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Wagenaar CA, Toonstra A, Walrabenstein W, van Schaardenburg D, van Nassau F. How the Plants for Joints multidisciplinary lifestyle intervention achieved its effects: a mixed methods process evaluation. BMC Public Health 2024; 24:1034. [PMID: 38615001 PMCID: PMC11016213 DOI: 10.1186/s12889-024-18554-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 04/08/2024] [Indexed: 04/15/2024] Open
Abstract
BACKGROUND Plants for Joints (PFJ) is a multidisciplinary intervention centered around a whole-food plant-based diet, physical activity, and sleep and stress management. The PFJ intervention successfully improved disease activity and symptoms in people with rheumatoid arthritis (RA) or osteoarthritis (OA), respectively, and metabolic health. To investigate how these effects were achieved a mixed methods process evaluation was conducted to understand the context, implementation, and mechanism of impact of the PFJ intervention. Also, the relationship between degree of implementation and lifestyle changes was explored. METHODS Quantitative and qualitative data were collected across the evaluation domains context (i.e. reach), implementation (i.e. recruitment and delivery), and mechanism of impact (i.e. responsiveness) of both the participants and coaches (incl. dietitians, sport coaches) according to the UK MRC guidelines for process evaluations. Data was collected from the participants via focus groups and questionnaires after the intervention, and interviews with coaches. Qualitative data were analyzed thematically, and quantitative data were assessed with descriptive statistics and linear regression analyses. Degree of implementation was quantified using a theory-driven implementation index score composed of different process evaluation constructs. RESULTS Of the 155 participants who participated in the PFJ intervention, 106 (68%) took part in the questionnaire and 34 (22%) attended a focus group. Participants felt the intervention was complete, coherent, and would recommend the intervention to others (mean score 9.2 (SD 1.4) out of 10). Participants felt heard and empowered to take control of their lifestyle and health outcomes. Components perceived as most useful were self-monitoring, social support, practical and theoretical information, and (individual) guidance by the multidisciplinary team. Participants perceived the intervention as feasible, and many indicated it effectively improved their health outcomes. In an explorative analysis there was no significant difference in healthy lifestyle changes across implementation index score groups. CONCLUSION This process evaluation offers important insights into why the PFJ intervention works and how the intervention can be optimized for future implementation. Results indicating the intervention's high satisfaction, feasibility, and perceived effectiveness, further support the use of plant-based lifestyle interventions as an additional treatment option for patients with RA, OA, or other chronic diseases. TRIAL REGISTRATION International Clinical Trial Registry Platform numbers: NL7800, NL7801, and NL7802, all registered 17-06-2019.
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Affiliation(s)
- Carlijn A Wagenaar
- Reade Center for Rheumtology and Rehabilitation, Amsterdam, The Netherlands.
- Department of Clinical Immunology and Rheumatology, Amsterdam University Medical Centers, Universiteit van Amsterdam, Amsterdam, The Netherlands.
- Amsterdam Rheumatology and Immunology Center, Amsterdam, The Netherlands.
