Comparing glycaemic benefits of Active Versus passive lifestyle Intervention in kidney Allograft Recipients (CAVIAR): study protocol for a randomised controlled trial.

PubMed

Wilcox, Joanne; Waite, Chantelle; Tomlinson, Lyndsey; Driscoll, Joanne; Karim, Asra; Day, Edward; Sharif, Adnan

2016-08-22

Lifestyle modification is widely recommended to kidney allograft recipients post transplantation due to the cardiometabolic risks associated with immunosuppression including new-onset diabetes, weight gain and cardiovascular events. However, we have no actual evidence that undertaking lifestyle modification protects from any adverse outcomes post transplantation. The aim of this study is to compare whether a more proactive versus passive interventional approach to modify lifestyle is associated with superior outcomes post kidney transplantation. We designed this prospective, single-centre, open-label, randomised controlled study to compare the efficacy of active versus passive lifestyle intervention for kidney allograft recipients early post transplantation. A total of 130 eligible patients, who are stable, nondiabetic and between 3 and 24 months post kidney transplantation, will be recruited. Randomisation is being undertaken by random block permutations into passive (n = 65, leaflet guidance only) versus active lifestyle modification (n = 65, supervised intervention) over a 6-month period. Supervised intervention is being facilitated by two dietitians during the 6-month intervention period to provide continuous lifestyle intervention guidance, support and encouragement. Both dietitians are accredited with behavioural intervention skills and will utilise motivational aids to support study recruits randomised to active intervention. The primary outcome is change in abnormal glucose metabolism parameters after 6 months of comparing active versus passive lifestyle intervention. Secondary outcomes include changes in a wide array of cardiometabolic parameters, kidney allograft function and patient-reported outcome measures. Long-term tracking of patients via data linkage to electronic patient records and national registries will facilitate long-term comparison of outcomes after active versus passive lifestyle intervention beyond the 6-month intervention period. This is the first randomised controlled study to investigate the benefits of active versus passive lifestyle intervention in kidney allograft recipients for the prevention of abnormal cardiometabolic outcomes. In addition, this is the first example of utilising behaviour therapy intervention post kidney transplantation to achieve clinically beneficial outcomes, which has potential implications on many spheres of post-transplant care. This study was registered with the Clinical Trials Registry on 27 August 2014 (ClinicalTrials.org Identifier: NCT02233491 ).

Breast cancer prevention.

PubMed

Euhus, David M; Diaz, Jennifer

2015-01-01

Breast cancer is the most common cancer in women with 232,670 new cases estimated in the USA for 2014. Approaches for reducing breast cancer risk include lifestyle modification, chemoprevention, and prophylactic surgery. Lifestyle modification has a variety of health benefits with few associated risks and is appropriate for all women regardless of breast cancer risk. Chemoprevention options have expanded rapidly, but most are directed at estrogen receptor positive breast cancer and uptake is low. Prophylactic surgery introduces significant additional risks of its own and is generally reserved for the highest risk women. © 2014 Wiley Periodicals, Inc.

Diet Modification for Hyperlipidemia

PubMed Central

Mann, Heather D.; Piotrowski, Pamela

1992-01-01

Hyperlipidemia is a major risk factor associated with cardiovascular disease. Dietary modification is effective in achieving and maintaining improved serum lipid levels. Nutritional care provided by a dietitian includes individual dietary and lifestyle assessment, formulating an appropriate dietary regimen, education, and follow-up assessments. PMID:21221406

Evaluating the Cost-Effectiveness of Lifestyle Modification versus Metformin Therapy for the Prevention of Diabetes in Singapore

PubMed Central

Png, May Ee; Yoong, Joanne Su-Yin

2014-01-01

Background In Singapore, as diabetes is an increasingly important public health issue, the cost-effectiveness of pursuing lifestyle modification programs and/or alternative prevention strategies is of critical importance for policymakers. While the US Diabetes Prevention Program (DPP) compared weight loss through lifestyle modification with oral treatment of diabetes drug metformin to prevent/delay the onset of type 2 diabetes in pre-diabetic subjects, no data on either the actual or potential cost effectiveness of such a program is available for East or South-east Asian populations. This study estimates the 3-year cost-effectiveness of lifestyle modification and metformin among pre-diabetic subjects from a Singapore health system and societal perspective. Methodology Cost effectiveness was analysed from 2010–2012 using a decision-based model to estimate the rates of getting diabetes, healthcare costs and health-related quality of life. Cost per quality-adjusted life year (QALY) was estimated using costs relevant to the time horizon of the study from Singapore. All costs are expressed in 2012 US dollars. Principal Findings The total economic cost for non-diabetic subjects from the societal perspective was US$25,867, US$28,108 and US$26,177 for placebo, lifestyle modification and metformin intervention respectively. For diabetic patients, the total economic cost from the societal perspective was US$32,921, US$35,163 and US$33,232 for placebo, lifestyle modification and metformin intervention respectively. Lifestyle modification relative to placebo is likely to be associated with an incremental cost per QALY gained at US$36,663 while that of metformin intervention is likely to be US$6,367 from a societal perspective. Conclusion Based on adaptation of the DPP data to local conditions, both lifestyle modification and metformin intervention are likely to be cost-effective and worth implementing in Singapore to prevent or delay the onset of type 2 diabetes. However, the cost of lifestyle modification from the societal perspective would have to be reduced in order to match the cost-effectiveness of metformin intervention. PMID:25203633

Epigenetics and lifestyle.

PubMed

Alegría-Torres, Jorge Alejandro; Baccarelli, Andrea; Bollati, Valentina

2011-06-01

The concept of 'lifestyle' includes different factors such as nutrition, behavior, stress, physical activity, working habits, smoking and alcohol consumption. Increasing evidence shows that environmental and lifestyle factors may influence epigenetic mechanisms, such as DNA methylation, histone acetylation and miRNA expression. It has been identified that several lifestyle factors such as diet, obesity, physical activity, tobacco smoking, alcohol consumption, environmental pollutants, psychological stress and working on night shifts might modify epigenetic patterns. Most of the studies conducted so far have been centered on DNA methylation, whereas only a few investigations have studied lifestyle factors in relation to histone modifications and miRNAs. This article reviews current evidence indicating that lifestyle factors might affect human health via epigenetic mechanisms.

The effect of lifestyle modification on physical fitness and work ability in different workstyles.

PubMed

Ohta, Masanori; Okufuji, Tatsuya; Matsushima, Yasuyuki; Ikeda, Masaharu

2004-12-01

It is generally considered that physical fitness is affected by daily life activities including leisure time activity and working time activity. The aim of this study is to investigate the effects of different levels of physical activity at work on physical fitness, analyze the effects of 12-week lifestyle modification outside of working hours on physical fitness, work satisfaction and subjective symptoms, and to consider the role of lifestyle modification in occupational health. Lifestyle modification, consisting of aerobic exercise and diet counseling, was conducted for 12 weeks. The data before and after the intervention from 49 male workers were obtained. Physical fitness such as exercise endurance, flexibility, agility, balance, muscular strength, muscular endurance, and muscular power was measured before and after the intervention. The subjects were asked to fill out questionnaires about their work activities, subjective complaints, and work satisfaction. Subjects were divided into active work group (n = 14) and sedentary work group (n = 35) for analysis according to their work activities. As for differences in physical fitness due to different levels of physical activity, the active work group had superior exercise endurance and balance compared to the sedentary work group. In addition, the sedentary work group tended to experience greater fatigue than the active work group. In the active work group, flexibility and muscular strength were significantly increased with lifestyle modification and, in the sedentary work group, exercise endurance, flexibility and muscular endurance were significantly improved while balance also showed a tendency to improve. In the sedentary work group, lifestyle modification resulted in reduced fatigue and stiff neck as well as an increased work satisfaction. In the active work group, no change was observed in complaints or work satisfaction, but improved physical fitness led to a reduction in subjective complaints and an increase in work satisfaction. The level of physical activity at work contributes to the physical fitness of the worker and the addition of aerobic exercise in the worker's leisure time improves physical fitness and thereby contributes to increased work ability regardless of differences in the level of physical activity at work.

Current and cutting-edge interventions for the treatment of obese patients.

PubMed

Vairavamurthy, Jenanan; Cheskin, Lawrence J; Kraitchman, Dara L; Arepally, Aravind; Weiss, Clifford R

2017-08-01

The number of people classified as obese, defined by the World Health Organization as having a body mass index ≥30, has been rising since the 1980s. Obesity is associated with comorbidities such as hypertension, diabetes mellitus, and nonalcoholic fatty liver disease. The current treatment paradigm emphasizes lifestyle modifications, including diet and exercise; however this approach produces only modest weight loss for many patients. When lifestyle modifications fail, the current "gold standard" therapy for obesity is bariatric surgery, including Roux-en-Y gastric bypass, sleeve gastrectomy, duodenal switch, and placement of an adjustable gastric band. Though effective, bariatric surgery can have severe short- and long-term complications. To fill the major gap in invasiveness between lifestyle modification and surgery, researchers have been developing pharmacotherapies and minimally invasive endoscopic techniques to treat obesity. Recently, interventional radiologists developed a percutaneous transarterial catheter-directed therapy targeting the hormonal function of the stomach. This review describes the current standard obesity treatments (including diet, exercise, and surgery), as well as newer endoscopic bariatric procedures and pharmacotherapies to help patients lose weight. We present data from two ongoing human trials of a new interventional radiology procedure for weight loss, bariatric embolization. Copyright © 2017 Elsevier B.V. All rights reserved.

Internet interventions to support lifestyle modification for diabetes management: a systematic review of the evidence.

PubMed

Cotter, Alexander P; Durant, Nefertiti; Agne, April A; Cherrington, Andrea L

2014-01-01

The Internet presents a widely accessible, 24-h means to promote chronic disease management. The objective of this review is to identify studies that used Internet based interventions to promote lifestyle modification among adults with type 2 diabetes. We searched PubMed using the terms: [internet, computer, phone, smartphone, mhealth, mobile health, web based, telehealth, social media, text messages] combined with [diabetes management and diabetes control] through January 2013. Studies were included if they described an Internet intervention, targeted adults with type 2 diabetes, focused on lifestyle modification, and included an evaluation component with behavioral outcomes. Of the 2803 papers identified, nine met inclusion criteria. Two studies demonstrated improvements in diet and/or physical activity and two studies demonstrated improvements in glycemic control comparing web-based intervention with control. Successful studies were theory-based, included interactive components with tracking and personalized feedback, and provided opportunities for peer support. Website utilization declined over time in all studies that reported on it. Few studies focused on high risk, underserved populations. Web-based strategies provide a viable option for facilitating diabetes self-management. Future research is needed on the use of web-based interventions in underserved communities and studies examining website utilization patterns and engagement over time. © 2014 Elsevier Inc. All rights reserved.

The primary prevention of cardiovascular disease: nurse practitioners using behaviour modification strategies.

PubMed

Farrell, Todd Charles; Keeping-Burke, Lisa

2014-01-01

Cardiovascular disease (CVD) places great financial strain on the health care system and dramatically affects individual quality of life. As primary health care providers, nurse practitioners (NPs) are ideally positioned to advise clients on risk factor and lifestyle modifications that ameliorate the impact of CVD. While the lifestyle targets for CVD prevention are established, the most effective means of achieving these goals remain uncertain. Behaviour modification strategies, including motivational interviewing (MI) and the transtheoretical model (TTM), have been suggested, but neither approach is established as being more efficacious than the other. In this paper, evidence on the effectiveness of the two approaches for modifying smoking, diet, and exercise behaviour are presented, and a recommendation for NP practice is made.

Practical perspectives on the management of overweight and obesity.

PubMed

Gregory, Robert S; Handelsman, Yehuda; Pezalla, Edmund J; Pikelny, Dan

2014-03-01

The prevalence of obesity, defined as a body mass index of 30 or more, has reached epidemic proportions in the United States. Obesity is associated with an increased risk of multiple conditions, including type 2 diabetes mellitus, cardiovascular disease, arthritis, and sleep apnea. To discuss issues related to obesity in the workplace, healthcare, and managed care settings, stakeholders from these areas participated in a roundtable discussion on several topics, including the management of obesity, managed care coverage policies for obesity treatments, and potential strategies for improving patient outcomes. Participants agreed that obesity is a challenging condition to treat. Lifestyle modification, one of the most commonly recommended treatment modalities, is often inadequate on its own, as patients are unable to maintain weight loss over time. Although lifestyle modification remains important, additional tools are needed. In patients who undergo bariatric surgery, lifestyle modification is also necessary for long-term weight maintenance; however, surgery is not appropriate for all patients. Pharmacologic treatment may also be considered, but cost and managed care coverage policies have the potential to limit patient access to this treatment modality. Increased awareness and additional efforts on the part of all stakeholders are needed to improve outcomes for patients affected by obesity.

Insulin sensitizing drugs for weight loss in women of reproductive age who are overweight or obese: systematic review and meta-analysis.

PubMed

Nieuwenhuis-Ruifrok, A E; Kuchenbecker, W K H; Hoek, A; Middleton, P; Norman, R J

2009-01-01

Women of reproductive age, who are overweight or obese, are prone to infertility. Weight loss in these women leads to increased fecundity, higher chances of conception after infertility treatment and improved pregnancy outcome. In spite of the advantages, most patients have difficulty in losing weight and often regain lost weight over time. This review assesses whether treatment with insulin sensitizing drugs contributes to weight loss, compared with diet or a lifestyle modification programme. After a systematic search of the literature, only randomized controlled trials (RCTs), investigating the effect of insulin sensitizing drugs on weight loss compared with placebo and diet and/or a lifestyle modification programme, were included. Subjects were restricted to women of reproductive age. The main outcome measure was change in body mass index (BMI). Only 14 trials, unintentionally all but two on women with polycystic ovary syndrome (PCOS) only, were included in the analysis. Treatment with metformin showed a statistically significant decrease in BMI compared with placebo (weighted mean difference, -0.68; 95% CI -1.13 to -0.24). There was some indication of greater effect with high-dose metformin (>1500 mg/day) and longer duration of therapy (>8 weeks). Limitations were power, low use of intention-to-treat analysis and heterogeneity of the studies. A structured lifestyle modification programme to achieve weight loss should still be the first line treatment in obese women with or without PCOS. Adequately powered RCTs are required to confirm the findings of this review and to assess whether the addition of high-dose metformin therapy to a structured lifestyle modification programme might contribute to more weight loss.

A salutogenic approach to prevention of metabolic syndrome: a mixed methods population study.

PubMed

Miettola, Juhani; Viljanen, Anna Maria

2014-12-01

To find a salutogenic approach for prevention of metabolic syndrome in primary care practice. An explanatory sequential mixed-methods procedure was used to find salutogenic approaches for lifestyle change by assessing individual need, potential, and personal motivation. Data from a population health survey and interviews that focused on a sense of coherence were analysed. Altogether 480 Finnish subjects participated in a population health survey, and 43 of them were interviewed. The 43 interviewees' data were included in the final analysis. With the health survey participants' liability for MetS was assessed, and the objective need for lifestyle intervention was determined. Through the focused interviews potential and personal motivation for lifestyle modification were explored. Finally the data of the 43 interviewed subjects were merged. Four possible lifestyle intervention approaches were identified for specific intervention. First, subjects with a strong sense of coherence only need encouragement to maintain a healthy lifestyle; second, professional support was found important for subjects with gaps in health awareness to improve health understanding; third, strengthening of social support for lifestyle change is necessary for subjects with various practical constraints in their everyday life; and fourth, strengthening of stress adaptation is important for subjects with redundant concerns about their health. Salutogenic client-centred lifestyle modification approaches should be part of primary care practice. Further, a cross-disciplinary approach is needed in primary care research and practice to combat the exploding lifestyle illnesses.

