55:674-679. [PMID: 37464943 DOI: 10.1002/lsm.23709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 06/29/2023] [Accepted: 07/10/2023] [Indexed: 07/20/2023]
Abstract
OBJECTIVES Excess pericardial adipose tissue (PAT) is associated with a higher risk of cardiovascular diseases. Currently, available methods for reducing PAT volume include weight loss through diet and exercise, weight loss with medications, and bariatric surgery. However, these methods are all limited by low patient compliance to maintain the results. We have developed an injectable ice slurry that could selectively target and reduce subcutaneous adipose tissue volume. The aim of this study was to investigate the feasibility and safety of using injectable slurry to selectively reduce PAT volume in a preclinical large animal model. METHODS PAT in Yucatan swine was injected with slurry or room temperature control solution. All animals were imaged with baseline chest computed tomography (CT) before slurry injection and at 2 months after injection to quantify PAT volume. Specimens from injected and noninjected PAT were harvested for histology. RESULTS Slurry treatment of PAT was well tolerated in all animals. Slurry-induced selective cryolipolysis in treated PAT. CT imaging showed decrease in PAT volume in treated area at 8 weeks posttreatment compared to baseline, that was significantly different from control solution treated group (median [range]: -29.66 [-35.07 to -27.92]% vs. -1.50 [-11.69 to 8.69]% in control animals respectively, p < 0.05). CONCLUSIONS This study demonstrated that slurry injection into PAT is feasible in a large animal model. Slurry injection was safe and effective in inducing selective cryolipolysis in PAT and reducing PAT volume. Slurry reduction of PAT could potentially serve as a novel treatment for cardiovascular diseases.
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Affiliation(s)
- Jeffrey Shuhaiber
- Wellman Center for Photomedicine, Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Sara Moradi Tuchayi
- Wellman Center for Photomedicine, Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Felicitas J Bijari
- Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Nicolas J Guehl
- Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ying Wang
- Wellman Center for Photomedicine, Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - William A Farinelli
- Wellman Center for Photomedicine, Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Knarik Arkun
- Department of Pathology and Laboratory Medicine, Tufts Medical Center, Boston, Massachusetts, USA
| | - Georges El Fakhri
- Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Richard R Anderson
- Wellman Center for Photomedicine, Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Lilit Garibyan
- Wellman Center for Photomedicine, Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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16
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Martiskainen T, Lamidi ML, Venojärvi M, Tikkanen H, Laatikainen T. Factors affecting the effectiveness of the physical activity counselling intervention implemented in primary health care in adults with type 2 diabetes. BMC Endocr Disord 2023; 23:166. [PMID: 37550678 PMCID: PMC10405502 DOI: 10.1186/s12902-023-01428-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 08/01/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND Type 2 diabetes (T2D) has become a major public health threat; physical inactivity and obesity are both independent risk factors. Increasing daily physical activity (PA) significantly benefits treatment. Individual PA counselling is helpful for people with T2D, especially those with previous inactivity or with diabetes complications. This study evaluated factors contributing to effectiveness of PA counselling in primary health care (PHC) patients with T2D in a real-world setting and using data elicited from electronic health records (EHRs). METHODS All patients with T2D were offered the opportunity to participate in a PA program organized as part of basic PHC services in the Siun sote region in North Karelia, Finland, from October 2016 to December 2018. The study population consists of patients aged 19 to 87 years (n = 546). During the intervention information on possible other factors in addition to age and sex influencing the intervention effect such as amount of counselling sessions, changes in PA and patients´ motivation was gathered. Changes in the participants' PA activity was generated by following the predefined rules from patient records and by assessing the descriptive documentation of activity patterns. The patients' motivation level was assessed using a Likert scale. RESULTS Over 60% of participants who attended PA counselling more than three times increased their PA compared with 1% of participants with one counselling session. Of the whole intervention group, the participants experiencing the largest weight loss were those with an increased level of PA (-1.36 kg vs. -0.63 kg among those with no change in PA). Age, sex, and baseline motivation did not affect the change the PA nor the main intervention outcomes. CONCLUSIONS Patients' compliance with the intervention was reflected in the number of PA counselling sessions attended which in turn was seen as increased levels of PA as well as better treatment outcomes. In the implementation of lifestyle counselling interventions attention should be paid on sufficient amount and frequency of counselling sessions. The individually tailored PA counselling provided in PHC has similar effects regardless of sex and age.
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Affiliation(s)
- Tuula Martiskainen
- Joint municipal authority for North Karelia social and health services (Siun sote), Tikkamäentie 16, Joensuu, 70210, Finland.
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, PO BOX 1627, Kuopio, 70211, Finland.
| | - Marja-Leena Lamidi
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, PO BOX 1627, Kuopio, 70211, Finland
| | - Mika Venojärvi
- Institute of Biomedicine/Sports and Exercise Medicine, University of Eastern Finland, PO BOX 1627, Kuopio, 70211, Finland
| | - Heikki Tikkanen
- Institute of Biomedicine/Sports and Exercise Medicine, University of Eastern Finland, PO BOX 1627, Kuopio, 70211, Finland
| | - Tiina Laatikainen
- Joint municipal authority for North Karelia social and health services (Siun sote), Tikkamäentie 16, Joensuu, 70210, Finland
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, PO BOX 1627, Kuopio, 70211, Finland
- Department of Public Health and Social Welfare, Finnish Institute for Health and Welfare, PO BOX 30, Helsinki, 00271, Finland
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Huijbers JCJ, Coenen P, Burchell GLB, Coppieters MW, Steenhuis IHM, Van Dieën JH, Koes BW, Kempen DHR, Anema JR, Kingma I, Voogt L, Williams CM, Van Dongen JM, Van der Ploeg HP, Ostelo RWJG, Scholten-Peeters GGM. The (cost-)effectiveness of combined lifestyle interventions for people with persistent low-back pain who are overweight or obese: A systematic review. Musculoskelet Sci Pract 2023; 65:102770. [PMID: 37167807 DOI: 10.1016/j.msksp.2023.102770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 04/21/2023] [Accepted: 04/27/2023] [Indexed: 05/13/2023]
Abstract
INTRODUCTION Lifestyle factors are expected to contribute to the persistence and burden of low-back pain (LBP). However, there are no systematic reviews on the (cost-)effectiveness of combined lifestyle interventions for overweight or obese people with LBP. AIM To assess whether combined lifestyle interventions are (cost-)effective for people with persistent LBP who are overweight or obese, based on a systematic review. DESIGN Systematic review METHOD: PubMed, Cochrane, Embase, CINAHL, PsycINFO and the Wiley/Cochrane Library were searched from database inception till January 6th 2023. Two independent reviewers performed study selection, data-extraction and risk of bias scoring using the Cochrane RoB tool 2 and/or the Consensus Health Economic Criteria list. GRADE was used to assess the level of certainty of the evidence. RESULTS In total 2510 records were screened, and 4 studies on 3 original RCTs with 216 participants were included. Low certainty evidence (1 study) showed that combined lifestyle interventions were not superior to usual care for physical functioning, pain and lifestyle outcomes. Compared to usual care, moderate certainty evidence showed that healthcare (-$292, 95%CI: 872; -33), medication (-$30, 95% CI -65; -4) and absenteeism costs (-$1000, 95%CI: 3573; -210) were lower for the combined lifestyle interventions. CONCLUSION There is low certainty evidence from 3 studies with predominantly small sample sizes, short follow-up and low intervention adherence that combined lifestyle interventions are not superior to physical functioning, pain and lifestyle outcomes compared to usual care, but are likely to be cost-effective.
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Affiliation(s)
- J C J Huijbers
- Department of Human Movement Sciences, Faculty of Behavioral and Movement Sciences Vrije Universiteit Amsterdam, Amsterdam Movement Sciences Program Musculoskeletal Health, the Netherlands
| | - P Coenen
- Amsterdam Public Health Research Institute, Amsterdam, the Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam, the Netherlands; Amsterdam Movement Sciences, Amsterdam, the Netherlands.
| | - G L B Burchell
- Medical Library, Vrije Universiteit Amsterdam, the Netherlands
| | - M W Coppieters
- Department of Human Movement Sciences, Faculty of Behavioral and Movement Sciences Vrije Universiteit Amsterdam, Amsterdam Movement Sciences Program Musculoskeletal Health, the Netherlands; Menzies Health Institute Queensland, Griffith University, Brisbane & Gold Coast, Australia
| | - I H M Steenhuis
- Department of Human Movement Sciences, Faculty of Behavioral and Movement Sciences Vrije Universiteit Amsterdam, Amsterdam Movement Sciences Program Musculoskeletal Health, the Netherlands; Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - J H Van Dieën
- Department of Human Movement Sciences, Faculty of Behavioral and Movement Sciences Vrije Universiteit Amsterdam, Amsterdam Movement Sciences Program Musculoskeletal Health, the Netherlands
| | - B W Koes
- Erasmus Medical Center, University Medical Center Rotterdam, Department of General Practice, the Netherlands
| | - D H R Kempen
- Department of Orthopedic Surgery, Joint Research, OLVG Amsterdam, Amsterdam, the Netherlands
| | - J R Anema
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam, the Netherlands
| | - I Kingma
- Department of Human Movement Sciences, Faculty of Behavioral and Movement Sciences Vrije Universiteit Amsterdam, Amsterdam Movement Sciences Program Musculoskeletal Health, the Netherlands
| | - L Voogt
- NVVR, Dutch Society of Back Pain, the Netherlands
| | - C M Williams
- School of Health Sciences, University of Sydney, Australia; Research and Knowledge Translation Directorate, Mid-North Coast Local Health District, Australia
| | - J M Van Dongen
- Faculty of Science and the Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Faculty of Science and Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - H P Van der Ploeg
- Amsterdam Public Health Research Institute, Amsterdam, the Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam, the Netherlands
| | - R W J G Ostelo
- Department of Health Sciences, Faculty of Science and Amsterdam Movement Sciences, Vrije Universiteit, Amsterdam, the Netherlands; Department of Epidemiology and Biostatistics, Vrije Universiteit Medical Center, Amsterdam, the Netherlands
| | - G G M Scholten-Peeters
- Department of Human Movement Sciences, Faculty of Behavioral and Movement Sciences Vrije Universiteit Amsterdam, Amsterdam Movement Sciences Program Musculoskeletal Health, the Netherlands
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Prasad F, De R, Korann V, Chintoh AF, Remington G, Ebdrup BH, Siskind D, Knop FK, Vilsbøll T, Fink-Jensen A, Hahn MK, Agarwal SM. Semaglutide for the treatment of antipsychotic-associated weight gain in patients not responding to metformin - a case series. Ther Adv Psychopharmacol 2023; 13:20451253231165169. [PMID: 37113745 PMCID: PMC10126648 DOI: 10.1177/20451253231165169] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 03/06/2023] [Indexed: 04/29/2023] Open
Abstract
Metformin is the currently accepted first-line treatment for antipsychotic-associated weight gain (AAWG). However, not all patients benefit from metformin. Glucagon-like peptide-1 receptor agonists (GLP1-RA) have shown promise in the management of obesity in the general population, with preliminary evidence supporting efficacy in AAWG. Semaglutide is a weekly injectable GLP-1RA which received recent approval for obesity management and noted superiority over other GLP-1RAs. This study explored the efficacy and tolerability of semaglutide in AAWG among individuals with severe mental illness. A retrospective chart review of patients treated with semaglutide in the Metabolic Clinic at the Center for Addiction and Mental Health (CAMH) between 2019 and 2021 was conducted. Patients failing a trial of metformin (<5% weight loss or continuing to meet criteria for metabolic syndrome) after 3 months at the maximum tolerated dose (1500-2000 mg/day) were initiated on semaglutide up to 2 mg/week. The primary outcome measure was a change in weight at 3, 6, and 12 months. Twelve patients on weekly semaglutide injections of 0.71 ± 0.47 mg/week were included in the analysis. About 50% were female; the average age was 36.09 ± 13.32 years. At baseline, mean weight was 111.4 ± 31.7 kg, BMI was 36.7 ± 8.2 kg/m2, with a mean waist circumference of 118.1 ± 19.3 cm. A weight loss of 4.56 ± 3.15 kg (p < 0.001), 5.16 ± 6.27 kg (p = 0.04) and 8.67 ± 9 kg (p = 0.04) was seen at 3, 6, and 12 months, respectively, after initiation of semaglutide with relatively well-tolerated side-effects. Initial evidence from our real-world clinical setting suggests that semaglutide may be effective in reducing AAWG in patients not responding to metformin. Randomized control trials investigating semaglutide for AAWG are needed to corroborate these findings.
