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Sun J, Jin X, Li Y. Current strategies for nonalcoholic fatty liver disease treatment (Review). Int J Mol Med 2024; 54:88. [PMID: 39129305 PMCID: PMC11335354 DOI: 10.3892/ijmm.2024.5412] [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: 05/22/2024] [Accepted: 07/23/2024] [Indexed: 08/13/2024] Open
Abstract
Nonalcoholic fatty liver disease (NAFLD), the most common chronic hepatic disease, has become a leading health problem worldwide. The present review summarized the methods and mechanisms to treat NAFLD, including the Mediterranean diet, physical activity and exercise, bariatric surgery and specific therapeutic agents, including statins, peroxisome proliferator‑activated receptor agonists, cenicriviroc and farnesoid X receptor agonists. Biologically active substances, such as peptides, alkaloids, polyphenolic compounds, silymarin, antibiotics, fatty acids, vitamins, probiotics, synbiotics and lamiaceae have also demonstrated actions that combat NAFLD. Considering their different mechanisms of action, combining some of them may prove an efficacious treatment for NAFLD. In this light, the present review describes recent progress and future prospects in treating NAFLD.
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Affiliation(s)
- Jing Sun
- Department of Gastroenterology, The First Hospital of China Medical University, Shenyang, Liaoning 110002, P.R. China
| | - Xiuli Jin
- Department of Gastroenterology, The First Hospital of China Medical University, Shenyang, Liaoning 110002, P.R. China
| | - Yiling Li
- Department of Gastroenterology, The First Hospital of China Medical University, Shenyang, Liaoning 110002, P.R. China
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Rose L, Wood A, Gill T. Gender differences in adherence and retention in Mediterranean diet interventions with a weight-loss outcome: A systematic review and meta-analysis. Obes Rev 2024:e13824. [PMID: 39228092 DOI: 10.1111/obr.13824] [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: 11/28/2023] [Accepted: 08/13/2024] [Indexed: 09/05/2024]
Abstract
BACKGROUND The Mediterranean diet has been shown to be effective in improving health outcomes and for weight loss. Adherence and retention in dietary interventions are critical to ensure the benefits of the exposure. No studies to date have assessed the role of gender in understanding participants who remain engaged and adhere to Mediterranean diet interventions. AIMS This study aimed to explore gender differences in recruitment, adherence, and retention for Mediterranean diet interventions and whether these were associated with differences in weight-loss outcomes. METHODS A systematic search was completed in EMBASE, Medline, Cochrane, and clinicaltrials.gov from inception to March 2023. A meta-analysis of studies reporting retention by gender was completed using odds ratios comparing female to male dropout numbers. A second meta-analysis was completed for adherence comparing standardized mean difference of Mediterranean diet scores stratified by gender. Newcastle Ottawa score was used to assess risk of bias. RESULTS A total of 70 articles were included in the systematic review with six articles included in the adherence meta-analysis and nine in the dropout meta-analysis. No statistically significant difference was shown for adherence or retention by gender. Weight-loss outcomes were inconsistent. CONCLUSIONS The results of the study suggest a higher adherence and lower dropout for women although these results were not statistically significant. Future studies of Mediterranean diet interventions should include adherence, retention, and weight-loss data stratified by gender to allow further investigation of this relationship.
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Affiliation(s)
- Laekin Rose
- Nutrition and Dietetics, School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
| | - Amelia Wood
- Nutrition and Dietetics, School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
| | - Timothy Gill
- Charles Perkins Centre, D17, University of Sydney, Camperdown, Australia
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Dobarrio-Sanz I, Chica-Pérez A, López-Entrambasaguas OM, Martínez-Linares JM, Granero-Molina J, Hernández-Padilla JM. Promoting the empowerment and emancipation of community-dwelling older adults with chronic multimorbidity through a home visiting programme: a hermeneutical study. BMC Nurs 2024; 23:444. [PMID: 38943097 PMCID: PMC11212443 DOI: 10.1186/s12912-024-02117-2] [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: 03/05/2024] [Accepted: 06/20/2024] [Indexed: 07/01/2024] Open
Abstract
INTRODUCTION Nurse-led preventive home visiting programmes can improve health-related outcomes in community-dwelling older adults, but they have not proven to be cost-effective. Home visiting programmes led by nursing students could be a viable alternative. However, we do not know how community-dwelling older adults with chronic multimorbidity experience home visiting programmes in which nursing students carry out health promotion activities. The aim of the study is to understand how community-dwelling older adults with chronic multimorbidity experience a home visiting programme led by nursing students. METHODS A qualitative study based on Gadamer's hermeneutics. Thirty-one community-dwelling older adults with chronic multimorbidity were interviewed in-depth. Fleming's method for conducting hermeneutic, Gadamerian-based studies was followed and ATLAS.ti software was used for data analysis. RESULTS Two main themes were generated: (1) 'The empowering experience of a personalised health-promoting intervention', and (2) 'The emancipatory effect of going beyond standardised self-care education'. CONCLUSIONS The home visiting programme contributed to the community-dwelling older adults feeling more empowered to engage in health-promoting self-care behaviours. It also improved the older adults' sense of autonomy and self-efficacy, while reducing their loneliness and addressing some perceived shortcomings of the healthcare system. CLINICAL RELEVANCE Older adults participating in a home visiting programme led by nursing students feel empowered to implement self-care behaviours, which has a positive impact on their perceived health status. Nurse leaders and nursing regulatory bodies could collaborate with nursing faculties to integrate preventive home visiting programmes led by nursing students into the services offered to community-dwelling older adults with chronic multimorbidity.
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Affiliation(s)
- Iria Dobarrio-Sanz
- Department of Nursing, Physiotherapy and Medicine, University of Almeria, Almeria, 04120, Spain
| | - Anabel Chica-Pérez
- Emera Nursing and Residential Home for Older Adults, Almería, 04007, Spain.
| | | | | | - José Granero-Molina
- Department of Nursing, Physiotherapy and Medicine, University of Almeria, Almeria, 04120, Spain
- Facultad de Ciencias de la Salud. Universidad Autónoma de Chile, Santiago de Chile, Chile
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Chinese Guidelines for Medical Nutrition Therapy for Patients with Diabetes (2022 Edition). Asia Pac J Clin Nutr 2024; 33:118-152. [PMID: 38794974 PMCID: PMC11170023 DOI: 10.6133/apjcn.202406_33(2).0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Accepted: 05/05/2024] [Indexed: 05/27/2024]
Abstract
Medical nutrition therapy (MNT) is the foundation of the comprehensive treatment of patients with diabetes. In 2010, the Chinese Clinical Nutritionist Center of the Chinese Medical Doctor Association developed the first Chinese guideline on MNT for patients with diabetes, and it was updated in 2015. Since then, new evidence has emerged in the field of MNT and metabolic therapy in patients with diabetes. The Nutrition and Metabolic Management Branch of the China International Exchange and Promotive Association for Medical and Health Care organized a team of experts from related institutions, including the Clinical Nutrition Branch of the Chinese Nutrition Society, Chinese Diabetes Society, Chinese Society for Parenteral and Enteral Nutri-tion, and Chinese Clinical Nutritionist Center of the Chinese Medical Doctor Association. Their task was to develop the Chinese Guidelines of Medical Nutrition Therapy in Diabetes (2022 Edition) in accordance with the requirements of the Guidelines for the Formulation/Revision of Clinical Guidelines in China (2022 Edition) by combining the questions raised and evidence gathered in clinical practices in China, to guide and standardize the clinical MNT.
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Shema A, Nouha T, Nesrine K, Asma M, Emna BM, Leila M, Radhouene D. Adherence and barriers to Mediterranean diet in Tunisian patients with nonalcoholic fatty liver disease. Future Sci OA 2024; 10:FSO919. [PMID: 38817356 PMCID: PMC11137804 DOI: 10.2144/fsoa-2023-0140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 10/05/2023] [Indexed: 06/01/2024] Open
Abstract
Aim: The burden of non alcoolic fatty liver disease (NAFLD) is globally increasing. While crucial for management, NAFLD patient adherence to the Mediterranean diet (MD) is underexplored, especially in Mediterranean countries such as Tunisia. Materials & methods: A prospective study (Nov 2022-Feb 2023) supervised MD introduction by a nutritionist, evaluated adherence with MEDAS scores (≥10 for good compliance), and explored barriers to good adherence. Results: Among 41 patients (11 male/30 female, mean age 56 [29-70]), 63% had low education and 51% had metabolic syndrome. Good MD adherence stood at 14.6%. Poor adherence tied to diet-induced higher costs (p = 0.021) and difficulty to new-diet adoption (p = 0.026). Conclusion: Tunisian NAFLD patients had low MD adherence due to financial constraints and dietary adaptation challenges.
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Affiliation(s)
- Ayadi Shema
- Gastroenterology Department, Charles Nicolle Hospital, Faculty of Medicine of Tunis, University Tunis El Manar Tunis, Tunisia
| | - Trad Nouha
- Gastroenterology Department, Charles Nicolle Hospital, Faculty of Medicine of Tunis, University Tunis El Manar Tunis, Tunisia
| | - Krifa Nesrine
- Gastroenterology Department, Charles Nicolle Hospital, Faculty of Medicine of Tunis, University Tunis El Manar Tunis, Tunisia
| | - Mensi Asma
- Gastroenterology Department, Charles Nicolle Hospital, Faculty of Medicine of Tunis, University Tunis El Manar Tunis, Tunisia
| | - Belhadj Mabrouk Emna
- Gastroenterology Department, Charles Nicolle Hospital, Faculty of Medicine of Tunis, University Tunis El Manar Tunis, Tunisia
| | - Mouelhi Leila
- Gastroenterology Department, Charles Nicolle Hospital, Faculty of Medicine of Tunis, University Tunis El Manar Tunis, Tunisia
| | - Dabbeche Radhouene
- Gastroenterology Department, Charles Nicolle Hospital, Faculty of Medicine of Tunis, University Tunis El Manar Tunis, Tunisia
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Zheng X, Zhang W, Wan X, Lv X, Lin P, Si S, Xue F, Wang A, Cao Y. The effects of Mediterranean diet on cardiovascular risk factors, glycemic control and weight loss in patients with type 2 diabetes: a meta-analysis. BMC Nutr 2024; 10:59. [PMID: 38641818 PMCID: PMC11027355 DOI: 10.1186/s40795-024-00836-y] [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: 12/24/2022] [Accepted: 01/31/2024] [Indexed: 04/21/2024] Open
Abstract
To explore the impact of the Mediterranean diet on cardiovascular risk factors, glycemic control and weight loss in patients with type 2 diabetes(T2D) by a meta-analysis of randomized controlled trials (RCTs). We systematically searched PubMed, Cochrance Library, EMBASE and four Chinese databases to identify RCTs that compared the Mediterranean diet with control diets in patients with T2D up to December 2021. The Risk of Bias of the included studies was assessed using the version 2 of the Cochrane risk-of-bias tools for randomized trials (ROB 2). Seven RCTs with 1371 patients met the eligibility criteria and entered into the meta-analysis. Compared to control diets, the beneficial effects of Mediterranean diet were not statistically significant in high-density lipoprotein (MD = 2.33; 95% CI: -0.27 to 4.92), low-density lipoprotein (MD = -2.34; 95% CI -5.67 to 0.99) and total cholesterol (MD = 2.60; 95% CI: -0.95 to 6.15). But Mediterranean diet led to reduce the level of diastolic blood pressure (MD = -1.20; 95% CI: -2.21 to -0.19) and systolic blood pressure (MD = -4.17; 95% CI: -7.12 to -1.22). Meanwhile, Mediterranean diet showed beneficial effects in glycemic control (HbA1[%]: MD = -0.39, 95% CI: -0.58 to -0.20; fasting plasma glucose: MD = -15.12, 95% CI: -24.69 to -5.55) and weight loss (BMI: MD = -0.71, 95% CI: -1.30 to -0.78; WC: MD = -1.69; 95% CI: -3.35 to -0.02) compared to the control diets. The meta-analysis presented evidence supporting the beneficial effects of the Mediterranean diet on blood pressure, glycemic control, and weight loss. However, the impact of the Mediterranean diet on the lipid profile was not found to be significant, warranting further verification. This Meta-analysis was registered on the INPLASY website (Registration number: INPLASY 202160096).
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Affiliation(s)
- Xing Zheng
- Department of Medical Oncology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250012, P.R. China
| | - Wenwen Zhang
- Department of Thoracic Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250012, P.R. China
| | - Xiaojuan Wan
- School of Nursing, Yangzhou University, Yangzhou, Jiangsu, 225000, P. R. China
| | - Xiaoyan Lv
- Department of Nursing, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250012, P. R. China
| | - Peng Lin
- Department of Endocrinology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250012, P. R. China
| | - Shucheng Si
- Institute for Medical Dataology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250012, P. R. China
| | - Fuzhong Xue
- Institute for Medical Dataology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250012, P. R. China
| | - Aijun Wang
- Department of Medical Oncology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250012, P.R. China
| | - Yingjuan Cao
- Department of Nursing, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250012, P. R. China.
- Theory & Practice Innovation Research Center, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250012, P. R. China.
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Manaf ZA, Rosli MHM, Noor NM, Jamil NA, Mazri FH, Shahar S. Exploring dietitians' views on digital nutrition educational tools in Malaysia: a qualitative study. Nutr Res Pract 2024; 18:294-307. [PMID: 38584814 PMCID: PMC10995771 DOI: 10.4162/nrp.2024.18.2.294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 10/30/2023] [Accepted: 03/22/2024] [Indexed: 04/09/2024] Open
Abstract
BACKGROUND/OBJECTIVES Dietitians frequently use nutrition education tools to facilitate dietary counselling sessions. Nevertheless, these tools may require adaptation to keep pace with technological advancements. This study had a 2-fold purpose: first, to identify the types of nutrition education tools currently in use, identify their limitations, and explore dietitians' perspectives on the importance of these tools; second, to investigate the features that dietitians prefer in digital nutrition education tools. SUBJECTS/METHODS A semi-structured face-to-face interview was conducted among 15 dietitians from selected public hospitals, primary care clinics, and teaching hospitals in Malaysia. Inductive thematic analysis of the responses was conducted using NVivo version 12 software. RESULTS Most dietitians used physical education tools including the healthy plate model, pamphlets, food models, and flip charts. These tools were perceived as important as they facilitate the nutrition assessment process, deliver nutrition intervention, and are time efficient. However, dietitians described the current educational tools as impersonal, outdated, limited in availability due to financial constraints, unhandy, and difficult to visualise. Alternatively, they strongly favoured digital education tools that provided instant feedback, utilised an automated system, included a local food database, were user-friendly, developed by experts in the field, and seamlessly integrated into the healthcare system. CONCLUSION Presently, although dietitians have a preference for digital educational tools, they heavily rely on physical nutrition education tools due to their availability despite the perception that these tools are outdated, impersonal, and inconvenient. Transitioning to digital dietary education tools could potentially address these issues.
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Affiliation(s)
- Zahara Abdul Manaf
- Dietetic Program and Centre for Healthy Ageing and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, 50300 Kuala Lumpur, Malaysia
| | - Mohd Hafiz Mohd Rosli
- Dietetic Program and Centre for Healthy Ageing and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, 50300 Kuala Lumpur, Malaysia
- Dietetics Unit, Kapar Health Clinic, Ministry of Health, 42200 Klang, Malaysia
| | - Norhayati Mohd Noor
- Pusat Genius @ Pintar, Universiti Kebangsaan Malaysia, 43600 Bangi, Malaysia
| | - Nor Aini Jamil
- Dietetic Program and Centre for Community Health Studies, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, 50300 Kuala Lumpur, Malaysia
| | - Fatin Hanani Mazri
- Dietetic Program and Centre for Healthy Ageing and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, 50300 Kuala Lumpur, Malaysia
| | - Suzana Shahar
- Dietetic Program and Centre for Healthy Ageing and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, 50300 Kuala Lumpur, Malaysia
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Di Martino G, della Valle C, Centorbi M, Buonsenso A, Fiorilli G, Calcagno G, Iuliano E, di Cagno A. Enhancing Behavioural Changes: A Narrative Review on the Effectiveness of a Multifactorial APP-Based Intervention Integrating Physical Activity. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:233. [PMID: 38397722 PMCID: PMC10888703 DOI: 10.3390/ijerph21020233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 02/10/2024] [Accepted: 02/13/2024] [Indexed: 02/25/2024]
Abstract
The rapid evolution of technologies is a key innovation in the organisation and management of physical activities (PA) and sports. The increase in benefits and opportunities related to the adoption of technologies for both the promotion of a healthy lifestyle and the management of chronic diseases is evident. In the field of telehealth, these devices provide personalised recommendations, workout monitoring and injury prevention. The study aimed to provide an overview of the landscape of technology application to PA organised to promote active lifestyles and improve chronic disease management. This review identified specific areas of focus for the selection of articles: the utilisation of mobile APPs and technological devices for enhancing weight loss, improving cardiovascular health, managing diabetes and cancer and preventing osteoporosis and cognitive decline. A multifactorial intervention delivered via mobile APPs, which integrates PA while managing diet or promoting social interaction, is unquestionably more effective than a singular intervention. The main finding related to promoting PA and a healthy lifestyle through app usage is associated with "behaviour change techniques". Even when individuals stop using the APP, they often maintain the structured or suggested lifestyle habits initially provided by the APP. Various concerns regarding the excessive use of APPs need to be addressed.