Lifestyle and Risk of Premature Sexual Activity in a High School Population of Seventh-Day Adventists: Valuegenesis 1989.

ERIC Educational Resources Information Center

Weinbender, Miriam L. M.; Rossignol, Annette MacKay

1996-01-01

Evaluated Adventist lifestyle as a modification of popular American culture which reduces the risk of early sexual activity in adolescents and thus also reduces the risk for both STDs and teen pregnancy. Data analysis demonstrated a wide variety of behaviors were associated with premature sexual activity, including previously reported high-risk…

Epigenetics and lifestyle

PubMed Central

Alegría-Torres, Jorge Alejandro; Baccarelli, Andrea; Bollati, Valentina

2013-01-01

The concept of “lifestyle” includes different factors such as nutrition, behavior, stress, physical activity, working habits, smoking and alcohol consumption. Increasing evidence shows that environmental and lifestyle factors may influence epigenetic mechanisms, such as DNA methylation, histone acetylation and microRNA expression. Several lifestyle factors have been identified that might modify epigenetic patterns, such as diet, obesity, physical activity, tobacco smoking, alcohol consumption, environmental pollutants, psychological stress, and working on night shifts. Most studies conducted so far have been centered on DNA methylation, whereas only a few investigations have studied lifestyle factors in relation to histone modifications and miRNAs. Here, we review current evidence indicating that lifestyle factors might affect human health via epigenetic mechanisms. PMID:22122337

Intentional Weight Loss and Changes in Symptoms of Depression: A Systematic Review and Meta-Analysis

PubMed Central

Fabricatore, Anthony N.; Wadden, Thomas A.; Higginbotham, Allison J.; Faulconbridge, Lucy F.; Nguyen, Allison M.; Heymsfield, Steven B.; Faith, Myles S.

2011-01-01

Objective Obesity is related to increased risk of several health complications, including depression. Many studies have reported improvements in mood with weight loss, but results have been equivocal. The present meta-analysis examined changes in symptoms of depression that were reported in trials of weight loss interventions. Between-groups comparisons of different weight loss methods (e.g., lifestyle modification, diet alone, pharmacotherapy) were examined, as were within-group changes for each treatment type. Method MEDLINE was searched for articles published between 1950 and January 2009. Several obesity-related terms were intersected with terms related to depression. Results were filtered to return only studies of human subjects, published in English. Of 5971 articles, 394 were randomized controlled trials. Articles were excluded if they did not report mean changes in weight or symptoms of depression, included children or persons with psychiatric disorders (other than depression), or provided insufficient data for analysis. Thirty-one studies (n = 7937) were included. Two authors independently extracted a description of each study treatment, sample characteristics, assessment methods, and changes in weight and symptoms of depression. Treatments were categorized as: lifestyle modification, non-dieting, dietary counseling, diet-alone, exercise-alone, pharmacotherapy, placebo, or control interventions. Results Random effects models found that lifestyle modification was superior to control and non-dieting interventions for reducing symptoms of depression, and marginally better than dietary counseling and exercise-alone programs. Exercise-alone programs were superior to controls. No differences were found for comparisons of pharmacologic agents and placebos. Within-group analyses found significant reductions in symptoms of depression for nearly all active interventions. A meta-regression found no relationship between changes in weight and changes in symptoms of depression in lifestyle modification interventions. Conclusions On average, obese individuals in weight loss trials experienced reductions in symptoms of depression. Future studies should examine incidence and resolution of clinically significant depressive disorders with weight loss interventions. PMID:21343903

MEASUREMENT OF CONTROLLED ATTENUATION PARAMETER: A SURROGATE MARKER OF HEPATIC STEATOSIS IN PATIENTS OF NONALCOHOLIC FATTY LIVER DISEASE ON LIFESTYLE MODIFICATION - A PROSPECTIVE FOLLOW-UP STUDY.

PubMed

Paul, Jayanta; Venugopal, Raj Vigna; Peter, Lorance; Shetty, Kula Naresh Kumar; Shetti, Mohit P

2018-01-01

Liver biopsy is a gold standard method for hepatic steatosis assessment. However, liver biopsy is an invasive and painful procedure and can cause severe complications therefore it cannot be frequently used in case of follow-up of patients. Non-invasive assessment of steatosis and fibrosis is of growing relevance in non-alcoholic fatty liver disease (NAFLD). To evaluate hepatic steatosis, transient elastography with controlled attenuation parameter (CAP) measurement is an option now days. Aim of this study is to evaluate role of measurement of controlled attenuation parameter, a surrogate marker of hepatic steatosis in patients of nonalcoholic fatty liver disease on lifestyle modification. In this study, initially 37 participants were included who were followed up after 6 months with transient elastography, blood biochemical tests and anthropometric measurements. The results were analyzed by Multivariate linear regression analysis and paired samples t-test (Dependent t-test) with 95% confidence interval. Correlation is calculated by Pearson correlation coefficients. Mean CAP value for assessing hepatic steatosis during 1st consultation (278.57±49.13 dB/m) was significantly improved (P=0.03) after 6 months of lifestyle modification (252.91±62.02 dB/m). Only fasting blood sugar (P=0.008), weight (P=0.000), body mass index (BMI) (P=0.000) showed significant positive correlation with CAP. Only BMI (P=0.034) and weight (P=0.035) were the independent predictor of CAP value in NAFLD patients. Lifestyle modification improves the hepatic steatosis, and CAP can be used to detect the improvement of hepatic steatosis during follow-up in patients with NAFLD on lifestyle modification. There is no relation between CAP and Fibroscan score in NAFLD patients. Only BMI and weight can predict CAP value independently.

Patient confidence regarding secondary lifestyle modification and knowledge of ‘heart attack’ symptoms following percutaneous revascularisation in Japan: a cross-sectional study

PubMed Central

Kitakata, Hiroki; Kohno, Takashi; Kohsaka, Shun; Fujino, Junko; Nakano, Naomi; Fukuoka, Ryoma; Yuasa, Shinsuke; Maekawa, Yuichiro; Fukuda, Keiichi

2018-01-01

Objective To assess patient perspectives on secondary lifestyle modification and knowledge of ‘heart attack’ after percutaneous coronary intervention (PCI) for coronary artery disease (CAD). Design Observational cross-sectional study. Setting A single university-based hospital centre in Japan. Participants In total, 236 consecutive patients with CAD who underwent PCI completed a questionnaire (age, 67.4±10.1 years; women, 14.8%; elective PCI, 75.4%). The survey questionnaire included questions related to confidence levels about (1) lifestyle modification at the time of discharge and (2) appropriate recognition of heart attack symptoms and reactions to these symptoms on a four-point Likert scale (1=not confident to 4=completely confident). Primary outcome measure The primary outcome assessed was the patients’ confidence level regarding lifestyle modification and the recognition of heart attack symptoms. Results Overall, patients had a high level of confidence (confident or completely confident,>75%) about smoking cessation, alcohol restriction and medication adherence. However, they had a relatively low level of confidence (<50%) about the maintenance of blood pressure control, healthy diet, body weight and routine exercise (≥3 times/week). After adjustment, male sex (OR 3.61, 95% CI 1.11 to 11.8) and lower educational level (OR 3.25; 95% CI 1.70 to 6.23) were identified as factors associated with lower confidence levels. In terms of confidence in the recognition of heart attack, almost all respondents answered ‘yes’ to the item ‘I should go to the hospital as soon as possible when I have a heart attack’; however, only 28% of the responders were confident in their ability to distinguish between heart attack symptoms and other conditions. Conclusions There were substantial disparities in the confidence levels associated with lifestyle modification and recognition/response to heart attack. These gaps need to be studied further and disseminated to improve cardiovascular care. PMID:29549203

Food Habits, Lifestyle Factors, and Risk of Prostate Cancer in Central Argentina: A Case Control Study Involving Self-Motivated Health Behavior Modifications after Diagnosis

PubMed Central

Pacheco, Sandaly O. S.; Pacheco, Fabio J.; Zapata, Gimena M. J.; Garcia, Julieta M. E.; Previale, Carlos A.; Cura, Héctor E.; Craig, Winston J.

2016-01-01

Cancer is the second most important non-communicable disease worldwide and disproportionately impacts low- to middle-income countries. Diet in combination with other lifestyle habits seems to modify the risk for some cancers but little is known about South Americans. Food habits of Argentinean men pre- and post-diagnosis of prostate cancer (n = 326) were assessed along with other lifestyle factors. We studied whether any of the behaviors and risk factors for prostate cancer were found in men with other cancers (n = 394), compared with control subjects (n = 629). Before diagnosis, both cases reported a greater mean consumption of meats and fats and lower intakes of fruits, green vegetables, cruciferous vegetables, legumes, nuts, seeds, and whole grains than the controls (all p < 0.001). After diagnosis, cases significantly reduced the intake of meats and fats, and reported other dietary modifications with increased consumption of fish, fruits (including red fruits in prostate cancer), cruciferous vegetables, legumes, nuts, and black tea (all p < 0.001). Additional lifestyle aspects significantly predominant in cases included a reduced quality of sleep, emotional stress, low physical activity, tobacco smoking, alcohol consumption, living in rural areas, and being exposed to environmental contaminants. Argentinian men were predisposed to modify their unhealthy dietary habits and other lifestyle factors after cancer diagnosis. PMID:27409631

Food Habits, Lifestyle Factors, and Risk of Prostate Cancer in Central Argentina: A Case Control Study Involving Self-Motivated Health Behavior Modifications after Diagnosis.

PubMed

Pacheco, Sandaly O S; Pacheco, Fabio J; Zapata, Gimena M J; Garcia, Julieta M E; Previale, Carlos A; Cura, Héctor E; Craig, Winston J

2016-07-09

Cancer is the second most important non-communicable disease worldwide and disproportionately impacts low- to middle-income countries. Diet in combination with other lifestyle habits seems to modify the risk for some cancers but little is known about South Americans. Food habits of Argentinean men pre- and post-diagnosis of prostate cancer (n = 326) were assessed along with other lifestyle factors. We studied whether any of the behaviors and risk factors for prostate cancer were found in men with other cancers (n = 394), compared with control subjects (n = 629). Before diagnosis, both cases reported a greater mean consumption of meats and fats and lower intakes of fruits, green vegetables, cruciferous vegetables, legumes, nuts, seeds, and whole grains than the controls (all p < 0.001). After diagnosis, cases significantly reduced the intake of meats and fats, and reported other dietary modifications with increased consumption of fish, fruits (including red fruits in prostate cancer), cruciferous vegetables, legumes, nuts, and black tea (all p < 0.001). Additional lifestyle aspects significantly predominant in cases included a reduced quality of sleep, emotional stress, low physical activity, tobacco smoking, alcohol consumption, living in rural areas, and being exposed to environmental contaminants. Argentinian men were predisposed to modify their unhealthy dietary habits and other lifestyle factors after cancer diagnosis.

Efficacy of lifestyle modification for long-term weight control.

PubMed

Wadden, Thomas A; Butryn, Meghan L; Byrne, Kirstin J

2004-12-01

A comprehensive program of lifestyle modification induces loss of approximately 10% of initial weight in 16 to 26 weeks, as revealed by a review of recent randomized controlled trials, including the Diabetes Prevention Program. Long-term weight control is facilitated by continued patient-therapist contact, whether provided in person or by telephone, mail, or e-mail. High levels of physical activity and the consumption of low-calorie, portion-controlled meals, including liquid meal replacements, can also help maintain weight loss. Additional studies are needed of the effects of macronutrient content (e.g., low-fat vs. low-carbohydrate diets) on long-term changes in weight and health. Research also is needed on effective methods of providing comprehensive weight loss control to the millions of Americans who need it.

Self-management for obesity and cardio-metabolic fitness: Description and evaluation of the lifestyle modification program of a randomised controlled trial

PubMed Central

Pettman, Tahna L; Misan, Gary MH; Owen, Katherine; Warren, Kate; Coates, Alison M; Buckley, Jonathan D; Howe, Peter RC

2008-01-01

Background Sustainable lifestyle modification strategies are needed to address obesity and cardiovascular risk factors. Intensive, individualised programs have been successful, but are limited by time and resources. We have formulated a group-based lifestyle education program based upon national diet and physical activity (PA) recommendations to manage obesity and cardio-metabolic risk factors. This article describes the content and delivery of this program, with information on compliance and acceptability. Methods Overweight/obese adults (n = 153) with metabolic syndrome were recruited from the community and randomly allocated to intervention (INT) or control (CON). Written copies of Australian national dietary and PA guidelines were provided to all participants. INT took part in a 16-week lifestyle program which provided a curriculum and practical strategies on 1) dietary and PA information based on national guidelines, 2) behavioural self-management tools, 3) food-label reading, supermarkets tour and cooking, 4) exercise sessions, and 5) peer-group support. Compliance was assessed using attendance records and weekly food/PA logs. Participants' motivations, perceived benefits and goals were assessed through facilitated discussion. Program acceptability feedback was collected through structured focus groups. Results Although completion of weekly food/PA records was poor, attendance at information/education sessions (77% overall) and exercise participation (66% overall) was high, and compared with CON, multiple markers of body composition and cardio-metabolic health improved in INT. Participants reported that the most useful program components included food-label reading, cooking sessions, and learning new and different physical exercises, including home-based options. Participants also reported finding self-management techniques helpful, namely problem solving and short-term goal setting. The use of a group setting and supportive 'peer' leaders were found to be supportive. More frequent clinical assessment was suggested for future programs. Conclusion This group-based lifestyle program achieved improvements in body composition and cardio-metabolic and physical fitness similar to individualised interventions which are more resource intensive to deliver. It confirmed that active training in lifestyle modification is more effective than passive provision of guidelines. Such programs should include social support and self-management techniques. Continued clinical follow up may be required for long-term maintenance in individuals attempting lifestyle behaviour change. Program facilitation by peers may help and should be further investigated in a community-based model. PMID:18954466

Clinical outcomes and cost-effectiveness of strategies for managing people at high risk for diabetes.