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Affiliation(s)
- Femin Prasad
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Riddhita De
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Vittal Korann
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Araba F. Chintoh
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Gary Remington
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Bjørn H. Ebdrup
- Center for Neuropsychiatric Schizophrenia Research, Mental Health Centre Glostrup, University of Copenhagen, Glostrup, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Center for Clinical Metabolic Research, Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
- Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS) Glostrup, Denmark
| | - Dan Siskind
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
- Metro South Addiction and Mental Health Service, Brisbane, QLD, Australia
| | - Filip Krag Knop
- Center for Neuropsychiatric Schizophrenia Research, Mental Health Centre Glostrup, University of Copenhagen, Glostrup, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Steno Diabetes Center Copenhagen, Copenhagen, Denmark
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Tina Vilsbøll
- Center for Neuropsychiatric Schizophrenia Research, Mental Health Centre Glostrup, University of Copenhagen, Glostrup, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Steno Diabetes Center Copenhagen, Copenhagen, Denmark
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Anders Fink-Jensen
- Center for Neuropsychiatric Schizophrenia Research, Mental Health Centre Glostrup, University of Copenhagen, Glostrup, Denmark
- Psychiatric Centre Copenhagen, Rigshospitalet, Mental Health Services – Capital Region of Denmark, Copenhagen, Denmark
| | - Margaret K. Hahn
- Clinician-Scientist, Schizophrenia Division, Centre for Addiction and Mental Health, 1051 Queen St W, Toronto, ON M6J 1H3, Canada
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada Banting and Best Diabetes Centre (BBDC), University of Toronto, Toronto, ON, Canada
| | - Sri Mahavir Agarwal
- Clinician-Scientist, Schizophrenia Division, Centre for Addiction and Mental Health, 1051 Queen St W, Toronto, ON M6J 1H3, Canada
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada Banting and Best Diabetes Centre (BBDC), University of Toronto, Toronto, ON, Canada
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19
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Huang HC, Szwerinski NK, Nasrallah C, Huang Q, Chopra V, Venditti EM, Azar KMJ, Romanelli RJ. Lifestyle change program engagement in real-world clinical practice: a mixed-methods analysis. Transl Behav Med 2023; 13:168-182. [PMID: 36694916 PMCID: PMC10068905 DOI: 10.1093/tbm/ibac098] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Participant engagement in structured lifestyle change programs (LCPs) is essential for adopting behaviors that promote weight loss; however, the challenges to, and facilitators that promote, engagement with such programs are not well understood. We conducted a mixed-methods study among real-world LCP participants to assess factors associated with program engagement and to examine the reasons for withdrawal. Using electronic health records (EHR), we identified LCP eligible participants between 2010 and 2017. Multivariable logistic regression was used to assess associations between program engagement and baseline characteristics. Semi-structured interviews with LCP participants were conducted and thematically analyzed to examine reasons for withdrawal. A total of 1,813 LCP participants were included. The median number of sessions attended was 10 of 21-25 sessions. Highest LCP engagement was associated with factors potentially related to self-efficacy/motivation, such as older age, higher baseline weight, prior healthcare utilization and an absence of a history of smoking or depression. Engagement was also negatively associated with being Non-Hispanic Black versus White. The qualitative analysis of the interviews revealed four general themes pertaining to participants' withdrawal: competing priorities, perceived program effectiveness, characteristics of the program, and facilitator-related factors. Taken together, results from this mixed-methods study suggest that motivation and self-efficacy are important for program engagement; future LCP enhancements should incorporate flexible formats that may help participants manage competing priorities and maximize personal and cultural relevance for all racial/ethnic groups, especially those who have not benefitted fully. Furthermore, participants should be encouraged to set realistic goals to manage expectations.
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Affiliation(s)
- Hsiao-Ching Huang
- Sutter Health, Center for Health Systems Research, Palo Alto, CA 94301, USA
| | - Nina K Szwerinski
- Sutter Health, Center for Health Systems Research, Palo Alto, CA 94301, USA
| | | | - Qiwen Huang
- Sutter Health, Center for Health Systems Research, Palo Alto, CA 94301, USA
| | - Vidita Chopra
- Sutter Health, Center for Health Systems Research, Palo Alto, CA 94301, USA
| | - Elizabeth M Venditti
- Department of Psychiatry, Diabetes Prevention Support Center, University of Pittsburgh, Pittsburgh, PA 15213, USA
- Department of Epidemiology, Diabetes Prevention Support Center, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Kristen M J Azar
- Sutter Health, Center for Health Systems Research, Palo Alto, CA 94301, USA
| | - Robert J Romanelli
- Sutter Health, Center for Health Systems Research, Palo Alto, CA 94301, USA
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20
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Lee C, Waite F, Piernas C, Aveyard P. Development and initial evaluation of a behavioural intervention to support weight management for people with serious mental illness: an uncontrolled feasibility and acceptability study. BMC Psychiatry 2023; 23:130. [PMID: 36859248 PMCID: PMC9979581 DOI: 10.1186/s12888-023-04517-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 01/02/2023] [Indexed: 03/03/2023] Open
Abstract
BACKGROUND The rates of obesity and associated health problems are higher in people with serious mental illness (SMI), such as schizophrenia and bipolar disorder, than the general population. A primary care referral to a behavioural weight management programme can be an effective intervention, but people with SMI have reported barriers to engaging with them and bespoke options are rarely provided in routine practice. It is possible that adjunct support addressing these specific barriers could help. Here we report the development, feasibility and acceptability of an intervention to improve uptake and engagement with a mainstream weight management programme for people with SMI. METHODS We worked with people with a lived-experience of SMI and used the person-based approach to develop the 'Weight cHange for people with sErious mEntal iLlness' (WHEEL) intervention. It comprised a referral to a mainstream weight management programme (WW®) to be attended once a week, in-person or online, for 12-weeks. The adjunct support comprised a one-off, online consultation called Meet Your Mentor and weekly, telephone or email Mentor Check Ins for 12-weeks. We assessed the feasibility of WHEEL through the number of programme and adjunct support sessions that the participants attended. We analysed the acceptability of WHEEL using a thematic analysis of qualitative interviews conducted at baseline and at 12-week follow-up. Our exploratory outcome of clinical effectiveness was self-reported weight at baseline and at end-of-programme. RESULTS Twenty participants were assessed for eligibility and 17 enrolled. All 17 participants attended Meet Your Mentor and one was lost to follow-up (94% retention). Nine out of 16 attended ≥50% of the weekly programme sessions and 12/16 attended ≥50% of the weekly check-ins. Participants reported in the interviews that the adjunct support helped to establish and maintain a therapeutic alliance. While some participants valued the in-person sessions, others reported that they preferred the online sessions because it removed a fear of social situations, which was a barrier for some participants. The mean change in self-reported weight was - 4·1 kg (SD: 3·2) at 12-weeks. CONCLUSIONS A mainstream weight management programme augmented with brief and targeted education and low-intensity check-ins generated sufficient engagement and acceptability to warrant a future trial.
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Affiliation(s)
- Charlotte Lee
- Nuffield Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, University of Oxford, Woodstock Road, Oxford, OX2 6GG, UK. .,Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, Oxfordshire, UK.
| | - Felicity Waite
- Department of Psychiatry, University of Oxford, Warneford Hospital, Warneford Lane, Headington, Oxford, Oxfordshire, OX3 7JX, UK.,Oxford Health NHS Foundation Trust, Warneford Lane, Headington, Oxford, Oxfordshire, OX3 7JX, UK
| | - Carmen Piernas
- Nuffield Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, University of Oxford, Woodstock Road, Oxford, OX2 6GG, UK
| | - Paul Aveyard
- Nuffield Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, University of Oxford, Woodstock Road, Oxford, OX2 6GG, UK.,Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, Oxfordshire, UK
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21
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Papini NM, Jung M, Kang M, Lopez NV, Herrmann SD. Development and Rasch Analysis of the 18-Item Health Resilience Profile (HRP). Nutrients 2023; 15:nu15040807. [PMID: 36839165 PMCID: PMC9962227 DOI: 10.3390/nu15040807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 01/30/2023] [Accepted: 02/01/2023] [Indexed: 02/09/2023] Open
Abstract
Existing resilience measures have psychometric shortcomings, and there is no current gold-standard resilience measure. Previous work indicates adults enrolled in a health coaching program may benefit from a resilience measure that is tailored and contextualized to this sample. This two-part study aimed to develop and evaluate a resilience instrument focused on health behavior change in adults in a health coaching program. Two studies were conducted to (1) create a resilience instrument (Health Resilience Profile; HRP) specific to adults attempting health behavior change (n = 427; female = 83.8%; age = 44.5 ± 11.9 years) and to (2) optimize the instrument performance using Rasch analysis (n = 493; female = 62.1%; age = 49.8 ± 12.5 years). Study 1 identified two issues: (1) four unacceptable misfit items and (2) inappropriate rating scale functioning. Study 2 evaluated an improved instrument based on the outcome of study 1 resulting in one more misfit item, and unidimensionality was supported. The new four-category rating scale functioned well. The item-person map indicated that item difficulty distribution was well matched to participants' resilience level, and items were free from measurement error. Finally, items did not show differential item functioning across age, sex, alcohol use, and obesity status. The 18-item HRP is optimized for adults in a health coaching program.
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Affiliation(s)
- Natalie M. Papini
- Department of Health Sciences, Northern Arizona University, Flagstaff, AZ 86011, USA
- Correspondence:
| | - Myungjin Jung
- Department of Health, Exercise Science, and Recreation Management, The University of Mississippi, Oxford, MS 38677, USA
| | - Minsoo Kang
- Department of Health, Exercise Science, and Recreation Management, The University of Mississippi, Oxford, MS 38677, USA
| | - Nanette V. Lopez
- Department of Health Sciences, Northern Arizona University, Flagstaff, AZ 86011, USA
| | - Stephen D. Herrmann
- Department of Internal Medicine, University of Kansas Medical Center, Kansas, KS 66160, USA
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22
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Ruelas AL, Martínez Contreras TDJ, Esparza Romero J, Díaz Zavala RG, Candia Plata MDC, Hingle M, Armenta Guirado B, Haby MM. Factors influencing adults to drop out of intensive lifestyle interventions for weight loss. Transl Behav Med 2023; 13:245-254. [PMID: 36694376 PMCID: PMC10105866 DOI: 10.1093/tbm/ibac112] [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: 01/26/2023] Open
Abstract
Reducing ≥5% of body weight can decrease the risk of developing chronic diseases in adults with excess weight. Although Intensive Lifestyle Interventions (ILIs) that include cognitive-behavioral techniques to improve physical activity and eating habits are the best approach for losing weight, the failure to retain participants is a barrier to their successful implementation. We aimed to investigate the factors influencing adults to drop out of ILIs for weight loss at six months. We conducted retrospective multiple logistic regression analysis of 268 participants with excess weight (body mass index ≥ 25 kg/m2) from a multicenter study (n = 237, in-person ILI in five clinics, delivered by nutrition interns), and a randomized controlled trial (n = 31, one online ILI, delivered by a master's degree student). The same research team conducted both studies in Northern Mexico, using the same intervention components, and identical instruments and techniques to collect the data. We found that older participants (≥50 years) were less likely to drop out of the ILI for weight loss compared to participants <35 years old (OR = 0.34, 95% CI = 0.16-0.70). For each unit increase in the bodily pain scale of the SF-36 (less perceived pain), the risk of dropping out decreased by 2% (OR = 0.98, 95% CI = 0.97, 0.996), while a change in the interventionist during the 6-month intervention more than doubled the risk of dropping out (OR 2.25, 95% CI = 1.23-4.14). Retention in ILIs may be improved by ensuring that the same interventionist remains during the six-month intervention. In addition, ILIs may need further tailoring for younger ages and for participants with higher perceived pain.