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Affiliation(s)
- Giulia Di Martino
- Department of Medicine and Health Sciences, University of Molise, 86100 Campobasso, Italy; (G.D.M.); (C.d.V.); (M.C.); (A.B.); (G.F.)
| | - Carlo della Valle
- Department of Medicine and Health Sciences, University of Molise, 86100 Campobasso, Italy; (G.D.M.); (C.d.V.); (M.C.); (A.B.); (G.F.)
- Department of Neurosciences, Biomedicine and Movement, University of Verona, 37129 Verona, Italy
| | - Marco Centorbi
- Department of Medicine and Health Sciences, University of Molise, 86100 Campobasso, Italy; (G.D.M.); (C.d.V.); (M.C.); (A.B.); (G.F.)
| | - Andrea Buonsenso
- Department of Medicine and Health Sciences, University of Molise, 86100 Campobasso, Italy; (G.D.M.); (C.d.V.); (M.C.); (A.B.); (G.F.)
| | - Giovanni Fiorilli
- Department of Medicine and Health Sciences, University of Molise, 86100 Campobasso, Italy; (G.D.M.); (C.d.V.); (M.C.); (A.B.); (G.F.)
| | - Giuseppe Calcagno
- Department of Medicine and Health Sciences, University of Molise, 86100 Campobasso, Italy; (G.D.M.); (C.d.V.); (M.C.); (A.B.); (G.F.)
| | - Enzo Iuliano
- Faculty of Medicine, University of Ostrava, 70103 Ostrava, Czech Republic;
- Faculty of Psychology, eCampus University, 22060 Novedrate, Italy
| | - Alessandra di Cagno
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, 00135 Rome, Italy;
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Béjar LM, Mesa-Rodríguez P, García-Perea MD. Short-Term Effect of a Health Promotion Intervention Based on the Electronic 12-Hour Dietary Recall (e-12HR) Smartphone App on Adherence to the Mediterranean Diet Among Spanish Primary Care Professionals: Randomized Controlled Clinical Trial. JMIR Mhealth Uhealth 2024; 12:e49302. [PMID: 38190226 PMCID: PMC10804253 DOI: 10.2196/49302] [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: 05/24/2023] [Revised: 09/14/2023] [Accepted: 12/20/2023] [Indexed: 01/09/2024] Open
Abstract
BACKGROUND The World Health Organization has called for addressing the growing burden of noncommunicable diseases (NCDs) by promoting healthy lifestyles among the population. Regarding patient health, primary care professionals (PCPs) are the first line of care who can positively influence patients' behavior and lifestyle habits. However, a significant percentage of PCPs do not lead a healthy lifestyle. Therefore, addressing their health behaviors may be the key to substantially increasing health promotion advice in general practice. The Mediterranean diet has been extensively studied, and there is strong evidence of it being a dietary pattern for the prevention of NCDs, in addition to its significant environmental, sociocultural, and local economics benefits. OBJECTIVE This study focused only on the dietary aspect of the PCPs' lifestyle. The primary objective was to evaluate the effect of using the Electronic 12-Hour Dietary Recall (e-12HR) smartphone app to improve diet, specifically to promote adherence to the Mediterranean diet (AMD), among PCPs. The secondary objectives were to establish the usability of the e-12HR app and to determine AMD among PCPs. METHODS An individual-level randomized, controlled, and single-blind clinical trial was conducted with 2 parallel groups: a control group (CG), using the nonfeedback version of the e-12HR app, and an intervention group (IG), using the feedback version of the e-12HR app. The level of human involvement was fully automated through the use of the app. There was a 28-day follow-up period. Participants were PCPs (medicine or nursing) recruited offline at one of the selected primary care centers (Andalusia, Spain, Southern Europe), of both sexes, over 18 years old, possessing a smartphone, and having smartphone literacy. RESULTS The study response rate was 73% (71 of 97 PCPs), with 27 (38%) women and 44 (62%) men: 40 (56%) PCPs in the CG and 31 (44%) in the IG. At baseline, AMD was medium (mean Mediterranean Diet Serving Score [MDSS] index 9.45, range 0-24), with 47 (66%) PCPs with a medium/high MDSS index. There were significant statistical improvements (CG vs IG, in favor of the IG) at week 4 (no significant statistical differences at baseline): +25.6% for the MDSS index (P=.002) and +213.1% for the percentage with a medium/high MDSS index (P=.001). In relation to specific food groups, there were significant statistical improvements for fruits (+33.8%, P=.02), vegetables (+352%, P=.001), nuts (+184%, P=.02), and legumes (+75.1%, P=.03). The responses to the usability rating questionnaire were satisfactory. CONCLUSIONS The results support recommending the use of the e-12HR app as a tool to contribute to improving diet and preventing NCDs among PCPs, while positively influencing patient dietary behavior and preventing diet-related NCDs among patients. TRIAL REGISTRATION ClinicalTrials.gov NCT05532137; https://clinicaltrials.gov/study/NCT05532137.
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Affiliation(s)
- Luis María Béjar
- Department of Preventive Medicine and Public Health, Institute of Anatomy, School of Medicine, University of Seville, Seville, Spain
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Galiero R, Caturano A, Vetrano E, Monda M, Marfella R, Sardu C, Salvatore T, Rinaldi L, Sasso FC. Precision Medicine in Type 2 Diabetes Mellitus: Utility and Limitations. Diabetes Metab Syndr Obes 2023; 16:3669-3689. [PMID: 38028995 PMCID: PMC10658811 DOI: 10.2147/dmso.s390752] [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: 04/14/2023] [Accepted: 10/27/2023] [Indexed: 12/01/2023] Open
Abstract
Type 2 diabetes mellitus (T2DM) is one of the most widespread diseases in Western countries, and its incidence is constantly increasing. Epidemiological studies have shown that in the next 20 years. The number of subjects affected by T2DM will double. In recent years, owing to the development and improvement in methods for studying the genome, several authors have evaluated the association between monogenic or polygenic genetic alterations and the development of metabolic diseases and complications. In addition, sedentary lifestyle and socio-economic and pandemic factors have a great impact on the habits of the population and have significantly contributed to the increase in the incidence of metabolic disorders, obesity, T2DM, metabolic syndrome, and liver steatosis. Moreover, patients with type 2 diabetes appear to respond to antihyperglycemic drugs. Only a minority of patients could be considered true non-responders. Thus, it appears clear that the main aim of precision medicine in T2DM is to identify patients who can benefit most from a specific drug class more than from the others. Precision medicine is a discipline that evaluates the applicability of genetic, lifestyle, and environmental factors to disease development. In particular, it evaluated whether these factors could affect the development of diseases and their complications, response to diet, lifestyle, and use of drugs. Thus, the objective is to find prevention models aimed at reducing the incidence of pathology and mortality and therapeutic personalized approaches, to obtain a greater probability of response and efficacy. This review aims to evaluate the applicability of precision medicine for T2DM, a healthcare burden in many countries.
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Affiliation(s)
- Raffaele Galiero
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Alfredo Caturano
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Erica Vetrano
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Marcellino Monda
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Raffaele Marfella
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Celestino Sardu
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Teresa Salvatore
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Luca Rinaldi
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Ferdinando Carlo Sasso
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy
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Pitt S, Sjöblom L, Bälter K, Trolle Lagerros Y, Bonn SE. The effect of an app-based dietary intervention on diet-related greenhouse gas emissions - results from a randomized controlled trial. Int J Behav Nutr Phys Act 2023; 20:123. [PMID: 37821876 PMCID: PMC10568795 DOI: 10.1186/s12966-023-01523-0] [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: 04/28/2023] [Accepted: 09/29/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND Dietary change towards a diet low in greenhouse gas emissions (GHGEs) can reduce climate impact and improve individual-level health. However, there is a lack of understanding if diet interventions can achieve low-GHGE diets. METHODS A randomized controlled trial was conducted to assess the effects of an app-based intervention. The intervention was designed to improve dietary intake of people with Type 2 diabetes, and was delivered via an app over 12 weeks, with each week covering one diet-related topic. Dietary intake was assessed at baseline and 3-month follow up by a 95-item food frequency questionnaire and linked to GHGE values. A total of n = 93 participants (n = 46 and n = 47 for the intervention and control group, respectively) were included in the analysis. Changes to GHGEs within and between the groups were analysed with inferential statistics. RESULTS The majority (60%) of participants were male, with a mean age of 63.2 years and body mass index of 30 kg/m2. At baseline, diet-related GHGEs were 4.8 and 4.9 kg CO2-eq/day in the intervention and control group, respectively. At 3-month follow up the corresponding GHGEs were 4.7 and 4.9 kg CO2-eq/day. We found no statistically significant changes to diet-related GHGEs within or between groups, or within food categories, from baseline to 3-month follow up. CONCLUSION No evidence was found for the effectiveness of the app-based intervention to generate changes to diet-related GHGEs in a population of people with Type 2 diabetes. However, future interventions that target reducing meat consumption specifically may have the potential to result in a reduction of individual-level diet-related GHGEs. TRIAL REGISTRATION ClinicalTrials.gov, NCT03784612. Registered 24 December 2018. www. CLINICALTRIALS gov/ct2/show/NCT03784612 .
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Affiliation(s)
- Stephanie Pitt
- Cardiovascular and Nutritional Epidemiology, C6 Institute of Environmental Medicine (IMM), Karolinska Institutet, Stockholm, 171 77, Sweden.
| | - Linnea Sjöblom
- Division of Clinical Epidemiology, Department of Medicine (Solna), Karolinska Institutet, Stockholm, 171 76, Sweden
| | - Katarina Bälter
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, 171 77, Sweden
- Division of Public Health Sciences, Mälardalen University, Västerås, 722 20, Sweden
| | - Ylva Trolle Lagerros
- Division of Clinical Epidemiology, Department of Medicine (Solna), Karolinska Institutet, Stockholm, 171 76, Sweden
- Obesity Center, Academic Specialist Center, Stockholm Health Care Services, Stockholm, 1113 64, Sweden
| | - Stephanie E Bonn
- Division of Clinical Epidemiology, Department of Medicine (Solna), Karolinska Institutet, Stockholm, 171 76, Sweden
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12
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Shen R, Guo X, Zou T, Ma L. Associations of cardiovascular health assessed by life's essential 8 with diabetic retinopathy and mortality in type 2 diabetes. Prim Care Diabetes 2023; 17:420-428. [PMID: 37573230 DOI: 10.1016/j.pcd.2023.08.001] [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: 07/28/2023] [Accepted: 08/03/2023] [Indexed: 08/14/2023]
Abstract
BACKGROUND Vascular complications are the leading causes of reduced life quality and mortality in type 2 diabetes mellitus (T2DM). Life's Essential 8 (LE8) is a newly modified measurement of cardiovascular health (CVH) by American Heart Association (AHA). Promoting CVH has been previously shown to improve the prognosis of T2DM. However, studies regarding the effects of CVH by LE8 on diabetic retinopathy (DR), a major microvascular complication, and death from the cardiovascular and overall causes in T2DM are currently lacking. This study aimed to investigate these associations thus providing preliminary evidence. METHODS A total of 3192 participants from the National Health and Nutrition Examination Survey (NHANES) were included in the final analysis. Records of mortality during follow-up were obtained by linking to the National Death Index. The multivariable logistic regression and Cox proportional hazard regression with restricted cubic splines were used to estimate the associations. Subgroup analyses were performed to examine the effects of gender, age, and duration of T2DM. RESULTS 648 individuals had DR at baseline. During a median follow-up of 76 months, 645 overall deaths (incidence per 1000 person-years, 26.53%; 95% confidence interval (CI), 26.50-26.56) were ascertained, including 216 from cardiovascular causes (incidence per 1000 person-years, 8.96%; 95% CI, 8.94-8.98). The multivariable-adjusted odds ratio (OR) per 100-point increase of LE8 was 0.80 (95% CI, 0.71-0.90) for DR, and participants with high levels of LE8 were associated with 47% risk reduction (OR, 0.53; 95% CI, 0.40-0.70). The multivariable-adjusted hazard ratio (HR) per 100-point increase of LE8 was 0.71 (95% CI, 0.62-0.81) and 0.68 (95% CI, 0.58-0.85) for all-cause mortality and cardiovascular mortality, respectively. Similar patterns of inverse associations were observed in participants with moderate and high levels of LE8 for all-cause and cardiovascular mortality. Notably, stronger associations between LE8 and mortality were discovered in participants below 60 years (P < 0.05 for interaction). Moreover, LE8 was correlated with all-cause mortality in a linear way (P for nonlinear=0.32). CONCLUSION The AHA's newly prompted LE8 was strongly and inversely associated with the risk of DR, all-cause mortality, and cardiovascular-specific mortality in T2DM. LE8 may be a feasible and effective approach in the tertiary prevention of T2DM.
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Affiliation(s)
- Ruihuan Shen
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Xuantong Guo
- State Key Laboratory of Cardiovascular Disease, Department of Cardiology, National Clinical Research Center of Cardiovascular Diseases, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Tong Zou
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China.
| | - Lihong Ma
- State Key Laboratory of Cardiovascular Disease, Department of Cardiology, National Clinical Research Center of Cardiovascular Diseases, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China.
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13
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Zheng Y, Campbell Rice B, Melkus GD, Sun M, Zweig S, Jia W, Parekh N, He H, Zhang Y, Wylie-Rosett J. Dietary Self-Management Using Mobile Health Technology for Adults With Type 2 Diabetes: A Scoping Review. J Diabetes Sci Technol 2023; 17:1212-1225. [PMID: 37162011 PMCID: PMC10563537 DOI: 10.1177/19322968231174038] [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] [Indexed: 05/11/2023]
Abstract
OBJECTIVE Dietary self-management is one key component to achieve optimal glycemic control. Advances in mobile health (mHealth) technology have reduced the burden of diabetes self-management; however, limited evidence has been known regarding the status of the current body of research using mHealth technology for dietary management for adults with type 2 diabetes. METHODS Literature searches were conducted electronically using PubMed, CINAHL (EBSCO), Web of Science Core Collection, PsycINFO (Ovid), EMBASE (Ovid), and Scopus. Keywords and subject headings covered dietary management, type 2 diabetes, and mHealth. Inclusion criteria included studies that applied mHealth for dietary self-management for adults with type 2 diabetes and were published in English as full articles. RESULTS This review (N = 15 studies) revealed heterogeneity of the mHealth-based dietary self-management or interventions and reported results related to physiological, dietary behavioral, and psychosocial outcomes. Twelve studies applied smartphone apps with varied functions for dietary management or intervention, while three studies applied continuous glucose monitoring (CGM) to guide dietary changes. Among 15 reviewed studies, only three of them were two-arm randomized clinical trial (RCT) with larger sample and 12-month study duration and 12 of them were pilot testing. Nine of 12 pilot studies showed improved HbA1c; most of them resulted in varied dietary changes; and few of them showed improved diabetes distress and depression. CONCLUSION Our review provided evidence that the application of mHealth technology for dietary intervention for adults with type 2 diabetes is still in pilot testing. The preliminary effects are inconclusive on physiological, dietary behavioral, and psychosocial outcomes.
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Affiliation(s)
- Yaguang Zheng
- NYU Rory Meyers College of Nursing, New
York, NY, USA
| | | | | | - Mingui Sun
- Department of Neurological Surgery
Pittsburgh, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Susan Zweig
- Division of Endocrinology, Department
of Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - Wenyan Jia
- Department of Neurological Surgery
Pittsburgh, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Niyati Parekh
- Public Health Nutrition Programme,
School of Global Public Health, New York University, New York, NY, USA
| | - Hanbin He
- NYU Rory Meyers College of Nursing, New
York, NY, USA
| | - YiLan Zhang
- NYU Rory Meyers College of Nursing, New
York, NY, USA
| | - Judith Wylie-Rosett
- Division of Health Behavior Research
and Implementation Science, Department of Epidemiology and Population Health, Albert
Einstein College of Medicine, New York, NY, USA
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14
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Arjona Garrido Á, Monserrat Hernández M, Checa Olmos JC. Healthy Eating in the Spanish University Community: A Case Study. Nutrients 2023; 15:2053. [PMID: 37432219 DOI: 10.3390/nu15092053] [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: 04/03/2023] [Revised: 04/20/2023] [Accepted: 04/23/2023] [Indexed: 07/12/2023] Open
Abstract
The Mediterranean Diet (MedD), which UNESCO recognizes as an Intangible Cultural Heritage, constitutes a healthy eating pattern that helps prevent illness. The aim of this work is to know how well the university community of Almeria (Spain) adheres to MedD as a healthy lifestyle standard. For this purpose, the authors administered a survey to students, teachers, and administrative and service personnel at the University of Almeria. The sample for the survey comprised 610 people. Of whom, 64.7% were women; 23% were Teaching, and Research Staff (PDI); 17.3% were Administration and Services Staff (PAS); and 59.7% were students. The average age was 32 years. Results show an average level of MedD adherence overall in the university community, although 40.9% have a low adherence level. The most representative MedD adherent can be profiled as a young Spanish female, who values sustainability, reads the labels of the products she consumes, exercises regularly, cooks healthy food, and recycles waste. We suggest [to the University authorities] to advertise the benefits of the Mediterranean Diet among the university community and offer menus based on the MedD in the university canteen.