| | - Alie Toonstra
- Reade Center for Rheumtology and Rehabilitation, Amsterdam, The Netherlands
| | | | - Dirkjan van Schaardenburg
- Reade Center for Rheumtology and Rehabilitation, Amsterdam, The Netherlands
- Department of Clinical Immunology and Rheumatology, Amsterdam University Medical Centers, Universiteit van Amsterdam, Amsterdam, The Netherlands
- Amsterdam Rheumatology and Immunology Center, Amsterdam, The Netherlands
| | - Femke van Nassau
- Department of Public and Occupational Health, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
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Wagenaar CA, Walrabenstein W, van der Leeden M, Turkstra F, Gerritsen M, Twisk JWR, Boers M, van der Esch M, van Middendorp H, Weijs PJM, van Schaardenburg D. Long-term effectiveness of a lifestyle intervention for rheumatoid arthritis and osteoarthritis: 1-year follow-up of the 'Plants for Joints' randomised clinical trial. RMD Open 2024; 10:e004025. [PMID: 38413171 PMCID: PMC10900348 DOI: 10.1136/rmdopen-2023-004025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 02/08/2024] [Indexed: 02/29/2024] Open
Abstract
OBJECTIVES In two randomised controlled trials, the Plants for Joints (PFJ) multidisciplinary lifestyle intervention reduced signs and symptoms of rheumatoid arthritis (RA), or metabolic syndrome-associated hip or knee osteoarthritis (MSOA) compared with usual care. The current study investigated long-term outcomes. METHODS After completion of two 16-week trials in people with (1) RA or (2) MSOA, control groups switched to the active PFJ intervention. At the end of the intervention, all participants were followed up in a 1-year observational extension study. Primary outcomes were 28-joint Disease Activity Score (DAS28) (RA) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) (MSOA). Secondary outcomes included body composition, metabolic outcomes, medication changes and intervention adherence. An intention-to-treat analysis with a linear mixed model was used to analyse within-group changes. RESULTS 65 (84%) of 77 RA participants and 49 (77%) of 64 MSOA participants completed the extension study. The effects of the PFJ intervention were replicated in the original control groups and sustained within the RA group a year after intervention completion (mean DAS28 -0.9 points; p<0.001), while in the MSOA group mean WOMAC increased towards but remained well under the starting value (-7.8 points, p<0.001). Improvements in C-reactive protein, waist circumference (RA and MSOA); low-density lipoprotein cholesterol (RA); and weight, haemoglobin A1c, blood pressure (MSOA) were also sustained. Participants had a net decrease of medication, and intervention adherence was largely sustained. CONCLUSIONS A year after the PFJ lifestyle intervention, improvements of disease activity and metabolic outcomes within RA and MSOA groups were largely sustained and related to sustained adherence, with a net decrease of medication. TRIAL REGISTRATION NUMBERS NL7800, NL7801.
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Affiliation(s)
- Carlijn A Wagenaar
- Reade Center for Rheumtology and Rehabilitation, Amsterdam Rheumatology and Immunology Center, Amsterdam, Netherlands
- Department of Clinical Immunology and Rheumatology, Amsterdam UMC Locatie AMC, Amsterdam, Netherlands
| | | | - Marike van der Leeden
- Reade Center for Rheumtology and Rehabilitation, Amsterdam Rheumatology and Immunology Center, Amsterdam, Netherlands
- Rehabilitation Medicine, Amsterdam UMC Locatie VUmc, Amsterdam, Netherlands
| | - Franktien Turkstra
- Reade Center for Rheumtology and Rehabilitation, Amsterdam Rheumatology and Immunology Center, Amsterdam, Netherlands
| | - Martijn Gerritsen
- Reade Center for Rheumtology and Rehabilitation, Amsterdam Rheumatology and Immunology Center, Amsterdam, Netherlands
| | - Jos W R Twisk
- Department of Epidemiology and Data Science, Amsterdam UMC Locatie VUmc, Amsterdam, Netherlands
| | - Maarten Boers
- Department of Epidemiology and Data Science, Amsterdam UMC Locatie VUmc, Amsterdam, Netherlands
| | - Martin van der Esch
- Reade Center for Rheumtology and Rehabilitation, Amsterdam Rheumatology and Immunology Center, Amsterdam, Netherlands
- Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
| | - Henriët van Middendorp
- Institute of Psychology, Health, Medical, & Neuropsychology Unit, Leiden University, Leiden, Netherlands
| | - Peter J M Weijs
- Department of Nutrition and Dietetics, Center of Expertise Urban Vitality, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
- Department of Nutrition & Dietetics, Amsterdam UMC Locatie VUmc, Amsterdam, Netherlands
| | - Dirkjan van Schaardenburg