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Affiliation(s)
- Alma L Ruelas
- Programa de Doctorado en Ciencias Químico Biológicas y de la Salud, Departamento de Ciencias Químico-Biológicas, Universidad de Sonora, Encinas y Rosales s/n Hermosillo, Sonora, 83000, México
| | - Teresita de Jesús Martínez Contreras
- Centro de Promoción de Salud Nutricional, Departamento de Ciencias Químico-Biológicas, Universidad de Sonora, Encinas y Rosales s/n Hermosillo, Sonora, 83000, México
| | - Julián Esparza Romero
- Unidad de Investigación en Diabetes, Centro de Investigación en Alimentación y Desarrollo, A.C. Carretera Gustavo Enrique Astiazarán Rosas, No.46, C.P. 83304, Hermosillo, Sonora, México
| | - Rolando Giovanni Díaz Zavala
- Centro de Promoción de Salud Nutricional, Departamento de Ciencias Químico-Biológicas, Universidad de Sonora, Encinas y Rosales s/n Hermosillo, Sonora, 83000, México
| | - Maria Del Carmen Candia Plata
- Departamento de Medicina y Ciencias de la Salud, Universidad de Sonora, Encinas y Rosales s/n Hermosillo, Sonora, 83000, México
| | - Melanie Hingle
- Department of Nutritional Sciences, College of Agriculture and Life Sciences, University of Arizona, Tucson, AZ, United States
| | - Brianda Armenta Guirado
- Centro de Investigación en Nutrición y Salud Pública, Instituto Nacional de Salud Pública, Av. Universidad 655, col. Santa María Ahuacatitlán, Cuernavaca, Morelos, 62100, México
| | - Michelle M Haby
- Departamento de Ciencias Químico-Biológicas, Universidad de Sonora, Encinas y Rosales s/n Hermosillo, Sonora, 83000, México.,Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, 3010, Australia
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23
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El Haddad L, Peiris CL, Taylor NF, McLean S. Determinants of Non-Adherence to Exercise or Physical Activity in People with Metabolic Syndrome: A Mixed Methods Review. Patient Prefer Adherence 2023; 17:311-329. [PMID: 36760232 PMCID: PMC9904214 DOI: 10.2147/ppa.s383482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Accepted: 10/18/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Long-term adherence to exercise or physical activity (EPA) is necessary for effective first-line management of metabolic syndrome (MetS). Little is known about the determinants of adherence in this population. This systematic review aims to identify the determinants of adherence to EPA in people with MetS. METHODS Six databases (MEDLINE, CINAHL Complete, PubMed, PsycINFO, SPORTDiscus, and Cochrane Central Register of Controlled Trials (CENTRAL)) were searched for studies published before April 26, 2021. Primary research studies investigating factors affecting EPA adherence in adults with MetS in outpatient settings were included. Risk of bias was assessed using the QUIPS (Quality in Prognostic Factor Studies) and CASP (Critical Appraisal Skills Program) tools, for quantitative and qualitative methodologies, respectively. RESULTS Four quantitative studies (n = 766) and one qualitative (n = 21) study were included in the review, evaluating 34 determinants of adherence to EPA in MetS. Limited evidence was found for an association between ten determinants and non-adherence to EPA: lower self-rated health, lower baseline EPA, lower high-density lipoprotein cholesterol (HDL-C), fewer walk-friendly routes within 1 km, less consciousness raising, lower self-re-evaluation, lower self-liberation, reporting more arguments against EPA (cons), lower social support, and fewer positive psychological constructs. There was limited evidence of no association or conflicting evidence for the remaining 24 determinants. CONCLUSION A small number of included studies, most of low methodological quality, resulted in limited confidence in the findings for all determinants. The identified determinants associated with non-adherence are all potentially modifiable, thus further high-quality studies are required to increase confidence in the determinants of EPA in people with MetS, and test interventions.
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Affiliation(s)
- Laila El Haddad
- Department of Allied Health Professions, Sheffield Hallam University, Sheffield, UK
| | - Casey L Peiris
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Nicholas F Taylor
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
- Allied Health Clinical Research Office, Eastern Health, Box Hill, Victoria, Australia
| | - Sionnadh McLean
- Department of Allied Health Professions, Sheffield Hallam University, Sheffield, UK
- Correspondence: Sionnadh McLean, Collegiate Campus, Sheffield Hallam University, L108, 36 Collegiate Crescent, Sheffield, S10 2BP, UK, Tel +447342 092 340, Email
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24
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Lee CY, Robertson MC, Johnston H, Le T, Raber M, Rechis R, Oestman K, Neff A, Macneish A, Basen-Engquist KM. Feasibility and Effectiveness of a Worksite-Weight-Loss Program for Cancer Prevention among School-District Employees with Overweight and Obesity. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:538. [PMID: 36612860 PMCID: PMC9819872 DOI: 10.3390/ijerph20010538] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 12/25/2022] [Accepted: 12/26/2022] [Indexed: 06/17/2023]
Abstract
The effects of Vibrant Lives, a 6-month worksite-weight-loss program, were examined in a cohort of school-district employees with overweight or obesity. The VL Basic (VLB) participants received materials and tailored text messages, the VL Plus (VLP) participants additionally received WIFI-enabled activity monitors and scales and participated in health challenges throughout the school year, and the VL Plus with Support (VLP + S) participants additionally received coaching support. The levels of program satisfaction and retention and changes in weight, physical activity (PA), and diet were compared across groups using Pearson chi-square tests, repeated-measure mixed models, and logistic regression. After the program, the VLB (n = 131), VLP (n = 87), and VLP + S (n = 88) groups had average weight losses of 2.5, 2.5, and 3.4 kg, respectively, and average increases in weekly PA of 40.4, 35.8, and 65.7 min, respectively. The VLP + S participants were more likely than the other participants to have clinically significant weight loss (≥3%; p = 0.026). Compared with the VLB participants, the VLP participants were less likely to meet the recommendations for consuming fast food (p = 0.022) and sugar-sweetened beverages (p = 0.010). The VLP and VLP + S participants reported higher program satisfaction than the VLB participants. The VL program facilitates weight loss among school-district employees with overweight and obesity by increasing their PA and healthy diet.
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Affiliation(s)
- Che Young Lee
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Michael C. Robertson
- Department of Nutrition, Metabolism & Rehabilitation Sciences, The University of Texas Medical Branch at Galveston, Galveston, TX 77555, USA
| | - Hannah Johnston
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Thuan Le
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Margaret Raber
- Department of Pediatrics-Nutrition, Baylor College of Medicine, Houston, TX 77030, USA
| | - Ruth Rechis
- Be Well Comminutes, Cancer Prevention and Control Platform, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Katherine Oestman
- Be Well Comminutes, Cancer Prevention and Control Platform, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Alise Neff
- Department of Physical Education/Health and Wellness, Pasadena Independent School District, Pasadena, TX 77502, USA
| | - Amber Macneish
- Department of Physical Education/Health and Wellness, Pasadena Independent School District, Pasadena, TX 77502, USA
| | - Karen M. Basen-Engquist
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
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25
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Rojo M, Lacruz T, Solano S, Gutiérrez A, Beltrán‐Garrayo L, Veiga OL, Graell M, Sepúlveda AR. Family-reported barriers and predictors of short-term attendance in a multidisciplinary intervention for managing childhood obesity: A psycho-family-system based randomised controlled trial (ENTREN-F). EUROPEAN EATING DISORDERS REVIEW 2022; 30:746-759. [PMID: 35644038 PMCID: PMC9796111 DOI: 10.1002/erv.2913] [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: 01/03/2022] [Revised: 04/08/2022] [Accepted: 04/11/2022] [Indexed: 01/01/2023]
Abstract
OBJECTIVE This study was aimed to examine patient enrolment in the pre-intervention stage, family-reported barriers, attendance rates and underlying predictors of short-term attendance in a family-system-based randomised controlled trial for managing childhood obesity in children aged 8-12-years-old (ENTREN-F). METHOD Psychosocial and anthropometric measures were collected through primary health referral. The data were used for descriptive analyses of sample characteristics and linear regression analyses. RESULTS Low enrolment rates and several family-reported barriers were observed in the pre-intervention stage. Logistical barriers were the most frequent family-reported reason for attrition in the different stages of the study. Having a first face-to-face orientation session with the families and the use of motivational interviewing helped to improve adherence in the initial phases of the study. After 6 months of intervention, family based treatments (FBTs) under consideration achieve greater adherence compared with the standard intervention. Moreover, family involvement was a predictor of success for better treatment adherence rates. By contrast, participants who attended a brief standard intervention, mothers with primary education, greater body mass index, higher levels of depressive symptomatology and more critical comments towards their children, children with higher weight status and lower levels of self-reported depressive symptoms at baseline attended interventions less frequently. CONCLUSIONS In future programmes a comprehensive screening of modifiable factors related to family and their setting characteristics is paramount prior to intervention, identifying key barriers related to drop-out, especially in the case of less-advantaged families.
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Affiliation(s)
- Marta Rojo
- Faculty of PsychologyDepartment of Biological and Health PsychologyAutonomous University of MadridMadridSpain
| | - Tatiana Lacruz
- Faculty of PsychologyDepartment of Biological and Health PsychologyAutonomous University of MadridMadridSpain
| | - Santos Solano
- Faculty of PsychologyDepartment of Biological and Health PsychologyAutonomous University of MadridMadridSpain
| | - Ana Gutiérrez
- Faculty of PsychologyDepartment of Biological and Health PsychologyAutonomous University of MadridMadridSpain
| | - Lucía Beltrán‐Garrayo
- Faculty of PsychologyDepartment of Biological and Health PsychologyAutonomous University of MadridMadridSpain
| | - Oscar L. Veiga
- Department of Physical Education, Sport & Human MotricityAutonomous University of MadridMadridSpain
| | - Montserrat Graell
- Department of Child and Adolescent Psychiatry and Clinical PsychologyNiño Jesús Children's HospitalMadridSpain,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM)MadridSpain
| | - Ana Rosa Sepúlveda
- Faculty of PsychologyDepartment of Biological and Health PsychologyAutonomous University of MadridMadridSpain
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26
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Berg A, McCarthy HD. A soy-yoghurt-honey product as a therapeutic functional food: mode of action and narrative review. Heliyon 2022; 8:e11011. [DOI: 10.1016/j.heliyon.2022.e11011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 07/18/2022] [Accepted: 10/05/2022] [Indexed: 11/06/2022] Open
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27
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Gerber S, Folta SC. You Are What You Eat… But Do You Eat What You Are? The Role of Identity in Eating Behaviors—A Scoping Review. Nutrients 2022; 14:nu14173456. [PMID: 36079713 PMCID: PMC9458161 DOI: 10.3390/nu14173456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/16/2022] [Accepted: 08/17/2022] [Indexed: 11/25/2022] Open
Abstract
Background: Identity is a major construct in the fields of psychology and anthropology that can relate to both the maintenance of eating behaviors and cultural sensitivity. However, there has not been any systematic effort to understand the role of identity in eating behaviors and the maintenance of eating behaviors, or to address multiple aspects of identity within an individual across scientific disciplines. This scoping review aims to understand and describe existing research relating identity to eating behaviors and to detail the measurement of identity. Methods: We conducted a systematic search of Ovid, PsychINFO, Embase, and Web of Science for articles on identity and eating behaviors published between January 1946 and March 2022. We utilized the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist, and search methods were developed with the assistance of a research librarian. We rated articles from 1 to 5 based on the depth, complexity, and multi-dimensionality of the identity measurement conducted. Scoring criteria included a review of the number of items directly querying or evaluating identity and the extent of measurement of identity domains. Results: In total, 100 articles were included, examining 10 different identities, 8 identity constructs, 11 eating behaviors, and construct contributions from 26 theories. The mean score of all articles was 2.9 on the scale from 1 to 5. A total of 10 studies scored a “1”; 30 scored a “2”, indicating the use of 1–2 basic questions about identity; 31 received a “3” for use of a common but non-complex identity instrument; 19 received a “4”, meaning they contained strong evaluation and included multiple types of identity but were lacking in terms of depth of measure and/or the comparison of identity effects to constructs; and 10 scored a “5” for their strong, in-depth measure of identity and inclusion of multiple types. Identity was found to be significantly related to eating behaviors in all but one study. Conclusion: Identity measurements seldom accounted for complexities such as multiple identities and identity shifting over time. Nonetheless, our findings indicate that multiple aspects of identity reciprocally reinforce behavior and that change maintenance is associated with identity salience and centrality. Identity is underutilized and heterogeneously applied in eating behavior research. The inclusion of identity assessments may lead to better outcomes being obtained within differing cultural, normative, and environmental scenarios.