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Affiliation(s)
- Ángeles Arjona Garrido
- Laboratory of Social and Cultural Anthropology, University of Almeria, 04120 Almeria, Spain
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15
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Béjar LM, Mesa-Rodríguez P, Quintero-Flórez A, Ramírez-Alvarado MDM, García-Perea MD. Effectiveness of a Smartphone App (e-12HR) in Improving Adherence to the Mediterranean Diet in Spanish University Students by Age, Gender, Field of Study, and Body Mass Index: A Randomized Controlled Trial. Nutrients 2023; 15:nu15071688. [PMID: 37049528 PMCID: PMC10096856 DOI: 10.3390/nu15071688] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 03/17/2023] [Accepted: 03/29/2023] [Indexed: 04/03/2023] Open
Abstract
There is an urgent need to implement intervention programs to promote adherence to the Mediterranean diet (AMD) in university students to prevent non-communicable diseases. A powerful tool for this is smartphone apps. Furthermore, it is necessary to determine the subgroups that are most likely to benefit from these technologies. The objective is to evaluate the effectiveness of an app (e-12HR) at improving AMD in a sample of Spanish university students and different strata. The study method was a controlled and randomized clinical trial over a four-week follow-up period and involving 385 participants (76.9% women). The participants were in two parallel groups: the control group (CG) and the intervention group (IG), with only the IG receiving feedback to improve their AMD. There were significant statistical improvements (with higher values in the IG) at week four, after no significant statistical differences at baseline (Week One): in the whole sample: +25.7% AMD index and +74.5% percentage with moderate/high AMD index. In the subgroups, seven of eight subgroups, ranging in AMD index from +17.8% (≥20 years) to +33.0% (<20 years); and for males, in weeks two (+27.9%) and three (+23.9%), but not at week four. In conclusion, e-12HR could improve AMD among university students (in the total sample and all subgroups, except ≥25 kg/m2).
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16
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Livingstone KM, Rawstorn JC, Partridge SR, Godrich SL, McNaughton SA, Hendrie GA, Blekkenhorst LC, Maddison R, Zhang Y, Barnett S, Mathers JC, Packard M, Alston L. Digital behaviour change interventions to increase vegetable intake in adults: a systematic review. Int J Behav Nutr Phys Act 2023; 20:36. [PMID: 36973716 PMCID: PMC10042405 DOI: 10.1186/s12966-023-01439-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 03/15/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND Digital interventions may help address low vegetable intake in adults, however there is limited understanding of the features that make them effective. We systematically reviewed digital interventions to increase vegetable intake to 1) describe the effectiveness of the interventions; 2) examine links between effectiveness and use of co-design, personalisation, behavioural theories, and/or a policy framework; and 3) identify other features that contribute to effectiveness. METHODS A systematic search strategy was used to identify eligible studies from MEDLINE, Embase, PsycINFO, Scopus, CINAHL, Cochrane Library, INFORMIT, IEEE Xplore and Clinical Trial Registries, published between January 2000 and August 2022. Digital interventions to increase vegetable intake were included, with effective interventions identified based on statistically significant improvement in vegetable intake. To identify policy-action gaps, studies were mapped across the three domains of the NOURISHING framework (i.e., behaviour change communication, food environment, and food system). Risk of bias was assessed using Cochrane tools for randomized, cluster randomized and non-randomized trials. RESULTS Of the 1,347 records identified, 30 studies were included. Risk of bias was high or serious in most studies (n = 25/30; 83%). Approximately one quarter of the included interventions (n = 8) were effective at improving vegetable intake. While the features of effective and ineffective interventions were similar, embedding of behaviour change theories (89% vs 61%) and inclusion of stakeholders in the design of the intervention (50% vs 38%) were more common among effective interventions. Only one (ineffective) intervention used true co-design. Although fewer effective interventions included personalisation (67% vs 81%), the degree of personalisation varied considerably between studies. All interventions mapped across the NOURISHING framework behaviour change communication domain, with one ineffective intervention also mapping across the food environment domain. CONCLUSION Few digital interventions identified in this review were effective for increasing vegetable intake. Embedding behaviour change theories and involving stakeholders in intervention design may increase the likelihood of success. The under-utilisation of comprehensive co-design methods presents an opportunity to ensure that personalisation approaches better meet the needs of target populations. Moreover, future digital interventions should address both behaviour change and food environment influences on vegetable intake.
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Affiliation(s)
- Katherine M Livingstone
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Melbourne Burwood Campus, 221 Burwood Highway, VIC, 3125, Melbourne, Australia.
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, 3220, Australia.
| | - Jonathan C Rawstorn
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, 3220, Australia
| | - Stephanie R Partridge
- Engagement and Co-Design Research Hub, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Stephanie L Godrich
- School of Medical and Health Sciences, Nutrition and Health Innovation Research Institute, Edith Cowan University, Bunbury, WA, 6230, Australia
| | - Sarah A McNaughton
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, 3220, Australia
| | - Gilly A Hendrie
- Human Health Program, Health & Biosecurity, CSIRO, Adelaide, SA, 5000, Australia
| | - Lauren C Blekkenhorst
- School of Medical and Health Sciences, Nutrition and Health Innovation Research Institute, Edith Cowan University, Perth, Australia
| | - Ralph Maddison
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, 3220, Australia
| | - Yuxin Zhang
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, 3220, Australia
| | - Scott Barnett
- Applied Artificial Intelligence Institute (A²I²), Deakin University, Geelong, Australia
| | - John C Mathers
- Human Nutrition & Exercise Research Centre, Centre for Healthier Lives, Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, NE2 4HH, UK
| | - Maria Packard
- The National Heart Foundation of Australia, Melbourne, VIC, 3000, Australia
| | - Laura Alston
- Deakin Rural Health, School of Medicine, Faculty of Health, Deakin University, Warrnambool, Australia
- The Global Obesity Centre, Institute for Health Transformation, Faculty of Health, Deakin University, 1 Gheringhap Street, Geelong, VIC, 3220, Australia
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17
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Behaviour Change Techniques Used in Mediterranean Diet Interventions for Older Adults: A Systematic Scoping Review. Nutrients 2023; 15:nu15051189. [PMID: 36904188 PMCID: PMC10005068 DOI: 10.3390/nu15051189] [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: 01/25/2023] [Revised: 02/24/2023] [Accepted: 02/24/2023] [Indexed: 03/02/2023] Open
Abstract
Mediterranean diet interventions have demonstrated positive effects in the prevention and management of several chronic conditions in older adults. Understanding the effective components of behavioural interventions is essential for long-term health behaviour change and translating evidence-based interventions into practice. The aim of this scoping review is to provide an overview of the current Mediterranean diet interventions for older adults (≥55 years) and describe the behaviour change techniques used as part of the interventions. A scoping review systematically searched Medline, Embase, CINAHL, Web of Science, Scopus, and PsycINFO from inception until August 2022. Eligible studies were randomized and non-randomized experimental studies involving a Mediterranean or anti-inflammatory diet intervention in older adults (average age > 55 years). Screening was conducted independently by two authors, with discrepancies being resolved by the senior author. Behaviour change techniques were assessed using the Behaviour Change Technique Taxonomy (version 1), which details 93 hierarchical techniques grouped into 16 categories. From 2385 articles, 31 studies were included in the final synthesis. Ten behaviour change taxonomy groupings and 19 techniques were reported across the 31 interventions. The mean number of techniques used was 5, with a range from 2 to 9. Common techniques included instruction on how to perform the behaviour (n = 31), social support (n = 24), providing information from a credible source (n = 16), information about health consequences (n = 15), and adding objects to the environment (n = 12). Although behaviour change techniques are commonly reported across interventions, the use of the Behaviour Change Technique Taxonomy for intervention development is rare, and more than 80% of the available techniques are not being utilised. Integrating behaviour change techniques in the development and reporting of nutrition interventions for older adults is essential for effectively targeting behaviours in both research and practice.
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18
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Sanz-Cánovas J, Ricci M, Cobos-Palacios L, López-Sampalo A, Hernández-Negrín H, Vázquez-Márquez M, Mancebo-Sevilla JJ, Álvarez-Recio E, López-Carmona MD, Pérez-Velasco MÁ, Pérez-Belmonte LM, Gómez-Huelgas R, Bernal-López MR. Effects of a New Group of Antidiabetic Drugs in Metabolic Diseases. Rev Cardiovasc Med 2023; 24:36. [PMID: 39077405 PMCID: PMC11273146 DOI: 10.31083/j.rcm2402036] [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: 08/17/2022] [Revised: 11/18/2022] [Accepted: 11/23/2022] [Indexed: 07/31/2024] Open
Abstract
The prevalence of type 2 diabetes mellitus (T2DM) is rising in the general population. This increase leads to higher cardiovascular risk, with cardiovascular diseases being the main cause of death in diabetic patients. New therapeutic weapons for diabetes mellitus are now available. Sodium-glucose cotransporter type 2 (SGLT2) inhibitors are novel drugs that are widely used due to their strong benefit in preventing hospitalization for decompensated heart failure and renal protection, limiting the deterioration of the glomerular filtration rate, independently of the presence of diabetes mellitus. These drugs have also shown benefit in the prevention of atherosclerotic cardiovascular events and cardiovascular mortality in diabetic patients with established cardiovascular disease. On the other hand, patients with T2DM usually present a high burden of associated comorbidities. Some of these entities are arterial hypertension, dyslipidemia, hyperuricemia, obesity, non-alcoholic fatty liver disease (NAFLD), polycystic ovary syndrome (PCOS), vascular aging, respiratory diseases, or osteoporosis and fractures. Healthcare professionals should treat these patients from an integral point of view, and not manage each pathology separately. Therefore, as potential mechanisms of SGLT2 inhibitors in metabolic diseases have not been fully reviewed, we conducted this review to know the current evidence of the use and effect of SGLT2 inhibitors on these metabolic diseases.
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Affiliation(s)
- Jaime Sanz-Cánovas
- Unidad de Gestión Clínica de Medicina Interna, Hospital Regional Universitario de Málaga, Universidad de Málaga (UMA), 29010 Málaga, Spain
- Instituto de Investigación Biomédica de Málaga (IBIMA-Plataforma Bionand), 29590 Málaga, Spain
| | - Michele Ricci
- Unidad de Gestión Clínica de Medicina Interna, Hospital Regional Universitario de Málaga, Universidad de Málaga (UMA), 29010 Málaga, Spain
- Instituto de Investigación Biomédica de Málaga (IBIMA-Plataforma Bionand), 29590 Málaga, Spain
| | - Lidia Cobos-Palacios
- Unidad de Gestión Clínica de Medicina Interna, Hospital Regional Universitario de Málaga, Universidad de Málaga (UMA), 29010 Málaga, Spain
- Instituto de Investigación Biomédica de Málaga (IBIMA-Plataforma Bionand), 29590 Málaga, Spain
| | - Almudena López-Sampalo
- Unidad de Gestión Clínica de Medicina Interna, Hospital Regional Universitario de Málaga, Universidad de Málaga (UMA), 29010 Málaga, Spain
- Instituto de Investigación Biomédica de Málaga (IBIMA-Plataforma Bionand), 29590 Málaga, Spain
| | - Halbert Hernández-Negrín
- Unidad de Gestión Clínica de Medicina Interna, Hospital Regional Universitario de Málaga, Universidad de Málaga (UMA), 29010 Málaga, Spain
- Instituto de Investigación Biomédica de Málaga (IBIMA-Plataforma Bionand), 29590 Málaga, Spain
| | - María Vázquez-Márquez
- Unidad de Gestión Clínica de Medicina Interna, Hospital Regional Universitario de Málaga, Universidad de Málaga (UMA), 29010 Málaga, Spain
- Instituto de Investigación Biomédica de Málaga (IBIMA-Plataforma Bionand), 29590 Málaga, Spain
| | - Juan José Mancebo-Sevilla
- Unidad de Gestión Clínica de Medicina Interna, Hospital Regional Universitario de Málaga, Universidad de Málaga (UMA), 29010 Málaga, Spain
- Instituto de Investigación Biomédica de Málaga (IBIMA-Plataforma Bionand), 29590 Málaga, Spain
| | - Elena Álvarez-Recio
- Unidad de Gestión Clínica de Medicina Interna, Hospital Regional Universitario de Málaga, Universidad de Málaga (UMA), 29010 Málaga, Spain
- Instituto de Investigación Biomédica de Málaga (IBIMA-Plataforma Bionand), 29590 Málaga, Spain
| | - María Dolores López-Carmona
- Unidad de Gestión Clínica de Medicina Interna, Hospital Regional Universitario de Málaga, Universidad de Málaga (UMA), 29010 Málaga, Spain
- Instituto de Investigación Biomédica de Málaga (IBIMA-Plataforma Bionand), 29590 Málaga, Spain
| | - Miguel Ángel Pérez-Velasco
- Unidad de Gestión Clínica de Medicina Interna, Hospital Regional Universitario de Málaga, Universidad de Málaga (UMA), 29010 Málaga, Spain
- Instituto de Investigación Biomédica de Málaga (IBIMA-Plataforma Bionand), 29590 Málaga, Spain
| | - Luis Miguel Pérez-Belmonte
- Unidad de Gestión Clínica de Medicina Interna, Hospital Regional Universitario de Málaga, Universidad de Málaga (UMA), 29010 Málaga, Spain
- Instituto de Investigación Biomédica de Málaga (IBIMA-Plataforma Bionand), 29590 Málaga, Spain
| | - Ricardo Gómez-Huelgas
- Unidad de Gestión Clínica de Medicina Interna, Hospital Regional Universitario de Málaga, Universidad de Málaga (UMA), 29010 Málaga, Spain
- Instituto de Investigación Biomédica de Málaga (IBIMA-Plataforma Bionand), 29590 Málaga, Spain
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Maria-Rosa Bernal-López
- Unidad de Gestión Clínica de Medicina Interna, Hospital Regional Universitario de Málaga, Universidad de Málaga (UMA), 29010 Málaga, Spain
- Instituto de Investigación Biomédica de Málaga (IBIMA-Plataforma Bionand), 29590 Málaga, Spain
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, 28029 Madrid, Spain
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Kaihara T, Falter M, Scherrenberg M, Xu L, Maes J, Meesen E, Dendale P. The impact of dietary education and counselling with a smartphone application on secondary prevention of coronary artery disease: A randomised controlled study (the TeleDiet study). Digit Health 2023; 9:20552076231164101. [PMID: 36960029 PMCID: PMC10028629 DOI: 10.1177/20552076231164101] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 02/28/2023] [Indexed: 03/25/2023] Open
Abstract
Objective: In a secondary prevention of coronary artery disease (CAD), nutritional management is an integral part of lifestyle optimisation. However, few studies have investigated the potential of remote nutritional follow-up using digital solutions. This study investigates the effectiveness of a smartphone application for nutrition education and feedback with pictures of meals by a dietitian for patients with CAD. Methods: Sixty participants with CAD were randomised to either a TeleDiet group or a control group. Participants in the TeleDiet group participated in dietary education using a messaging application. The primary outcome was the change of the Mediterranean diet score (MedDietScore). The Nutrition-Score, a modification of the MedDietScore, blood tests (blood lipids, blood glucose and kidney function), body mass index, self-efficacy, medication adherence and health-related quality of life during the observation period were analysed as secondary outcomes. Results: Sixty participants participated in the study. The difference in the MedDietScore in the TeleDiet group was greater than in the control group, but not significant (2.0 [-1.0, 4.0] vs. 0.0 [-3.0, 1.5], p = 0.066). The difference in the Nutrition-Score in the TeleDiet group was significantly greater than in the control group (3.0 [1.0, 3.5] vs. 0.0 [-3.0, 2.0], p = 0.029). Nutrition knowledge of the TeleDiet group improved significantly compared to the control group (1.9 ± 1.7 vs. 0.8 ± 2.1, p = 0.048). Conclusions: A feedback system using a simple messaging application that allows patients with CAD to simply send a picture of their food has a positive effect on nutrition knowledge. It could be a hint for the implementation of the Mediterranean diet.