PubMed

Eddy, David M; Schlessinger, Leonard; Kahn, Richard

2005-08-16

Lifestyle modification can forestall diabetes in high-risk people, but the long-term cost-effectiveness is uncertain. To estimate the effects of the lifestyle modification program used in the Diabetes Prevention Program (DPP) on health and economic outcomes. Cost-effectiveness analysis using the Archimedes model. Published basic and epidemiologic studies, clinical trials, and Kaiser Permanente administrative data. Adults at high risk for diabetes (body mass index >24 kg/m2, fasting plasma glucose level of 5.2725 to 6.9375 mmol/L [95 to 125 mg/dL], 2-hour glucose tolerance test result of 7.77 to 11.0445 mmol/L [140 to 199 mg/dL]). 5 to 30 years. Patient, health plan, and societal. No prevention, DPP's lifestyle modification program, lifestyle modification begun after a person develops diabetes, and metformin. Diagnosis and complications of diabetes. Compared with no prevention program, the DPP lifestyle program would reduce a high-risk person's 30-year chances of getting diabetes from about 72% to 61%, the chances of a serious complication from about 38% to 30%, and the chances of dying of a complication of diabetes from about 13.5% to 11.2%. Metformin would deliver about one third the long-term health benefits achievable by immediate lifestyle modification. Compared with not implementing any prevention program, the expected 30-year cost/quality-adjusted life-year (QALY) of the DPP lifestyle intervention from the health plan's perspective would be about 143,000 dollars. From a societal perspective, the cost/QALY of the lifestyle intervention compared with doing nothing would be about 62,600 dollars. Either using metformin or delaying the lifestyle intervention until after a person develops diabetes would be more cost-effective, costing about 35,400 dollars or 24,500 dollars per QALY gained, respectively, compared with no program. Compared with delaying the lifestyle program until after diabetes is diagnosed, the marginal cost-effectiveness of beginning the DPP lifestyle program immediately would be about 201,800 dollars. Variability and uncertainty deriving from the structure of the model were tested by comparing the model's results with the results of real clinical trials of diabetes and its complications. The most critical element of uncertainty is the effectiveness of the lifestyle program, as expressed by the 95% CI of the DPP study. The most important potentially controllable factor is the cost of the lifestyle program. Compared with no program, lifestyle modification for high-risk people can be made cost-saving over 30 years if the annual cost of the intervention can be reduced to about 100 dollars. Results depend on the accuracy of the model. Lifestyle modification is likely to have important effects on the morbidity and mortality of diabetes and should be recommended to all high-risk people. The program used in the DPP study may be too expensive for health plans or a national program to implement. Less expensive methods are needed to achieve the degree of weight loss seen in the DPP.

Obesity medications: what does the future look like?

PubMed

Butsch, W Scott

2015-10-01

Lifestyle modification remains the mainstay of treatment for obesity despite the lack of substantial long-term efficacy. For many who do not respond to lifestyle therapy and are not candidates for weight loss surgery, pharmacotherapy is a viable treatment option. Advances in understanding mechanisms of appetite control, nutrient sensing, and energy expenditure have not only helped shape current drug development but have also changed the way in which antiobesity medications are prescribed. Current antiobesity medications and pharmacological strategies will be reviewed. Two new antiobesity drugs - naltrexone/bupropion (Contrave) and liraglutide (Saxenda) - were approved by the US Food and Drug Administration in 2014 and join four other approved obesity medications, including phentermine/topiramate XR (Qsymia) and lorcaserin (Belviq), to form the largest number of medications available for the treatment of obesity. In addition, investigational drugs, like belnoranib, show promise in early clinical trials, brightening the outlook on drug development. To combat the complex physiological system of energy regulation and the known variation of treatment response, combinatory therapies for obesity, including pharmacotherapy, are needed. Now six US Food and Drug Administration-approved antiobesity medications, including two combination medications, will allow providers to tailor obesity treatment in combination with lifestyle modification for a great number of individuals with obesity.

Personalized lifestyle medicine: relevance for nutrition and lifestyle recommendations.

PubMed

Minich, Deanna M; Bland, Jeffrey S

2013-01-01

Public health recommendations for lifestyle modification, including diet and physical activity, have been widely disseminated for the prevention and treatment of disease. These guidelines are intended for the overall population without significant consideration for the individual with respect to one's genes and environment. Personalized lifestyle medicine is a newly developed term that refers to an approach to medicine in which an individual's health metrics from point-of-care diagnostics are used to develop lifestyle medicine-oriented therapeutic strategies for improving individual health outcomes in managing chronic disease. Examples of the application of personalized lifestyle medicine to patient care include the identification of genetic variants through laboratory tests and/or functional biomarkers for the purpose of designing patient-specific prescriptions for diet, exercise, stress, and environment. Personalized lifestyle medicine can provide solutions to chronic health problems by harnessing innovative and evolving technologies based on recent discoveries in genomics, epigenetics, systems biology, life and behavioral sciences, and diagnostics and clinical medicine. A comprehensive, personalized approach to medicine is required to promote the safety of therapeutics and reduce the cost of chronic disease. Personalized lifestyle medicine may provide a novel means of addressing a patient's health by empowering them with information they need to regain control of their health.

Targets to treat metabolic syndrome in polycystic ovary syndrome

PubMed Central

Mahalingaiah, Shruthi; Diamanti-Kandarakis, Evanthia

2016-01-01

Introduction Metabolic syndrome is comprised of a combination of the following states: increased insulin resistance, dyslipidemia, cardiovascular disease, and increased abdominal obesity. Women with polycystic ovary syndrome (PCOS) have an increased risk of developing metabolic syndrome over the course of their lives. Metabolic syndrome increases risk of major cardiovascular events, morbidity, quality of life, and overall health care costs. Though metabolic syndrome in women with PCOS is an area of great concern, there is no effective individual medical therapeutic to adequately treat this issue. Areas Covered This article will review key aspects of metabolic syndrome in PCOS. We will discuss classic and novel therapeutics to address metabolic syndrome in women with PCOS. We will conclude with the importance of developing strategic interventions to increase the compliance to lifestyle and dietary modification, in addition to appreciation of the emerging pharmaceutical therapeutics available. Expert Opinion Innovation in lifestyle modification, including diet, exercise, with and without dedicated stress reduction techniques is the future in treatment of metabolic syndrome in PCOS. Application of novel interventions, such as group medical care, may improve future adherence to lifestyle modification recommendations, in addition to or in combination with pharmaceutical therapeutics. PMID:26488852

Patient confidence regarding secondary lifestyle modification and knowledge of 'heart attack' symptoms following percutaneous revascularisation in Japan: a cross-sectional study.

PubMed

Kitakata, Hiroki; Kohno, Takashi; Kohsaka, Shun; Fujino, Junko; Nakano, Naomi; Fukuoka, Ryoma; Yuasa, Shinsuke; Maekawa, Yuichiro; Fukuda, Keiichi

2018-03-16

To assess patient perspectives on secondary lifestyle modification and knowledge of 'heart attack' after percutaneous coronary intervention (PCI) for coronary artery disease (CAD). Observational cross-sectional study. A single university-based hospital centre in Japan. In total, 236 consecutive patients with CAD who underwent PCI completed a questionnaire (age, 67.4±10.1 years; women, 14.8%; elective PCI, 75.4%). The survey questionnaire included questions related to confidence levels about (1) lifestyle modification at the time of discharge and (2) appropriate recognition of heart attack symptoms and reactions to these symptoms on a four-point Likert scale (1=not confident to 4=completely confident). The primary outcome assessed was the patients' confidence level regarding lifestyle modification and the recognition of heart attack symptoms. Overall, patients had a high level of confidence (confident or completely confident,>75%) about smoking cessation, alcohol restriction and medication adherence. However, they had a relatively low level of confidence (<50%) about the maintenance of blood pressure control, healthy diet, body weight and routine exercise (≥3 times/week). After adjustment, male sex (OR 3.61, 95% CI 1.11 to 11.8) and lower educational level (OR 3.25; 95% CI 1.70 to 6.23) were identified as factors associated with lower confidence levels. In terms of confidence in the recognition of heart attack, almost all respondents answered 'yes' to the item 'I should go to the hospital as soon as possible when I have a heart attack'; however, only 28% of the responders were confident in their ability to distinguish between heart attack symptoms and other conditions. There were substantial disparities in the confidence levels associated with lifestyle modification and recognition/response to heart attack. These gaps need to be studied further and disseminated to improve cardiovascular care. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Management of weight loss in obesity-associated male infertility: a spotlight on bariatric surgery.

PubMed

Abiad, Firass; Awwad, Johnny; Abbas, Hussein A; Zebian, Dina; Ghazeeri, Ghina

2017-12-01

In recent years, there has been a paralleled increase between male obesity and infertility rates. Obesity is associated with impaired hypothalamic-pituitary-gonadal axis, aberrant semen parameters, and subfertility or infertility. Weight loss is strongly recommended for the management of obesity-associated infertility. Lifestyle modifications that include caloric restriction and increased physical activity have a short-lived impact. Bariatric surgery is a better and more durable weight loss alternative. Comprehensive information about the benefits of weight loss on obesity-associated male infertility following bariatric surgery is still emerging. In this review, we discuss the hormonal, physical and environmental mechanism contributing to obesity-associated infertility. We then assess weight loss approaches, which include lifestyle modification, medical and surgical approaches, that can improve fertility in obese men. This review focuses also on bariatric surgery for the management of obese men seeking fertility treatment. Anecdotal evidence suggesting that bariatric surgery can impair fertility is also discussed.

The effect of lifestyle modification and glycemic control on the efficiency of sildenafil citrate in patients with erectile dysfunction due to type-2 diabetes mellitus.

PubMed

Kirilmaz, Utku; Guzel, Ozer; Aslan, Yilmaz; Balci, Melih; Tuncel, Altug; Atan, Ali

2015-01-01

We evaluated the effect of lifestyle modifications and glycemic control on the efficiency of sildenafil citrate in patients with type-2 diabetes (T2DM) and erectile dysfunction (ED). Eighty-three men with ED due to T2DM were included in the study. The Group 1 (n = 41) patients received lifestyle modifications (diet and exercise), and medical treatment for intensive glycemic control. In Group 2 (n = 42), in addition to the intensive glycemic control, the patients were given sildenafil citrate® 100 mg for 2-3 per weeks. The changes in ED were compared between the two groups after three months of treatment. The mean age was 54.9 ± 9.1 (26-75) years. An increase in the IIEF-5 scores was observed in 23 of 41 patients in Group 1 (44.2%) and 29 of 42 in Group 2 (55.8%). When the changes of the IIEF-5 scores were evaluated, the mean increase was 2.5 in Group 1, and 5.0 in Group 2 (p = 0.012). The mean IIEF changes according to the duration of diabetes were 4.8 in <5 years, 3.6 in 5-10 years and 1.6 in >10 years (p = 0.021). Glycemic control and lifestyle changes are not solely adequate for a better sexual function in ED due to diabetes, and sildenafil citrate should be used additionally.

[Educational effectiveness of a group health education program in the workplace and an examination of educational methods to promote behavior modification].

PubMed

Kageyama, Makoto; Odagiri, Keiichi; Suzuki, Naoko; Honda, Kumiko; Onoue, Kazue; Yamamoto, Makoto; Mizuta, Isagi; Uehara, Akihiko

2014-01-01

It is well-known that health education programs carried out in the work place are useful for employees' health promotion. However, the effectiveness of group health education programs for workers as a population approach is unclear. The purpose of this study was to examine the effectiveness of a group health education program in the workplace, and to investigate educational methods which support workers modifying their health behaviors. A total of 289 workers who received a group health education program in the manufacturing industry (mean age, 42.1 ± 11.3 years old; 175 males and 114 females) were enrolled in this study. The group health education program was carried out to educate the subjects about periodontitis, oral health actions and lifestyle behaviors to prevent oral diseases. Participants were required to fill out a self-administered questionnaire which included information about oral health knowledge, oral health actions, lifestyle behaviors and symptoms of periodontitis before, immediately after and one month after the education. We used McNemar's test for the paired comparison of questionnaire responses. The relation between acquiring knowledge about periodontitis and subjects' modification of oral health action, behavior modification and symptoms of periodontitis were examined using the chi-squared test. The relationships of knowledge retention about periodontitis, the modification of the oral health actions and lifestyle behaviors (i.e., cigarette smoking, alcohol drinking and eating between meals), were examined with participants' characteristics (i.e., age, gender and occupational category) using Fisher's exact test. Knowledge about periodontitis significantly improved immediately after receiving the health education, and this effect of education was evident one month later. However, not all of the knowledge was sufficiently retained one month after the education session. The proportion of participants undertaking desirable oral health actions significantly increased one month after the education, whereas lifestyle behaviors did not alter. The modification of oral health actions improved periodontitis-related symptoms, however, no relationship was found between knowledge acquisition and behavior modification. The characteristics of the participants did not influence knowledge retention about periodontitis or modification of oral health actions. Our group health education program was appropriate and effective at providing knowledge about periodontitis and at modifying oral health actions. We should identify factors that obstruct workers behavior modification, and eliminate them to improve health behaviors.

Personalized Lifestyle Medicine: Relevance for Nutrition and Lifestyle Recommendations

PubMed Central

Minich, Deanna M.; Bland, Jeffrey S.

2013-01-01

Public health recommendations for lifestyle modification, including diet and physical activity, have been widely disseminated for the prevention and treatment of disease. These guidelines are intended for the overall population without significant consideration for the individual with respect to one's genes and environment. Personalized lifestyle medicine is a newly developed term that refers to an approach to medicine in which an individual's health metrics from point-of-care diagnostics are used to develop lifestyle medicine-oriented therapeutic strategies for improving individual health outcomes in managing chronic disease. Examples of the application of personalized lifestyle medicine to patient care include the identification of genetic variants through laboratory tests and/or functional biomarkers for the purpose of designing patient-specific prescriptions for diet, exercise, stress, and environment. Personalized lifestyle medicine can provide solutions to chronic health problems by harnessing innovative and evolving technologies based on recent discoveries in genomics, epigenetics, systems biology, life and behavioral sciences, and diagnostics and clinical medicine. A comprehensive, personalized approach to medicine is required to promote the safety of therapeutics and reduce the cost of chronic disease. Personalized lifestyle medicine may provide a novel means of addressing a patient's health by empowering them with information they need to regain control of their health. PMID:23878520

Lifestyle modification and progressive renal failure.

PubMed

Ritz, Eberhard; Schwenger, Vedat

2005-08-01

There is increasing evidence that lifestyle factors impact on the risk of developing chronic kidney disease (CKD) and the risk of progression of CKD. Equally important is the consideration that patients with CKD are more likely to die from cardiovascular disease than to reach the stage of end-stage renal failure. It is advantageous that manoeuvres that interfere with progression at the same time also reduce the risk of cardiovascular events. Lifestyle factors that aggravate progression include, among others, smoking, obesity and dietary salt intake. Alcohol consumption, according to some preliminary information, has a bimodal relationship to cardiovascular risk and progression, with moderate consumption being protective.

Lifestyle modification with diet and exercise in obese patients with heart failure - A pilot study

USDA-ARS?s Scientific Manuscript database

There is a paucity of data regarding intentional weight loss in obese heart failure patients. This study sought to ascertain the safety and effectiveness of a lifestyle modification program in patients with systolic heart failure and metabolic syndrome. Patients (n=20) with systolic heart failure (e...

Development and validation of a knowledge test for health professionals regarding lifestyle modification.