- Reade Center for Rheumtology and Rehabilitation, Amsterdam Rheumatology and Immunology Center, Amsterdam, Netherlands
- Department of Clinical Immunology and Rheumatology, Amsterdam UMC Locatie AMC, Amsterdam, Netherlands
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Walrabenstein W, Wagenaar CA, van de Put M, van der Leeden M, Gerritsen M, Twisk JWR, van der Esch M, van Middendorp H, Weijs PJM, Roorda LD, van Schaardenburg D. A multidisciplinary lifestyle program for metabolic syndrome-associated osteoarthritis: the "Plants for Joints" randomized controlled trial. Osteoarthritis Cartilage 2023; 31:1491-1500. [PMID: 37328047 DOI: 10.1016/j.joca.2023.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 05/04/2023] [Accepted: 05/04/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVE To determine the effectiveness of the "Plants for Joints" multidisciplinary lifestyle program in patients with metabolic syndrome-associated osteoarthritis (MSOA). DESIGN Patients with hip or knee MSOA were randomized to the intervention or control group. The intervention group followed a 16-week program in addition to usual care based on a whole food plant-based diet, physical activity, and stress management. The control group received usual care. The patient-reported Western Ontario and McMasters Universities Osteoarthritis Index (WOMAC) total score (range 0-96) was the primary outcome. Secondary outcomes included other patient-reported, anthropometric, and metabolic measures. An intention-to-treat analysis with a linear-mixed model adjusted for baseline values was used to analyze between-group differences. RESULTS Of the 66 people randomized, 64 completed the study. Participants (84% female) had a mean (SD) age of 63 (6) years and body mass index of 33 (5) kg/m2. After 16 weeks, the intervention group (n = 32) had a mean 11-point larger improvement in WOMAC-score (95% CI 6-16; p = 0.0001) compared to the control group. The intervention group also lost more weight (-5 kg), fat mass (-4 kg), and waist circumference (-6 cm) compared to the control group. Patient-Reported Outcomes Measurement Information System (PROMIS) fatigue, pain interference, C-reactive protein, hemoglobin A1c, fasting glucose, and low-density lipoproteins improved in the intervention versus the control group, while other PROMIS measures, blood pressure, high-density lipoproteins, and triglycerides did not differ significantly between the groups. CONCLUSION The "Plants for Joints" lifestyle program reduced stiffness, relieved pain, and improved physical function in people with hip or knee MSOA compared to usual care.
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Affiliation(s)
- Wendy Walrabenstein
- Reade Center for Rheumatology and Rehabilitation, Amsterdam, the Netherlands; Department of Clinical Immunology and Rheumatology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Rheumatology & immunology Center, Amsterdam, the Netherlands; Department of Nutrition and Dietetics, Center of Expertise Urban Vitality, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands; Amsterdam Rehabilitation Research Center Reade, Amsterdam, the Netherlands.
| | - Carlijn A Wagenaar
- Reade Center for Rheumatology and Rehabilitation, Amsterdam, the Netherlands; Department of Clinical Immunology and Rheumatology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Rheumatology & immunology Center, Amsterdam, the Netherlands; Amsterdam Rehabilitation Research Center Reade, Amsterdam, the Netherlands
| | - Marieke van de Put
- Reade Center for Rheumatology and Rehabilitation, Amsterdam, the Netherlands; Amsterdam Rehabilitation Research Center Reade, Amsterdam, the Netherlands
| | - Marike van der Leeden
- Reade Center for Rheumatology and Rehabilitation, Amsterdam, the Netherlands; Department of Rehabilitation Medicine, Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands; Amsterdam Movement Sciences Research Institute, Amsterdam, the Netherlands; Amsterdam Rehabilitation Research Center Reade, Amsterdam, the Netherlands
| | - Martijn Gerritsen
- Reade Center for Rheumatology and Rehabilitation, Amsterdam, the Netherlands; Amsterdam Rheumatology & immunology Center, Amsterdam, the Netherlands; Amsterdam Rehabilitation Research Center Reade, Amsterdam, the Netherlands
| | - Jos W R Twisk
- Department of Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands; Amsterdam Rehabilitation Research Center Reade, Amsterdam, the Netherlands
| | - Martin van der Esch
- Reade Center for Rheumatology and Rehabilitation, Amsterdam, the Netherlands; Center of Expertise Urban Vitality, Amsterdam University of Applied Sciences, Faculty of Health, Amsterdam, the Netherlands; Amsterdam Rehabilitation Research Center Reade, Amsterdam, the Netherlands