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Affiliation(s)
- Toshiki Kaihara
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
- Faculty of Medicine and Life Sciences / Human-Computer Interaction
and eHealth, UHasselt, Diepenbeek, Belgium
- Division of Cardiology, Department of Internal Medicine, St.
Marianna University School of Medicine, Kawasaki, Japan
- Toshiki Kaihara, Division of Cardiology,
Department of Internal Medicine, St. Marianna University School of Medicine,
2-16-1 Sugao, Miyamae-ku, Kawasaki 216-8511, Japan.
| | - Maarten Falter
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
- Faculty of Medicine and Life Sciences / Human-Computer Interaction
and eHealth, UHasselt, Diepenbeek, Belgium
- Faculty of Medicine, KULeuven, Leuven, Belgium
| | - Martijn Scherrenberg
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
- Faculty of Medicine and Life Sciences / Human-Computer Interaction
and eHealth, UHasselt, Diepenbeek, Belgium
- Faculty of Medicine, University of Antwerp, Antwerp, Belgium
| | - Linqi Xu
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
- Faculty of Medicine and Life Sciences / Human-Computer Interaction
and eHealth, UHasselt, Diepenbeek, Belgium
- School of Nursing, Jilin University, Changchun, People's Republic of
China
| | - Jana Maes
- Faculty of Medicine and Life Sciences / Human-Computer Interaction
and eHealth, UHasselt, Diepenbeek, Belgium
| | - Elise Meesen
- Faculty of Medicine and Life Sciences / Human-Computer Interaction
and eHealth, UHasselt, Diepenbeek, Belgium
| | - Paul Dendale
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
- Faculty of Medicine and Life Sciences / Human-Computer Interaction
and eHealth, UHasselt, Diepenbeek, Belgium
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20
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Barnett A, Wright C, Stone C, Ho NY, Adhyaru P, Kostjasyn S, Hickman IJ, Campbell KL, Mayr HL, Kelly JT. Effectiveness of dietary interventions delivered by digital health to adults with chronic conditions: Systematic review and meta-analysis. J Hum Nutr Diet 2022; 36:632-656. [PMID: 36504462 DOI: 10.1111/jhn.13125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 12/05/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Digital health interventions may facilitate management of chronic conditions; however, no reviews have systematically assessed the effectiveness of dietary interventions delivered by digital health platforms for improving dietary intake and clinical outcomes for adults with diet-related chronic conditions. METHODS Databases CINAHL, CENTRAL, Embase and MEDLINE were searched from inception to April 2021 to identify controlled trials for dietary education delivered by digital health (mobile or electronic health) to adults with diet-related chronic conditions. Random effects analysis was performed for diet quality, food groups, nutrients and clinical outcomes. Screening, data extraction and quality checking were completed in duplicate. RESULTS Thirty-nine studies were included involving 7333 participants. Significant changes were found for Mediterranean diet adherence score (standardised mean difference [SMD] = 0.79; 95% confidence interval [CI] = 0.18 to 1.40), overall fruit and vegetable intake (mean difference [MD]: 0.63 serves/day; 95% CI = 0.27-0.98), fruit intake alone (MD = 0.58 serves/day; 95% CI = 0.39 to 0.77) and sodium intake (SMD = -0.22; 95% CI = -0.44 to -0.01). Improvements were also found for waist circumference [MD = -2.24 centimetres; 95% CI = -4.14 to -0.33], body weight (MD = -1.94 kg; 95% CI = -2.63 to -1.24) and haemoglobin A1c (MD = -0.17%; 95% CI = -0.29 to -0.04). Validity of digital assessment tools to measure dietary intake were not reported. The quality of evidence was considered to have low to moderate certainty. CONCLUSIONS Modest improvements in diet and clinical outcomes may result from intervention via digital health for those with diet-related chronic conditions. However, additional robust trials with better reporting of digital dietary assessment tools are needed to support implementation within clinical practice.
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Affiliation(s)
- Amandine Barnett
- Centre for Online Health, The University of Queensland, Brisbane, QLD, Australia.,Centre for Health Services Research, The University of Queensland, Brisbane, QLD, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Charlene Wright
- Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia.,School of Applied Psychology, Griffith University, Mount Gravatt, QLD, Australia
| | - Christine Stone
- Department of Nutrition and Dietetics, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Nok Yin Ho
- Bond University Nutrition and Dietetics Research Group, Faculty of Health Sciences and Medicine, Bond University, Robina, QLD, Australia
| | - Pooja Adhyaru
- Bond University Nutrition and Dietetics Research Group, Faculty of Health Sciences and Medicine, Bond University, Robina, QLD, Australia
| | - Sarah Kostjasyn
- Bond University Nutrition and Dietetics Research Group, Faculty of Health Sciences and Medicine, Bond University, Robina, QLD, Australia
| | - Ingrid J Hickman
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia.,Department of Nutrition and Dietetics, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Katrina L Campbell
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia.,Healthcare Excellence and Innovation, Metro North Hospital and Health Service, Brisbane, QLD, Australia
| | - Hannah L Mayr
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia.,Department of Nutrition and Dietetics, Princess Alexandra Hospital, Brisbane, QLD, Australia.,Bond University Nutrition and Dietetics Research Group, Faculty of Health Sciences and Medicine, Bond University, Robina, QLD, Australia.,Centre for Functioning and Health Research, Metro South Hospital and Health Service, Brisbane, QLD, Australia
| | - Jaimon T Kelly
- Centre for Online Health, The University of Queensland, Brisbane, QLD, Australia.,Centre for Health Services Research, The University of Queensland, Brisbane, QLD, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
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21
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Recio-Rodriguez JI, Garcia-Ortiz L, Garcia-Yu IA, Lugones-Sanchez C, Olmo EZD, Bolibar B, Casajuana-Closas M, Lopez-Jimenez T, Llobera J, Ramos R, Pombo H, Motrico E, Gil-Girbau M, Lopez-Mendez F, Represas-Carrera F, Maderuelo-Fernandez JA. Effectiveness of a multiple health-behaviour-change intervention in increasing adherence to the Mediterranean Diet in adults (EIRA study): a randomized controlled hybrid trial. BMC Public Health 2022; 22:2127. [PMID: 36401247 PMCID: PMC9675247 DOI: 10.1186/s12889-022-14590-y] [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: 11/19/2021] [Accepted: 11/10/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The present study describes the effectiveness of a complex intervention that addresses multiple lifestyles to promote healthy behaviours in increasing adherence to the Mediterranean diet (MD). METHODS: Cluster-randomised, hybrid clinical trial controlled with two parallel groups. The study was carried out in 26 primary Spanish healthcare centres. People aged 45-75 years who presented at least two of the following criteria were included: smoker, low adherence to the MD or insufficient level of physical activity. The intervention group (IG) had three different levels of action: individual, group, and community, with the aim of acting on the behaviours related to smoking, diet and physical activity at the same time. The individual intervention included personalised recommendations and agreements on the objectives to attain. Group sessions were adapted to the context of each healthcare centre. The community intervention was focused on the social prescription of resources and activities performed in the environment of the community of each healthcare centre. Control group (CG) received brief advice given in the usual visits to the doctor's office. The primary outcome was the change, after 12 months, in the number of participants in each group with good adherence to the MD pattern. Secondary outcomes included the change in the total score of the MD adherence score (MEDAS) and the change in some cardiovascular risk factors. RESULTS Three thousand sixty-two participants were included (IG = 1,481, CG = 1,581). Low adherence to the MD was present in 1,384 (93.5%) participants, of whom 1,233 initiated the intervention and conducted at least one individual visit with a healthcare professional. A greater increase (13.7%; 95% CI, 9.9-17.5; p < 0.001) was obtained by IG in the number of participants who reached 9 points or more (good adherence) in the MEDAS at the final visit. Moreover, the effect attributable to the intervention obtained a greater increase (0.50 points; 95% CI, 0.35 to 0.66; p < 0.001) in IG. CONCLUSIONS A complex intervention modelled and carried out by primary healthcare professionals, within a real clinical healthcare context, achieved a global increase in the adherence to the MD compared to the brief advice. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03136211. Retrospectively registered on 02/05/2017 https://clinicaltrials.gov/ct2/show/NCT03136211.
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Affiliation(s)
- Jose I Recio-Rodriguez
- Unidad de Investigación de Atención Primaria de Salamanca (APISAL), Instituto de Investigación Biomédica de Salamanca (IBSAL), Red de Investigación en Cronicidad, Atención Primaria Y Promoción de La Salud (RICAPPS) (RD21/0016), Facultad de Enfermería Y Fisioterapia (Universidad de Salamanca), Salamanca, Spain.
| | - Luis Garcia-Ortiz
- Unidad de Investigación de Atención Primaria de Salamanca (APISAL), Instituto de Investigación Biomédica de Salamanca (IBSAL), Gerencia de Atención Primaria de Salamanca, Departamento de Ciencias Biomédicas Y del Diagnóstico (Universidad de Salamanca), Gerencia Regional de Salud de Castilla Y León (SACyL), 37007, Salamanca, Spain
| | - Irene A Garcia-Yu
- Unidad de Investigación de Atención Primaria de Salamanca (APISAL), Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
| | - Cristina Lugones-Sanchez
- Unidad de Investigación de Atención Primaria de Salamanca (APISAL), Instituto de Investigación Biomédica de Salamanca (IBSAL), Gerencia de Atención Primaria de Salamanca, Gerencia Regional de Salud de Castilla Y León (SACyL), Salamanca, Spain
| | - Edurne Zabaleta-Del Olmo
- Nursing Department, Nursing Faculty (Universitat de Girona), Fundació Institut Universitari Per a La Recerca a L'Atenció Primària de Salut Jordi Gol I Gurina (IDIAPJGol), Gerència Territorial de Barcelona (Institut Català de La Salut), UniversitatAutònoma de Barcelona, Barcelona, Spain
| | - Bonaventura Bolibar
- Fundació Institut Universitari Per a La Recerca a L'Atenció Primària de Salut Jordi Gol I Gurina (IDIAPJGol), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Marc Casajuana-Closas
- Fundació Institut Universitari Per a La Recerca a L'Atenció Primària de Salut Jordi Gol I Gurina (IDIAPJGol), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Tomas Lopez-Jimenez
- Fundació Institut Universitari Per a La Recerca a L'Atenció Primària de Salut Jordi Gol I Gurina (IDIAPJGol), Barcelona, Spain
| | - Joan Llobera
- Unitat de Recerca, Atenció Primària de Mallorca. Servei de Salut de Les Illes Balears. IdISBa, Palma, Spain
| | - Rafel Ramos
- Fundació Institut Universitari Per a La Recerca a L'Atenció Primària de Salut Jordi Gol I Gurina (IDIAPJGol), Group of Research in Vascular Health, Unitat de Suport a La Recerca de Girona, Girona Biomedical Research Institute (IdibGi), Girona, Spain
| | - Haizea Pombo
- Bizkaia, Deputy Directorate of Healthcare Assistance, Ezkerraldea-Enkarterri-Cruces Integrated Health Organisation-Biocruces Bizkaia Health Research Institute Innovation Unit, Osakidetza-Servicio Vasco de Salud, Araba, Spain
| | | | - Montserrat Gil-Girbau
- Research and Development Unit, Institut de Recerca Sant Joan de Déu, Sant Boi de Llobregat, Spain
| | | | - Francisco Represas-Carrera
- Atención Primaria, Área Sanitaria de Vigo, Servicio Gallego de Salud (SERGAS), Grupo I-Saúde (Instituto de Investigación Sanitaria Galicia Sur), Galicia, Spain
| | - Jose A Maderuelo-Fernandez
- Unidad de Investigación de Atención Primaria de Salamanca (APISAL), Instituto de Investigación Biomédica de Salamanca (IBSAL), Gerencia de Atención Primaria de Salamanca, Gerencia Regional de Salud de Castilla Y León (SACyL), Salamanca, Spain
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22
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Long-Term Effectiveness of a Smartphone App and a Smart Band on Arterial Stiffness and Central Hemodynamic Parameters in a Population with Overweight and Obesity (Evident 3 Study): Randomised Controlled Trial. Nutrients 2022; 14:nu14224758. [PMID: 36432446 PMCID: PMC9695348 DOI: 10.3390/nu14224758] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 11/02/2022] [Accepted: 11/09/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND mHealth technologies could help to improve cardiovascular health; however, their effect on arterial stiffness and hemodynamic parameters has not been explored to date. OBJECTIVE To evaluate the effect of a mHealth intervention, at 3 and 12 months, on arterial stiffness and central hemodynamic parameters in a sedentary population with overweight and obesity. METHODS Randomised controlled clinical trial (Evident 3 study). 253 subjects were included: 127 in the intervention group (IG) and 126 in the control group (CG). The IG subjects were briefed on the use of the Evident 3 app and a smart band (Mi Band 2, Xiaomi) for 3 months to promote healthy lifestyles. All measurements were recorded in the baseline visit and at 3 and 12 months. The carotid-femoral pulse wave velocity (cfPWV) and the central hemodynamic parameters were measured using a SphigmoCor System® device, whereas the brachial-ankle pulse wave velocity (baPWV) and the Cardio Ankle Vascular Index (CAVI) were measured using a VaSera VS-2000® device. RESULTS Of the 253 subjects who attended the initial visit, 237 (93.7%) completed the visit at 3 months of the intervention, and 217 (85.3%) completed the visit at 12 months of the intervention. At 12 months, IG showed a decrease in peripheral augmentation index (PAIx) (-3.60; 95% CI -7.22 to -0.00) and ejection duration (ED) (-0.82; 95% CI -1.36 to -0.27), and an increase in subendocardial viability ratio (SEVR) (5.31; 95% CI 1.18 to 9.44). In CG, cfPWV decreased at 3 months (-0.28 m/s; 95% CI -0.54 to -0.02) and at 12 months (-0.30 m/s, 95% CI -0.54 to -0.05), central diastolic pressure (cDBP) decreased at 12 months (-1.64 mm/Hg; 95% CI -3.19 to -0.10). When comparing the groups we found no differences between any variables analyzed. CONCLUSIONS In sedentary adults with overweight or obesity, the multicomponent intervention (Smartphone app and an activity-tracking band) for 3 months did not modify arterial stiffness or the central hemodynamic parameters, with respect to the control group. However, at 12 months, CG presented a decrease of cfPWV and cDBP, whereas IG showed a decrease of PAIx and ED and an increase of SEVR.
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23
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Siniarski A, Sobieraj P, Samel-Kowalik P, Sińska B, Milewska M, Bzikowska-Jura A. Nutrition-related mobile applications - Should they be used for dietary prevention and treatment of cardiovascular diseases? Nutr Metab Cardiovasc Dis 2022; 32:2505-2514. [PMID: 36064687 DOI: 10.1016/j.numecd.2022.07.010] [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: 02/07/2022] [Revised: 07/11/2022] [Accepted: 07/12/2022] [Indexed: 10/31/2022]
Abstract
BACKGROUND AND AIMS There is no prior research on the usefulness that popular nutrition-related mobile applications would have in assessing fatty acids intake. In this study, we examine these applications through their utilization in the assessment of consumption of saturated (SFAs) and polyunsaturated (PUFAs) fatty acids against the Polish reference method (RM, Dieta 6.0). This report does also include the information about monounsaturated fatty acids and cholesterol intake. METHODS AND RESULTS SFAs and PUFAs intake was assessed using two-day dietary recalls obtained from 120 individuals by 3 selected mobile applications (App1 = Yazio, App2 = MyFitnessPal, App3 = Fitatu) and compared with RM. Despite strong (SFAs by App1 and App3) and moderate (SFAs by App2 and PUFAs by App1, App2, App3) correlations with RM, Bland-Altman analyses showed relevant biases and wide range between limits of agreement. Considering SFAs and MUFAs intake, App1 had the best agreement. App1 had high sensitivity (94.6%) in recognition of subjects with SFAs intake >10% with moderate specificity (67.9%), while App2 had poor sensitivity (27.2%) and high specificity (100%). App3 showed moderate sensitivity and specificity (77.2% and 75%, respectively). CONCLUSIONS Mobile applications are not accurate tools in SFAs and PUFAs assessment when compared to the RM. Nonetheless, their ability to recognize SFAs intake >10% energy intake may suggest that further development of mobile applications could potentially become an attractive tool in clinical practice.