PubMed

Talip, Whadi-ah; Steyn, Nelia P; Visser, Marianne; Charlton, Karen E; Temple, Norman

2003-09-01

We wanted to develop and validate a test that assesses the knowledge and practices of health professionals (HPs) with regard to the role of nutrition, physical activity, and smoking cessation (lifestyle modification) in chronic diseases of lifestyle. A descriptive cross-sectional validation study was carried out. The validation design consisted of two phases, namely 1) test planning and development and 2) test evaluation. The study sample consisted of five groups of HPs: dietitians, dietetic interns, general practitioners, medical students, and nurses. The overall response rate was 58%, resulting in a sample size of 186 participants. A test was designed to evaluate the knowledge and practices of HPs. The test was first evaluated by an expert group to ensure content, construct, and face validity. Thereafter, the questionnaire was tested on five groups of HPs to test for criterion validity. Internal consistency was evaluated by Cronbach's alpha. An expert panel ensured content, construct, and face validity of the test. Groups with the most training and exposure to nutrition (dietitians and dietetic interns) had the highest group mean score, ranging from 61% to 88%, whereas those with limited nutrition training (general practitioners, medical students, and nurses) had significantly lower scores, ranging from 26% to 80%. This result demonstrated criterion validity. Internal consistency of the overall test demonstrated a Cronbach's alpha of 0.99. Most HPs identified the mass media as their main source of information on lifestyle modification. These HPs also identified lack of time, lack of patient compliance, and lack of knowledge as barriers that prevent them from providing counseling on lifestyle modification. The results of this study showed that this test instrument identifies groups of health professionals with adequate training (knowledge) in lifestyle modification and those who require further training (knowledge).

Associations among family history of cancer, cancer screening and lifestyle behaviors: a population-based study.

PubMed

Bostean, Georgiana; Crespi, Catherine M; McCarthy, William J

2013-08-01

Some cancers are largely preventable through modification of certain behavioral risk factors and preventive screening, even among those with a family history of cancer. This study examined the associations between (1) family cancer history and cancer screening, (2) family history and cancer preventive lifestyle behaviors, and (3) cancer screening and lifestyle behaviors. Data were from the 2009 California Health Interview Survey (n = 12,603). Outcomes included screening for breast cancer (BC) and colorectal cancer (CRC) and six cancer preventive lifestyle behaviors, based on World Cancer Research Fund recommendations. Multivariate logistic regression analyses, stratified by gender and race-ethnicity, examined associations. Predicted probabilities of cancer screening by family cancer history, race-ethnicity, and sex were computed. Family history of site-specific cancer-CRC for men and women, and BC for women-was associated with higher probability of cancer screening for most groups, especially for CRC, but was largely unrelated to other lifestyle behaviors. In the few cases in which family history was significantly associated with lifestyle-for example, physical activity among White and Latino males, smoking among White and Asian females-individuals with a family history had lower odds of adherence to recommendations than those with no family history. Greater overall adherence to lifestyle recommendations was associated with higher odds of up-to-date CRC screening among White and Asian males, and lower odds among Asian females (no significant association with BC screening); this relationship did not vary by family cancer history. The fact that family history of cancer is not associated with better lifestyle behaviors may reflect shared behavioral risks within families, or the lack of knowledge about how certain lifestyle behaviors impact personal cancer risk. Findings can inform interventions aimed at lifestyle behavioral modification for individuals at increased cancer risk due to family history.

Relationships among medication adherence, lifestyle modification, and health-related quality of life in patients with acute myocardial infarction: a cross-sectional study.

PubMed

Lee, Yu-Mi; Kim, Rock Bum; Lee, Hey Jean; Kim, Keonyeop; Shin, Min-Ho; Park, Hyeung-Keun; Ahn, Soon-Ki; Kim, So Young; Lee, Young-Hoon; Kim, Byoung-Gwon; Lee, Heeyoung; Lee, Won Kyung; Lee, Kun Sei; Kim, Mi-Ji; Park, Ki-Soo

2018-05-22

The healthy adherer effect is a phenomenon in which patients who adhere to medical therapies tend to pursue health-seeking behaviors. Although the healthy adherer effect is supposed to affect health outcomes in patients with coronary artery disease, evaluation of its presence and extent is not easy. This study aimed to assess the relationship between medication adherence and lifestyle modifications and health-related quality of life among post-acute myocardial infarction (AMI) patients. A cross-sectional study was conducted in 417 post-AMI patients who underwent percutaneous coronary intervention (PCI). Patients were recruited from 11 university hospitals from December 2015 to March 2016 in South Korea. Details regarding socio-demographic factors, six health behaviors (low-salt intake, low-fat diet and/or weight-loss diet, regular exercise, stress reduction in daily life, drinking in moderation, and smoking cessation), medication adherence using the Modified Morisky Scale (MMS), and HRQoL using the Coronary Revascularization Outcome Questionnaire (CROQ) were surveyed in a one-on-one interview. In the univariate logistic analysis, sex (female), age (≥70 years), MMS score (≥5), and CROQ score were associated with adherence to lifestyle modification. In the multiple logistic analysis, a high MMS score (≥5) was associated with adherence to lifestyle modification after adjusting for sex, age, marital status, education, and family income (adjusted odds ratio [OR] = 11.7, 95% confidence interval [CI] = 1.5-91.3). After further adjusting for the CROQ score, the association between high MMS score and adherence to lifestyle modification was significant (adjusted OR = 11.5, 95% CI = 1.4-93.3). Adherence to medication was associated with adherence to lifestyle modification, suggesting the possible presence of the healthy adherer effect in post-AMI patients. After further adjusting for HRQoL, the association remained. To improve health outcome in post-AMI patients, early detection of patients with poor adherence to medication and lifestyle modification and motivational education programs to improve adherence are important. In addition, the healthy adherer effect should be considered in clinical research, in particular, in studies evaluating the effects of therapies on health outcomes.

The Downstart Program: a hospital-based pediatric healthy lifestyle program for obese and morbidly obese minority youth.

PubMed

Sternberg, Alex; Muzumdar, Hiren; Dinkevich, Eugene; Quintos, Jose Bernardo; Austin-Leon, Galia; Owens, Terrel; Murphy, Cheryl; Dapul, Geraldine; Rao, Madu

2006-12-01

Although obesity affects all cultures, ethnic groups and social strata, this disorder affects African Americans, Hispanics and the poor at a disproportionate rate. The Downstart Pediatric Healthy Lifestyle Program was developed to provide a multi-disciplinary behavioral modification program for inner city families in Brooklyn, New York interested in leading a healthier, more active lifestyle. The Downstart Program uses a four-pronged approach of medical evaluation, exercise, nutritional education and lifestyle modification. A psychological evaluation is performed to determine the individual's ability and readiness to participate in group activities. Baseline physical fitness, flexibility and muscle strength are measured, followed by a twice-weekly karate/martial arts/dance program, incorporating principles established by the President's Council on Exercise. Nutritional and behavioral modification aspects of the program consist of weekly education about food groups, portion control, goal setting and appropriate rewards for attaining goals. Our preliminary results indicate that the Downstart Program may be a viable intervention for weight loss. Further study is needed to improve strategies for motivating patients and means and criteria for assessing long-term effects on health and lifestyle.

Lifestyle measures in the management of gastro-oesophageal reflux disease: clinical and pathophysiological considerations.

PubMed

Kang, J H-E; Kang, J Y

2015-03-01

Several lifestyle and dietary factors are commonly cited as risk factors for gastro-oesophageal reflux disease (GORD) and modification of these factors has been advocated as first-line measures for the management of GORD. We performed a systematic review of the literature from 2005 to the present relating to the effect of these factors and their modification on GORD symptoms, physiological parameters of reflux as well as endoscopic appearances. Conflicting results existed for the association between smoking, alcohol and various dietary factors in the development of GORD. These equivocal findings are partly due to methodology problems. There is recent good evidence that weight reduction and smoking cessation are beneficial in reducing GORD symptoms. Clinical and physiological studies also suggest that some physical measures as well as modification of meal size and timing can also be beneficial. However, there is limited evidence for the role of avoiding alcohol and certain dietary ingredients including carbonated drinks, caffeine, fat, spicy foods, chocolate and mint.

Lifestyle measures in the management of gastro-oesophageal reflux disease: clinical and pathophysiological considerations

PubMed Central

Kang, J.H.-E.

2015-01-01

Several lifestyle and dietary factors are commonly cited as risk factors for gastro-oesophageal reflux disease (GORD) and modification of these factors has been advocated as first-line measures for the management of GORD. We performed a systematic review of the literature from 2005 to the present relating to the effect of these factors and their modification on GORD symptoms, physiological parameters of reflux as well as endoscopic appearances. Conflicting results existed for the association between smoking, alcohol and various dietary factors in the development of GORD. These equivocal findings are partly due to methodology problems. There is recent good evidence that weight reduction and smoking cessation are beneficial in reducing GORD symptoms. Clinical and physiological studies also suggest that some physical measures as well as modification of meal size and timing can also be beneficial. However, there is limited evidence for the role of avoiding alcohol and certain dietary ingredients including carbonated drinks, caffeine, fat, spicy foods, chocolate and mint. PMID:25729556

Effects of Lifestyle Modification on Telomerase Gene Expression in Hypertensive Patients: A Pilot Trial of Stress Reduction and Health Education Programs in African Americans.

PubMed

Duraimani, Shanthi; Schneider, Robert H; Randall, Otelio S; Nidich, Sanford I; Xu, Shichen; Ketete, Muluemebet; Rainforth, Maxwell A; Gaylord-King, Carolyn; Salerno, John W; Fagan, John

2015-01-01

African Americans suffer from disproportionately high rates of hypertension and cardiovascular disease. Psychosocial stress, lifestyle and telomere dysfunction contribute to the pathogenesis of hypertension and cardiovascular disease. This study evaluated effects of stress reduction and lifestyle modification on blood pressure, telomerase gene expression and lifestyle factors in African Americans. Forty-eight African American men and women with stage I hypertension who participated in a larger randomized controlled trial volunteered for this substudy. These subjects participated in either stress reduction with the Transcendental Meditation technique and a basic health education course (SR) or an extensive health education program (EHE) for 16 weeks. Primary outcomes were telomerase gene expression (hTERT and hTR) and clinic blood pressure. Secondary outcomes included lifestyle-related factors. Data were analyzed for within-group and between-group changes. Both groups showed increases in the two measures of telomerase gene expression, hTR mRNA levels (SR: p< 0.001; EHE: p< 0.001) and hTERT mRNA levels (SR: p = 0.055; EHE: p< 0.002). However, no statistically significant between-group changes were observed. Both groups showed reductions in systolic BP. Adjusted changes were SR = -5.7 mm Hg, p< 0.01; EHE = -9.0 mm Hg, p < 0.001 with no statistically significant difference between group difference. There was a significant reduction in diastolic BP in the EHE group (-5.3 mm Hg, p< 0.001) but not in SR (-1.2 mm Hg, p = 0.42); the between-group difference was significant (p = 0.04). The EHE group showed a greater number of changes in lifestyle behaviors. In this pilot trial, both stress reduction (Transcendental Meditation technique plus health education) and extensive health education groups demonstrated increased telomerase gene expression and reduced BP. The association between increased telomerase gene expression and reduced BP observed in this high-risk population suggest hypotheses that telomerase gene expression may either be a biomarker for reduced BP or a mechanism by which stress reduction and lifestyle modification reduces BP. ClinicalTrials.gov NCT00681200.

Effects of Lifestyle Modification on Telomerase Gene Expression in Hypertensive Patients: A Pilot Trial of Stress Reduction and Health Education Programs in African Americans

PubMed Central

Duraimani, Shanthi; Schneider, Robert H.; Randall, Otelio S.; Nidich, Sanford I.; Xu, Shichen; Ketete, Muluemebet; Rainforth, Maxwell A.; Gaylord-King, Carolyn; Salerno, John W.; Fagan, John

2015-01-01

Background African Americans suffer from disproportionately high rates of hypertension and cardiovascular disease. Psychosocial stress, lifestyle and telomere dysfunction contribute to the pathogenesis of hypertension and cardiovascular disease. This study evaluated effects of stress reduction and lifestyle modification on blood pressure, telomerase gene expression and lifestyle factors in African Americans. Methods Forty-eight African American men and women with stage I hypertension who participated in a larger randomized controlled trial volunteered for this substudy. These subjects participated in either stress reduction with the Transcendental Meditation technique and a basic health education course (SR) or an extensive health education program (EHE) for 16 weeks. Primary outcomes were telomerase gene expression (hTERT and hTR) and clinic blood pressure. Secondary outcomes included lifestyle-related factors. Data were analyzed for within-group and between-group changes. Results Both groups showed increases in the two measures of telomerase gene expression, hTR mRNA levels (SR: p< 0.001; EHE: p< 0.001) and hTERT mRNA levels (SR: p = 0.055; EHE: p< 0.002). However, no statistically significant between-group changes were observed. Both groups showed reductions in systolic BP. Adjusted changes were SR = -5.7 mm Hg, p< 0.01; EHE = -9.0 mm Hg, p < 0.001 with no statistically significant difference between group difference. There was a significant reduction in diastolic BP in the EHE group (-5.3 mm Hg, p< 0.001) but not in SR (-1.2 mm Hg, p = 0.42); the between-group difference was significant (p = 0.04). The EHE group showed a greater number of changes in lifestyle behaviors. Conclusion In this pilot trial, both stress reduction (Transcendental Meditation technique plus health education) and extensive health education groups demonstrated increased telomerase gene expression and reduced BP. The association between increased telomerase gene expression and reduced BP observed in this high-risk population suggest hypotheses that telomerase gene expression may either be a biomarker for reduced BP or a mechanism by which stress reduction and lifestyle modification reduces BP. Trial Registration ClinicalTrials.gov NCT00681200 PMID:26571023

Individual approach to the treatment of obese copd patients can reduce anthropometric indicators, the level of systemic inflammation and improve the quality of life.

PubMed

Savchenko, Lesia V; Kaidashev, Igor P

2018-01-01

Introduction: Chronic obstructive pulmonary disease (COPD) and obesity are major causes of morbidity and mortality worldwide, and according to current estimates, the global burden of these conditions will be even greater. The basis for COPD treatment is bronchodilator therapy and non-pharmacotherapy approaches, such as respiratory rehabilitation and dietary counseling. The aim of this study was to assess the impact of lifestyle modification on anthropometric indices, markers of systemic inflammation, quality of life in patients with COPD and obesity. Materials and methods: 53 patients with COPD in stable condition with BMI - 30.0-39.9 kg/m2 were included in the study. The patients were divided into 2 groups: the first group - obese COPD patients with lifestyle modification (n=26) and the second group (n=27) -without lifestyle modification. Lifestyle modification involved: nutritional correction and regular physical exercise. The duration of the study was 9 months. We evaluated body mass indices (BMI), waist circumference (WC), actual nutrition, dyspnea by the mMRC scale, quality of life (QL), 6-minute walking distance test (6MWD), spirometry, serum levels of C-reactive protein (CRP) and sputum level of interleukin-26 (IL-26). Results: After 9 months in obese COPD patients with lifestyle modification we found a decrease in body weight and BMI by 1.16 times (p <0.0001), WC by 1.07 times (p<0.0001), the basal metabolic rate by 1.07 times (p=0.02), the actual energy value of consumed food per work day and weekend by 1.19 times and 1.23 times, respectively (p<0.0001), the level of dyspnea by 1.42 times (p <0.0001), systemic inflammation markers decreased - serum CRP by 2.06 times (p < 0.0001), IL-26 level in the induced sputum by 1.65 times (p <0.0001); increased the walked distance by 9.38% (p = 0.0004) and QL (p <0.0001). Conclusions: Application of individually developed therapeutic measures incorporating the nutrition correction, taking into account the indicators of the basic metabolism in patients and regular physical activity against the background of inhaled basic therapy, allows us to the reduction of WC, BMI, activity of the inflammatory process, increase tolerance to physical activity and improvement of life quality.