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Affiliation(s)
- Suzannah Gerber
- Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA 02111, USA
- Betty and Guy Beatty Liver and Obesity Research Program, Inova Medical System, Falls Church, VA 22043, USA
- Correspondence:
| | - Sara C. Folta
- Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA 02111, USA
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Clinical Evaluation of a Novel Tablet Formulation of Traditional Thai Polyherbal Medicine Named Nawametho in Comparison with Its Decoction in the Treatment of Hyperlipidemia. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:2530266. [PMID: 35966727 PMCID: PMC9365582 DOI: 10.1155/2022/2530266] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 06/02/2022] [Indexed: 11/25/2022]
Abstract
In the traditional medical system in Thailand, medicinal plants and polyherbal medicines have been prescribed as lipid-lowering agents, including Nawametho decoction. This polyherbal formulation is described in the Worayokasan scripture. It consists of nine medicinal plants (Aegle marmelos (L.), Carthamus tinctorius L., Hibiscus sabdariffa Linn., Phyllanthus emblica L., Piper longum L., Piper nigrum L., Terminalia bellirica (Gaertn.) Roxb., Terminalia chebula Retz., and Zingiber officinale Roscoe). Apart from its utilization in Thai traditional medicine, there is a lack of evidence supporting its use. This research work thereby aims to formulate and evaluate the tablet containing Nawametho decoction. The feasibility of Nawametho decoction and NawaTab for patients with borderline hyperlipidemia was additionally examined using a prospective, open-label, randomized, parallel-group design. The dry granulation technique was employed to formulate the polyherbal tablets. The tablets were developed using the spray-dried Nawametho decoction as the active ingredient in addition to other excipients. The chosen formulation, the FB (NawaTab), consisted of 385 milligrams of the extract, 12% w/w of a diluent (lactose), 8% w/w of a lubricant (magnesium stearate), 5% w/w of a disintegrant (microcrystalline cellulose), and 5% w/w of an anti-adherent (talcum). Their hardness, friability, and disintegration time were 4.4 ± 0.32 kg, 0.05 ± 0.02%, and 4.60 ± 0.05 min, respectively. Accelerated stability study results revealed that NawaTab was stable for six months at 40°C/75% RH and 25°C/60% RH. Even though taking NawaTabs (500 mg twice daily) for eight consecutive weeks was unable to improve the lipid profile of the patients, the administration of Nawametho decoction (30 mL twice daily) was associated with a significant decrease in serum triglycerides of the patients. The results show that the dry granulation technique is suitable for the formulation of NawaTab based on the tablet evaluation. Furthermore, the triglyceride-lowering effect of Nawametho decoction was reported for the first time.
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29
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Adherence to lifestyle advice and its related cardiovascular disease risk among US adults with high cholesterol. Clin Nutr ESPEN 2022; 51:267-273. [DOI: 10.1016/j.clnesp.2022.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 08/11/2022] [Indexed: 11/20/2022]
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30
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Tenbult N, Kraal J, Brouwers R, Spee R, Eijsbouts S, Kemps H. Adherence to a Multidisciplinary Lifestyle Program for Patients With Atrial Fibrillation and Obesity: Feasibility Study. JMIR Form Res 2022; 6:e32625. [PMID: 35486435 PMCID: PMC9107041 DOI: 10.2196/32625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 12/23/2021] [Accepted: 01/13/2022] [Indexed: 11/23/2022] Open
Abstract
Background Atrial fibrillation is commonly associated with obesity. Observational studies have shown that weight loss is associated with improved prognosis and a decrease in atrial fibrillation frequency and severity. However, despite these benefits, nonadherence to lifestyle programs is common. Objective In this study, we evaluated adherence to and feasibility of a multidisciplinary lifestyle program focusing on behavior change in patients with atrial fibrillation and obesity. Methods Patients with atrial fibrillation and obesity participated in a 1-year goal-oriented cardiac rehabilitation program. After baseline assessment, the first 3 months included a cardiac rehabilitation intervention with 4 fixed modules: lifestyle counseling (with an advanced nurse practitioner), exercise training, dietary consultation, and psychosocial therapy; relaxation sessions were an additional optional treatment module. An advanced nurse practitioner monitored the personal lifestyle of each individual patient, with assessments and consultations at 3 months (ie, immediately after the intervention) and at the end of the year (ie, 9 months after the intervention). At each timepoint, level of physical activity, personal goals and progress, atrial fibrillation symptoms and frequency (Atrial Fibrillation Severity Scale), psychosocial stress (Generalized Anxiety Disorder–7), and depression (Patient Health Questionnaire–9) were assessed. The primary endpoints were adherence (defined as the number of visits attended as percentage of the number of planned visits) and completion rates of the cardiac rehabilitation intervention (defined as performing at least of 80% of the prescribed sessions). In addition, we performed an exploratory analysis of effects of the cardiac rehabilitation program on weight and atrial fibrillation symptom frequency and severity. Results Patients with atrial fibrillation and obesity (male: n=8; female: n=2; age: mean 57.2 years, SD 9.0; baseline weight: mean 107.2 kg, SD 11.8; baseline BMI: mean 32.4 kg/m2, SD 3.5) were recruited. Of the 10 participants, 8 participants completed the 3-month cardiac rehabilitation intervention, and 2 participants did not complete the cardiac rehabilitation intervention (both because of personal issues). Adherence to the fixed treatment modules was 95% (mean 3.8 sessions attended out of mean 4 planned) for lifestyle counseling, 86% (mean 15.2 sessions attended out of mean 17.6 planned) for physiotherapy sessions, 88% (mean 3.7 sessions attended out of mean 4.1 planned) for dietician consultations, and 60% (mean 0.6 sessions attended out of mean 1.0 planned) for psychosocial therapy; 70% of participants (7/10) were referred to the optional relaxation sessions, for which adherence was 86% (mean 2 sessions attended out of mean 2.4 planned). The frequency of atrial fibrillation symptoms was reduced immediately after the intervention (before: mean 35.6, SD 3.8; after: mean 31.2, SD 3.3), and this was sustained at 12 months (mean 24.8, SD 3.2). The severity of atrial fibrillation complaints immediately after the intervention (mean 20.0, SD 3.7) and at 12 months (mean 9.3, SD 3.6) were comparable to that at baseline (mean 16.6, SD 3.3). Conclusions A 1-year multidisciplinary lifestyle program for obese patients with atrial fibrillation was found to be feasible, with high adherence and completion rates. Exploratory analysis revealed a sustained reduction in atrial fibrillation symptoms; however, these results remain to be confirmed in large-scale studies.
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Affiliation(s)
- Nicole Tenbult
- Telemedicine and Rehabilitation in Chronic Disease, Flow, Center for Prevention, Máxima MC, Veldhoven/Eindhoven, Netherlands
| | - Jos Kraal
- Telemedicine and Rehabilitation in Chronic Disease, Flow, Center for Prevention, Máxima MC, Veldhoven/Eindhoven, Netherlands.,Faculty Industrial Design Engineering, Delft, Netherlands
| | - Rutger Brouwers
- Telemedicine and Rehabilitation in Chronic Disease, Flow, Center for Prevention, Máxima MC, Veldhoven/Eindhoven, Netherlands
| | - Ruud Spee
- Telemedicine and Rehabilitation in Chronic Disease, Flow, Center for Prevention, Máxima MC, Veldhoven/Eindhoven, Netherlands.,Department of Cardiology, Máxima MC, Veldhoven/Eindhoven, Netherlands
| | - Sabine Eijsbouts
- Department of Cardiology, Máxima MC, Veldhoven/Eindhoven, Netherlands
| | - Hareld Kemps
- Telemedicine and Rehabilitation in Chronic Disease, Flow, Center for Prevention, Máxima MC, Veldhoven/Eindhoven, Netherlands.,Department of Cardiology, Máxima MC, Veldhoven/Eindhoven, Netherlands.,Department of Industrial Design, University of Technology Eindhoven, Eindhoven, Netherlands
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Widén E, Junna N, Ruotsalainen S, Surakka I, Mars N, Ripatti P, Partanen JJ, Aro J, Mustonen P, Tuomi T, Palotie A, Salomaa V, Kaprio J, Partanen J, Hotakainen K, Pöllänen P, Ripatti S. How Communicating Polygenic and Clinical Risk for Atherosclerotic Cardiovascular Disease Impacts Health Behavior: an Observational Follow-up Study. CIRCULATION. GENOMIC AND PRECISION MEDICINE 2022; 15:e003459. [PMID: 35130028 DOI: 10.1161/circgen.121.003459] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Prediction tools that combine polygenic risk scores with clinical factors provide a new opportunity for improved prediction and prevention of atherosclerotic cardiovascular disease, but the clinical utility of polygenic risk score has remained unclear. METHODS We collected a prospective cohort of 7342 individuals (64% women, mean age 56 years) and estimated their 10-year risk for atherosclerotic cardiovascular disease both by a traditional risk score and a composite score combining the effect of a polygenic risk score and clinical risk factors. We then tested how returning the personal risk information with an interactive web-tool impacted on the participants' health behavior. RESULTS When reassessed after 1.5 years by a clinical visit and questionnaires, 20.8% of individuals at high (>10%) 10-year atherosclerotic cardiovascular disease risk had seen a doctor, 12.4% reported weight loss, 14.2% of smokers had quit smoking, and 15.4% had signed up for health coaching online. Altogether, 42.6% of persons at high risk had made one or more health behavioral changes versus 33.5% of persons at low/average risk such that higher baseline risk predicted a favorable change (OR [CI], 1.53 [1.37-1.72] for persons at high risk versus the rest, P<0.001), with both high clinical (P<0.001) and genomic risk (OR [CI], 1.10 [1.03-1.17], P=0.003) contributing independently. CONCLUSIONS Web-based communication of personal atherosclerotic cardiovascular disease risk-data including polygenic risk to middle-aged persons motivates positive changes in health behavior and the propensity to seek care. It supports integration of genomic information into clinical risk calculators as a feasible approach to enhance disease prevention.
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Affiliation(s)
- Elisabeth Widén
- Institute for Molecular Medicine Finland, FIMM, HiLIFE (E.W., N.J., S.R., I.S., N.M., P.R., J.J.P., J.A., T.T., A.P., J.K., S.R.), University of Helsinki, Helsinki, Finland
| | - Nella Junna
- Institute for Molecular Medicine Finland, FIMM, HiLIFE (E.W., N.J., S.R., I.S., N.M., P.R., J.J.P., J.A., T.T., A.P., J.K., S.R.), University of Helsinki, Helsinki, Finland
| | - Sanni Ruotsalainen
- Institute for Molecular Medicine Finland, FIMM, HiLIFE (E.W., N.J., S.R., I.S., N.M., P.R., J.J.P., J.A., T.T., A.P., J.K., S.R.), University of Helsinki, Helsinki, Finland
| | - Ida Surakka
- Institute for Molecular Medicine Finland, FIMM, HiLIFE (E.W., N.J., S.R., I.S., N.M., P.R., J.J.P., J.A., T.T., A.P., J.K., S.R.), University of Helsinki, Helsinki, Finland.,Department of Internal Medicine, University of Michigan, Ann Arbor (I.D.)
| | - Nina Mars
- Institute for Molecular Medicine Finland, FIMM, HiLIFE (E.W., N.J., S.R., I.S., N.M., P.R., J.J.P., J.A., T.T., A.P., J.K., S.R.), University of Helsinki, Helsinki, Finland
| | - Pietari Ripatti
- Institute for Molecular Medicine Finland, FIMM, HiLIFE (E.W., N.J., S.R., I.S., N.M., P.R., J.J.P., J.A., T.T., A.P., J.K., S.R.), University of Helsinki, Helsinki, Finland
| | - Juulia J Partanen
- Institute for Molecular Medicine Finland, FIMM, HiLIFE (E.W., N.J., S.R., I.S., N.M., P.R., J.J.P., J.A., T.T., A.P., J.K., S.R.), University of Helsinki, Helsinki, Finland
| | - Johanna Aro
- Institute for Molecular Medicine Finland, FIMM, HiLIFE (E.W., N.J., S.R., I.S., N.M., P.R., J.J.P., J.A., T.T., A.P., J.K., S.R.), University of Helsinki, Helsinki, Finland
| | - Pekka Mustonen
- Duodecim Publishing Company Ltd, Helsinki, Finland. (P.M.)
| | - Tiinamaija Tuomi
- Institute for Molecular Medicine Finland, FIMM, HiLIFE (E.W., N.J., S.R., I.S., N.M., P.R., J.J.P., J.A., T.T., A.P., J.K., S.R.), University of Helsinki, Helsinki, Finland.,Research Program Unit, Clinical and Molecular Metabolism (T.T.), University of Helsinki, Helsinki, Finland.,Folkhälsan Research Center, Helsinki, Finland (T.T.).,Lund University Diabetes Centre, Department of Clinical Sciences, Lund University, Malmö, Sweden (T.T.)
| | - Aarno Palotie
- Institute for Molecular Medicine Finland, FIMM, HiLIFE (E.W., N.J., S.R., I.S., N.M., P.R., J.J.P., J.A., T.T., A.P., J.K., S.R.), University of Helsinki, Helsinki, Finland.,Analytic and Translational Genetics Unit, Massachusetts General Hospital & Harvard Medical School, Boston & Broad Institute of MIT & Harvard, Cambridge (A.P., S.R.)
| | - Veikko Salomaa
- Finnish Institute for Health and Welfare, Helsinki, Finland (V.S.)
| | - Jaakko Kaprio
- Institute for Molecular Medicine Finland, FIMM, HiLIFE (E.W., N.J., S.R., I.S., N.M., P.R., J.J.P., J.A., T.T., A.P., J.K., S.R.), University of Helsinki, Helsinki, Finland
| | - Jukka Partanen
- Finnish Red Cross Blood Service, Helsinki, Finland (J.P.)
| | | | - Pasi Pöllänen
- Clinicum (P.P.), University of Helsinki, Helsinki, Finland.,CAREA - Kymenlaakso social and health care services, Kotka, Finland (P.P.)
| | - Samuli Ripatti
- Institute for Molecular Medicine Finland, FIMM, HiLIFE (E.W., N.J., S.R., I.S., N.M., P.R., J.J.P., J.A., T.T., A.P., J.K., S.R.), University of Helsinki, Helsinki, Finland.,Department of Public Health, Clinicum (S.R.), University of Helsinki, Helsinki, Finland.,Analytic and Translational Genetics Unit, Massachusetts General Hospital & Harvard Medical School, Boston & Broad Institute of MIT & Harvard, Cambridge (A.P., S.R.)