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Affiliation(s)
- Aleksander Siniarski
- Department of Coronary Artery Disease and Heart Failure, Institute of Cardiology, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland; John Paull II Hospital in Krakow, Poland
| | - Piotr Sobieraj
- Department of Internal Medicine, Hypertension and Vascular Diseases, Medical University of Warsaw, Poland
| | - Piotr Samel-Kowalik
- Department of Prevention of Environmental Hazards and Allergology, Medical University of Warsaw, Warsaw, Poland
| | - Beata Sińska
- Department of Human Nutrition, Medical University of Warsaw, Warsaw, Poland
| | - Magdalena Milewska
- Department of Clinical Dietetics, Medical University of Warsaw, Warsaw, Poland
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Dietary Management Tools Improve the Dietary Skills of Patients with T2DM in Communities. Nutrients 2022; 14:nu14214453. [PMID: 36364716 PMCID: PMC9654010 DOI: 10.3390/nu14214453] [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: 09/06/2022] [Revised: 10/18/2022] [Accepted: 10/18/2022] [Indexed: 11/06/2022] Open
Abstract
Dietary management is of paramount importance in the prevention and control of type 2 diabetes mellitus (T2DM). This one-year cluster-randomized controlled trial aims to evaluate the effect of dietary management tools on the dietary skills of patients with T2DM. Twenty-two communities were randomly assigned to an intervention group and a control group, and participants in the intervention group received a food guiding booklet (G) and a dinner set (D). The frequency of dietary management tools usage was collected at baseline and every three months, and different use patterns were identified by a group-based trajectory model. A self-compiled diabetic dietary skills scale and blood glucose were collected at baseline, 3, and 12 months, and a using generalized linear mixed model (GLMM) to explore the influence factors of dietary skills and blood glucose. The finding revealed four dietary tool-usage patterns among the participants: Insist using G/D, Give up gradually G/D, Give up after use G, and Never use G/D. GLMM indicated that dietary skills were higher over time (p < 0.05), and in participants using the guiding booklet (p < 0.001) or dinner set (p < 0.001), or with higher education (p < 0.001). Additionally, blood glucose were lower among participants with higher dietary skills (p = 0.003), higher educational level (p = 0.046), and a 3000−5000 monthly income (p = 0.026). These findings support using food management tools like the guiding booklet and dinner set as a useful strategy in primary health care centers for individuals with T2DM to increase their dietary skills and blood glucose control.
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25
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Béjar LM, García-Perea MD, Mesa-Rodríguez P. Evaluation of an Application for Mobile Telephones (e-12HR) to Increase Adherence to the Mediterranean Diet in University Students: A Controlled, Randomized and Multicentric Study. Nutrients 2022; 14:nu14194196. [PMID: 36235848 PMCID: PMC9571971 DOI: 10.3390/nu14194196] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 09/30/2022] [Accepted: 10/07/2022] [Indexed: 11/07/2022] Open
Abstract
Mediterranean diet (MD) is potentially one of the best diets regarding health benefits and sustainability. However, it is faced with serious difficulties staying alive, even in traditionally Mediterranean regions. The objective was to evaluate the effectiveness of an application (e-12HR) to improve adherence to the MD (AMD) in university students. This study was a controlled, randomized, and multicentric clinical trial with two parallel groups (control group (CG) and intervention group (IG)), a 28-day follow-up period, and 286 participants (74.1% women). There were two versions of e-12HR: ‘feedback’ e-12HR (IG) and ‘non-feedback’ e-12HR (CG). Only the ‘feedback’ e-12HR had two specific automatic functions: 1. Evaluation of the user’s AMD; 2. Identification of the food groups for which the user has not fulfilled the MD recommendations. Both versions of the application allowed the collection of data on dietary intake in order to calculate the AMD. When comparing CG and IG at 14-, 21-, and 28-days follow-up (no significant statistical differences at baseline), there were significant statistical improvements in favor of IG in AMD index (0.71, 1.56, and 1.43 points, respectively), and in the percentage of participants with medium/high AMD index (14.4%, 20.6%, and 23.7%, respectively). In conclusion, e-12HR could improve AMD among university students.
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Affiliation(s)
- Luis M. Béjar
- Department of Preventive Medicine and Public Health, School of Medicine, University of Seville, 41004 Seville, Spain
- Correspondence: ; Tel.: +34-954-551-771
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26
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Recio-Rodríguez JI, Gonzalez-Sanchez S, Tamayo-Morales O, Gómez-Marcos MA, Garcia-Ortiz L, Niño-Martín V, Lugones-Sanchez C, Rodriguez-Sanchez E. Changes in lifestyles, cognitive impairment, quality of life and activity day living after combined use of smartphone and smartband technology: a randomized clinical trial (EVIDENT-Age study). BMC Geriatr 2022; 22:782. [PMID: 36203135 PMCID: PMC9535859 DOI: 10.1186/s12877-022-03487-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 09/28/2022] [Indexed: 12/04/2022] Open
Abstract
Background The aim of this study was to assess the efficacy of the combined use of smartphone and smartband technology for 3-months alongside brief lifestyle counselling, versus counselling alone, in increasing physical activity. As secondary objectives, the effects of the intervention on dietary habits, body composition, quality of life, level of functionality and cognitive performance were assessed. Methods This study employed a randomized clinical trial of two-parallel groups design – control group (CG) and intervention group (IG). The study was conducted in 3 Spanish health-centres between October 2018-February 2020. Eligible participants were people of both sexes and aged between 65–80 years attending the health-centres with a score ≥ 24 points on the Mini-Mental State Examination. Key variables included physical activity, dietary pattern, body composition, cognitive performance, level of functionality and quality of life. All variables were measured at baseline and after 3-months. Both groups received a brief nutritional and physical activity advice. Intervention group participants were instructed to use a smartphone application for a period of 3-months. This application integrates information on physical activity received from a fitness bracelet and self-reported information on the patient’s daily nutritional composition. Results The study population comprised 160 participants (IG = 81, CG = 79), with a mean age of 70.8 ± 4.0 years (61.3% women). No difference was found in the primary and secondary outcomes analyzed (physical activity (steps/min -0.4 (-1.0 to 0.2) p = 0.174), and dietary habits (Mediterranean diet score 0.0 (-0.6 to 0.6) p = 0.956) that could be attributed to either group after an ANCOVA test. A difference attributable to the intervention was observed in the total Clock test score (0.7 (0.1 to 1.2) p = 0.018. Conclusions In a sample of people over 65 years of age, the combined use of the EVIDENT 3 smartphone app and an activity tracking bracelet for 3-months did not result in lifestyles changes related to the amount and level of physical activity or the eating habits, compared to brief lifestyle advice. Other clinical parameters were not changed either, although at the cognitive level, a slight improvement was observed in the score on the Clock test assessing a variety of cognitive functions such as memory. Trial registration The study was registered in ClinicalTrials.gov Identifier: NCT03574480. Date of trial Registration 02/07/2018.
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Affiliation(s)
- José I Recio-Rodríguez
- Unidad de Investigación de Atención Primaria de Salamanca (APISAL), Instituto de Investigación Biomédica de Salamanca (IBSAL), Red de investigación en cronicidad, Atención Primaria Y Promoción de La Salud (RICAPPS) (RD21/0016), Gerencia de Atención Primaria de Salamanca, Gerencia Regional de Salud de Castilla Y León (SACyL), Salamanca, Spain. .,Facultad de Enfermería Y Fisioterapia, Universidad de Salamanca, Donantes de Sangre S/N, 37007, Salamanca, Spain.
| | - Susana Gonzalez-Sanchez
- Unidad de Investigación de Atención Primaria de Salamanca (APISAL), Instituto de Investigación Biomédica de Salamanca (IBSAL), Red de investigación en cronicidad, Atención Primaria Y Promoción de La Salud (RICAPPS) (RD21/0016), Gerencia de Atención Primaria de Salamanca, Gerencia Regional de Salud de Castilla Y León (SACyL), Salamanca, Spain
| | - Olaya Tamayo-Morales
- Unidad de Investigación de Atención Primaria de Salamanca (APISAL), Instituto de Investigación Biomédica de Salamanca (IBSAL), Red de investigación en cronicidad, Atención Primaria Y Promoción de La Salud (RICAPPS) (RD21/0016), Gerencia de Atención Primaria de Salamanca, Gerencia Regional de Salud de Castilla Y León (SACyL), Salamanca, Spain
| | - Manuel A Gómez-Marcos
- Unidad de Investigación de Atención Primaria de Salamanca (APISAL), Instituto de Investigación Biomédica de Salamanca (IBSAL), Red de investigación en cronicidad, Atención Primaria Y Promoción de La Salud (RICAPPS) (RD21/0016), Gerencia de Atención Primaria de Salamanca, Gerencia Regional de Salud de Castilla Y León (SACyL), Salamanca, Spain.,Departamento de Medicina, Universidad de Salamanca, Salamanca, Spain
| | - Luis Garcia-Ortiz
- Unidad de Investigación de Atención Primaria de Salamanca (APISAL), Instituto de Investigación Biomédica de Salamanca (IBSAL), Red de investigación en cronicidad, Atención Primaria Y Promoción de La Salud (RICAPPS) (RD21/0016), Gerencia de Atención Primaria de Salamanca, Gerencia Regional de Salud de Castilla Y León (SACyL), Salamanca, Spain.,Departamento de Ciencias Biomédicas Y del Diagnóstico, Universidad de Salamanca, Salamanca, Spain
| | | | - Cristina Lugones-Sanchez
- Unidad de Investigación de Atención Primaria de Salamanca (APISAL), Instituto de Investigación Biomédica de Salamanca (IBSAL), Red de investigación en cronicidad, Atención Primaria Y Promoción de La Salud (RICAPPS) (RD21/0016), Gerencia de Atención Primaria de Salamanca, Gerencia Regional de Salud de Castilla Y León (SACyL), Salamanca, Spain
| | - Emiliano Rodriguez-Sanchez
- Unidad de Investigación de Atención Primaria de Salamanca (APISAL), Instituto de Investigación Biomédica de Salamanca (IBSAL), Red de investigación en cronicidad, Atención Primaria Y Promoción de La Salud (RICAPPS) (RD21/0016), Gerencia de Atención Primaria de Salamanca, Gerencia Regional de Salud de Castilla Y León (SACyL), Salamanca, Spain.,Departamento de Medicina, Universidad de Salamanca, Salamanca, Spain
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27
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Albuquerque PEDS, da Silva ABJ, Vieira NMDSF, da Silva JML, Barros WMA. Letter to the editor: Weight-loss induced by carbohydrate restriction does not negatively affect health-related quality of life and cognition in people with type 2 diabetes: A randomized controlled trial. Clin Nutr 2022; 41:2428-2429. [DOI: 10.1016/j.clnu.2022.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 08/02/2022] [Accepted: 08/08/2022] [Indexed: 11/24/2022]
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Diabetes Management after a Therapeutic Education Program: A Qualitative Study. Healthcare (Basel) 2022; 10:healthcare10081375. [PMID: 35893197 PMCID: PMC9394246 DOI: 10.3390/healthcare10081375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 07/18/2022] [Accepted: 07/20/2022] [Indexed: 11/17/2022] Open
Abstract
(1) Background: Structured education has been used in patients treated with insulin, promoting their ability to adhere to and self-manage their treatment. We aimed to know the perception and adherence to the recommendations on the management of diabetes in type 1 diabetes patients after participating in a therapeutic education program. (2) Methods: A descriptive qualitative study followed the Standards for Reporting Qualitative Research guidelines. Patients with type 1 diabetes participating in a therapeutic education program were recruited from February to April 2022. Semi-structured, in-depth interviews were used, and transcriptions were analyzed using the inductive qualitative content analysis method. The final sample consisted of 18 type 1 diabetes mellitus patients. (3) Results: A number of patients with type 1 diabetes said that they had improved their glycemic control after participating in the therapeutic education program. Some patients recognized that the chronic disease and the complications complexity generated stress and anxiety. This influenced their usual life, at work, and their interpersonal relationships. (4) Conclusions: In terms of satisfaction, the majority of patients reported a good perception of the quality of the organization, the professionals involved, and the contents of the program. The physical and psychosocial benefits of self-care training have been demonstrated.
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Dobrow L, Estrada I, Burkholder-Cooley N, Miklavcic J. Potential Effectiveness of Registered Dietitian Nutritionists in Healthy Behavior Interventions for Managing Type 2 Diabetes in Older Adults: A Systematic Review. Front Nutr 2022; 8:737410. [PMID: 35141261 PMCID: PMC8819057 DOI: 10.3389/fnut.2021.737410] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 12/03/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose A systematic review was conducted to assess how the involvement of a registered dietitian nutritionist (RDN) in healthy behavior interventions (HBIs) potentially affects outcomes in older adults with type 2 diabetes (T2D). Methods Literature was searched for primary research published between 2016 and 2020 on HBI involving a RDN affecting outcomes in older adults with T2D. Evaluations of hemoglobin A1c (HbA1c), blood glucose, blood pressure, cholesterol, anthropometry, body composition, medication usage, healthcare cost, and self-efficacy and/or adherence to healthy behaviors outcomes were selected for inclusion. All the literature included were summarized, evaluated for certainty of evidence criteria, and assessed for bias. Results A total of 12 studies were included for assessment. Involvement of a RDN in HBI was shown to reduce HbA1c, fasting blood glucose, low-density lipoprotein (LDL) cholesterol, and blood pressure and improve lean body mass, body mass index (BMI), and self-efficacy in populations of older adults with T2D. Compared to older adults with T2D receiving HBI involving RDNs, patients receiving usual care may incur higher healthcare costs or longer hospital stays. There was a high certainty of evidence for a RDN involvement in HBI with regard to reduction in HbA1c. There was a moderate certainty of evidence for a RDN involvement in HBI with regard to favorable changes in weight or body composition and cardiometabolic health outcomes. Statistically significant improvements in outcomes were usually sustained in follow-up after conclusion of HBI. Conclusion RDNs may play an integral role in HBIs resulting in improved glycemic control, weight management, cardiovascular outcomes, and presumably comorbidity management. RDNs are important facilitators of diet education and nutrition assessment, which are essential in T2D management and should, therefore, be considered for routine inclusion in interprofessional teams for improved outcomes in older adults with T2D.
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Affiliation(s)
- Laurel Dobrow
- Schmid College of Science and Technology, Chapman University, Orange, CA, United States
| | - Isabella Estrada
- Schmid College of Science and Technology, Chapman University, Orange, CA, United States
| | | | - John Miklavcic
- Schmid College of Science and Technology, Chapman University, Orange, CA, United States
- School of Pharmacy, Chapman University, Irvine, CA, United States
- *Correspondence: John Miklavcic
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Xu C, Cao Z, Yang H, Hou Y, Wang X, Wang Y. Association Between the EAT-Lancet Diet Pattern and Risk of Type 2 Diabetes: A Prospective Cohort Study. Front Nutr 2022; 8:784018. [PMID: 35096931 PMCID: PMC8795697 DOI: 10.3389/fnut.2021.784018] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 12/01/2021] [Indexed: 12/11/2022] Open
Abstract
Background: The EAT-Lancet Commission has promulgated a sustainable dietary guideline and recommended that it was designed to improve the human health and support environmental sustainability. Objective: This research was designed to explore the association between this healthy diet pattern (EAT-Lancet diet pattern, EAT-LDP) and risk of type 2 diabetes (T2D). Methods: Between 2006 and 2010, a total of 59,849 participants from the UK Biobank without diabetes, cardiovascular disease, or cancers were included at baseline. The EAT-LDP score was constructed on the sum of 14 food components and then categorized into three tertiles. Multivariable Cox proportional hazards regression models were conducted to explore the association between EAT-LDP score and the risk of incident T2D. A mediation analysis was also implemented to disentangle the role of body mass index (BMI) and waist circumference in the relationship between EAT-LDP score and T2D. Results: During a median follow-up of 10 years, 2,461 incident T2D cases were recorded. In analyses that compared tertile 3 of the EAT-LDP score (highest) with tertile 1 (lowest), the hazard ratio (HR) for T2D was 0.81 (95% CI: 0.72–0.90) after adjusting for sociodemographic status and health-related factors. Participants who reported a one-point increase in the diet score were associated with a 6% decrease in risk of T2D (HR: 0.94, 95% CI: 0.91–0.97). A significant indirect association was observed between the EAT-LDP score and T2D (β: 0.66, 95% CI: 0.65–0.67), indicating that 44% of the association of EAT-LDP score with T2D was mediated by BMI. Additionally, 40% of the association of EAT-LDP score with T2D was mediated by waist circumference was also observed. Conclusions: Our findings indicate that a higher adherence to EAT-LDP contributes to lower risk of T2D. Further independent validation is needed to be conducted before applying the EAT-LDP to inform dietary guidelines.