Cardiovascular risk reduction and weight management at a hospital-based postpartum preeclampsia clinic.

PubMed

Janmohamed, Rahim; Montgomery-Fajic, Erin; Sia, Winnie; Germaine, Debbie; Wilkie, Jodi; Khurana, Rshmi; Nerenberg, Kara A

2015-04-01

Women who develop preeclampsia during pregnancy are at high risk of developing future chronic diseases, including premature cardiovascular disease. We have established an interdisciplinary clinic that aims to prevent cardiovascular disease through educational counselling focused on lifestyle modifications in the early postpartum period. The objective of this study was to evaluate changes in weight and cardiovascular risk factors in participating women after six months of attendance at the clinic. We conducted a retrospective chart review of women who had a pregnancy complicated by preeclampsia, and who subsequently attended the Postpartum Preeclampsia Clinic. Study subjects had baseline assessments of lifestyle, physical, and laboratory parameters. Individualized goals for cardiovascular risk reduction and lifestyle were established, centering on physical activity and dietary modifications. The primary outcome was change in weight. Over the study period, 21 women were seen for a minimum of six months of follow-up. At an average (± SD) of 4.4 ± 1.4 months postpartum, subjects showed a non-significant improvement in weight (mean weight loss of 0.4 ± 4.5 kg) and BMI (mean decrease in BMI 0.1 ± 1.7 kg/m2). Physical activity improved significantly, from 14% of subjects participating in physical activity before pregnancy to 76% at a mean of 4.4 months postpartum. This study has demonstrated the early benefits of a longitudinal interdisciplinary intervention with counselling about lifestyle modifications for prevention of cardiovascular disease in women with recent preeclampsia. A study with a larger sample size and longer duration of follow-up is planned to confirm these findings.

Community-based lifestyle modification of cardiovascular disease risks in middle-aged Japanese: a 27-month update.

PubMed

Fujii, Hiroko; Muto, Takashi; Haruyama, Yasuo; Nakade, Makiko; Kobayashi, Emiko; Ishisaki, Kaori; Yamasaki, Akiko

2010-04-01

Lifestyle modification is the cornerstone of preventive management for people with cardiovascular disease risks, such as obesity, hypertension, dyslipidemia and diabetes. This study investigated the effect of a 27-month community-based lifestyle intervention on the reduction of cardiovascular disease risks in middle-aged Japanese. Of 549 participants with cardiovascular disease risk factors of overweight, hypertension, dyslipidemia or diabetes enrolled in this non-randomized controlled study, 397 participants aged 39-71 years old completed all 3 serial surveys at baseline, 15 months and 27 months. For the intervention group (39 males and 174 females), 31 specific interventions including individual counselling and group sessions were conducted. The control group (64 males and 120 females) only received 7 newsletters providing health information and results of health checkups. Multiple logistic regression analysis adjusted for sex, each baseline risk category and age category showed that the proportion of those who were overweight or showed dyslipidemia risk were significantly lower in the intervention group only at 27 months [Odds ratio (OR): 0.43 (95% CI 0.20-0.94), OR: 0.43 (95% CI 0.21-0.87), respectively] and the proportion of those showing diabetes risk was significantly lower in the intervention group at both 15 months [OR: 0.42 (95% CI 0.18-0.97)] and 27 months [OR: 0.56 (95% CI 0.32-0.99)]. In conclusion, the 27-month community-based lifestyle modification of cardiovascular disease risks shows significant reductions in risks of diabetes, overweight and dyslipidemia in middle-aged Japanese.

The Use of Lifestyle and Behavioral Modification Approaches in Obesity Interventions for Black Women: A Literature Review

ERIC Educational Resources Information Center

Walker, Renee E.; Gordon, Melanie

2014-01-01

The alarming obesity prevalence in Black women is well documented yet poorly understood. Obesity interventions for Black women have failed to produce long-term reductions in weight. Recommendations to incorporate a lifestyle and behavioral modification approach have been made to address obesity in this population. The purpose of this article was…

Perceptions among women with gestational diabetes.

PubMed

Parsons, Judith; Ismail, Khalida; Amiel, Stephanie; Forbes, Angus

2014-04-01

Women with gestational diabetes are at high risk of developing type 2 diabetes, which could be prevented or delayed by lifestyle modification. Lifestyle interventions need to take into account the specific situation of women with gestational diabetes. We aimed to gain a deeper understanding of women's experiences of gestational diabetes, their diabetes risk perceptions, and their views on type 2 diabetes prevention, to inform future lifestyle interventions. We conducted a metasynthesis that included 16 qualitative studies and identified 11 themes. Factors that require consideration when developing a type 2 diabetes prevention intervention in this population include addressing the emotional impact of gestational diabetes; providing women with clear and timely information about future diabetes risk; and offering an intervention that fits with women's multiple roles as caregivers, workers, and patients, and focuses on the health of the whole family.

Lifestyle modification: A primary prevention approach to colorectal cancer

USDA-ARS?s Scientific Manuscript database

Early detection of cancer through screening is an important step in decreasing both morbidity and mortality. Likewise, specific modifiable lifestyle behaviors are associated with reduced risk of colorectal cancer. Lifestyle practices have also been shown to maximize health after the primary treatmen...

Impact of a 1-year lifestyle modification program on cholesterol efflux capacities in men with abdominal obesity and dyslipidemia.

PubMed

Boyer, Marjorie; Mitchell, Patricia L; Poirier, Dr Paul; Alméras, Natalie; Tremblay, Angelo; Bergeron, Jean; Despres, Jean-Pierre; Arsenault, Benoit J

2018-06-05

Cholesterol efflux capacities (CECs) are negatively associated with cardiovascular disease risk, irrespective of plasma high-density lipoprotein (HDL) cholesterol levels. Whether interventions targeting lifestyle improve HDL-CECs is unknown. Our objective was to determine whether improving dietary quality and increasing physical activity levels improves HDL-CECs in abdominally obese men with dyslipidemia. Our study sample included men (488.5 years) with an elevated waist circumference ({greater than or equal to}90 cm) associated with dyslipidemia (triglycerides {greater than or equal to}1.69 and/or HDL cholesterol <1.03 mmol/l); 113 men completed a 1-year intervention, consisting of a healthy eating and physical activity/exercise program and 32 were included in a control group. An oral lipid tolerance test (OLTT) was performed in a subsample of 28 men who completed the intervention and blood was collected every 2 hours during 8 hours. HDL-CECs were measured using 3 H cholesterol labeled J774 macrophages and HepG2 hepatocytes. The lifestyle modification program led to an overall improvement in the cardiometabolic risk profile, increases in J774-HDL-CEC by 14.1% (+0.881.09%, p<0.0001), HepG2-HDL-CEC by 3.4% (+0.170.75%, p=0.01), HDL-C and apolipoprotein A-1 levels (13.5%, p<0.0001 and 14.9%, p<0.0001, respectively). J774-HDL-CECs and HepG2-HDL-CECs did not change in the control group. The best predictor for changes in HDL-CEC was Apo A1 level. The lifestyle modification program also improved HDL-CECs response in postprandial lipemia during an OLTT. HDL-CEC did not change during the OLTT. Our results suggest that increasing physical activity levels and improving diet quality can have a positive impact on both HDL quantity and quality in abdominally obese men with dyslipidemia.

Review of the Clinical Effect of Orlistat

NASA Astrophysics Data System (ADS)

Qi, Xiguang

2018-01-01

Obesity has been a main risk for the development of diabetes mellitus, cardiovascular diseases and many other chronic problems worldwide. Lifestyle modification is the best way to lose weight but very hard to implement, thus pharmacotherapy is regarded as a good add-on to dietary and lifestyle therapies. This review provides an overview of the olistat, a drug for obesity approved by FDA, about its mechanism of action, efficacy for obesity and some other diseases including cardiovascular disease, type 2 diabetes and some cancers, as well as its safety and adverse effects.

Treatment Options for Severe Obesity in the Pediatric Population: Current Limitations and Future Opportunities.

PubMed

Ryder, Justin R; Fox, Claudia K; Kelly, Aaron S

2018-06-01

Severe obesity is the only obesity classification increasing in prevalence among children and adolescents. Treatment options that produce meaningful and sustained weight loss and comorbidity resolution are urgently needed. The purpose of this review is to provide a brief overview of the current treatment options for pediatric severe obesity and offer suggestions regarding future opportunities for accelerating the development and evaluation of innovative treatment strategies. At present, there are three treatment options for youth with severe obesity: lifestyle modification therapy, pharmacotherapy, and bariatric surgery. Lifestyle modification therapy can be useful for improving many chronic disease risk factors and comorbid conditions but often fails to achieve clinically meaningful and sustainable weight loss. Pharmacotherapy holds promise as an effective adjunctive treatment but remains in the primordial stages of development in the pediatric population. Bariatric surgery provides robust weight loss and risk factor/comorbidity improvements but is accompanied by higher risks and lower uptake compared to lifestyle modification therapy and pharmacotherapy. New areas worth pursuing include combination pharmacotherapy, device therapy, identification of predictors of response aimed at precision treatment, and interventions in the postbariatric surgical setting to improve long-term outcomes. Treating pediatric severe obesity effectively and safely is extremely challenging. Some progress has been made, but substantially more effort and innovation are needed in the future to combat this serious and ongoing medical and public health issue. © 2018 The Obesity Society.

Predischarge education improves adherence to a healthy lifestyle among Jordanian patients with acute coronary syndrome.

PubMed

Eshah, Nidal F

2013-09-01

Risk factor reduction and modification of patient lifestyle have become the focus of secondary prevention and cardiac rehabilitation programs. Considering the scarcity of resources in developing countries, nurses can potentially provide great benefit to acute coronary syndrome patients by utilizing hospital time to teach the patients how to lower their risk for recurrence and adopt healthier lifestyles after discharge. The purpose of this study was to identify the effectiveness of a predischarge education on acute coronary syndrome patients' lifestyles. Quasi-experimental pretest-post-test design was used. The patients assigned to the experimental group were offered predischarge education that stimulates lifestyle modification and adoption of a healthier lifestyle. The experimental group scored significantly higher than the control group in three lifestyle components - health responsibilities, nutrition, and interpersonal relations. In conclusion, predischarge education helps motivate acute coronary syndrome patients to adhere to a healthy lifestyle postdischarge. Therefore, nurses must be educated and prepared to be qualified health educators, and health education should continue as one of the most important daily nursing practices, thus it is invested in the preparation of acute coronary patients' discharge plan. © 2012 Wiley Publishing Asia Pty Ltd.

PNPLA3 gene polymorphism and response to lifestyle modification in patients with nonalcoholic fatty liver disease.

PubMed

Shen, Jiayun; Wong, Grace Lai-Hung; Chan, Henry Lik-Yuen; Chan, Ruth Suk-Mei; Chan, Hoi-Yun; Chu, Winnie Chiu-Wing; Cheung, Bernice Ho-Ki; Yeung, David Ka-Wai; Li, Liz Sin; Sea, Mandy Man-Mei; Woo, Jean; Wong, Vincent Wai-Sun

2015-01-01

Lifestyle modification is the cornerstone for the management of nonalcoholic fatty liver disease (NAFLD), and patatin-like phospholipase 3 (PNPLA3) is one of the most important genetic determinants of NAFLD. We aimed to investigate the effect of PNPLA3 gene polymorphism on the response to lifestyle modification in NAFLD patients. This was a post-hoc analysis of a randomized controlled trial on a lifestyle modification program in community NAFLD patients. The PNPLA3 rs738409 gene polymorphism was correlated with changes in metabolic profile and intrahepatic triglyceride content (IHTG) as measured by proton magnetic resonance spectroscopy. One hundred and fifty-four patients were equally randomized into the intervention and control groups. The presence of G allele was associated with greater reduction in IHTG (CC: 3.7 ± 5.2%, CG: 6.5 ± 3.6%), and GG: 11.3 ± 8.8% (Spearman's correlation, 0.34; P = 0.002), body weight (P = 0.030), waist-to-hip ratio (P = 0.024), total cholesterol (P = 0.031), and low-density lipoprotein cholesterol (P = 0.009) in the intervention group. In contrast, PNPLA3 polymorphism had no impact on IHTG changes in the control group. By multivariable analysis, PNPLA3 genotype and body mass index (BMI) change were independently associated with IHTG reduction in the intervention group. Only BMI change was associated with IHTG reduction in the control group. Although the PNPLA3 rs738409 GG genotype confers a higher risk of NAFLD, these patients are more sensitive to the beneficial effects of lifestyle modification and should be encouraged to do so. © 2014 Journal of Gastroenterology and Hepatology Foundation and Wiley Publishing Asia Pty Ltd.

Lifestyle modification for metabolic syndrome: a systematic review.

PubMed

Bassi, Nikhil; Karagodin, Ilya; Wang, Serena; Vassallo, Patricia; Priyanath, Aparna; Massaro, Elaine; Stone, Neil J

2014-12-01

All 5 components of metabolic syndrome have been shown to improve with lifestyle and diet modification. New strategies for achieving adherence to meaningful lifestyle change are needed to optimize atherosclerotic cardiovascular risk reduction. We performed a systematic literature review, based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses framework (PRISMA), investigating optimal methods for achieving lifestyle change in metabolic syndrome. We submitted standardized search terms to the PubMed Central, CINAHL, Web of Science, and Ovid databases. Within those results, we selected randomized controlled trials (RCTs) presenting unique methods of achieving lifestyle change in patients with one or more components of the metabolic syndrome. Data extraction using the population, intervention, comparator, outcome, and risk of bias framework (PICO) was used to compare the following endpoints: prevalence of metabolic syndrome, prevalence of individual metabolic syndrome components, mean number of metabolic syndrome components, and amount of weight loss achieved. Twenty-eight RCTs (6372 patients) were included. Eight RCTs demonstrated improvement in metabolic syndrome risk factors after 1 year. Team-based, interactive approaches with high-frequency contact with patients who are motivated made the largest and most lasting impact. Technology was found to be a useful tool in achieving lifestyle change, but ineffective when compared with personal contact. Patient motivation leading to improved lifestyle adherence is a key factor in achieving reduction in metabolic syndrome components. These elements can be enhanced via frequent encounters with the health care system. Use of technologies such as mobile and Internet-based communication can increase the effectiveness of lifestyle change in metabolic syndrome, but should not replace personal contact as the cornerstone of therapy. Our ability to derive quantitative conclusions is limited by inconsistent outcome measures across studies, low power and homogeneity of individual studies, largely motivated study populations, short follow-up periods, loss to follow-up, and lack of or incomplete blinding. Copyright © 2014 Elsevier Inc. All rights reserved.