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Team members influence retention in a First Peoples’ community-based weight-loss program. Prev Med Rep 2022; 26:101710. [PMID: 35141119 PMCID: PMC8814646 DOI: 10.1016/j.pmedr.2022.101710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 01/06/2022] [Accepted: 01/23/2022] [Indexed: 11/21/2022] Open
Abstract
Program completion is strongly influenced by teammate completion. Other factors influencing program completion vary with participation occasion. Previous participation and health behaviors do not influence subsequent completion.
The aim of this study was to evaluate program retention factors in a repeated team-based weight-loss and healthy lifestyle program for Aboriginal and Torres Strait Islander Peoples. Data comprised 3107 participants in 10 Aboriginal Knockout Health Challenge contests. Multiple variable and bivariate analyses compared age, gender, self-reported behaviors (physical activity and fruit and vegetable consumption) and objectively measured weight between completers and non-completers. First-time participants (n = 3107) who completed were more likely to be female, be older, weigh less and have more completing members in their team; only the number of team members completing was significant among participants (n = 1245) who took part in a second contest participation. Multivariate results were similar, with a participant’s odds of completing on their first and second participation occasion increasing by 1.16 and 1.18, respectively, with every teammate completed. Given that the strongest effect centered on a social factor, this highlights the importance of having community-driven design and the benefits of a group-based approach to engage and maintain First Peoples’ engagement in preventive health programs. Further, by identifying a change in factors associated with retention in successive weight-loss attempts, this study improves understanding of retention in weight-loss programs more generally.
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Bjerre N, Holm L, Veje N, Quist JS, Færch K, Hempler NF. What happens after a weight loss intervention? A qualitative study of drivers and challenges of maintaining time-restricted eating among people with overweight at high risk of type 2 diabetes. Appetite 2022; 174:106034. [PMID: 35378218 DOI: 10.1016/j.appet.2022.106034] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 03/29/2022] [Accepted: 03/30/2022] [Indexed: 11/18/2022]
Abstract
Time-restricted eating (TRE)1 has been conceptualised as a strategy for achieving weight loss and improving metabolic health, but limited knowledge exists about how people can maintain TRE in daily life. This study examined how TRE was maintainable in daily life after a three-month intervention (the RESET study) in which participants were encouraged to consume all food and beverages except water within a 10-hour daily window. Specifically, we examined TRE maintenance patterns across participants, including drivers and challenges for maintenance success. A qualitative longitudinal study was conducted, and twenty participants with overweight at high risk of type 2 diabetes were interviewed using a semi-structured interview guide at the end of the intervention and after a three-month follow-up period. Data were analysed longitudinally in two steps inspired by a pattern-oriented longitudinal analysis approach. Seven participants maintained a strict 10-hour window, ten maintained an adjusted TRE regimen (e.g., taking days off), and three did not attempt maintenance. Maintenance drivers included consistent daily rhythms and regular meal patterns, subjective experiences (e.g., feeling healthier), making flexible adjustments to the TRE regimen, family support and avoiding feelings of guilt. Maintenance challenges included social evening events, inconsistent daily rhythms and eating patterns, preoccupation with losing weight, lack of family support and self-blame. TRE was manageable for most participants; however, personalised support for adjusting TRE to daily life is needed to ensure long-term maintenance. Future studies should explore the effectiveness of a personalised TRE concept to determine the usefulness of TRE in real-life settings.
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Affiliation(s)
- Natasja Bjerre
- Health Promotion Research, Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Borgmester Ib Juuls Vej 83, 2730, Herlev, Denmark; Department of Food and Resource Economics, University of Copenhagen, Rolighedsvej 25, 1958, Frederiksberg, Denmark.
| | - Lotte Holm
- Department of Food and Resource Economics, University of Copenhagen, Rolighedsvej 25, 1958, Frederiksberg, Denmark.
| | - Nanna Veje
- Health Promotion Research, Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Borgmester Ib Juuls Vej 83, 2730, Herlev, Denmark.
| | - Jonas Salling Quist
- Clinical Research, Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Borgmester Ib Juuls Vej 83, 2730, Herlev, Denmark.
| | - Kristine Færch
- Clinical Research, Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Borgmester Ib Juuls Vej 83, 2730, Herlev, Denmark; Department of Biomedical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen, Denmark.
| | - Nana Folmann Hempler
- Health Promotion Research, Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Borgmester Ib Juuls Vej 83, 2730, Herlev, Denmark.
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Zong P, Feng J, Yue Z, Yu AS, Vacher J, Jellison ER, Miller B, Mori Y, Yue L. TRPM2 deficiency in mice protects against atherosclerosis by inhibiting TRPM2-CD36 inflammatory axis in macrophages. NATURE CARDIOVASCULAR RESEARCH 2022; 1:344-360. [PMID: 35445217 PMCID: PMC9015693 DOI: 10.1038/s44161-022-00027-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Atherosclerosis is the major cause of ischemic heart disease and stroke, the leading causes of mortality worldwide. The central pathological features of atherosclerosis include macrophage infiltration and foam cell formation. However, the detailed mechanisms regulating these two processes remain unclear. Here we show that oxidative stress-activated Ca2+-permeable transient receptor potential melastatin 2 (TRPM2) plays a critical role in atherogenesis. Both global and macrophage-specific Trpm2 deletion protect Apoe−/− mice against atherosclerosis. Trpm2 deficiency reduces oxidized low-density lipoprotein (oxLDL) uptake by macrophages, thereby minimizing macrophage infiltration, foam cell formation and inflammatory responses. Activation of the oxLDL receptor CD36 induces TRPM2 activity, and vice versa. In cultured macrophages, TRPM2 is activated by CD36 ligands oxLDL and thrombospondin-1 (TSP1), and deleting Trpm2 or inhibiting TRPM2 activity suppresses the activation of CD36 signaling cascade induced by oxLDL and TSP1. Our findings establish the TRPM2-CD36 axis as a molecular mechanism underlying atherogenesis, and suggest TRPM2 as a potential therapeutic target for atherosclerosis.
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Affiliation(s)
- Pengyu Zong
- Department of Cell Biology, Calhoun Cardiology Center, University of Connecticut School of Medicine (UConn Health), Farmington, CT 06030, USA
| | - Jianlin Feng
- Department of Cell Biology, Calhoun Cardiology Center, University of Connecticut School of Medicine (UConn Health), Farmington, CT 06030, USA
| | - Zhichao Yue
- Department of Cell Biology, Calhoun Cardiology Center, University of Connecticut School of Medicine (UConn Health), Farmington, CT 06030, USA
| | - Albert S Yu
- Department of Cell Biology, Calhoun Cardiology Center, University of Connecticut School of Medicine (UConn Health), Farmington, CT 06030, USA
| | - Jean Vacher
- Institut de Recherches Cliniques de Montréal (IRCM), 110 avenue des Pins Ouest, Montréal, Québec; Département de Médecine, Université de Montréal, Montréal, Québec, Canada
| | - Evan R Jellison
- Department of Immunology, University of Connecticut School of Medicine (UConn Health), Farmington, CT 06030, USA
| | - Barbara Miller
- Departments of Pediatrics, and Biochemistry and Molecular Biology, The Pennsylvania State University College of Medicine, P.O. Box 850, Hershey, Pennsylvania, 17033, USA
| | - Yasuo Mori
- Laboratory of Molecular Biology, Department of Synthetic Chemistry and Biological Chemistry, Graduate School of Engineering, Kyoto University, Katsura Campus A4-218, Kyoto 615-8510, Japan
| | - Lixia Yue
- Department of Cell Biology, Calhoun Cardiology Center, University of Connecticut School of Medicine (UConn Health), Farmington, CT 06030, USA
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Terranova CO, Winkler EAH, Healy GN, Demark-Wahnefried W, Eakin EG, Reeves MM. Dietary and physical activity changes and adherence to WCRF/AICR cancer prevention recommendations following a remotely delivered weight loss intervention for female breast cancer survivors: The Living Well after Breast Cancer randomized controlled trial. J Acad Nutr Diet 2022; 122:1644-1664.e7. [PMID: 35182789 DOI: 10.1016/j.jand.2022.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 01/25/2022] [Accepted: 02/11/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND Diet, exercise, and weight management are key in improving outcomes for breast cancer survivors, with international recommendations for cancer survivors relating to these behaviors. However, few behavioral interventions have reported outcomes aligned specifically with these recommendations. OBJECTIVE To evaluate a remotely delivered weight loss intervention versus usual care for female breast cancer survivors, on changes in multiple diet and physical activity behaviors. DESIGN A randomized controlled trial with assessments at study baseline, 6-, 12- and 18 months (i.e., mid-intervention, post-intervention, and non-contact follow-up). PARTICIPANTS/SETTING Participants were recruited between October 2012 and December 2014 through hospitals in Brisbane (Australia) and the state-based cancer registry. Eligible participants (female, 18-75 years, BMI 25-45 kg/m2, diagnosed with stage I-III breast cancer in previous two years) were randomly allocated to intervention (n=79) or usual care (n=80). INTERVENTION Participants randomized to the intervention group received 22 counseling telephone calls targeting diet and physical activity aimed at achieving 5-10% weight loss, and optional text messages, over 12 months. Usual care participants received their standard medical care and brief feedback following each assessment, which was similar to that provided to intervention participants with the exception that usual care participants' results were not compared to national and study recommendations. MAIN OUTCOME MEASURES Dietary intake (24-hour recalls); physical activity (hip-worn Actigraph); sitting time (thigh-worn activPAL3); and, adherence to World Cancer Research Fund/American Cancer Research Institute (WCRF/AICR) recommendations for cancer survivors (0-7 score) were measured at each assessment, with data collected between November 2012 and October 2016. STATISTICAL ANALYSES PERFORMED Intervention effects were assessed by linear mixed models, accounting for repeated measures and baseline values. Significance was set at P<0.05. RESULTS At baseline, participants were (mean±SD) aged 55±9 years, with a BMI of 31.4±5.0 kg/m2, 10.7±5.0 months post-diagnosis, and primarily non-minority. At baseline, only 8% (n=12) of participants met ≥5/7 WCRF/AICR recommendations (mean±SD WCRF/AICR adherence score: 3.8±1.0). At 12 months, significant intervention effects were observed in walking/running ( +21 mins/week; 95%CI: 4, 38) and WCRF/AICR adherence scores (+0.3 points; 95%CI: 0.0, 0.6) only. At 18 months, significant intervention effects were observed for energy intake (-229 kcal/day energy; 95%CI: -373, -84), total fat (-10 g/day; 95%CI: -18, -2), and saturated fat (-5 g/day; 95%CI: -9, -1), and were sustained for WCRF/AICR adherence scores (+0.5 points; 95%CI: 0.2, 0.8). CONCLUSIONS This remotely delivered weight loss intervention led to sustained improvements in WCRF/AICR adherence scores, and some improvements in diet and physical activity. These findings provide support for the health benefit of programs targeting lifestyle behaviors in line with cancer survivor recommendations, and the potential for dissemination of such programs following treatment for early-stage female breast cancer.