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Affiliation(s)
- Chenjie Xu
- School of Public Health, Hangzhou Normal University, Hangzhou, China
- School of Public Health, Tianjin Medical University, Tianjin, China
| | - Zhi Cao
- Department of Big Data in Health Science, School of Public Health, Zhejiang University School of Medicine, Hangzhou, China
| | - Hongxi Yang
- Department of Bioinformatics, School of Basic Medical Sciences, Tianjin Medical University, Tianjin, China
| | - Yabing Hou
- School of Public Health, Tianjin Medical University, Tianjin, China
| | - Xiaohe Wang
- School of Public Health, Hangzhou Normal University, Hangzhou, China
- *Correspondence: Xiaohe Wang
| | - Yaogang Wang
- School of Public Health, Tianjin Medical University, Tianjin, China
- Yaogang Wang
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MacDonald CS, Ried-Larsen M, Soleimani J, Alsawas M, Lieberman DE, Ismail AS, Serafim LP, Yang T, Prokop L, Joyner M, Murad MH, Barwise A. A systematic review of adherence to physical activity interventions in individuals with type 2 diabetes. Diabetes Metab Res Rev 2021; 37:e3444. [PMID: 33769660 DOI: 10.1002/dmrr.3444] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 01/20/2021] [Accepted: 02/09/2021] [Indexed: 02/05/2023]
Abstract
Lifestyle interventions are pivotal for successful management of type 2 diabetes (T2D), however, the proportion of people with T2D adhering to physical activity advice has not been thoroughly studied. The purpose of this systematic review was to summarise the evidence on adherence to exercise or physical activity components in lifestyle interventions in those with T2D. We searched MEDLINE EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews and Scopus on 12 November 2019. Eligible studies enrolled adults with T2D and reported the proportion of adherence to lifestyle interventions as a primary or secondary outcome. We included 11 studies (nine randomised controlled trials (RCTs) enrolling 1717 patients and two nonrandomised studies enrolling 62 patients). Only one of the studies had low risk of bias. The proportion of participants adhering to physical activity varied from 32% to 100% with a median of 58%. Adherence was higher in interventions using supervised training and lowest in interventions using remote coaching and the adherence rate in observational studies was higher compared to RCTs (92% vs. 55%; p < 0.01). Study duration, risk of bias, or participants' sex, were not associated with adherence to physical activity. The proportion of those with T2D adhering to physical activity interventions for T2D varies widely and most of the included studies had a high risk of bias. These findings have important implications for planning and power analysis of future trials and when counselling patients about lifestyle interventions including physical activity or exercise components.
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Affiliation(s)
- Christopher S MacDonald
- The Centre of Inflammation and Metabolism and the Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Mathias Ried-Larsen
- The Centre of Inflammation and Metabolism and the Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Jalal Soleimani
- Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Mouaz Alsawas
- Mayo Clinic Evidence-Based Practice Center, Mayo Clinic, Rochester, Minnesota, USA
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Daniel E Lieberman
- Department of Human Evolutionary Biology, Harvard University, Cambridge, Massachusetts, USA
| | - Abdalla S Ismail
- Canton Medical Education Foundation (CMEF), Aultman Hospital, Canton, Ohio, USA
| | - Laura P Serafim
- School of medicine, Universidade Federal Do Rio Grande Do Sul (UFRGS), Porto Alegre, Brazil
| | - Ting Yang
- Pulmonary and Critical Care Medicine Department, West China Hospital, Si Chuan University, China
| | - Larry Prokop
- Mayo Clinic Libraries, Mayo Clinic, Rochester, Minnesota, USA
| | - Michael Joyner
- Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Amelia Barwise
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Benajiba N, Dodge E, Khaled MB, Chavarria EA, Sammartino CJ, Aboul-Enein BH. Technology-based nutrition interventions using the Mediterranean diet: a systematic review. Nutr Rev 2021; 80:1419-1433. [PMID: 34664675 DOI: 10.1093/nutrit/nuab076] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
CONTEXT Over the past 2 decades, overweight and obesity rates have increased exponentially, along with related comorbidities including type 2 diabetes, hypertension, cardiovascular disease, and some cancers. The Mediterranean Diet (MDiet) has been suggested as a potential way to mitigate the health burdens related to overweight and obesity. OBJECTIVE For this review, the literature on MDiet-focused digital interventions was examined to determine efficacy, best practices, and potential limitations. DATA SOURCES The search was conducted across 15 databases for relevant publications published through April 2020 in English, French, Spanish, Arabic, or Italian. DATA EXTRACTION Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed using a combination of keywords and phrases and evaluated independently for relevance, merit, and inclusion and exclusion criteria. DATA ANALYSIS The systematic literature review resulted in 15 articles that met the search criteria. Ten interventions were delivered online, and 5 were delivered via smartphone using an app. The majority of online MDiet-focused interventions were effective, particularly when modeled after evidence-based and best-practice online nutrition education interventions. Such interventions also are effective for promoting positive health behaviors and health outcomes, such as increased physical activity, increased levels of high-density lipoprotein cholesterol, and a lower total high-density lipoprotein cholesterol ratio. CONCLUSION Technology-based interventions to educate and promote adherence to the MDiet are successful in helping individuals achieve the stated outcomes. More research is needed to determine the efficacy of MDiet interventions delivered via smartphone apps.
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Affiliation(s)
- Nada Benajiba
- Nada Benajiba is with the Department of Health Basic Sciences, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia. Elizabeth Dodge is with the College of Graduate & Professional Studies, University of New England, Portland, Maine, USA. Meghit Boumédiène Khaled is with the Faculty of Life and Natural Science, Department of Biology, Laboratory of Nutrition, Pathology, Biotechnology and Health, Djillali Liabes University of Sidi-Bel-Abbes, Sidi-Bel-Abbes, Algeria. Enmanuel A. Chavarria is with the Rollins School of Public Health, Department of Behavioral, Social, and Health Education Sciences, Emory University, Atlanta, Georgia, USA. Cara J. Sammartino is with the College of Health & Wellness, Department of Health Science, Johnson & Wales University, Providence, Rhode Island, USA. Basil H. Aboul-Enein is with the Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Elizabeth Dodge
- Nada Benajiba is with the Department of Health Basic Sciences, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia. Elizabeth Dodge is with the College of Graduate & Professional Studies, University of New England, Portland, Maine, USA. Meghit Boumédiène Khaled is with the Faculty of Life and Natural Science, Department of Biology, Laboratory of Nutrition, Pathology, Biotechnology and Health, Djillali Liabes University of Sidi-Bel-Abbes, Sidi-Bel-Abbes, Algeria. Enmanuel A. Chavarria is with the Rollins School of Public Health, Department of Behavioral, Social, and Health Education Sciences, Emory University, Atlanta, Georgia, USA. Cara J. Sammartino is with the College of Health & Wellness, Department of Health Science, Johnson & Wales University, Providence, Rhode Island, USA. Basil H. Aboul-Enein is with the Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Meghit Boumédiène Khaled
- Nada Benajiba is with the Department of Health Basic Sciences, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia. Elizabeth Dodge is with the College of Graduate & Professional Studies, University of New England, Portland, Maine, USA. Meghit Boumédiène Khaled is with the Faculty of Life and Natural Science, Department of Biology, Laboratory of Nutrition, Pathology, Biotechnology and Health, Djillali Liabes University of Sidi-Bel-Abbes, Sidi-Bel-Abbes, Algeria. Enmanuel A. Chavarria is with the Rollins School of Public Health, Department of Behavioral, Social, and Health Education Sciences, Emory University, Atlanta, Georgia, USA. Cara J. Sammartino is with the College of Health & Wellness, Department of Health Science, Johnson & Wales University, Providence, Rhode Island, USA. Basil H. Aboul-Enein is with the Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Enmanuel A Chavarria
- Nada Benajiba is with the Department of Health Basic Sciences, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia. Elizabeth Dodge is with the College of Graduate & Professional Studies, University of New England, Portland, Maine, USA. Meghit Boumédiène Khaled is with the Faculty of Life and Natural Science, Department of Biology, Laboratory of Nutrition, Pathology, Biotechnology and Health, Djillali Liabes University of Sidi-Bel-Abbes, Sidi-Bel-Abbes, Algeria. Enmanuel A. Chavarria is with the Rollins School of Public Health, Department of Behavioral, Social, and Health Education Sciences, Emory University, Atlanta, Georgia, USA. Cara J. Sammartino is with the College of Health & Wellness, Department of Health Science, Johnson & Wales University, Providence, Rhode Island, USA. Basil H. Aboul-Enein is with the Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Cara J Sammartino
- Nada Benajiba is with the Department of Health Basic Sciences, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia. Elizabeth Dodge is with the College of Graduate & Professional Studies, University of New England, Portland, Maine, USA. Meghit Boumédiène Khaled is with the Faculty of Life and Natural Science, Department of Biology, Laboratory of Nutrition, Pathology, Biotechnology and Health, Djillali Liabes University of Sidi-Bel-Abbes, Sidi-Bel-Abbes, Algeria. Enmanuel A. Chavarria is with the Rollins School of Public Health, Department of Behavioral, Social, and Health Education Sciences, Emory University, Atlanta, Georgia, USA. Cara J. Sammartino is with the College of Health & Wellness, Department of Health Science, Johnson & Wales University, Providence, Rhode Island, USA. Basil H. Aboul-Enein is with the Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Basil H Aboul-Enein
- Nada Benajiba is with the Department of Health Basic Sciences, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia. Elizabeth Dodge is with the College of Graduate & Professional Studies, University of New England, Portland, Maine, USA. Meghit Boumédiène Khaled is with the Faculty of Life and Natural Science, Department of Biology, Laboratory of Nutrition, Pathology, Biotechnology and Health, Djillali Liabes University of Sidi-Bel-Abbes, Sidi-Bel-Abbes, Algeria. Enmanuel A. Chavarria is with the Rollins School of Public Health, Department of Behavioral, Social, and Health Education Sciences, Emory University, Atlanta, Georgia, USA. Cara J. Sammartino is with the College of Health & Wellness, Department of Health Science, Johnson & Wales University, Providence, Rhode Island, USA. Basil H. Aboul-Enein is with the Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Mobile health strategies for blood pressure self-management in urban populations with digital barriers: systematic review and meta-analyses. NPJ Digit Med 2021; 4:114. [PMID: 34294852 PMCID: PMC8298448 DOI: 10.1038/s41746-021-00486-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 06/21/2021] [Indexed: 12/17/2022] Open
Abstract
Mobile health (mHealth) technologies improve hypertension outcomes, but it is unknown if this benefit applies to all populations. This review aimed to describe the impact of mHealth interventions on blood pressure outcomes in populations with disparities in digital health use. We conducted a systematic search to identify studies with systolic blood pressure (SBP) outcomes located in urban settings in high-income countries that included a digital health disparity population, defined as mean age ≥65 years; lower educational attainment (≥60% ≤high school education); and/or racial/ethnic minority (<50% non-Hispanic White for US studies). Interventions were categorized using an established self-management taxonomy. We conducted a narrative synthesis; among randomized clinical trials (RCTs) with a six-month SBP outcome, we conducted random-effects meta-analyses. Twenty-nine articles (representing 25 studies) were included, of which 15 were RCTs. Fifteen studies used text messaging; twelve used mobile applications. Studies were included based on race/ethnicity (14), education (10), and/or age (6). Common intervention components were: lifestyle advice (20); provision of self-monitoring equipment (17); and training on digital device use (15). In the meta-analyses of seven RCTs, SBP reduction at 6-months in the intervention group (mean SBP difference = -4.10, 95% CI: [-6.38, -1.83]) was significant, but there was no significant difference in SBP change between the intervention and control groups (p = 0.48). The use of mHealth tools has shown promise for chronic disease management but few studies have included older, limited educational attainment, or minority populations. Additional robust studies with these populations are needed to determine what interventions work best for diverse hypertensive patients.
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García Pérez de Sevilla G, Barceló Guido O, De la Cruz MDLP, Blanco Fernández A, Alejo LB, Montero Martínez M, Pérez-Ruiz M. Adherence to a Lifestyle Exercise and Nutrition Intervention in University Employees during the COVID-19 Pandemic: A Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18147510. [PMID: 34299960 PMCID: PMC8305330 DOI: 10.3390/ijerph18147510] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 06/28/2021] [Accepted: 07/06/2021] [Indexed: 01/09/2023]
Abstract
Healthy lifestyles should be encouraged in the workplace through the occupational health teams of the companies. The objective of the present study was to evaluate the adherence to a lifestyle intervention carried out in university employees during the COVID-19 pandemic and its impact on health-related quality of life (HrQoL). A randomized controlled trial following the CONSORT guidelines was performed, consisting of three supervised interventions lasting for 18 weeks: an educational intervention on healthy habits, a nutritional intervention, and a telematic aerobic and strength exercise intervention. Lifestyle and HrQoL were analyzed six months post-intervention to assess adherence. Twenty-three middle-aged participants completed the study. The intervention group significantly improved their lifestyle according to the Health Promoting Lifestyle Profile II questionnaire, especially in the categories of Health Responsibility, Physical Activity, and Nutrition, with a large effect size. Sitting time was reduced by 2.5 h per day, with a moderate effect size. Regarding HrQoL, the intervention group showed a clinically significant improvement in the Physical Component Summary. Despite the lockdown and the mobility restrictions caused by the COVID-19 pandemic, this intervention performed on university employees achieved adherence to a healthier lifestyle and improved their HrQoL, which is of great clinical relevance.
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Affiliation(s)
- Guillermo García Pérez de Sevilla
- Department of Physiotherapy, Faculty of Sport Sciences, Universidad Europea de Madrid, 28670 Madrid, Spain
- Correspondence: ; Tel.: +34-62920-7357
| | - Olga Barceló Guido
- Faculty of Sport Sciences, Universidad Europea de Madrid, 28670 Madrid, Spain; (O.B.G.); (L.B.A.); (M.P.-R.)
| | | | - Ascensión Blanco Fernández
- Faculty of Biomedical and Health Sciences, Universidad Europea de Madrid, 28670 Madrid, Spain; (A.B.F.); (M.M.M.)
| | - Lidia B. Alejo
- Faculty of Sport Sciences, Universidad Europea de Madrid, 28670 Madrid, Spain; (O.B.G.); (L.B.A.); (M.P.-R.)
| | - María Montero Martínez
- Faculty of Biomedical and Health Sciences, Universidad Europea de Madrid, 28670 Madrid, Spain; (A.B.F.); (M.M.M.)
| | - Margarita Pérez-Ruiz
- Faculty of Sport Sciences, Universidad Europea de Madrid, 28670 Madrid, Spain; (O.B.G.); (L.B.A.); (M.P.-R.)
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Martos-Cabrera MB, Gómez-Urquiza JL, Cañadas-González G, Romero-Bejar JL, Suleiman-Martos N, Cañadas-De la Fuente GA, Albendín-García L. Nursing-Intense Health Education Intervention for Persons with Type 2 Diabetes: A Quasi-Experimental Study. Healthcare (Basel) 2021; 9:832. [PMID: 34356210 PMCID: PMC8307700 DOI: 10.3390/healthcare9070832] [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: 06/02/2021] [Revised: 06/23/2021] [Accepted: 06/25/2021] [Indexed: 11/04/2022] Open
Abstract
Type 2 diabetes mellitus (DM2) is a highly prevalent disease, the progression of which depends on high blood glucose levels, which are reflected in the level of glycosylated haemoglobin (HbA1c). Appropriate health education equips patients with the knowledge and skills to control their glucose and HbA1c levels to avoid long-term complications. This study was set up to compare the results of an intensive (360 min) educational intervention to improve HbA1c parameters in patients with DM2 with those of a usual 90 min intervention. For this purpose, healthcare personnel led a quasi-experimental study of 249 diabetics: 171 in the control group, and 78 in the intervention group. In the control group, the mean HbA1c value decreased from 6.97 to 6.75, while in intervention group it fell from 8.97 to 8.06. The before and after mean difference between both groups was compared with a Wilcoxon test, and the results statistically significant (W = 4530; p < 0.001), indicating a higher reduction of HbA1c in the intervention group. We concluded that the intensive health education provided by nurses during the consultation helped improve HBA1c levels in persons with DM2.