Prior to Conception: The Role of an Acupuncture Protocol in Improving Women's Reproductive Functioning Assessed by a Pilot Pragmatic Randomised Controlled Trial

PubMed Central

Cochrane, Suzanne; Smith, Caroline A.; Possamai-Inesedy, Alphia; Bensoussan, Alan

2016-01-01

The global average of couples with fertility problems is 9%. Assisted reproductive technologies are often inaccessible. Evidence points to acupuncture offering an opportunity to promote natural fertility. This study asked whether providing a multiphasic fertility acupuncture protocol to women with sub/infertility would increase their awareness of fertility and achieve normalisation of their menstrual cycle compared with a lifestyle control. In a pragmatic randomised controlled trial sub/infertile women were offered an intervention of acupuncture and lifestyle modification or lifestyle modification only. There was a statistically significant increase in fertility awareness in the acupuncture group (86.4%, 19) compared to 40% (n = 8) of the lifestyle only participants (Relative Risk (RR) 2.38, 95% confidence interval (CI) of 1.25, 4.50), with an adjusted p value of 0.011. Changes in menstrual regularity were not statistically significant. There was no statistical difference in the pregnancy rate with seven women (adjusted p = 0.992) achieving pregnancy during the course of the study intervention. Those receiving the acupuncture conceived within an average of 5.5 weeks compared to 10.67 weeks for the lifestyle only group (p = 0.422). The acupuncture protocol tested influenced women who received it compared to women who used lifestyle modification alone: their fertility awareness and wellbeing increased, and those who conceived did so in half the time. PMID:27242910

Effect of Lifestyle Modification Using a Smartphone Application on Obesity With Obstructive Sleep Apnea: A Short-term, Randomized Controlled Study.

PubMed

Cho, Sung-Woo; Wee, Jee Hye; Yoo, Sooyoung; Heo, Eunyoung; Ryu, Borim; Kim, Yoojung; Lee, Joong Seek; Kim, Jeong-Whun

2018-01-30

To investigate the short-term effects of a lifestyle modification intervention based on a mobile application (app) linked to a hospital electronic medical record (EMR) system on weight reduction and obstructive sleep apnea (OSA). We prospectively enrolled adults (aged >20 years) with witnessed snoring or sleep apnea from a sleep clinic. The patients were randomized into the app user (n=24) and control (n=23) groups. The mobile app was designed to collect daily lifestyle data by wearing a wrist activity tracker and reporting dietary intake. A summary of the lifestyle data was displayed on the hospital EMR and was reviewed. In the control group, the lifestyle modification was performed as per usual practice. All participants underwent peripheral arterial tonometry (WatchPAT) and body mass index (BMI) measurements at baseline and after 4 weeks of follow-up. Age and BMI did not differ significantly between the two groups. While we observed a significant decrease in the BMI of both groups, the decrease was greater in the app user group (P <0.001). Apnea-hypopnea index, respiratory distress index, and oxygenation distress index did not change significantly in both groups. However, the proportion of sleep spent snoring at >45 dB was significantly improved in the app user group alone (P =0.014). In either group, among the participants with successful weight reduction, the apnea-hypopnea index was significantly reduced after 4 weeks (P =0.015). Multiple regression analyses showed that a reduction in the apnea-hypopnea index was significantly associated with BMI. Although a short-term lifestyle modification approach using a mobile app was more effective in achieving weight reduction, improvement in OSA was not so significant. Long-term efficacy of this mobile app should be evaluated in the future studies.

Stage of Change and Motivation to a Healthier Lifestyle before and after an Intensive Lifestyle Intervention.

PubMed

Livia, Buratta; Elisa, Reginato; Claudia, Ranucci; Roberto, Pippi; Cristina, Aiello; Emilia, Sbroma Tomaro; Chiara, Perrone; Alberto, Tirimagni; Angelo, Russo; Pierpaolo, De Feo; Claudia, Mazzeschi

2016-01-01

Lifestyle modification programs are different but typically include both nutritional aspects and physical activity as main domains with different behavioral and/or psychological strategies designed to affect change. A fundamental role in modifying unhealthy habits is played by personal motivation for change. The present study sought to investigate, in a group of 100 overweight/obese outpatients with and/or without TMD2, treatment seeking, the effect of an intensive lifestyle program on medical measures and motivational profile for physical activity (PA) and healthy nutrition (NUTR). Subjects participated in an intensive multidisciplinary lifestyle intervention at C.U.R.I.A.MO. Before and after the intervention, patients received a comprehensive evaluation of their clinical, anthropometric, and metabolic states and motivation to lifestyle changes. Data showed differences before and after intervention in both medical and motivational measures. Before the intervention patients reported to be ready, open, and determined to change and gave importance to healthy habits. After the intervention patients continued to be determined but increased the actions toward the change showing a higher degree of maintenance and of acquisition of habits especially in the physical domain of the new lifestyle. Data support the notion that the motivation should be followed during all the lifestyle interventions to support the change on both domains of the lifestyle program.

[Effects of a coaching program on comprehensive lifestyle modification for women with gestational diabetes mellitus].

PubMed

Ko, Jung Mi; Lee, Jong Kyung

2014-12-01

The purpose of this study was to investigate the effects of using a Coaching Program on Comprehensive Lifestyle Modification with pregnant women who have gestational diabetes. The research design for this study was a non-equivalent control group quasi-experimental study. Pregnant women with gestational diabetes were recruited from D women's hospital located in Gyeonggi Province from April to October, 2013. Participants in this study were 34 for the control group and 34 for the experimental group. The experimental group participated in the Coaching Program on Comprehensive Lifestyle Modification. The program consisted of education, small group coaching and telephone coaching over 4weeks. Statistical analysis was performed using the SPSS 21.0 program. There were significant improvements in self-care behavior, and decreases in depression, fasting blood sugar and HbA1C in the experimental group compared to the control group. However, no significant differences were found between the two groups for knowledge of gestational diabetes mellitus. The Coaching Program on Comprehensive Lifestyle Modification used in this study was found to be effective in improving self-care behavior and reducing depression, fasting blood sugar and HbA1C, and is recommended for use in clinical practice as an effective nursing intervention for pregnant women with gestational diabetes.

An Overview of Factors Associated with Adherence to Lifestyle Modification Programs for Weight Management in Adults

PubMed Central

Chan, Ruth S. M.; Sea, Mandy M. M.

2017-01-01

This review aims to provide an overview of the factors associated with adherence reported in existing literature on lifestyle modification programs for weight management among the adult population. An electronic search was performed using PubMed, Medline, PsycINFO and PsycARTICLE to identify studies that examined the factors of adherence to lifestyle modification programs with explicit definition of adherence indicators. We identified 19 studies published between 2004 and 2016. The most commonly used indicator of adherence was attrition, followed by attendance, self-monitoring and dietary adherence. A broad array of factors has been studied but only few studies exploring each factor. Limited evidence suggested older age, higher education, healthier eating and physical activity behaviours, higher stage of change at baseline and higher initial weight loss may predict better adherence. On the other hand, having depression, stress, strong body shape concern, more previous weight loss attempts and being unemployed may predict poor adherence. Inconsistent findings were obtained for self-efficacy, motivation and male gender. This review highlights the need for more rigorous studies to enhance our knowledge on factors related to adherence. Identification of the factors of adherence could provide important implication for program improvement, ultimately improving the effectiveness and the cost-effectiveness of lifestyle modification program. PMID:28813030

Implementation of psychiatric-focused lifestyle medicine programs in Asia.

PubMed

Sarris, Jerome; Nishi, Daisuke; Xiang, Yu-Tao; Su, Kuan-Pin; Bannatyne, Amy; Oliver, Georgina; Kua, Ee-Heok; Ng, Chee Hong

2015-12-01

Lifestyle-focused health programs are growing in interest throughout Western society, and a range of lifestyle factors are known to enhance both physical and mental health. However, it remains largely unknown as to whether this approach is salient for the Asian context. The major components of integrative lifestyle-focused health programs to enhance mental and physical health are considered to include the evidence-based adoption of physical activity and exercise, dietary modification, general psychoeducation, adequate relaxation/sleep and social interaction, use of mindfulness techniques, the reduction of substance use, attention of intersecting environmental factors, and the potential use of motivation and goal-setting techniques. This paper outlines an overview of the evidence underpinning these elements, and discusses potential barriers and challenges, and what logistical considerations may need to be addressed in the implementation of such programs within the context of Asian cultures. © 2015 Wiley Publishing Asia Pty Ltd.

Efficacy of dietary behavior modification for preserving cardiovascular health and longevity.

PubMed

Pryde, Moira McAllister; Kannel, William Bernard

2010-12-28

Cardiovascular disease (CVD) and its predisposing risk factors are major lifestyle and behavioral determinants of longevity. Dietary lifestyle choices such as a heart healthy diet, regular exercise, a lean weight, moderate alcohol consumption, and smoking cessation have been shown to substantially reduce CVD and increase longevity. Recent research has shown that men and women who adhere to this lifestyle can substantially reduce their risk of coronary heart disease (CHD). The preventive benefits of maintaining a healthy lifestyle exceed those reported for using medication and procedures. Among the modifiable preventive measures, diet is of paramount importance, and recent data suggest some misconceptions and uncertainties that require reconsideration. These include commonly accepted recommendations about polyunsaturated fat intake, processed meat consumption, fish choices and preparation, transfatty acids, low carbohydrate diets, egg consumption, coffee, added sugar, soft drink beverages, glycemic load, chocolate, orange juice, nut consumption, vitamin D supplements, food portion size, and alcohol.

Improvement in Quality of Life Questionnaire Measures (PCOSQ) in Obese Adolescent Females with PCOS treated with Lifestyle Changes and Oral Contraceptives, with or without Metformin

PubMed Central

Harris-Glocker, Miranda; Davidson, Kristin; Kochman, Lynda; Guzick, David; Hoeger, Kathleen

2013-01-01

We studied the effect of metformin or placebo in a lifestyle modification program (LSM) combined with oral contraceptives (OC) on quality of life parameters measured by the PCOS questionnaire (PCOSQ) in obese adolescent women with validated PCOS. The quality of life indicators were measured at baseline and conclusion for 5 domains on the PCOSQ, with equal improvement in scores in both placebo and Metformin groups, suggesting metformin addition does not add improvement to quality of life measures above those observed with lifestyle modification and oral contraceptive treatment. PMID:19781696

Effectiveness of Treatment Modalities on Kidney Stone Recurrence.

PubMed

Zisman, Anna L

2017-10-06

Nephrolithiasis is highly prevalent across all demographic groups in the Western world and beyond, and its incidence rates are rising. In addition to the morbidity of the acute event, stone disease often becomes a lifelong problem that requires preventative therapy to diminish ongoing morbidity. Across the majority of stone types, increased fluid intake and targeted dietary modifications are mainstays of therapy. Specific dietary interventions associated with reduced calcium stone risk include adequate dietary calcium intake and restriction of sodium, protein, and oxalate intake, among others. Pharmaceutical therapy may be required if lifestyle changes are insufficient to minimize risk of stone recurrence, and must be targeted to the specific metabolic abnormalities portending risk for a given patient. Therapeutic options for idiopathic calcium stone disease include thiazides, citrate salts, and uric acid-lowering agents. Alkali salts are also the treatment of choice for uric acid stone disease. Management of struvite stone disease is largely surgical, but acetohydroxamic acid is a proven second line therapy. Cystinuria requires lifestyle modifications and may call for thiol-binding agents. Significant heterogeneity of the clinical population with stone disease has previously limited opportunities for large randomized controlled trials. However, as clinical phenotypes and genotypes are increasingly clarified, there are mounting opportunities for targeted randomized controlled trials in stone prevention. In the meantime, the currently available evidence for both lifestyle and pharmacologic interventions is reviewed herein. Copyright © 2017 by the American Society of Nephrology.

Lifestyle Intervention Is Associated With Lower Prevalence of Urinary Incontinence

PubMed Central

Brown, Jeanette S.; Wing, Rena; Barrett-Connor, Elizabeth; Nyberg, Leroy M.; Kusek, John W.; Orchard, Trevor J.; Ma, Yong; Vittinghoff, Eric; Kanaya, Alka M.

2006-01-01

OBJECTIVE Diabetes is associated with increased urinary incontinence risk. Weight loss improves incontinence, but exercise may worsen this condition. We examined whether an intensive lifestyle intervention or metformin therapy among overweight pre-diabetic women was associated with a lower prevalence of incontinence. RESEARCH DESIGN AND METHODS We analyzed data from the Diabetes Prevention Program, a randomized controlled trial in 27 U.S. centers. Of the 1,957 women included in this analysis, 660(34%) were randomized to intensive lifestyle therapy, 636(32%) to metformin, and 661 (34%) to placebo with standard lifestyle advice. The main outcome measure was incontinence symptoms by frequency and type by a validated questionnaire completed at the end-of-trial visit (mean 2.9 years). RESULTS The prevalence of total (stress or urge) weekly incontinence was lower among women in the intensive lifestyle group (38.3%) than those randomized to metformin (48.1%) or placebo (45.7%). This difference was most apparent among women with stress incontinence (31.3% for intensive lifestyle group vs. 39.7% for metformin vs. 36.7% for placebo, P = 0.006). Changes in weight accounted for most of the protective effect of the intensive lifestyle intervention on stress incontinence. CONCLUSIONS Less-frequent urinary incontinence may be a powerful motivator for women to choose lifestyle modification to prevent diabetes. PMID:16443892

Intensive cardiovascular risk reduction induces sustainable changes in expression of genes and pathways important to vascular function.

PubMed

Ellsworth, Darrell L; Croft, Daniel T; Weyandt, Jamie; Sturtz, Lori A; Blackburn, Heather L; Burke, Amy; Haberkorn, Mary Jane; McDyer, Fionnuala A; Jellema, Gera L; van Laar, Ryan; Mamula, Kimberly A; Chen, Yaqin; Vernalis, Marina N

2014-04-01

Healthy lifestyle changes are thought to mediate cardiovascular disease risk through pathways affecting endothelial function and progression of atherosclerosis; however, the extent, persistence, and clinical significance of molecular change during lifestyle modification are not well known. We examined the effect of a rigorous cardiovascular disease risk reduction program on peripheral blood gene expression profiles in 63 participants and 63 matched controls to characterize molecular responses and identify regulatory pathways important to cardiovascular health. Dramatic changes in dietary fat intake (-61%; P<0.001 versus controls) and physical fitness (+34%; P<0.001) led to significant improvements in cardiovascular disease risk factors. Analysis of variance with false discovery rate correction for multiple testing (P<0.05) identified 26 genes after 12 weeks and 143 genes after 52 weeks that were differentially expressed from baseline in participants. Controls showed little change in cardiovascular disease risk factors or gene expression. Quantitative reverse transcription polymerase chain reaction validated differential expression for selected transcripts. Lifestyle modification effectively reduced expression of proinflammatory genes associated with neutrophil activation and molecular pathways important to vascular function, including cytokine production, carbohydrate metabolism, and steroid hormones. Prescription medications did not significantly affect changes in gene expression. Successful and sustained modulation of gene expression through lifestyle changes may have beneficial effects on the vascular system not apparent from traditional risk factors. Healthy lifestyles may restore homeostasis to the leukocyte transcriptome by downregulating lactoferrin and other genes important in the pathogenesis of atherosclerosis. Clinical Trial Registration- URL: www.clinicaltrials.gov. Unique identifier: NCT01805492.