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Affiliation(s)
- C O Terranova
- School of Public Health, The University of Queensland, Brisbane, Australia
| | - E A H Winkler
- School of Public Health, The University of Queensland, Brisbane, Australia
| | - G N Healy
- School of Public Health, The University of Queensland, Brisbane, Australia; Baker Heart & Diabetes Institute, Melbourne, Victoria, Australia; School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia
| | - W Demark-Wahnefried
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - E G Eakin
- School of Public Health, The University of Queensland, Brisbane, Australia
| | - M M Reeves
- School of Public Health, The University of Queensland, Brisbane, Australia
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Associations between weight loss history and factors related to type 2 diabetes risk in the Stop Diabetes study. Int J Obes (Lond) 2022; 46:935-942. [PMID: 35022546 PMCID: PMC9050593 DOI: 10.1038/s41366-021-01061-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 12/09/2021] [Accepted: 12/22/2021] [Indexed: 12/02/2022]
Abstract
Background Frequent weight loss attempts are related to maladaptive eating behaviours and higher body mass index (BMI). We studied associations of several type 2 diabetes (T2D) risk factors with weight loss history, defined as the frequency of prior weight loss attempts, among Finnish adults at increased risk for T2D. Methods This study (n = 2684, 80% women) is a secondary analysis of the 1-year StopDia lifestyle intervention with digital intervention group, digital intervention + face-to-face counselling group, or control group. The frequency of prior weight loss attempts was categorized into five groups: no attempts/no attempts to lose weight, but trying to keep weight stable/1–2 attempts/3 or more attempts/ continuous attempts. Data on emotional eating and social/emotional nutrition self-efficacy were collected with a digital questionnaire. We assessed baseline differences between categories of weight loss history as well as the intervention effects. Results Altogether 84% of participants had attempted weight loss. Those with one or more weight loss attempts had higher BMI, larger waist circumference, and more emotional eating compared to ‘no attempts’ and ‘no attempts to lose weight, but trying to keep weight stable’ categories. The ‘no attempts’ category had the highest baseline fasting insulin, whereas it showed the largest decrease in this measure with the intervention. This change in fasting insulin in the ‘no attempts’ category was significantly different from all the other categories. Emotional nutrition self-efficacy slightly improved in the ‘no attempts’ category, which was significantly different from its concomitant decrease in the categories ‘1-2 attempts’ and ‘3 or more attempts’. The intervention group assignment did not affect the results. Conclusions Multiple attempts to lose weight may unfavourably affect T2D risk factors as well as lifestyle intervention outcomes. More research is needed on how weight loss frequency could affect T2D risk factors and how to design lifestyle interventions for individuals with frequent previous weight loss attempts.
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James A, Lawrence B, O’Connor M. Healthy Eating as a New Way of Life: A Qualitative Study of Successful Long-Term Diet Change. INQUIRY: THE JOURNAL OF HEALTH CARE ORGANIZATION, PROVISION, AND FINANCING 2022; 59:469580221090397. [PMID: 35418258 PMCID: PMC9016560 DOI: 10.1177/00469580221090397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Improving diet quality has been shown to be an effective way to improve
health and well-being. Yet information on how to assist those wanting to
transition to and maintain a healthier diet is still limited. The aim of
this study was to explore what motivated people to initiate and maintain a
healthy diet. Methods Semi-structured interviews were conducted with 20 participants (all
Australian residents) who had made significant improvements to their diets
and had maintained these changes for a minimum of two years
(nfemale = 15, nmale = 5, Mage = 37.7, SD = 12.4). The transcripts were analysed
using thematic analysis which identified five overarching themes: A desire
to feel better, investigation and learning, helpful habits, benefits, and
values. Results Participants reported a strong wish to feel better and investigated the role
of diet as a possible way to improve well-being. Through daily habits and
continuous engagement with the topic, healthy eating became a way of life
for many participants. Experiencing the benefits of a healthier diet and
having developed strong values regarding diet and health supported long-term
maintenance. Conclusions Findings from the present study contribute to the literature in highlighting
the importance of internal motivation and autonomy for health behaviours.
Findings may inform the development of healthy eating interventions.
Encouraging autonomy, fostering values aligned with a healthier diet, and
helping individuals establish daily habits is likely to support change.
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Affiliation(s)
- Anna James
- WA Cancer Prevention Research Unit, Discipline of Psychology, School of Population Health, Curtin University, Perth, WA, Australia
| | - Blake Lawrence
- WA Cancer Prevention Research Unit, Discipline of Psychology, School of Population Health, Curtin University, Perth, WA, Australia
| | - Moira O’Connor
- WA Cancer Prevention Research Unit, Discipline of Psychology, School of Population Health, Curtin University, Perth, WA, Australia
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Lee SE, Park SK, Park YS, Kim KA, Choi HS, Oh SW. Effects of Short-term Mobile Application Use on Weight Reduction for Patients with Type 2 Diabetes. J Obes Metab Syndr 2021; 30:345-353. [PMID: 34875628 PMCID: PMC8735826 DOI: 10.7570/jomes21047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 07/11/2021] [Accepted: 08/11/2021] [Indexed: 12/22/2022] Open
Abstract
Background The increasing prevalence of type 2 diabetes mellitus (T2DM) has led to a significant health burden. Technological advancements have highlighted the benefits of digital therapeutics for chronic diseases. In this study, we aimed to investigate the effects of a mobile application on weight reduction in patients with T2DM. Methods A total of 48 patients with T2DM was included in this single-center, randomized, controlled trial. In addition to conventional treatment, participants in the intervention group used a mobile application-based self-management system for diet, exercise, and medication adherence. The primary outcome of this study was weight change after 3 months of intervention, and secondary outcomes were metabolic parameters. Results After 12 weeks, no significant differences in body weight change were observed between the intervention and control groups (P=0.229). However, a significant difference was found in waist circumference (WC) between the two groups, wherein the control group showed an increase in WC (from 95.00±8.89 cm to 95.76±9.72 cm), while the intervention group showed a reduction (from 91.93±6.25 cm to 90.75±6.01 cm) with a significant time by group interaction (P=0.016). Additionally, participants with good compliance exhibited a more evident reduction in WC (P=0.037). However, no significant differences were found in other metabolic parameters between the two groups. Conclusion Lifestyle modification using short-term mobile applications effectively reduced WC, especially in patients with good adherence to the application. However, weight reduction was not achieved.
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Affiliation(s)
- Seung Eun Lee
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea
| | - Su-Kyung Park
- Department of Family Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea
| | - Ye-Seul Park
- Department of Family Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea
| | - Kyoung-Ah Kim
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea
| | - Han Seok Choi
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea
| | - Sang Woo Oh
- Department of Family Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea
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Torres L, Lee JL, Park S, Di Lorenzo RC, Branam JP, Fraser SA, Salisbury BA. Retention, Fasting Patterns, and Weight Loss With an Intermittent Fasting App: A Large-scale, 52-week Observational Study (Preprint). JMIR Mhealth Uhealth 2021; 10:e35896. [PMID: 36194463 PMCID: PMC9579929 DOI: 10.2196/35896] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 07/14/2022] [Accepted: 07/26/2022] [Indexed: 11/13/2022] Open
Abstract
Background Intermittent fasting (IF) is an increasingly popular approach to dietary control that focuses on the timing of eating rather than the quantity and content of caloric intake. IF practitioners typically seek to improve their weight and other health factors. Millions of practitioners have turned to purpose-built mobile apps to help them track and adhere to their fasts and monitor changes in their weight and other biometrics. Objective This study aimed to quantify user retention, fasting patterns, and weight loss by users of 2 IF mobile apps. We also sought to describe and model starting BMI, amount of fasting, frequency of weight tracking, and other demographics as correlates of retention and weight change. Methods We assembled height, weight, fasting, and demographic data of adult users (ages 18-100 years) of the LIFE Fasting Tracker and LIFE Extend apps from 2018 to 2020. Retention for up to 52 weeks was quantified based on recorded fasts and correlated with user demographics. Users who provided height and at least 2 readings of weight and whose first fast and weight records were contemporaneous were included in the weight loss analysis. Fasting was quantified as extended fasting hours (EFH; hours beyond 12 in a fast) averaged per day (EFH per day). Retention was modeled using a Cox proportional hazards regression. Weight loss was analyzed using linear regression. Results A total of 792,692 users were followed for retention based on 26 million recorded fasts. Of these, 132,775 (16.7%) users were retained at 13 weeks, 54,881 (6.9%) at 26 weeks, and 16,478 (2.1%) at 52 weeks, allowing 4 consecutive weeks of inactivity. The survival analysis using Cox regression indicated that retention was positively associated with age and exercise and negatively associated with stress and smoking. Weight loss in the qualifying cohort (n=161,346) was strongly correlated with starting BMI and EFH per day, which displayed a positive interaction. Users with a BMI ≥40 kg/m2 lost 13.9% of their starting weight by 52 weeks versus a slight weight gain on average for users with starting BMI <23 kg/m2. EFH per day was an approximately linear predictor of weight loss. By week 26, users lost over 1% of their starting weight per EFH per day on average. The regression analysis using all variables was highly predictive of weight change at 26 weeks (R2=0.334) with starting BMI and EFH per day as the most significant predictors. Conclusions IF with LIFE mobile apps appears to be a sustainable approach to weight reduction in the overweight and obese population. Healthy weight and underweight individuals do not lose much weight on average, even with extensive fasting. Users who are obese lose substantial weight over time, with more weight loss in those who fast more.
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Affiliation(s)
| | - Joy L Lee
- Indiana University School of Medicine, Indianapolis, IN, United States
- The Regenstrief Institute, Indianapolis, IN, United States
| | - Seho Park
- Indiana University School of Medicine, Indianapolis, IN, United States
- The Regenstrief Institute, Indianapolis, IN, United States
| | | | | | - Shelagh A Fraser
- LifeOmic, Indianapolis, IN, United States
- Priority Physicians, Carmel, IN, United States
| | - Benjamin A Salisbury
- LifeOmic, Indianapolis, IN, United States
- Program in Biomedical Sciences, Wright State University, Dayton, OH, United States
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Schembre SM, Jospe MR, Giles ED, Sears DD, Liao Y, Basen-Engquist KM, Thomson CA. A Low-Glucose Eating Pattern Improves Biomarkers of Postmenopausal Breast Cancer Risk: An Exploratory Secondary Analysis of a Randomized Feasibility Trial. Nutrients 2021; 13:nu13124508. [PMID: 34960058 PMCID: PMC8707938 DOI: 10.3390/nu13124508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 11/24/2021] [Accepted: 12/14/2021] [Indexed: 11/30/2022] Open
Abstract
Postmenopausal breast cancer is the most common obesity-related cancer death among women in the U.S. Insulin resistance, which worsens in the setting of obesity, is associated with higher breast cancer incidence and mortality. Maladaptive eating patterns driving insulin resistance represent a key modifiable risk factor for breast cancer. Emerging evidence suggests that time-restricted feeding paradigms (TRF) improve cancer-related metabolic risk factors; however, more flexible approaches could be more feasible and effective. In this exploratory, secondary analysis, we identified participants following a low-glucose eating pattern (LGEP), defined as consuming energy when glucose levels are at or below average fasting levels, as an alternative to TRF. Results show that following an LGEP regimen for at least 40% of reported eating events improves insulin resistance (HOMA-IR) and other cancer-related serum biomarkers. The magnitude of serum biomarkers changes observed here has previously been shown to favorably modulate benign breast tissue in women with overweight and obesity who are at risk for postmenopausal breast cancer. By comparison, the observed effects of LGEP were similar to results from previously published TRF studies in similar populations. These preliminary findings support further testing of LGEP as an alternative to TRF and a postmenopausal breast cancer prevention strategy. However, results should be interpreted with caution, given the exploratory nature of analyses.
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Affiliation(s)
- Susan M. Schembre
- Department of Family and Community Medicine, College of Medicine-Tucson, University of Arizona, Tucson, AZ 85721, USA;
- Correspondence:
| | - Michelle R. Jospe
- Department of Family and Community Medicine, College of Medicine-Tucson, University of Arizona, Tucson, AZ 85721, USA;
| | - Erin D. Giles
- Department of Nutrition, Texas A & M University, College Station, TX 77843, USA;
| | - Dorothy D. Sears
- College of Health Solutions, Arizona State University, Tempe, AZ 85287, USA;
| | - Yue Liao
- Department of Kinesiology, College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, TX 76019, USA;
| | - Karen M. Basen-Engquist
- Department of Behavioral Science, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
| | - Cynthia A. Thomson
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ 85721, USA;
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Stansbury ML, Harvey JR, Krukowski RA, Pellegrini CA, Wang X, West DS. Distinguishing early patterns of physical activity goal attainment and weight loss in online behavioral obesity treatment using latent class analysis. Transl Behav Med 2021; 11:2164-2173. [PMID: 34662410 PMCID: PMC8672928 DOI: 10.1093/tbm/ibab130] [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: 11/14/2022] Open
Abstract
Physical activity (PA) goal adherence is consistently associated with greater weight loss during behavioral obesity treatment, and early weight loss response predicts future weight loss success. However, it remains unclear which behaviors during the initial weeks of treatment distinguish responders from nonresponders and might be effective targets for improving treatment outcomes. To characterize subgroups with distinct patterns of PA goal adherence during the initial 2 months of an online, group-based weight control program and determine associations between these patterns and 6-month weight loss. Participants received an online behavioral obesity intervention with PA goals and daily self-monitoring. Weekly adherence to step goals and moderate-to-vigorous PA (MVPA) minute goals based on self-monitoring records were examined using latent class analysis. Body weight was objectively measured at 0, 2, and 6 months. Participants (N = 212; 91.5% female, 31.6% race/ethnic minority, mean body mass index: 35.8 ± 5.9 kg/m2) clustered into three subgroups based on early goal attainment: "Both PA Goals," "MVPA Goals Only," and "Neither PA Goal." The "Both PA Goals" class had significantly greater 6-month weight loss (estimated mean weight loss [95% CI]: -9.4% [7.4 to 11.5]) compared to the "MVPA Goals Only" (-4.8% [3.4 to 6.1]) and "Neither PA Goal" classes (-2.5% [1.4 to 3.6]). Individuals meeting both PA goals early in treatment achieve greater weight losses than those meeting MVPA but not step goals, pointing to the need to explore factors associated with nonadherence to each of the PA goals to better understand these potential targets for treatment refinement and adaptive interventions.