| | - Henriët van Middendorp
- Institute of Psychology, Health, Medical, & Neuropsychology Unit, Leiden University, Leiden, the Netherlands; Amsterdam Rehabilitation Research Center Reade, Amsterdam, the Netherlands
| | - Peter J M Weijs
- Department of Nutrition and Dietetics, Center of Expertise Urban Vitality, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands; Amsterdam Movement Sciences Research Institute, Amsterdam, the Netherlands; Department of Nutrition & Dietetics, Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands; Amsterdam Rehabilitation Research Center Reade, Amsterdam, the Netherlands
| | - Leo D Roorda
- Reade Center for Rheumatology and Rehabilitation, Amsterdam, the Netherlands; Amsterdam Rehabilitation Research Center Reade, Amsterdam, the Netherlands
| | - Dirkjan van Schaardenburg
- Reade Center for Rheumatology and Rehabilitation, Amsterdam, the Netherlands; Department of Clinical Immunology and Rheumatology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Rheumatology & immunology Center, Amsterdam, the Netherlands; Amsterdam Rehabilitation Research Center Reade, Amsterdam, the Netherlands
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Walrabenstein W, Wagenaar CA, van der Leeden M, Turkstra F, Twisk JWR, Boers M, van Middendorp H, Weijs PJM, van Schaardenburg D. A multidisciplinary lifestyle program for rheumatoid arthritis: the "Plants for Joints" randomized controlled trial. Rheumatology (Oxford) 2023:6972770. [PMID: 36617162 PMCID: PMC10393439 DOI: 10.1093/rheumatology/keac693] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 11/02/2022] [Accepted: 11/24/2022] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE To determine the effect of a multidisciplinary lifestyle program in patients with RA with low-moderate disease activity. METHODS In the "Plants for Joints" (PFJ) parallel-arm, assessor-blind randomized controlled trial, patients with RA and 28-joint Disease Activity Score [DAS28] ≥ 2.6 and ≤ 5.1 were randomized to the PFJ or control group. The PFJ group followed a 16-week lifestyle program based on a whole food plant-based diet, physical activity, and stress management. The control group received usual care. Medication was kept stable three months before and during the trial whenever possible. We hypothesized that PFJ would lower disease activity (DAS28). Secondary outcomes included anthropometric, metabolic, and patient-reported measures. An intention-to-treat analysis with a linear mixed model adjusted for baseline values was used to analyse between-group differences. RESULTS Of the 83 people randomized, 77 completed the study. Participants were 92% female with mean (SD) age of 55 (12), BMI of 26 (4) kg/m2 and mean DAS28 of 3.8 (0.7). After 16 weeks the PFJ group had a mean 0.9-point greater improvement of DAS28 vs the control group (95% CI 0.4-1.3; p < 0.0001). The PFJ intervention led to greater decreases in body weight (difference -3.9 kg), fat mass (-2.8 kg), waist circumference (-3 cm), HbA1c (-1.3 mmol/mol) and LDL (-0.32 mmol/l), whereas patient-reported outcome measures, blood pressure, glucose and other lipids did not change. CONCLUSION The 16-week PFJ multidisciplinary lifestyle program substantially decreased disease activity and improved metabolic status in people with RA with low-moderate disease activity. TRIAL REGISTRATION International Clinical Trials Registry Platform; https://www.who.int/clinical-trials-registry-platform; NL7800.
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Affiliation(s)
- Wendy Walrabenstein
- Reade Center for Rheumatology and Rehabilitation, Amsterdam, The Netherlands.,Department of Clinical Immunology and Rheumatology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Rheumatology & immunology Center, Amsterdam, The Netherlands
| | - Carlijn A Wagenaar
- Reade Center for Rheumatology and Rehabilitation, Amsterdam, The Netherlands.,Department of Clinical Immunology and Rheumatology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Rheumatology & immunology Center, Amsterdam, The Netherlands
| | - Marike van der Leeden
- Reade Center for Rheumatology and Rehabilitation, Amsterdam, The Netherlands.,Amsterdam Rheumatology & immunology Center, Amsterdam, The Netherlands.,Department of Rehabilitation Medicine, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands.,Amsterdam Movement Sciences Research Institute, Amsterdam, The Netherlands
| | - Franktien Turkstra
- Reade Center for Rheumatology and Rehabilitation, Amsterdam, The Netherlands.,Amsterdam Rheumatology & immunology Center, Amsterdam, The Netherlands
| | - Jos W R Twisk
- Department of Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Maarten Boers