Lifestyle medicine for depression

PubMed Central

2014-01-01

The prevalence of depression appears to have increased over the past three decades. While this may be an artefact of diagnostic practices, it is likely that there are factors about modernity that are contributing to this rise. There is now compelling evidence that a range of lifestyle factors are involved in the pathogenesis of depression. Many of these factors can potentially be modified, yet they receive little consideration in the contemporary treatment of depression, where medication and psychological intervention remain the first line treatments. “Lifestyle Medicine” provides a nexus between public health promotion and clinical treatments, involving the application of environmental, behavioural, and psychological principles to enhance physical and mental wellbeing. This may also provide opportunities for general health promotion and potential prevention of depression. In this paper we provide a narrative discussion of the major components of Lifestyle Medicine, consisting of the evidence-based adoption of physical activity or exercise, dietary modification, adequate relaxation/sleep and social interaction, use of mindfulness-based meditation techniques, and the reduction of recreational substances such as nicotine, drugs, and alcohol. We also discuss other potential lifestyle factors that have a more nascent evidence base, such as environmental issues (e.g. urbanisation, and exposure to air, water, noise, and chemical pollution), and the increasing human interface with technology. Clinical considerations are also outlined. While data supports that some of these individual elements are modifiers of overall mental health, and in many cases depression, rigorous research needs to address the long-term application of Lifestyle Medicine for depression prevention and management. Critically, studies exploring lifestyle modification involving multiple lifestyle elements are needed. While the judicious use of medication and psychological techniques are still advocated, due to the complexity of human illness/wellbeing, the emerging evidence encourages a more integrative approach for depression, and an acknowledgment that lifestyle modification should be a routine part of treatment and preventative efforts. PMID:24721040

Multi-component access to a community-based weight loss program: 12 week results

USDA-ARS?s Scientific Manuscript database

The current study examined weight loss between a comprehensive lifestyle modification program (Weight Watchers PointsPlus program) that included three ways to access and a self-help (SH) condition. A total of 293 participants were randomized to either a Weight Watchers condition (WW) (n=148) or a SH...

Effectiveness of motivational interviewing on lifestyle modification and health outcomes of clients at risk or diagnosed with cardiovascular diseases: A systematic review.

PubMed

Lee, Windy W M; Choi, K C; Yum, Royce W Y; Yu, Doris S F; Chair, S Y

2016-01-01

Clinically, there is an increasing trend in using motivational interviewing as a counseling method to help clients with cardiovascular diseases to modify their unhealthy lifestyle in order to decrease the risk of disease occurrence. As motivational interviewing has gained increased attention, research has been conducted to examine its effectiveness. This review attempts to identify the best available evidence related to the effectiveness of motivational interviewing on lifestyle modification, physiological and psychological outcomes for clients at risk of developing or with established cardiovascular diseases. Systematic review of studies incorporating motivational interviewing in modifying lifestyles, improving physiological and psychological outcomes for clients at risk of or diagnosed with cardiovascular diseases. Major English and Chinese electronic databases were searched to identify citations that reported the effectiveness of motivational interviewing. The searched databases included MEDLINE, British Nursing Index, CINAHL Plus, PsycINFO, SCOPUS, CJN, CBM, HyRead, WanFang Data, Digital Dissertation Consortium, and so on. Two reviewers independently assessed the relevance of citations based on the inclusion criteria. Full texts of potential citations were retrieved for more detailed review. Critical appraisal was conducted by using the standardized critical appraisal checklist for randomized and quasi-randomized controlled studies from the Joanna Briggs Institute - Meta Analysis of Statistics Assessment and Review Instrument (JBI-MAStaRI). After eligibility screening, 14 articles describing 9 studies satisfied the inclusion criteria and were included in the analysis. Only certain outcomes in certain studies were pooled for meta-analysis because of the large variability of the studies included, other findings were presented in narrative form. For lifestyle modification, the review showed that motivational interviewing could be more effective than usual care on altering smoking habits. For physiological outcomes, the review showed that motivational interviewing positively improved client's systolic and diastolic blood pressures but the result was not significant. For psychological outcomes, the review showed that motivational interviewing might have favorable effect on improving clients' depression. For other outcomes, the review showed that motivational interviewing did not differ from usual care or usual care was even more effective. The review showed that motivational interviewing might have favorable effects on changing clients' smoking habits, depression, and three SF-36 domains. For the other outcomes, most of the results were inconclusive. Further studies should be performed to identify the optimal format and frequency of motivational interviewing. Primary research on the effectiveness of motivational interviewing on increasing clients' motivation and their actual changes in healthy behavior is also recommended. Copyright © 2015 Elsevier Ltd. All rights reserved.

Stage of Change and Motivation to a Healthier Lifestyle before and after an Intensive Lifestyle Intervention

PubMed Central

Livia, Buratta; Elisa, Reginato; Claudia, Ranucci; Roberto, Pippi; Cristina, Aiello; Emilia, Sbroma Tomaro; Chiara, Perrone; Alberto, Tirimagni; Angelo, Russo; Pierpaolo, De Feo; Claudia, Mazzeschi

2016-01-01

Objective. Lifestyle modification programs are different but typically include both nutritional aspects and physical activity as main domains with different behavioral and/or psychological strategies designed to affect change. A fundamental role in modifying unhealthy habits is played by personal motivation for change. The present study sought to investigate, in a group of 100 overweight/obese outpatients with and/or without TMD2, treatment seeking, the effect of an intensive lifestyle program on medical measures and motivational profile for physical activity (PA) and healthy nutrition (NUTR). Method. Subjects participated in an intensive multidisciplinary lifestyle intervention at C.U.R.I.A.MO. Before and after the intervention, patients received a comprehensive evaluation of their clinical, anthropometric, and metabolic states and motivation to lifestyle changes. Results. Data showed differences before and after intervention in both medical and motivational measures. Before the intervention patients reported to be ready, open, and determined to change and gave importance to healthy habits. After the intervention patients continued to be determined but increased the actions toward the change showing a higher degree of maintenance and of acquisition of habits especially in the physical domain of the new lifestyle. Conclusion. Data support the notion that the motivation should be followed during all the lifestyle interventions to support the change on both domains of the lifestyle program. PMID:27239339

Current nutritional treatments of obesity.

PubMed

Greenwald, Ashli

2006-01-01

Obesity in our country is a growing concern. There are several different options for weight loss; however, individuals must be self-motivated and amendable to change in order to achieve success with their weight loss goals. Several strategies used by professionals in the US today to treat overweight and obesity, include diet therapy, exercise, behavior modification, pharmacotherapy, and surgery. The focus of the American Dietetic Association (ADA) Weight Management Position Statement is no longer just on weight loss but now on weight management. Reaching one's ideal body weight is recommended but not often realistic. Frequently, the goal of treatment shifts to maintenance of ones current weight or attempts at moderate weight loss. Lifestyle modification or behavioral modification interventions rely on analyzing behavior to identify events that are associated with appropriate vs. inappropriate eating, exercise, or thinking habits. Certain primary strategies that have been found to be useful for helping people change their behaviors so that they can lose weight and maintain their weight loss, include self-monitoring, stimulus control, cognitive restructuring, stress management, social support, physical activity, and relapse prevention. Weight loss programs should strive to combine a nutritionally balanced dietary regimen with exercise and lifestyle modifications at the lowest possible cost. There are several different methods used for dietary modifications; low calorie diets, very low calorie diets, fasting, formula diets and meal replacement programs, and popular diets. Bariatric surgery is gaining popularity as it has been an effective way to treat obesity. Following gastric bypass surgery, the patients must be prepared to modify their eating behaviors and dietary selections to assist with weight loss and prevent potential complications. Patients should be educated on the dietary guidelines extensively prior to surgery and again post-operatively.

Effects of exercise and lifestyle modification on fitness, insulin resistance, skeletal muscle oxidative phosphorylation and intramyocellular lipid content in obese children and adolescents.

PubMed

McCormack, S E; McCarthy, M A; Harrington, S G; Farilla, L; Hrovat, M I; Systrom, D M; Thomas, B J; Torriani, M; McInnis, K; Grinspoon, S K; Fleischman, A

2014-08-01

Obesity is associated with poor fitness and adverse metabolic consequences in children. To investigate how exercise and lifestyle modification may improve fitness and insulin sensitivity in this population. Randomized controlled trial, 21 obese (body mass index ≥ 95% percentile) subjects, ages 10 to 17 years. Subjects were given standardized healthful lifestyle advice for 8 weeks. In addition, they were randomized to an in-home supervised exercise intervention (n = 10) or control group (n = 11). Fasting laboratory studies (insulin, glucose, lipid profile) and assessments of fitness, body composition, skeletal muscle oxidative phosphorylation and intramyocellular lipid content (IMCL), were performed at baseline and study completion. Subjects were 13.0 ± 1.9 (standard deviation) years old, 72% female and 44% non-white. Exercise improved fitness (P = 0.03) and power (P = 0.01), and increased IMCL (P = 0.02). HOMA-IR decreased among all subjects in response to lifestyle modification advice (P = 0.01), regardless of exercise training assignment. In univariate analysis in all subjects, change in cardiovascular fitness was associated with change in HOMA-IR. In exploratory analyses, increased IMCL was associated with greater resting energy expenditure (r = 0.78, P = 0.005) and a decrease in fasting respiratory quotient (r = -0.70, P = 0.02) (n = 11). Change in fitness was found to be related to change in insulin resistance in response to lifestyle modification and exercise in obese children. IMCL increased with exercise in these obese children, which may reflect greater muscle lipid oxidative capacity. © 2013 The Authors. Pediatric Obesity © 2013 International Association for the Study of Obesity.

Computer-supported indirect-form lifestyle-modification support program using Lifestyle Intervention Support Software for Diabetes Prevention (LISS-DP) for people with a family history of type 2 diabetes in a medical checkup setting: a randomized controlled trial.

PubMed

Tokunaga-Nakawatase, Yuri; Nishigaki, Masakazu; Taru, Chiemi; Miyawaki, Ikuko; Nishida, Junko; Kosaka, Shiho; Sanada, Hiromi; Kazuma, Keiko

2014-10-01

To investigate the effect of a computer-supported indirect-form lifestyle-modification program using Lifestyle Intervention Support Software for Diabetes Prevention (LISS-DP), as a clinically feasible strategy for primary prevention, on diet and physical activity habits in adults with a family history of type 2 diabetes. This was a two-arm, randomized controlled trial: (1) lifestyle intervention (LI) group (n=70); (2) control (n=71). Healthy adults aged 30-60 years with a history of type 2 diabetes among their first-degree relatives were recruited. LI group received three times of lifestyle intervention using LISS-DP during six-month intervention period via mail. Lifestyle intervention group showed significantly greater decrease in energy intake six months after baseline, compared to control (-118.31 and -24.79 kcal/day, respectively, p=0.0099, Cohen's d=0.22), though the difference disappeared 1 year after from baseline. No difference was found in physical activity energy expenditure. A computer-based, non-face-to-face lifestyle intervention was effective on dietary habits, only during the intervention period. Further examination of the long-term effects of such intervention and physical activity is required. Copyright © 2014 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.

Metabolic Syndrome: Insulin Resistance and Prediabetes.

PubMed

Mayans, Laura

2015-08-01

Metabolic syndrome is a cluster of conditions that synergistically increase the risk of cardiovascular disease, type 2 diabetes, and premature mortality. The components are abdominal obesity, impaired glucose metabolism, dyslipidemia, and hypertension. Prediabetes, which is a combination of excess body fat and insulin resistance, is considered an underlying etiology of metabolic syndrome. Prediabetes manifests as impaired fasting glucose and/or impaired glucose tolerance. Impaired fasting glucose is defined as a fasting blood glucose level of 100 to 125 mg/dL; impaired glucose tolerance requires a blood glucose level of 140 to 199 mg/dL 2 hours after a 75-g oral intake of glucose. In patients with prediabetes, the rate of progression to diabetes within 3 years can be decreased by approximately 58% with lifestyle modifications. These include weight loss through exercise (30 minutes or more of moderate physical activity on most, preferably all, days of the week) and dietary modifications. Recommended diets are high in fruits, vegetables, whole grains, and fish. Consumption of sweetened beverages, including diet soda, should be avoided. For patients who do not achieve goals with lifestyle modifications, metformin can be considered. Weight loss drugs and bariatric surgery are appropriate for select patients. Hypertension and dyslipidemia should be managed according to current guidelines. Written permission from the American Academy of Family Physicians is required for reproduction of this material in whole or in part in any form or medium.

Lifestyle medicine consulting walking meetings for sustained weight loss

PubMed Central

Frates, Elizabeth Pegg; Crane, Margaret E

2016-01-01

With rates of obesity and diabetes rising worldwide, effective ways of managing weight are becoming more important. We present the case study of a middle-aged Caucasian-American woman (body mass index (BMI) 27.8, overweight category) who wanted to lose weight. The patient participated in a behaviour modification programme with a physician trained in lifestyle medicine as well as health and wellness coaching. After the 14-week programme, which included 9, 1 h long walking sessions with the clinician, the patient lost 11 Ibs (BMI 24.7, normal category). The programme included a combination of increasing physical activity, eating appropriate quantities of healthy foods, goal setting and a positive attitude. The patient has kept her BMI at or below 24.1 for over 2 years. This case demonstrates a novel approach to weight loss management—walking therapeutic sessions—and also outlines critical components of lifestyle medicine counselling that facilitate the process of sustainable weight loss and lasting change. PMID:26833954

Determinants of Physical Activity in Adolescents and Young Adults: The Basis for High School and College Physical Education To Promote Active Lifestyles.

ERIC Educational Resources Information Center

Nahas, Markus V.; Goldfine, Bernie; Collins, Mitchell A.