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Affiliation(s)
- Melissa L Stansbury
- Department of Exercise Science, Arnold School of Public Health,
University of South Carolina, Columbia, SC
29208, USA
| | - Jean R Harvey
- Department of Nutrition and Food Sciences, University of
Vermont, Burlington, VT 05405, USA
| | - Rebecca A Krukowski
- Department of Preventive Medicine, University of Tennessee Health
Science Center, Memphis, TN 38163, USA
| | - Christine A Pellegrini
- Department of Exercise Science, Arnold School of Public Health,
University of South Carolina, Columbia, SC
29208, USA
| | - Xuewen Wang
- Department of Exercise Science, Arnold School of Public Health,
University of South Carolina, Columbia, SC
29208, USA
| | - Delia S West
- Department of Exercise Science, Arnold School of Public Health,
University of South Carolina, Columbia, SC
29208, USA
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Coumans JMJ, Oenema A, Bolman CAW, Lechner L. Use and Appreciation of a Web-Based, Computer-Tailored Diet and Physical Activity Intervention Based on the Self-determination Theory: Evaluation Study of Process and Predictors. JMIR Form Res 2021; 5:e22390. [PMID: 34860670 PMCID: PMC8686464 DOI: 10.2196/22390] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 11/23/2020] [Accepted: 09/29/2021] [Indexed: 12/30/2022] Open
Abstract
Background eHealth is a promising tool for promoting lifestyle behaviors such as a healthy diet and physical activity (PA). However, making people use interventions is a crucial and challenging problem in eHealth. More insight into use patterns and predicting factors is needed to improve future interventions. Objective This study aims to examine the use, predictors of use, and appreciation of a web-based, computer-tailored, dietary and PA promotion intervention, MyLifestyleCoach, which is based on the self-determination theory. First, we depict the participants’ flow in the intervention and identify moments when they are likely to discontinue use. Second, we investigate whether demographic, motivational, and program-related characteristics predict the use of several intervention elements. Finally, we report the appreciation scores for the intervention and the participant and program characteristics associated with these scores. Methods This study was based on data from web-based self-report questionnaires. Here, objectively assessed intervention use data were analyzed from participants randomized to the intervention condition. Multiple stepwise (logistic) regression analyses were conducted to examine the predictors of intervention use and evaluation scores. Results Our findings indicate a low full completion rate for the intervention among those who chose and completed the diet module (49/146, 33.6%), the PA module (2/12, 17%), and both modules (58/273, 21.2%). Several points in the intervention where participants were likely to stop using the intervention were identified. Autonomous and intrinsic motivation toward diet were related to the completion of the initial sessions of the intervention (ie, the opening session in which participants could choose which module to follow and the first session of the diet module). In contrast, controlled motivation was linked to the completion of both modules (initial and follow-up sessions). Appreciation scores were somewhat positive. Appreciation was predicted by several motivational constructs, such as amotivation and basic psychological needs (eg, competence) and program-related features (eg, number of completed sessions). Conclusions This study adds meaningful information on the use and appreciation of a web-based, computer-tailored dietary and PA intervention, MyLifestyleCoach. The results indicate that different types of motivations, such as extrinsic and intrinsic motivation, are at play at the points when people are likely to stop using the intervention. The intervention was appreciated fairly well, and several motivational constructs and fulfillment of basic psychological needs were associated with appreciation. Practical implications of these findings have been provided in this study.
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Affiliation(s)
- Juul M J Coumans
- Department of Health Psychology, Faculty of Psychology, Open University of the Netherlands, Heerlen, Netherlands
| | - Anke Oenema
- Department of Health Promotion, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands.,Care and Public Health Research Institute, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - Catherine A W Bolman
- Department of Health Psychology, Faculty of Psychology, Open University of the Netherlands, Heerlen, Netherlands
| | - Lilian Lechner
- Department of Health Psychology, Faculty of Psychology, Open University of the Netherlands, Heerlen, Netherlands
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Peiris CL, van Namen M, O’Donoghue G. Education-based, lifestyle intervention programs with unsupervised exercise improve outcomes in adults with metabolic syndrome. A systematic review and meta-analysis. Rev Endocr Metab Disord 2021; 22:877-890. [PMID: 33730230 PMCID: PMC7968142 DOI: 10.1007/s11154-021-09644-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/08/2021] [Indexed: 12/22/2022]
Abstract
To determine whether lifestyle intervention programs comprising dietary intervention and prescribed, unsupervised exercise improve outcomes for people with metabolic syndrome. A systematic review and meta-analysis of randomised controlled trials. Online databases CINAHL, MEDLINE, PubMed and Embase were searched from the earliest date available to October 2020. Post-intervention data were pooled to calculate mean differences (MD) or standardised mean differences (SMD) and 95% confidence intervals (CI) using inverse variance methods and random effects models. Trial methodological quality was assessed using the Physiotherapy Evidence Database (PEDro) scale and overall quality of each meta-analysis was assessed using the Grading of Recommendation Assessment, Development and Evaluation approach. Eleven studies from 9 randomised controlled trials with 1,835 participants were included. There was high quality evidence that lifestyle intervention programs with unsupervised exercise reduced waist circumference (MD -2.82 cm, 95%CI -5.64 to 0.00, I2 91%) and blood pressure (systolic: MD -3.89 mmHg, 95%CI -5.19 to -2.58, I2 4%; diastolic: MD -3.16 mmHg, 95%CI -4.83 to -1.49, I2 50%) and increased physical activity levels (SMD 0.47, 95%CI 0.24 to 0.70, I2 45%) when compared to usual care. There was low quality evidence that they improved quality of life (SMD 0.59, 95%CI 0.05 to 1.13, I2 84%). Unsupervised programs had no significant effect on fasting blood glucose (unless > 3 months duration), metabolic syndrome prevalence or cholesterol. Lifestyle intervention programs with prescribed, unsupervised exercise are a practical alternative to supervised programs for people with metabolic syndrome when time, access or resources are limited or when social distancing is required.
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Affiliation(s)
- Casey L. Peiris
- grid.1018.80000 0001 2342 0938School of Allied Health, La Trobe University, Human Services and Sport, Physiotherapy, Melbourne, VIC 3086 Australia
| | - Maria van Namen
- grid.414366.20000 0004 0379 3501Eastern Health, Peter James Centre, Burwood East, PhysiotherapyVictoria, 3151 Australia
| | - Gráinne O’Donoghue
- grid.7886.10000 0001 0768 2743University College Dublin, UCD School of Public Health, Physiotherapy and Sports Science, Dublin 4, Belfield, Ireland
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Almodallal Y, Cook K, Lammert LM, Lee M, Le-Rademacher JG, Jatoi A. Can older patients adopt and maintain a ketogenic diet? An observational study in support of clinical trials in older patients. Medicine (Baltimore) 2021; 100:e28033. [PMID: 34964801 PMCID: PMC8615410 DOI: 10.1097/md.0000000000028033] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 11/11/2021] [Indexed: 01/05/2023] Open
Abstract
Ketogenic diets appear promising for obesity, diabetes, cancer, and other illnesses. Because older patients are more likely to contend with such illnesses and because of a paucity of dietary outcomes among these patients, we examined ketogenic diets in older patients.This multisite study focused on patients (≥65 years of age) on a ketogenic diet. Medical records were identified with the keywords "keto," "ketogenic," and "Atkins." Records were reviewed in detail with extraction of direct quotations to substantiate observations.We report on 200 consecutive patients with a median age of 70 years. Reasons for diet included weight loss, diabetes, and cancer; the majority remained on the diet for >1 month. In 134 (67%: 95% confidence interval: 60, 73%), the ketogenic diet appeared beneficial: 93 of 117 (79%) who sought weight loss lost weight ("She has lost 15 pounds and plans to lose another 8"); 36 of 67 (54%) who sought glucose control appeared to achieve the latter ("He has gone on a ketogenic diet and has been able to bring his sugars down significantly"); and 5 of 8 (63%) who sought improved cancer outcomes appeared to derive them ("He attributes part of the control of his cancer and increased QOL to adopting the keto for cancer diet"). Adverse events occurred in 30 patients (15%): dyslipidemia (n = 14), constipation (n = 9), sub-therapeutic international normalized ratio (n = 3), pancreatitis (n = 2), diarrhea (n = 1), and fatigue (n = 1).Trials that test ketogenic diets for a variety of illnesses should enroll older adults.
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Affiliation(s)
| | - Kathryn Cook
- Department of Oncology, Mayo Clinic, Rochester, MN
| | - Lisa M. Lammert
- Diet and Clinical Nutrition Unit, Mayo Clinic, Rochester, MN
| | - Minji Lee
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | | | - Aminah Jatoi
- Department of Oncology, Mayo Clinic, Rochester, MN
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Ee C, Pirotta S, Mousa A, Moran L, Lim S. Providing lifestyle advice to women with PCOS: an overview of practical issues affecting success. BMC Endocr Disord 2021; 21:234. [PMID: 34814919 PMCID: PMC8609880 DOI: 10.1186/s12902-021-00890-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 10/28/2021] [Indexed: 12/22/2022] Open
Abstract
Polycystic Ovary Syndrome (PCOS) is a common endocrine disorder affecting up to 13 % of women. Lifestyle interventions are first-line treatments, however attrition in women with PCOS is high. This review summarises current evidence on barriers to lifestyle management in PCOS and suggested strategies for overcoming these challenges, mapped to the Capability, Opportunity, Motivation and Behaviour model.Physical capability for lifestyle changes may be impacted by altered gut hormone regulation and energy expenditure in PCOS. This may contribute to difficulties with weight management. The higher prevalence of eating disorders, disordered eating, fatigue and sleep disturbances are further barriers. Psychological capability may be reduced due psychological symptoms and lack of critical health literacy. Women with PCOS face similar challenges in terms of Opportunity to make lifestyle changes as other women of reproductive age. However, these are complicated by features more common in PCOS including body dissatisfaction. Motivation to adopt healthy lifestyles may be impacted by suboptimal risk perception and intrinsic motivation.To address these barriers, screening for and management of eating disorders, disordered eating, depression, and Obstructive Sleep Apnoea should be undertaken as per international evidence-based guidelines. A weight-neutral approach may be appropriate with disordered eating. Building capability among health professionals to better partner with women with PCOS on their management is essential in addressing health literacy gaps. Behavioural strategies that target risk perception and build intrinsic motivation should be utilised. More research is required to understand optimal self-management strategies, risk perception, energy homeostasis and overcoming attrition in women with PCOS.