- Department of Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Henriët van Middendorp
- Institute of Psychology, Health, Medical, & Neuropsychology unit, Leiden University, Leiden, The Netherlands
| | - Peter J M Weijs
- Amsterdam Movement Sciences Research Institute, Amsterdam, The Netherlands.,Department of Nutrition and Dietetics, Center of Expertise Urban Vitality, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands.,Department of Nutrition & Dietetics, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Dirkjan van Schaardenburg
- Reade Center for Rheumatology and Rehabilitation, Amsterdam, The Netherlands.,Department of Clinical Immunology and Rheumatology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Rheumatology & immunology Center, Amsterdam, The Netherlands
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Walrabenstein W, de Jonge CS, Kretova AM, van de Put M, Wagenaar CA, Turkstra F, Kahleova H, Hill SJ, van Schaardenburg D. Commentary: United States Dietary Trends Since 1800: Lack of Association Between Saturated Fatty Acid Consumption and Non-communicable Diseases. Front Nutr 2022; 9:891792. [PMID: 35571907 PMCID: PMC9096699 DOI: 10.3389/fnut.2022.891792] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 04/07/2022] [Indexed: 12/17/2022] Open
Affiliation(s)
- Wendy Walrabenstein
- Amsterdam Rheumatology & Immunology Center, Reade, Amsterdam, Netherlands.,Amsterdam Rheumatology & Immunology Center, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Catharina S de Jonge
- Department of Radiology and Nuclear Medicine, Amsterdam Gastroenterology, Endocrinology and Metabolism Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Anna M Kretova
- Amsterdam Rheumatology & Immunology Center, Reade, Amsterdam, Netherlands
| | - Marieke van de Put
- Amsterdam Rheumatology & Immunology Center, Reade, Amsterdam, Netherlands
| | - Carlijn A Wagenaar
- Amsterdam Rheumatology & Immunology Center, Reade, Amsterdam, Netherlands.,Amsterdam Rheumatology & Immunology Center, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Franktien Turkstra
- Amsterdam Rheumatology & Immunology Center, Reade, Amsterdam, Netherlands
| | - Hana Kahleova
- Clinical Research, Physicians Committee for Responsible Medicine, Washington, DC, United States
| | - Simon J Hill
- Industry Partner Bond University, Gold Coast, QLD, Australia
| | - Dirkjan van Schaardenburg
- Amsterdam Rheumatology & Immunology Center, Reade, Amsterdam, Netherlands.,Amsterdam Rheumatology & Immunology Center, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
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Wagenaar CA, van de Put M, Bisschops M, Walrabenstein W, de Jonge CS, Herrema H, van Schaardenburg D. The Effect of Dietary Interventions on Chronic Inflammatory Diseases in Relation to the Microbiome: A Systematic Review. Nutrients 2021; 13:nu13093208. [PMID: 34579085 PMCID: PMC8464906 DOI: 10.3390/nu13093208] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 09/03/2021] [Accepted: 09/07/2021] [Indexed: 12/29/2022] Open
Abstract
Chronic inflammation plays a central role in the pathophysiology of various non-communicable diseases. Dietary interventions can reduce inflammation, in part due to their effect on the gut microbiome. This systematic review aims to determine the effect of dietary interventions, specifically fiber intake, on chronic inflammatory diseases and the microbiome. It aims to form hypotheses on the potential mediating effects of the microbiome on disease outcomes after dietary changes. Included were clinical trials which performed a dietary intervention with a whole diet change or fiber supplement (>5 g/day) and investigated the gut microbiome in patients diagnosed with chronic inflammatory diseases such as cardiovascular disease (CVD), type 2 diabetes (T2DM), and autoimmune diseases (e.g., rheumatoid arthritis (RA), inflammatory bowel disease (IBD)). The 30 articles which met the inclusion criteria had an overall moderate to high risk of bias and were too heterogeneous to perform a meta-analysis. Dietary interventions were stratified based on fiber intake: low fiber, high fiber, and supplemental fiber. Overall, but most pronounced in patients with T2DM, high-fiber plant-based dietary interventions were consistently more effective at reducing disease-specific outcomes and pathogenic bacteria, as well as increasing microbiome alpha diversity and short-chain fatty acid (SCFA)-producing bacteria, compared to other diets and fiber supplements.
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Affiliation(s)
- Carlijn A. Wagenaar
- Amsterdam Rheumatology and Immunology Center, Reade, 1056 AB Amsterdam, The Netherlands; (M.v.d.P.); (M.B.); (W.W.); (D.v.S.)