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Affiliation(s)
- María Begoña Martos-Cabrera
- Neonatal Intensive Care Unit, University Hospital San Cecilio, Avenida del Conocimiento, 18016 Granada, Spain;
| | - José Luis Gómez-Urquiza
- Faculty of Health Sciences, University of Granada, Avenida de la Ilustración, 60, 18016 Granada, Spain; (J.L.G.-U.); (N.S.-M.); (G.A.C.-D.l.F.)
| | - Guillermo Cañadas-González
- Support Device South Area of Cordoba, Andalusian Health Service, Av. Góngora, 9B, Cabra, 14940 Córdoba, Spain;
| | - José Luis Romero-Bejar
- Department of Statistics and Operational Research, University of Granada, 18071 Granada, Spain
| | - Nora Suleiman-Martos
- Faculty of Health Sciences, University of Granada, Avenida de la Ilustración, 60, 18016 Granada, Spain; (J.L.G.-U.); (N.S.-M.); (G.A.C.-D.l.F.)
| | | | - Luis Albendín-García
- Casería de Montijo Health Center, Granada Metropolitan District, Andalusian Health Service, Calle Virgen de la Consolación, 12, 18015 Granada, Spain;
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Represas-Carrera F, Couso-Viana S, Méndez-López F, Masluk B, Magallón-Botaya R, Recio-Rodríguez JI, Pombo H, Leiva-Rus A, Gil-Girbau M, Motrico E, Martí-Lluch R, Gude F, Clavería A. Effectiveness of a Multicomponent Intervention in Primary Care That Addresses Patients with Diabetes Mellitus with Two or More Unhealthy Habits, Such as Diet, Physical Activity or Smoking: Multicenter Randomized Cluster Trial (EIRA Study). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:5788. [PMID: 34071171 PMCID: PMC8198299 DOI: 10.3390/ijerph18115788] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 05/14/2021] [Accepted: 05/24/2021] [Indexed: 12/23/2022]
Abstract
Introduction: We evaluated the effectiveness of an individual, group and community intervention to improve the glycemic control of patients with diabetes mellitus aged 45-75 years with two or three unhealthy life habits. As secondary endpoints, we evaluated the inverventions' effectiveness on adhering to Mediterranean diet, physical activity, sedentary lifestyle, smoking and quality of life. Method: A randomized clinical cluster (health centers) trial with two parallel groups in Spain from January 2016 to December 2019 was used. Patients with diabetes mellitus aged 45-75 years with two unhealthy life habits or more (smoking, not adhering to Mediterranean diet or little physical activity) participated. Centers were randomly assigned. The sample size was estimated to be 420 people for the main outcome variable. Educational intervention was done to improve adherence to Mediterranean diet, physical activity and smoking cessation by individual, group and community interventions for 12 months. Controls received the usual health care. The outcome variables were: HbA1c (main), the Mediterranean diet adherence score (MEDAS), the international diet quality index (DQI-I), the international physical activity questionnaire (IPAQ), sedentary lifestyle, smoking ≥1 cigarette/day and the EuroQuol questionnaire (EVA-EuroQol5D5L). Results: In total, 13 control centers (n = 356) and 12 intervention centers (n = 338) were included with similar baseline conditions. An analysis for intention-to-treat was done by applying multilevel mixed models fitted by basal values and the health center: the HbA1c adjusted mean difference = -0.09 (95% CI: -0.29-0.10), the DQI-I adjusted mean difference = 0.25 (95% CI: -0.32-0.82), the MEDAS adjusted mean difference = 0.45 (95% CI: 0.01-0.89), moderate/high physical activity OR = 1.09 (95% CI: 0.64-1.86), not living a sedentary lifestyle OR = 0.97 (95% CI: 0.55-1.73), no smoking OR = 0.61 (95% CI: 0.54-1.06), EVA adjusted mean difference = -1.26 (95% CI: -4.98-2.45). Conclusions: No statistically significant changes were found for either glycemic control or physical activity, sedentary lifestyle, smoking and quality of life. The multicomponent individual, group and community interventions only showed a statistically significant improvement in adhering to Mediterranean diet. Such innovative interventions need further research to demonstrate their effectiveness in patients with poor glycemic control.
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Affiliation(s)
- Francisco Represas-Carrera
- Galicia South Health Research Institute, Hospital Álvaro Cunqueiro, Technical Block, Floor 2, Roal Clara Campoamor nº 341, 36213 Vigo, Spain; (S.C.-V.); (A.C.)
| | - Sabela Couso-Viana
- Galicia South Health Research Institute, Hospital Álvaro Cunqueiro, Technical Block, Floor 2, Roal Clara Campoamor nº 341, 36213 Vigo, Spain; (S.C.-V.); (A.C.)
| | - Fátima Méndez-López
- Aragonese Research Group in Primary Care (GAIAP), Institute of Health Research, Avenue San Juan Bosco, 13, 50009 Zaragoza, Spain; (F.M.-L.); (B.M.); (R.M.-B.)
| | - Bárbara Masluk
- Aragonese Research Group in Primary Care (GAIAP), Institute of Health Research, Avenue San Juan Bosco, 13, 50009 Zaragoza, Spain; (F.M.-L.); (B.M.); (R.M.-B.)
| | - Rosa Magallón-Botaya
- Aragonese Research Group in Primary Care (GAIAP), Institute of Health Research, Avenue San Juan Bosco, 13, 50009 Zaragoza, Spain; (F.M.-L.); (B.M.); (R.M.-B.)
| | - Jose I. Recio-Rodríguez
- San Juan Health Centre, Salamanca Primary Care Research Unit (APISAL), Institute of Biomedical Research of Salamanca (IBSAL), Department of Nursing and Physiotherapy (University of Salamanca), Avenue Portugal 83, 2 Floor, 37005 Salamanca, Spain;
| | - Haizea Pombo
- Ezkerraldea-Enkarterri-Cruces Integrated Health Organisation, Biocruces Bizkaia Health Research Institute Innovation Unit, Plaza de Cruces s/n, 48903 Barakaldo, Spain;
| | - Alfonso Leiva-Rus
- Balearic Islands Health Research Institute (IdISBa), Highway Valldemosa 79, 07120 Palma, Spain;
| | - Montserrat Gil-Girbau
- Research Group in Health Technology Assessment in Primary Care and Mental Health (PRISMA), Research and Development Unit, Institut de Recerca Sant Joan de Déu, Parc Sanitari Sant Joan de Déu, Street Dr. Antoni Pujadas, 42, 08830 Sant Boi de Llobregat, Spain;
| | - Emma Motrico
- Psychology Department, Universidad Loyola Andalucía, Avenue of the Universities, s/n, 41704 Dos Hermanas, Spain;
| | - Ruth Martí-Lluch
- Girona Research Support Unit, Jordi Gol i Gurina University Institute for Research in Primary Health Care Foundation (IDIAPJGol), Street Maluquer Salvador 11, 17002 Girona, Spain;
| | - Francisco Gude
- Clinical Epidemiology Unit, Research Methods Group, Santiago Institute of Sanitary Research (IDIS), Complejo Hospitalario Universitario de Santiago, Travesía da Choupana, s/n, 157056 Santiago de Compostela, Spain;
| | - Ana Clavería
- Galicia South Health Research Institute, Hospital Álvaro Cunqueiro, Technical Block, Floor 2, Roal Clara Campoamor nº 341, 36213 Vigo, Spain; (S.C.-V.); (A.C.)
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Suardi S, Razak A, Amiruddin R, Ishak H, Salmah U, Maria IL. Effectiveness of Diabetes Self-management Education Against Diet Behavior in Patients Type 2 Diabetes Mellitus: A Literature Review. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.6033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Diabetes mellitus (DM) is a disease that describes a problem with insulin deficiency and the inability of the pancreas to produce enough insulin. The World Health Organization predicts that the number of people with DM type II in Indonesia will increase to 12 million by 2030.
AIM: This study looks at Journals on diabetes selfmanagement education (DSME) on DM patients in improving dietary behavior.
METHODS: This study uses an online journal database that provides free articles and journals in PDF such as: ProQuest, EBCSO, PubMed, Elsevier, Scinapse, MDPI, and Google Scholar. Literature was collected from the past 10 years, namely, 2010–2020 using the following set of keywords: “DSME,” “DSME Program Evaluation,” and “Diabetes Self-Care Education.”
RESULTS: DSME intervention can improve the condition of DM patients if it is routinely carried out. In addition, the DSME intervention was able to control hemoglobin A1c levels and control blood sugar. This intervention still needs to be developed, considering that various forms of education in DM patients have been carried out such as using text messages, leaflets, illustrated pictures or leaflets, by telephone, video, handbooks, or direct education. These investigations can be developed into empirical research.
CONCLUSIONS: The application of DSME interventions can help improve the conditions experienced by DM type II sufferers if it is routinely carried out.
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Enricho Nkhoma D, Jenya Soko C, Joseph Banda K, Greenfield D, Li YCJ, Iqbal U. Impact of DSMES app interventions on medication adherence in type 2 diabetes mellitus: systematic review and meta-analysis. BMJ Health Care Inform 2021; 28:bmjhci-2020-100291. [PMID: 33853862 PMCID: PMC8054079 DOI: 10.1136/bmjhci-2020-100291] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 02/18/2021] [Accepted: 03/15/2021] [Indexed: 12/29/2022] Open
Abstract
Objectives To conduct systematic review and meta-analysis of interventional studies to investigate the impact of diabetes self-management education and support (DSMES) apps on adherence in patients with type 2 diabetes mellitus (T2D). Methods PubMed, Embase, CENTRAL, Web of Science, Scopus and ProQuest were searched, in addition to references of identified articles and similar reviews. Experimental studies, reported in English, assessing DSMES app intervention’s impact on adherence and clinical outcomes of patients with T2D compared with usual care were included. Study bias was assessed using Cochrane Risk of Bias V.2.0 tool. Analysis plan involved narrative synthesis, moderator and meta-analysis. Results Six randomised controlled trials were included, involving 696 participants (average age 57.6 years, SD 10.59). Mobile apps were mostly used for imputing clinical data, dietary intake or physical activity, and transmitting information to the provider. At 3 months, DSMES apps proved effective in improving medication adherence (standardized mean difference (SMD)=0.393, 95% CI 0.17 to 0.61), glycated haemoglobin (HbA1c) (mean difference (MD)=−0.314, 95% CI −0.477 to –0.151) and Body Mass Index (BMI) (MD=−0.28, 95% CI −0.545 to –0.015). All pooled estimates had low heterogeneity (I2 0%). Four studies had moderate risk of bias while one each was judged to be low and high risks, respectively. Conclusion DSMES apps had significant small to moderate effects on medication adherence, HbA1c and BMI of patients with T2D compared with usual care. Apps were described as reliable, easy to use and convenient, though participants were required to be phone literate. Evidence comes from feasibility trials with generally moderate risk of bias. Larger trials with longer follow-up periods using theory-based interventions are required to improve current evidence.
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Affiliation(s)
- Dumisani Enricho Nkhoma
- Nkhata Bay District Health Office, Nkhata Bay District Hospital, Nkhata Bay, Malawi.,Global Health and Development Department, College of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Charles Jenya Soko
- Global Health and Development Department, College of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Kondwani Joseph Banda
- PhD Program in Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - David Greenfield
- Australian Institute of Health Service Management, Tasmanian School of Business and Economics, University of Tasmania, Sydney, New South Wales, Australia
| | - Yu-Chuan Jack Li
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan.,International Center for Health Information Technology (ICHIT), Taipei Medical University, Taipei, Taiwan.,Department of Dermatology, Taipei Municipal Wan Fang Hospital, Taipei, Taiwan.,International Medical Informatics Association (IMIA), Geneva, Switzerland.,Research Center for Artificial Intelligence in Medicine, Taipei Medical University, Taipei, Taiwan
| | - Usman Iqbal
- Global Health and Development Department, College of Public Health, Taipei Medical University, Taipei, Taiwan .,International Center for Health Information Technology (ICHIT), Taipei Medical University, Taipei, Taiwan.,PhD Program of Global Health and Health Security, College of Public Health, Taipei Medical University, Taipei, Taiwan
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Kroeger J, Siegmund T, Schubert O, Keuthage W, Lettmann M, Richert K, Pfeiffer A. AGP und Ernährung – Mit CGM postprandiale Glukoseverläufe analysieren. DIABETOL STOFFWECHS 2021. [DOI: 10.1055/a-1310-2736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
ZusammenfassungErnährungstherapien zählen zu den Grundlagen eines effektiven Diabetesmanagements bei Menschen sowohl mit Typ-1-, als auch mit Typ-2-Diabetes. Auch für Menschen mit Prädiabetes oder Adipositas sind Lebensstilinterventionen, einschließlich Ernährungsempfehlungen, Bestandteil der grundlegenden Therapie. Es wird empfohlen, die Ernährung individuell an die persönlichen Umstände, Präferenzen und metabolischen Ziele anzupassen. Im Zeitalter der Digitalisierung finden mHealth-Interventionen, beispielsweise in Form von kontinuierlich Glukose messenden Systemen (CGM), vermehrt Einzug in die Ernährungstherapie. Das ambulante Glukoseprofil (AGP) zeigt eine strukturierte und grafische Zusammenstellung der durch CGM gewonnenen Daten. Nach einer Bewertung der glykämischen Situation (Hypoglykämien, Variabilität und Stabilität der Glukosewerte) kann das AGP auch als Unterstützung bezüglich einer Ernährungsanpassung dienen. Ziel dieser Publikation ist es, eine allgemeine Übersicht über die Ernährungsempfehlungen, speziell in Deutschland, zu ermöglichen und den Nutzen kontinuierlicher Glukosemessungen in Bezug auf Ernährung zu beschreiben.
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Affiliation(s)
- Jens Kroeger
- Diabetologie, Zentrum für Diabetologie Hamburg-Bergedorf, Hamburg, Germany
| | - Thorsten Siegmund
- Diabetes-, Hormon- und Stoffwechselzentrum, Diabetes-, Hormon- und Stoffwechselzentrum, Privatpraxis am Isar Klinikum, München, Germany
| | - Oliver Schubert
- Ärztehaus am ZOB, Diabetes Schwerpunktpraxis, Buxtehude, Germany
| | - Winfried Keuthage
- Diabetes und Ernährungsmedizin, Schwerpunktpraxis für Diabetes und Ernährungsmedizin, Münster, Germany
| | - Melanie Lettmann
- Diabetes und Ernährungsmedizin, ehemals Schwerpunktpraxis für Diabetes und Ernährungsmedizin, Münster, Germany
| | - Katja Richert
- Endokrinologie, Diabetologie und Angiologie, Klinik für Endokrinologie, Diabetologie und Angiologie, München, Klinik Bogenhausen, München, Germany
| | - Andreas Pfeiffer
- Endokrinologie, Stoffwechsel- und Ernährungsmedizin, Klinik für Endokrinologie, Stoffwechsel- und Ernährungsmedizin, Charité Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
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Kröger J, Siegmund T, Schubert-Olesen O, Keuthage W, Lettmann M, Richert K, Pfeiffer AFH. AGP and Nutrition - Analysing postprandial glucose courses with CGM. Diabetes Res Clin Pract 2021; 174:108738. [PMID: 33711395 DOI: 10.1016/j.diabres.2021.108738] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 02/18/2021] [Accepted: 02/22/2021] [Indexed: 01/02/2023]
Abstract
Nutritional therapies are one of the fundamentals of effective management of diabetes type 1 and type 2. Lifestyle interventions, including nutritional recommendations, are also part of the basic therapy for people with prediabetes or obesity. It is recommended that the diet should be individually adapted to personal circumstances, preferences and metabolic goals. In the age of digitalisation, mHealth interventions, like continuous glucose monitoring systems (CGM), are increasingly finding their way into nutrition therapy. The ambulatory glucose profile (AGP), a structured and graphical compilation of the obtained CGM data, can also be used as a support for dietary adjustment. After assessment of the glycaemic situation (hypoglycaemia, variability and stability of glucose levels). This publication aims to provide a general overview of nutritional recommendations, especially in Germany, and to describe the benefits of CGM measurements with regard to nutrition.
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Affiliation(s)
- Jens Kröger
- Centre for Diabetology Hamburg Bergedorf, Hamburg, Germany.
| | - Thorsten Siegmund
- Diabetes, Hormones and Metabolism Centre, Private Practice at the Isar Hospital, Munich, Germany
| | | | - Winfried Keuthage
- Medical Practise Specialised on Diabetes and Nutritional Medicine, Münster, Germany
| | - Melanie Lettmann
- Formerly Medical Practise Specialised on Diabetes and Nutritional Medicine, Münster, Germany
| | - Katja Richert
- Clinic for Endocrinology, Diabetology and Angiology, Munich Bogenhausen Clinic, Germany
| | - Andreas F H Pfeiffer
- Clinic for Endocrinology, Metabolic and Nutritional Medicine, Charité University Medicine Berlin, Campus Benjamin Franklin, Germany
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Shah SZA, Karam JA, Zeb A, Ullah R, Shah A, Haq IU, Ali I, Darain H, Chen H. Movement is Improvement: The Therapeutic Effects of Exercise and General Physical Activity on Glycemic Control in Patients with Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Diabetes Ther 2021; 12:707-732. [PMID: 33547579 PMCID: PMC7947168 DOI: 10.1007/s13300-021-01005-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 01/15/2021] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Exercise is considered a cornerstone in achieving an optimized blood glucose level and reducing body weight, body mass index (BMI), and waist circumference. This study aimed to investigate and quantitatively summarize the literature regarding the therapeutic effects of exercise and general physical activity on glycemic control. METHODS A systematic review and meta-analysis of the literature on the therapeutic effects of exercise on glycemic control in patients with type 2 diabetes mellitus (type 2 DM) were conducted using electronic databases. Studies with an exercise intervention lasting more than 8 weeks were included. Both qualitative and quantitative analyses were performed. Qualitative data were presented narratively in table form. Quantitative analysis was performed using a random-effects model with a 95% confidence interval and a significance level of 0.05. The Physiotherapy Evidence Database (PEDro) scale and the Cochrane Risk of Bias 2 (RoB2) tool were used to assess the quality of evidence and the risk of bias. RESULTS A total of 21,559 articles were identified through different databases. Out of 21559 studies, only 32 randomized controlled trials were deemed eligible for inclusion in this study. The average exercise session was 45.15 min, while the average follow-up duration was 21.94 weeks. The mean exercise frequency according to our findings was 3.25 days/week. Almost all the studies reported decreases in glycated hemoglobin (HbA1c; P < 0.0001), fasting blood glucose (P = 0.03), BMI (P = 0.04), and waist circumference (P = 0.007) after the exercise intervention. CONCLUSION Exercise plays an important role in optimizing glycemic control and improving quality of life (QoL), BMI, and waist circumference in type 2 DM patients. Exercise could be a safe adjunct therapy to medical treatments in these patients. REGISTRATION PROSPERO: CRD42020210816.