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Affiliation(s)
- Carolyn Ee
- NICM Health Research Institute, Western Sydney University, Locked Bag 1797, NSW 2751 Penrith, Australia
| | - Stephanie Pirotta
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, 553 St. Kilda Road, VIC 3004 Melbourne, Australia
| | - Aya Mousa
- Monash Centre for Health Research and Implementation - MCHRI, School of Public Health and Preventive Medicine, Monash University, Level 1, 43-51 Kanooka Grove, VIC 3168 Clayton, Australia
| | - Lisa Moran
- Monash Centre for Health Research and Implementation - MCHRI, School of Public Health and Preventive Medicine, Monash University, Level 1, 43-51 Kanooka Grove, VIC 3168 Clayton, Australia
| | - Siew Lim
- Monash Centre for Health Research and Implementation - MCHRI, School of Public Health and Preventive Medicine, Monash University, Level 1, 43-51 Kanooka Grove, VIC 3168 Clayton, Australia
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Bazrafkan L, Choobineh MA, Shojaei M, Bozorgi A, Sharifi MH. How do overweight people dropout of a weight loss diet? A qualitative study. BMC Nutr 2021; 7:76. [PMID: 34794513 PMCID: PMC8603507 DOI: 10.1186/s40795-021-00480-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 10/25/2021] [Indexed: 11/17/2022] Open
Abstract
Background The growing trend of overweight and obesity in many developed and developing countries in recent years has made obesity one of the most significant health problems in the world. The treatment of overweight and obese people is challenging, as patients have difficulty adhering to a weight-loss diet. Thus, the present study aimed to identify the reasons for the dropout of weight-loss diets. Methods This qualitative study using content analysis was conducted in a comprehensive health center in Shiraz, southern Iran, between April and October 2020. The study was performed on 27 participants with a history of obesity and diet dropout selected via purposive and theoretical sampling. The data were gathered through semi-structured interviews and were thematically analyzed. Results The participants included 25 females (92.6%) and two males (7.4%) with a mean age of 33.4 ± 8.4 years. Data analysis resulted in the emergence of three themes and 14 sub-themes. The first theme was personal reasons for diet dropout, which included six sub-themes; i.e., misunderstanding of diet, not having enough motivation, stress and hormonal disorder, having the feel of “being harmful to health”, lack of mental and psychological preparation, and personal taste. The second theme was familial and social reasons for diet dropout, including two sub-themes, i.e., social and familial problems. Finally, the third theme was the reasons related to diet characteristics, including six sub-themes: ineffectiveness of diet, expensiveness of diet food and dietary supplements, family problems, unavailability of food, unscientific and unconventional diets feeling bad about the diet, and unpalatable diet food. All the concepts were related to each other and resulted in a pattern revealing the experiences of overweight people and who had dropped out of weight-loss diets. Conclusion The reasons for diet dropout were divided into three levels: personal reasons, familial and social reasons, and diet characteristics. Overall, clinicians should pay attention to the complexity of diets to increase the success rate of weight management. Based on the current study findings, a guideline is recommended to guide patients who dropout of weight-loss diets.
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Affiliation(s)
- Leila Bazrafkan
- Clinical Education Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Mehrnaz Shojaei
- Department of Community Nutrition, School of Nutrition & Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Alireza Bozorgi
- Research Center for Traditional Medicine and History of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Hossein Sharifi
- Research Center for Traditional Medicine and History of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
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Jones RA, Mueller J, Sharp SJ, Vincent A, Duschinsky R, Griffin SJ, Ahern AL. The impact of participant mental health on attendance and engagement in a trial of behavioural weight management programmes: secondary analysis of the WRAP randomised controlled trial. Int J Behav Nutr Phys Act 2021; 18:146. [PMID: 34743721 PMCID: PMC8574009 DOI: 10.1186/s12966-021-01216-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 10/20/2021] [Indexed: 01/07/2023] Open
Abstract
Background Low attendance and engagement in behavioural weight management trials are common. Mental health may play an important role, however previous research exploring this association is limited with inconsistent findings. We aimed to investigate whether mental health was associated with attendance and engagement in a trial of behavioural weight management programmes. Methods This is a secondary data analysis of the Weight loss referrals for adults in primary care (WRAP) trial, which randomised 1267 adults with overweight or obesity to brief intervention, WW (formerly Weight Watchers) for 12-weeks, or WW for 52-weeks. We used regression analyses to assess the association of baseline mental health (depression and anxiety (by Hospital Anxiety and Depression Scale), quality of life (by EQ5D), satisfaction with life (by Satisfaction with Life Questionnaire)) with programme attendance and engagement in WW groups, and trial attendance in all randomised groups. Results Every one unit of baseline depression score was associated with a 1% relative reduction in rate of WW session attendance in the first 12 weeks (Incidence rate ratio [IRR] 0.99; 95% CI 0.98, 0.999). Higher baseline anxiety was associated with 4% lower odds to report high engagement with WW digital tools (Odds ratio [OR] 0.96; 95% CI 0.94, 0.99). Every one unit of global quality of life was associated with 69% lower odds of reporting high engagement with the WW mobile app (OR 0.31; 95% CI 0.15, 0.64). Greater symptoms of depression and anxiety and lower satisfaction with life at baseline were consistently associated with lower odds of attending study visits at 3-, 12-, 24-, and 60-months. Conclusions Participants were less likely to attend programme sessions, engage with resources, and attend study assessments when reporting poorer baseline mental health. Differences in attendance and engagement were small, however changes may still have a meaningful effect on programme effectiveness and trial completion. Future research should investigate strategies to maximise attendance and engagement in those reporting poorer mental health. Trial registration The original trial (ISRCTN82857232) and five year follow up (ISRCTN64986150) were prospectively registered with Current Controlled Trials on 15/10/2012 and 01/02/2018. Supplementary Information The online version contains supplementary material available at 10.1186/s12966-021-01216-6.
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Affiliation(s)
- Rebecca A Jones
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK.
| | - Julia Mueller
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Stephen J Sharp
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Ann Vincent
- Department of Medicine, University College London, London, UK
| | - Robbie Duschinsky
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Simon J Griffin
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK.,Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Amy L Ahern
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
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Kresovich JK, Park YMM, Keller JA, Sandler DP, Taylor JA. Healthy eating patterns and epigenetic measures of biological age. Am J Clin Nutr 2021; 115:171-179. [PMID: 34637497 PMCID: PMC8754996 DOI: 10.1093/ajcn/nqab307] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 09/02/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Healthy eating is associated with lower risks of disease and mortality, but the mechanisms underlying these associations are unclear. Age is strongly related to health outcomes, and biological age can be estimated using the blood methylome. OBJECTIVES To determine whether healthy eating patterns are associated with methylation-based measures of biological age. METHODS Among women in the Sister Study, we calculated scores on 4 recommendation-based healthy eating indexes [Dietary Approaches to Stop Hypertension diet, Healthy Eating Index-2015, Alternative Healthy Eating Index (aHEI-2010), and the Alternative Mediterranean diet] using a validated 110-item Block FFQ completed at enrollment. Genome-wide DNA methylation data were generated using the HumanMethylation450 BeadChip on whole blood samples collected at enrollment from a case-cohort sample of 2694 women and were used to calculate 4 measures of epigenetic age acceleration (Hannum AgeAccel, Horvath AgeAccel, PhenoAgeAccel, and GrimAgeAccel). Linear regression models, adjusted for covariates and cohort sampling weights, were used to examine cross-sectional associations between eating patterns and measures of biological age. RESULTS All 4 healthy eating indexes had inverse associations with epigenetic age acceleration, most notably with PhenoAgeAccel and GrimAgeAccel. Of these, the strongest associations were for aHEI-2010 [per 1-SD increase in diet quality, PhenoAgeAccel β = -0.5 y (95% CI: -0.8 to -0.2 y) and GrimAgeAccel β = -0.4 y (95% CI: -0.6 to -0.3 y)]. Although effect modification was not observed for most lifestyle factors, in analyses stratified by physical activity, the benefits of a healthy diet on epigenetic age acceleration were more pronounced among women who did not meet physical activity guidelines (reporting <2.5 h/wk of exercise). CONCLUSIONS Higher diet quality is inversely associated with methylation-based measures of biological age. Improving diet could have the most benefits in lowering biological age among women with lower levels of physical activity. This trial was registered at clinicaltrials.gov as NCT00047970.
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Affiliation(s)
- Jacob K Kresovich
- Epidemiology Branch, National Institute of Environmental Health Sciences, NIH, Research Triangle Park, NC, USA
| | - Yong-Moon Mark Park
- Epidemiology Branch, National Institute of Environmental Health Sciences, NIH, Research Triangle Park, NC, USA,Department of Epidemiology, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | | | - Dale P Sandler
- Epidemiology Branch, National Institute of Environmental Health Sciences, NIH, Research Triangle Park, NC, USA
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Gonzalez Gonzalez YK, Yaun K, Shah P, Iglesias G, Hale GM, Khanfar NM. A literature review of pharmacist’s impact on lifestyle modifications among obese, hypertensive patients. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2021. [DOI: 10.1093/jphsr/rmab053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Objectives
Previous trials have confirmed a positive relationship between obesity and hypertension. The purpose of this article is to identify the impact of pharmacists in lifestyle adherence among obese, hypertensive patients.
Methods
A literature search was performed at an academic institution using secondary databases, PubMed/MEDLINE and EBSCOhost. Reviews, observational and experimental reports published in English between 2010 and 2020 were included. Terms searched were pharmacy, pharmacist, lifestyle modifications, adherence, compliance, hypertension, obesity, consultation, intervention. Effect on lifestyle modifications consisted of change in blood pressure values, weight, body mass index, diet/sodium intake and/or exercise.
Key findings
Six hundred seventy-five articles were reviewed with 10 meeting inclusion criteria. The role of a pharmacist has a positive impact on compliance in lifestyle adherence with obese, hypertensive patients. Additionally, age, gender marital status, education, monthly income, knowledge level and beliefs of hypertension and co-morbidities all can affect adherence to lifestyle modifications.
Conclusions
The pharmacist has a vital role in the management of hypertension and obesity through frequent interactions with patients to increase adherence to lifestyle modifications.
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Affiliation(s)
- Yaran K Gonzalez Gonzalez
- Department of Pharmacy Practice, Nova Southeastern University College of Pharmacy, Palm Beach Gardens, FL, USA
- Department of Pharmacy Practice, Nova Southeastern University College of Pharmacy, Palm Beach Gardens, FL, USA
| | - Kristen Yaun
- Department of Pharmacy Practice, Nova Southeastern University College of Pharmacy, Palm Beach Gardens, FL, USA
- Department of Pharmacy Practice, Nova Southeastern University College of Pharmacy, Palm Beach Gardens, FL, USA
| | - Pooja Shah
- Department of Pharmacy Practice, Nova Southeastern University College of Pharmacy, Palm Beach Gardens, FL, USA
- Department of Pharmacy Practice, Nova Southeastern University College of Pharmacy, Palm Beach Gardens, FL, USA
| | - George Iglesias
- Department of Pharmacy Practice, Nova Southeastern University College of Pharmacy, Palm Beach Gardens, FL, USA
- Department of Pharmacy Practice, Nova Southeastern University College of Pharmacy, Palm Beach Gardens, FL, USA
| | - Genevieve Marie Hale
- Department of Pharmacy Practice, Nova Southeastern University College of Pharmacy, Palm Beach Gardens, FL, USA
| | - Nile M Khanfar
- Department of Sociobehavioral and Administrative Pharmacy, Nova Southeastern University College of Pharmacy, Palm Beach Gardens, FL, USA
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Moradi F, Heshmati J, Daneshzad E, Ahmadi A, Jafari T, Persad E, Fazelian S. Association between dietary satisfaction and depression, anxiety and stress in obese and overweight patients during the coronavirus pandemic. Clin Nutr ESPEN 2021; 45:399-403. [PMID: 34620346 PMCID: PMC8299144 DOI: 10.1016/j.clnesp.2021.07.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 06/26/2021] [Accepted: 07/12/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND & AIM The coronavirus disease-2019 (COVID-19) pandemic is a global health threat. The aim of this study was to evaluate the association between D-Sat and depression, anxiety and stress in obese patients during the coronavirus pandemic. METHODS A cross-sectional study in 228 obese and overweight women on a weight loss diet was conducted through the use of two questionnaires. General characteristics, anthropometric indices, D-Sat and mental status were assessed in these patients. RESULTS The greatest weight loss (WL) and waist circumference (WC) change was associated with the highest tertile of the D-Sat score in the first four months of the coronavirus pandemic (P < 0.05). Participants with the highest tertile of all D-sat score compared to those with the lowest had an 84% decrease in odds of depression. The highest tertile was also associated with decreased odds of anxiety (OR: 0.32 95%CI: 0.14; 0.68) The adjusted odds of stress score were negatively associated to the highest tertile of the D-Sat score (OR: 0.09, 95%CI (0.03, 0.23). WL was inversely related to stress (P < 0.05). Participants with higher WL and WC reduction had fewer depressive symptoms (P < 0.05). Sleep time and family income were associated with obesity. CONCLUSIONS D-Sat and positive personal and family dynamics can improve the mental status of obese and overweight patients during quarantine.
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Affiliation(s)
- Fatemeh Moradi
- Vice-Chancellery for Health, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Javad Heshmati
- Songhor Healthcare Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Elnaz Daneshzad
- Non-communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Ali Ahmadi
- Modeling in Health Research Center, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Tina Jafari
- Department of Biochemistry and Nutrition, School of Medicine, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Emma Persad
- Department for Evidence-based Medicine and Evaluation, Danube University Krems, Krems, Austria
| | - Siavash Fazelian
- Clinical Research Development Unit, Ayatollah Kashani Hospital, Shahrekord University of Medical Sciences, Shahrekord, Iran.
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