- Amsterdam UMC, Amsterdam Medical Center, 1105 AZ Amsterdam, The Netherlands
- Correspondence:
| | - Marieke van de Put
- Amsterdam Rheumatology and Immunology Center, Reade, 1056 AB Amsterdam, The Netherlands; (M.v.d.P.); (M.B.); (W.W.); (D.v.S.)
| | - Michelle Bisschops
- Amsterdam Rheumatology and Immunology Center, Reade, 1056 AB Amsterdam, The Netherlands; (M.v.d.P.); (M.B.); (W.W.); (D.v.S.)
| | - Wendy Walrabenstein
- Amsterdam Rheumatology and Immunology Center, Reade, 1056 AB Amsterdam, The Netherlands; (M.v.d.P.); (M.B.); (W.W.); (D.v.S.)
- Amsterdam UMC, Amsterdam Medical Center, 1105 AZ Amsterdam, The Netherlands
| | - Catharina S. de Jonge
- Department of Radiology and Nuclear Medicine, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands;
| | - Hilde Herrema
- Department of Experimental Vascular Medicine, Amsterdam University Medical Centers (UMC), Academic Medical Center, 1105 AZ Amsterdam, The Netherlands;
| | - Dirkjan van Schaardenburg
- Amsterdam Rheumatology and Immunology Center, Reade, 1056 AB Amsterdam, The Netherlands; (M.v.d.P.); (M.B.); (W.W.); (D.v.S.)
- Amsterdam UMC, Amsterdam Medical Center, 1105 AZ Amsterdam, The Netherlands
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Wagenaar CA, Dekker LH, Navis GJ. Prevalence of sarcopenic obesity and sarcopenic overweight in the general population: The lifelines cohort study. Clin Nutr 2021; 40:4422-4429. [PMID: 33485705 DOI: 10.1016/j.clnu.2021.01.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 11/16/2020] [Accepted: 01/03/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND & AIMS Sarcopenic obesity (SO) is defined by a relatively low muscle mass in combination with obesity. Sarcopenic obesity was first noted as a health risk in geriatric populations but has recently been recognized as a scientific and clinical priority that may extend beyond geriatric settings. Obesity is generally preceded by overweight, so the prevalence and health risks of sarcopenia in those with overweight (SOW) is of interest for preventive purposes. The aim of this study, therefore, was to assess the prevalence and determinants of SO and SOW in a general population. METHODS Participants (n = 119,494), aged 18-90 years were included from the Dutch Lifelines cohort study. Muscle mass was assessed by 24-h urine creatinine excretion and stratified for gender for analysis, and obesity was defined as a Body Mass Index (BMI) ≥30 kg/m2 and overweight ≥25 kg/m2. Multivariate logistic regression models were applied to assess the relevant determinants of SO and SOW. RESULTS Respectively for men and women the prevalence of SO was 0.9% and 1.4%, and prevalence of SOW 6.5% and 6.0%. In subjects with sarcopenia, BMI was ≥25 kg/m2 in 45.5% and ≥30 kg/m2 in 6.1%. Overall females had a higher prevalence of SOW and SO in all age groups except for SOW in males between ages 40-59. Also, age was a significant determinant of SO and SOW, with a rise in prevalence as of age 50. Of all subjects with SO and SOW, respectively 82.5% and 80.4% were below the age of 70. Compared to those with no morbidities, the odds ratio of SO and SOW among participants with >3 comorbidities was 2.71 (95% CI: 1.62-4.54) and 1.33 (95% CI: 1.07-1.65) among males and 1.14 (95% CI: 0.79-1.65) and 1.28 (95% CI: 1.06-1.54) among females, independent of other determinants. Overall, an inverse association was found between SOW and SO and physical activity and macronutrient intake. CONCLUSION The results support the need for more awareness of SO beyond the field of geriatrics, in particular in subjects with comorbidities. SOW is more prevalent than SO and may provide opportunities for preventive strategies for the general population.
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Affiliation(s)
- Carlijn A Wagenaar
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, Hanzeplein 1, 9713, GZ, Groningen, the Netherlands.
| | - Louise H Dekker
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, Hanzeplein 1, 9713, GZ, Groningen, the Netherlands
| | - Gerjan J Navis
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, Hanzeplein 1, 9713, GZ, Groningen, the Netherlands
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