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Affiliation(s)
- Sayed Z A Shah
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Jawad A Karam
- Department of applied exercise science, Concordia University Chicago, 7400 Augusta St., River Forest, IL, 60305, United States
| | - Alam Zeb
- School of Health Sciences, Peshawar, Pakistan
| | - Rafi Ullah
- Paraplegic Centre, Phase#4, Hayatabad, Peshawar, Pakistan
| | - Arif Shah
- Paraplegic Centre, Phase#4, Hayatabad, Peshawar, Pakistan
| | - Ijaz Ul Haq
- Paraplegic Centre, Phase#4, Hayatabad, Peshawar, Pakistan
| | - Iftikhar Ali
- Paraplegic Centre, Phase#4, Hayatabad, Peshawar, Pakistan
| | - Haider Darain
- Institute of Physical Medicine and Rehabilitation Sciences, Khyber Medical University, Hayatabad, Peshawar, Pakistan
| | - Hong Chen
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China.
- WHO Collaborating Center for Training and Research in Rehabilitation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China.
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Trolle Lagerros Y, Dahlgren A, Sjöblom L, Bonn SE. Digital Support for Healthier Eating Habits Among Patients With Type 2 Diabetes: Protocol for a Randomized Clinical Trial Within Primary Care (HAPPY Trial). JMIR Res Protoc 2020; 9:e24422. [PMID: 33196448 PMCID: PMC7704281 DOI: 10.2196/24422] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 10/15/2020] [Accepted: 10/20/2020] [Indexed: 11/17/2022] Open
Abstract
Background Despite the large impact that dietary habits have in the management of diabetes, few tools for supporting healthy eating habits are available for persons with diabetes. Objective The aim of this randomized clinical trial is to evaluate the effect of a 12-week, mobile health (mHealth), app-based intervention promoting healthy eating habits among patients with type 2 diabetes. Methods The HAPPY (Healthy eating using APP technologY) trial is a randomized clinical trial with two arms aiming to include 200 patients, 18 years of age or older, with type 2 diabetes. Both women and men are eligible for inclusion. Study participants are randomized 1:1 to an intervention group, where they are instructed to use a smartphone app promoting healthy eating, or to a control group, where they receive standard primary care only, for a period of 12 weeks. Each week a new topic (eg, vegetable intake) is introduced via the app. After an introduction text, the user is given a topic-related activity to perform (eg, eat one additional serving of vegetables per day during that week). The app records daily progress and sends automatic reminders or feedback to the user. Dietary intake, body composition, clinical variables, and biomarkers are measured at baseline and at 3- and 6-month follow-ups. An extensive web-based questionnaire comprising several validated questionnaires assessing a number of lifestyle factors is distributed via email at baseline and at 3-, 6-, and 12-month follow-ups; lifestyle factors include, for example, sleep, physical activity, eating behavior, and health-related quality of life. The effect of the intervention on dietary intake (primary outcome) and on glycated hemoglobin and blood lipid levels, body composition, blood pressure, other lifestyle factors, and overall health (secondary outcomes) will be assessed. Results Data collection is ongoing. Recruitment of participants started in January 2019. Findings from the study are expected to be published by the end of 2021. Conclusions Technology development provides new ways to promote and support long-term adherence to healthier eating habits. mHealth-based approaches allow for real-time interaction and the delivery of an intervention at any time. Further, focusing on overall diet allows the user to apply new knowledge to current eating patterns, creating an individualized approach. In this study, we evaluate the effect of using a new smartphone app promoting healthy eating habits on dietary intake, clinical markers, and lifestyle factors among patients with type 2 diabetes. Trial Registration ClinicalTrials.gov NCT03784612; https://clinicaltrials.gov/ct2/show/NCT03784612 International Registered Report Identifier (IRRID) DERR1-10.2196/24422
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Affiliation(s)
- Ylva Trolle Lagerros
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Solna, Sweden.,Center for Obesity, Academic Specialist Center, Stockholm Health Services, Stockholm, Sweden
| | - Anna Dahlgren
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Solna, Sweden
| | - Linnea Sjöblom
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Solna, Sweden
| | - Stephanie E Bonn
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Solna, Sweden
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Pérez Unanua MP, Alonso Fernández M, López Simarro F, Soriano Llora T, Peral Martínez I, Mancera Romero J. [Adherence to healthy lifestyle behaviours in patients with type 2 diabetes in Spain]. Semergen 2020; 47:161-169. [PMID: 33160855 DOI: 10.1016/j.semerg.2020.08.009] [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: 06/14/2020] [Revised: 08/03/2020] [Accepted: 08/09/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES The aim of this study was to report on the main lifestyle components and related factors in adults with diabetes type 2 treated in Primary Care clinics in Spain. MATERIAL AND METHODS A cross-sectional and multicentre study was performed on a consecutive sample of patients with type 2 diabetes attending 25 Primary Care clinics between April 2018 and April 2019. Data were collected by auditing the computerised medical records, and an interview. An analysis was carried out on adherence to 4 healthy lifestyle trends (Mediterranean diet, regular exercise, not smoking, and emotional well-being). RESULTS A total of 412 patients were included in the analysis (mean age 69 (SD 8.65) years; 50.2% men). Only a minority was highly adherent to the Mediterranean diet, 92 (22.3%). Regular physical activity was carried out by 189 (45.8%). A total of 361 (87.6%) were non-smoking, and 259 (62.8%) felt emotional well-being. A small number (9, 2.1%) of patients had not followed any of the healthy lifestyle recommendations, with 87 (21.1%) following one, 145 (35.1%) two, 128 (31%) three, and 43 (10.4%) all 4 healthy habits: diet, exercise, not smoking, and emotional well-being. Healthy lifestyle adherence was related to gender. Obesity is poorly associated with adherence to diet and physical activity. The results for age, time with the disease, socioeconomic status, and treatment regimen were not consistent. CONCLUSIONS This study suggest that adherence to a healthy lifestyle pattern in DM2 is low. Less than a quarter follow a healthy diet, and less than a half practice regular exercise. Gender is the variable that most influences a healthy lifestyle in DM2, but not age, time with the disease, or treatment regimen.
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Affiliation(s)
| | | | - F López Simarro
- Área Básica de Salud Martorell, Martorell, Barcelona, España
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Kelly JT, Collins PF, McCamley J, Ball L, Roberts S, Campbell KL. Digital disruption of dietetics: are we ready? J Hum Nutr Diet 2020; 34:134-146. [DOI: 10.1111/jhn.12827] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 09/03/2020] [Accepted: 09/25/2020] [Indexed: 02/06/2023]
Affiliation(s)
- J. T. Kelly
- Menzies Health Institute Queensland Griffith University Southport QLD Australia
| | - P. F. Collins
- Menzies Health Institute Queensland Griffith University Southport QLD Australia
- School of Allied Health Sciences Griffith University Southport QLD Australia
| | - J. McCamley
- Metro North Hospital and Health Service Herston QLD Australia
| | - L. Ball
- Menzies Health Institute Queensland Griffith University Southport QLD Australia
| | - S. Roberts
- Menzies Health Institute Queensland Griffith University Southport QLD Australia
- School of Allied Health Sciences Griffith University Southport QLD Australia
- Gold Coast Hospital and Health Service Southport QLD Australia
| | - K. L. Campbell
- Menzies Health Institute Queensland Griffith University Southport QLD Australia
- Centre of Applied Health Economics School of Medicine Griffith University Southport QLD Australia
- Metro North Hospital and Health Service Herston QLD Australia
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Ventriglio A, Sancassiani F, Contu MP, Latorre M, Di Slavatore M, Fornaro M, Bhugra D. Mediterranean Diet and its Benefits on Health and Mental Health: A Literature Review. Clin Pract Epidemiol Ment Health 2020; 16:156-164. [PMID: 33029192 PMCID: PMC7536728 DOI: 10.2174/1745017902016010156] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 06/04/2020] [Accepted: 06/06/2020] [Indexed: 12/26/2022]
Abstract
Mediterranean Diet (MD) is currently considered one of the most healthy dietary models worldwide. It is generally based on the daily intake of fruit and vegetables, whole grains, legumes, nuts, fish, white meats, and olive oil. It may also include moderate consumption of fermented dairy products, a low intake of red meat, and red/white wine during the main course. Even if the effect of MD on cancer prevention as well as on human metabolic and cardiovascular balance has been discussed, including the quality of life of the exposed population, the putative effects on mental health are still not properly investigated. This narrative review reports on some emerging pieces of evidence on the possible impact of MD on general health and the outcome of psychiatric disorders (e.g., major depression, anxiety) and encourages further studies to test the benefits of healthy food selection on the health of the general population.
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Affiliation(s)
- Antonio Ventriglio
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Federica Sancassiani
- Dipartimento di Scienze Mediche e Sanità Pubblica, Università degli Studi di Cagliari, Cagliari, Italy
| | - Maria Paola Contu
- Dipartimento di Scienze Chirurgiche, Università degli Studi di Cagliari, Cagliari, Italy
| | - Mariateresa Latorre
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Melanie Di Slavatore
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Michele Fornaro
- Department of Neuroscience, Reproductive Science and Odontostomatology, School of Medicine 'Federico II' Naples, Naples, Italy
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Martos-Cabrera MB, Velando-Soriano A, Pradas-Hernández L, Suleiman-Martos N, Cañadas-De la Fuente GA, Albendín-García L, Gómez-Urquiza JL. Smartphones and Apps to Control Glycosylated Hemoglobin (HbA1c) Level in Diabetes: A Systematic Review and Meta-Analysis. J Clin Med 2020; 9:jcm9030693. [PMID: 32143452 PMCID: PMC7141208 DOI: 10.3390/jcm9030693] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 02/27/2020] [Accepted: 02/28/2020] [Indexed: 02/08/2023] Open
Abstract
Introduction: Diabetes mellitus is a chronic endocrine-metabolic disease, the evolution of which is closely related to people’s self-control of glycemic levels through nutrition, exercise, and medicines. Aim: To determine whether smartphone apps can help persons with diabetes to improve their % levels of glycosylated hemoglobin. Method: A systematic review and meta-analysis were done. ProQuest, Pubmed/Medline, and Scopus databases were used. The search equation used was “(Prevention and Control) AND Diabetes Mellitus AND Smartphones”. The inclusion criteria applied were clinical trials, conducted in 2014–2019. Results: n = 18 studies were included in the review. The studies tried different applications to monitor glycemia and support patients to improve glycosylated hemoglobin (HbA1c) levels. More than half of the studies found statistically significant differences in HbA1c in the intervention group compared with the control group. Eleven studies were included in the meta-analysis and the study sample was n = 545 for the experimental group and n = 454 for the control group. The meta-analytic estimation of the HbA1c % level means differences between intervention and control group was statistically significant in favour of the intervention group with a mean difference of –0.37 (–0.58, –0.15. 95% confidence interval). Conclusion: Smartphone apps can help people with diabetes to improve their level of HbA1c, but the clinical impact is low.
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Affiliation(s)
- María Begoña Martos-Cabrera
- San Cecilio Clinical University Hospital, Andalusian Health Service, Avenida del Conocimiento, s/n, 18016 Granada, Spain;
| | | | - Laura Pradas-Hernández
- Las Gabias Health Center, Granada Metropolitan District, Andalusian-Health Service, Plaza Montes Jovellar S.N, 18110. Granada, Spain;
| | - Nora Suleiman-Martos
- Faculty of Health Sciences, University of Granada, Calle Cortadura del Valle S.N., 51001 Ceuta, Spain;
| | - Guillermo A. Cañadas-De la Fuente
- Faculty of Health Sciences, University of Granada, Avenida de la Ilustración, 60, 18016 Granada, Spain; (G.A.C.-D.l.F.); (J.L.G.-U.)
| | - Luis Albendín-García
- La Chana Health Center, Granada Metropolitan District, Andalusian Health Service, Calle Virgen de la Consolación, 12, 18015 Granada, Spain
- Correspondence:
| | - José L. Gómez-Urquiza
- Faculty of Health Sciences, University of Granada, Avenida de la Ilustración, 60, 18016 Granada, Spain; (G.A.C.-D.l.F.); (J.L.G.-U.)
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Steinmetz M, Rammos C, Rassaf T, Lortz J. Digital interventions in the treatment of cardiovascular risk factors and atherosclerotic vascular disease. IJC HEART & VASCULATURE 2020; 26:100470. [PMID: 32021904 PMCID: PMC6994620 DOI: 10.1016/j.ijcha.2020.100470] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Revised: 01/01/2020] [Accepted: 01/12/2020] [Indexed: 02/07/2023]
Affiliation(s)
- Martin Steinmetz
- West German Heart and Vascular Center, Department of Cardiology and Angiology, University Hospital Essen, Germany
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García-Molina L, Lewis-Mikhael AM, Riquelme-Gallego B, Cano-Ibáñez N, Oliveras-López MJ, Bueno-Cavanillas A. Improving type 2 diabetes mellitus glycaemic control through lifestyle modification implementing diet intervention: a systematic review and meta-analysis. Eur J Nutr 2019; 59:1313-1328. [PMID: 31781857 DOI: 10.1007/s00394-019-02147-6] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 11/18/2019] [Indexed: 12/12/2022]
Abstract
PURPOSE Type 2 diabetes mellitus represents a significant health problem. Many studies have reported that intensive nutritional intervention by itself or in addition to medications is the best method to improve glycaemic control in type 2 diabetes mellitus. However, in clinical practice, dietary education is not implemented as an integral part in the management of type 2 diabetes mellitus. The purpose of this systematic review and meta-analysis is to analyse the scientific evidence concerning the role of nutritional intervention in the glycaemic control of type 2 diabetes mellitus. METHODS We searched Pubmed, Scopus, Cochrane Library and Web of Science databases from inception till May 2019 for randomised controlled trials (RCTs) that include dietary interventions in the management of patients with type 2 diabetes mellitus. RESULTS A total of 28 studies were included. Our results demonstrated that lifestyle interventions significantly lowered glycosylated haemoglobin (HbA1c) levels compared to the usual care for patients with type 2 diabetes mellitus, overall weighted mean difference, WMD = - 0.51 (- 0.67, - 0.35). Strategies combining individualized and group-based activities were the most effective, WMD = - 0.95 (- 1.24, - 0.66). Most of stratified analyses did not totally resolve heterogeneity, but improvement in HbA1c levels has been consistently observed. CONCLUSIONS The available evidence from RCTs shows that lifestyle intervention is more effective than the standard care regarding the glycaemic control of type 2 diabetic patients, particularly when there is a weight loss. It is time to translate this evidence to the primary health care practice. The protocol of the present systematic review was registered in PROSPERO, registration number CRD42018090469.
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Affiliation(s)
- Laura García-Molina
- Department of Preventive Medicine and Public Health, University of Granada, Avenida de la Investigación, 11, 18016, Granada, Spain.
- CIBER Epidemiología y Salud Pública (CIBERESP), Avenida Monforte de Lemos, 3-5, 28029, Madrid, Spain.
| | - Anne-Mary Lewis-Mikhael
- Department of Obstetrics and Gynecology, McMaster University, 1280 Main Street West, Hamilton, ON, Canada
- High Institute of Pubic Health, Alexandria University, 165 El-Horreya Avenue - El-Ibrahimia, Alexandria, Egypt
| | - Blanca Riquelme-Gallego
- Department of Preventive Medicine and Public Health, University of Granada, Avenida de la Investigación, 11, 18016, Granada, Spain
- Fundación para la Investigación Biosanitaria de Andalucía Oriental (FIBAO), Avenida de Madrid, 15, 18018, Granada, Spain
| | - Naomi Cano-Ibáñez
- Department of Preventive Medicine and Public Health, University of Granada, Avenida de la Investigación, 11, 18016, Granada, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Avenida Monforte de Lemos, 3-5, 28029, Madrid, Spain
| | - María-Jesús Oliveras-López
- Department of Molecular Biology and Biochemical Engineering, University Pablo de Olavide, Carretera de Utrera, Km 1, 41013, Seville, Spain
| | - Aurora Bueno-Cavanillas
- Department of Preventive Medicine and Public Health, University of Granada, Avenida de la Investigación, 11, 18016, Granada, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Avenida Monforte de Lemos, 3-5, 28029, Madrid, Spain
- Instituto de Investigación Biosanitaria de Granada (ibs.Granada), Servicio Andaluz de Salud/Universidad de Granada, Avenida de Madrid, 15, 18018, Granada, Spain
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