2003-01-01

Reviews factors that influence high school and college students' physical activity adoption and/or maintenance based on recent behavioral research. Relevant determinants of physical activity include self-efficacy, intentions, perceived barriers, enjoyment, stages of change, and social support. Suggestions for behavior modifications to increase…

Benefit of Delayed Fertility Therapy With Preconception Weight Loss Over Immediate Therapy in Obese Women With PCOS

PubMed Central

Dodson, William C.; Kunselman, Allen R.; Stetter, Christy M.; Kris-Etherton, Penny M.; Williams, Nancy I.; Gnatuk, Carol L.; Estes, Stephanie J.; Allison, Kelly C.; Sarwer, David B.; Diamond, Michael P.; Schlaff, William D.; Casson, Peter R.; Christman, Gregory M.; Barnhart, Kurt T.; Bates, G. Wright; Usadi, Rebecca; Lucidi, Scott; Baker, Valerie; Zhang, Heping; Eisenberg, Esther; Coutifaris, Christos; Dokras, Anuja

2016-01-01

Context: In overweight/obese women with polycystic ovary syndrome (PCOS), the relative benefit of delaying infertility treatment to lose weight vs seeking immediate treatment is unknown. Objective: We compared the results of two, multicenter, concurrent clinical trials treating infertility in women with PCOS. Design, Setting, and Participants: This was a secondary analysis of two randomized trials conducted at academic health centers studying women 18–40 years of age who were overweight/obese and infertile with PCOS. Intervention: We compared immediate treatment with clomiphene from the Pregnancy in Polycystic Ovary Syndrome II (PPCOS II) trial (N = 187) to delayed treatment with clomiphene after preconception treatment with continuous oral contraceptives, lifestyle modification (Lifestyle: including caloric restriction, antiobesity medication, behavioral modification, and exercise) or the combination of both (combined) from the Treatment of Hyperandrogenism Versus Insulin Resistance in Infertile Polycystic Ovary Syndrome (OWL PCOS) trial (N = 142). Main Outcome Measures: Live birth, pregnancy loss, and ovulation were measured. Results: In PPCOS II, after four cycles of clomiphene, the cumulative per-cycle ovulation rate was 44.7% (277/619) and the cumulative live birth rate was 10.2% (19/187), nearly identical to that after oral contraceptive pretreatment in the OWL PCOS trial (ovulation 45% [67/149] and live birth: 8.5% [4/47]). In comparison, deferred clomiphene treatment preceded by lifestyle and combined treatment in OWL PCOS offered a significantly better cumulative ovulation rate compared to immediate treatment with clomiphene. (Lifestyle: 62.0% [80/129]; risk ratio compared to PPCOS II = 1.4; 95% confidence interval [CI], 1.1–1.7; P = .003; combined: 64.3% [83/129]; risk ratio compared to PPCOS II = 1.4; 95% CI, 1.2–1.8; P < .001 and a significantly better live birth rate lifestyle: 25.0% [12/48]; risk ratio compared to PPCOS II = 2.5; 95% CI, 1.3–4.7; P = .01 and combined: 25.5% [12/47]; risk ratio compared to PPCOS II = 2.5; 95% CI, 1.3–4.8; P = .01). Conclusions: These data show the benefit of improved ovulation and live birth with delayed infertility treatment with clomiphene citrate when preceded by lifestyle modification with weight loss compared with immediate treatment. Pretreatment with oral contraceptives likely has little effect on the ovulation and live birth rate compared with immediate treatment. PMID:27172435

Benefit of Delayed Fertility Therapy With Preconception Weight Loss Over Immediate Therapy in Obese Women With PCOS.

PubMed

Legro, Richard S; Dodson, William C; Kunselman, Allen R; Stetter, Christy M; Kris-Etherton, Penny M; Williams, Nancy I; Gnatuk, Carol L; Estes, Stephanie J; Allison, Kelly C; Sarwer, David B; Diamond, Michael P; Schlaff, William D; Casson, Peter R; Christman, Gregory M; Barnhart, Kurt T; Bates, G Wright; Usadi, Rebecca; Lucidi, Scott; Baker, Valerie; Zhang, Heping; Eisenberg, Esther; Coutifaris, Christos; Dokras, Anuja

2016-07-01

In overweight/obese women with polycystic ovary syndrome (PCOS), the relative benefit of delaying infertility treatment to lose weight vs seeking immediate treatment is unknown. We compared the results of two, multicenter, concurrent clinical trials treating infertility in women with PCOS. This was a secondary analysis of two randomized trials conducted at academic health centers studying women 18-40 years of age who were overweight/obese and infertile with PCOS. We compared immediate treatment with clomiphene from the Pregnancy in Polycystic Ovary Syndrome II (PPCOS II) trial (N = 187) to delayed treatment with clomiphene after preconception treatment with continuous oral contraceptives, lifestyle modification (Lifestyle: including caloric restriction, antiobesity medication, behavioral modification, and exercise) or the combination of both (combined) from the Treatment of Hyperandrogenism Versus Insulin Resistance in Infertile Polycystic Ovary Syndrome (OWL PCOS) trial (N = 142). Live birth, pregnancy loss, and ovulation were measured. In PPCOS II, after four cycles of clomiphene, the cumulative per-cycle ovulation rate was 44.7% (277/619) and the cumulative live birth rate was 10.2% (19/187), nearly identical to that after oral contraceptive pretreatment in the OWL PCOS trial (ovulation 45% [67/149] and live birth: 8.5% [4/47]). In comparison, deferred clomiphene treatment preceded by lifestyle and combined treatment in OWL PCOS offered a significantly better cumulative ovulation rate compared to immediate treatment with clomiphene. (Lifestyle: 62.0% [80/129]; risk ratio compared to PPCOS II = 1.4; 95% confidence interval [CI], 1.1-1.7; P = .003; combined: 64.3% [83/129]; risk ratio compared to PPCOS II = 1.4; 95% CI, 1.2-1.8; P < .001 and a significantly better live birth rate lifestyle: 25.0% [12/48]; risk ratio compared to PPCOS II = 2.5; 95% CI, 1.3-4.7; P = .01 and combined: 25.5% [12/47]; risk ratio compared to PPCOS II = 2.5; 95% CI, 1.3-4.8; P = .01). These data show the benefit of improved ovulation and live birth with delayed infertility treatment with clomiphene citrate when preceded by lifestyle modification with weight loss compared with immediate treatment. Pretreatment with oral contraceptives likely has little effect on the ovulation and live birth rate compared with immediate treatment.

Multiple biological pathways link cognitive lifestyle to protection from dementia.

PubMed

Valenzuela, Michael J; Matthews, Fiona E; Brayne, Carol; Ince, Paul; Halliday, Glenda; Kril, Jillian J; Dalton, Marshall A; Richardson, Kathryn; Forster, Gill; Sachdev, Perminder S

2012-05-01

An active cognitive lifestyle is linked to diminished dementia risk, but the underlying mechanisms are poorly understood. Potential mechanisms include disease modification, neuroprotection, and compensation. Prospective, population-based brain series provide the rare opportunity to test the plausibility of these mechanisms in humans. Participants came from the United Kingdom Medical Research Council Cognitive Function and Ageing Study, comprising 13,004 individuals aged over 65 years and followed for 14 years. In study 1, a Cognitive Lifestyle Score (CLS) was computed on all Cognitive Function and Ageing Study subjects to define low, middle, and high groups. By August 2004, 329 individuals with CLS data had come to autopsy and underwent Consortium to Establish a Registry of Alzheimer's Disease assessment. Study 2 involved more detailed quantitative histology in the hippocampus and Brodmann area 9 in 72 clinically matched individuals with high and low CLS. CLS groups did not differ on several Alzheimer disease neuropathologic measures; however, high CLS men had less cerebrovascular disease after accounting for vascular risk factors, and women had greater brain weight. No group differences were evident in hippocampal neuronal density. In Brodmann area 9, cognitively active individuals had significantly greater neuronal density, as well as correlated increases in cortical thickness. An active cognitive lifestyle was associated with protection from cerebrovascular disease in men, but there was no evidence for Alzheimer disease modification or hippocampal neuroprotection. Men and women both exhibited neurotrophic changes in the prefrontal lobe linked to cognitive lifestyle, consistent with a compensatory process. Lifespan complex cognitive activity may therefore protect against dementia through multiple biological pathways. Copyright © 2012 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.

Cost analysis of PET and comprehensive lifestyle modification for the reversal of atherosclerosis.

PubMed

Delgado, Rigoberto I; Swint, J Michael; Lairson, David R; Johnson, Nils P; Gould, K Lance; Sdringola, Stefano

2014-01-01

We present a preliminary cost analysis of a combination intervention using PET and comprehensive lifestyle modification to reverse atherosclerosis. With a sensitivity of 92%-95% and specificity of 85%-95%, PET is an essential tool for high-precision diagnosis of coronary artery disease, accurately guiding optimal treatment for both symptomatic and asymptomatic patients. PET imaging provides a powerful visual and educational aid for helping patients identify and adopt appropriate treatments. However, little is known about the operational cost of using the technology for this purpose. The analysis was done in the context of the Century Health Study for Cardiovascular Medicine (Century Trial), a 1,300-patient, randomized study combining PET imaging with lifestyle changes. Our methodology included a microcosting and time study focusing on estimating average direct and indirect costs. The total cost of the Century Trial in present-value terms is $9.2 million, which is equal to $7,058 per patient. Sensitivity analysis indicates that the present value of total costs is likely to range between $8.8 and $9.7 million, which is equivalent to $6,655-$7,606 per patient. The clinical relevance of the Century Trial is significant since it is, to our knowledge, the first randomized controlled trial to combine high-precision imaging with lifestyle strategies. The Century Trial is in its second year of a 5-y protocol, and we present preliminary findings. The results of this cost study, however, provide policy makers with an early estimate of the costs of implementing, at large scale, a combined intervention such as the Century Trial. Further, we believe that imaging-guided lifestyle management may have considerable potential for improving outcomes and reducing health-care costs by eliminating unnecessary invasive procedures.

Improvement in quality-of-life questionnaire measures in obese adolescent females with polycystic ovary syndrome treated with lifestyle changes and oral contraceptives, with or without metformin.

PubMed

Harris-Glocker, Miranda; Davidson, Kristin; Kochman, Lynda; Guzick, David; Hoeger, Kathleen

2010-02-01

We studied the effect of metformin or placebo in a lifestyle modification program combined with oral contraceptives (OC) on quality-of-life parameters measured by the polycystic ovary syndrome (PCOS) questionnaire in obese adolescent women with validated PCOS. The quality-of-life indicators were measured at baseline and conclusion for five domains on the PCOS questionnaire, with equal improvement in scores in both placebo and metformin groups, suggesting that the addition of metformin does not add improvement to quality-of-life measures above those observed with lifestyle modification and OC treatment. Copyright 2010 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

Novel approaches for the promotion of physical activity and exercise for prevention and management of type 2 diabetes.

PubMed

Arena, R; Sagner, M; Byrne, N M; Williams, A D; McNeil, A; Street, S J; Hills, A P

2017-07-01

Despite increased evidence for the importance of lifestyle modification, physical activity and diet in diabetes prevention and management, habitual physical activity levels have declined in recent decades in China and India. Further, other risk factors for type 2 diabetes, including overweight, obesity and physical inactivity, have also worsened. Here we present evidence for the importance of physical activity and exercise in the amelioration of type 2 diabetes and propose a novel approach to address the challenge of improving lifestyle behaviors in China and India-Movement is Medicine and a P4 (predictive, preventive, personalized and participatory) approach.

Short-term effects of an intensive lifestyle modification program on lipid peroxidation and antioxidant systems in patients with coronary artery disease.

PubMed

Jatuporn, Srisakul; Sangwatanaroj, Somkiat; Saengsiri, Aem-Orn; Rattanapruks, Sopida; Srimahachota, Suphot; Uthayachalerm, Wasan; Kuanoon, Wanpen; Panpakdee, Orasa; Tangkijvanich, Pisit; Tosukhowong, Piyaratana

2003-01-01

The purpose of this study was to compare the short-term effects of an intensive lifestyle modification (ILM) program on lipid peroxidation and antioxidant systems in patients with coronary artery disease (CAD). Twenty-two patients in the control group continued to receive their conventional treatment with lipid-lowering drugs, whereas 22 patients in the experimental group were assigned to intensive lifestyle modification (ILM) without taking any lipid-lowering agent. The ILM program comprised dietary advice on low-fat diets, high antioxidants and high fiber intakes, yoga exercise, stress management and smoking cessation. After 4 months of intervention, patients in the experimental group revealed a statistically significant increase in plasma total antioxidants, plasma vitamin E and erythrocyte glutathione (GSH) compared to patients in the control group. There was no significant change in plasma malondialdehyde (MDA), a circulating product of lipid peroxidation, in either group. We concluded that the ILM program increased circulating antioxidants and reduced oxidative stress in patients with CAD.

Frequency of different lifestyle modification measures among patients with GERD based on monthly income.

PubMed

Chen, Philumena; Khan, Mahnoor Saeed; Naseem, Sajida

2017-11-01

A cross-sectional study was carried out at Shifa International Hospital Islamabad over a period of 6 months, to determine the frequency and compare the different lifestyle modifications among patients with Gastroesophageal Reflux Disease (GERD) of different monthly income groups. Two hundred patients of GERD were enrolled in the study and divided into two groups based on monthly income less than and more than Rs. 30,000 respectively. Data was analyzed using SPSS 21. Descriptive statistics were calculated. Chi-square test was applied keeping p-value <0.05. Mean age was 40±13 years, 82 (41%) males and 118 (59%) females. Walking was undertaken by 32% after meals and 87.5% consumed tea. Significant difference was seen between income groups and higher intake of fried and spicy foods respectively. Thus, effort needs to be made in creating awareness and counseling patients to practice lifestyle modifications to reduce GERD symptoms and stop sole reliance on medications.

Diabetes mellitus prevention.

PubMed

Allende-Vigo, Myriam Zaydee

2015-01-01

The aim of this study was to review lifestyle modification interventions and pharmacological clinical studies designed to prevent diabetes and provide evidence-based recommendations for the prevention of Diabetes Mellitus. A review of relevant literature compiled via a literature search (PUBMED) of English-language publications between 1997 and 2010 was conducted. It is found that people at increased risk of developing type 2 diabetes mellitus can halt the development of the disease. Lifestyle modification intervention with reduction of 5%-10% of excess body weight and increase in moderate physical activity by 150 min/wk has consistently proven to reduce the appearance of diabetes in different at-risk populations. Pharmacologic interventions have also demonstrated the prevention of the appearance of diabetes in persons at risk. Bariatric surgery has decreased the appearance of diabetes patients in a select group of individuals. The progression from prediabetes to diabetes mellitus can be prevented. Lifestyle modification intervention changes with weight loss and increased physical activity are currently recommended for the prevention of diabetes.

Management of dyslipidemia in women in the post-hormone therapy era.

PubMed

Mosca, Lori

2005-03-01

Cardiovascular disease (CVD) is the leading cause of death for women in the United States and is largely preventable. The American Heart Association has recently released evidence-based guidelines for the prevention of CVD in women; these include gender-specific recommendations for the management of dyslipidemia. This article reviews these recommendations and the evidence supporting them. This was a qualitative review of a systematic literature search related to lipid guidelines for women and discussion of rationale and evidence for new clinical recommendations. Lifestyle modifications are the cornerstone of lipid management. Substantial evidence from randomized clinical trials supports the use of low-density lipoprotein cholesterol-lowering therapy (primarily statins) in all high-risk women and the use of niacin or fibrates when high-density lipoprotein cholesterol is low or non-high-density lipoprotein cholesterol is elevated. Fewer data are available for women at lower or intermediate risk. Encouragement of lifestyle modification and appropriate use of lipid-altering therapy will have a substantial impact on reducing the burden of cardiovascular disease in women.

Status of lifestyle modifications in hypertension.

PubMed

Chhabra, M K; Lal, A; Sharma, K K

2001-09-01

Hypertension is essentially the elevation of arterial blood pressure beyond an arbitrary cut off point, though the dividing line between normal and elevated BP is lacking. Hypertension can be classified into primary, essential or idiopathic hypertension on one hand, and secondary one due to some disease itself. In treating hypertension, antihypertensives have their role, but attention may be directed towards some lifestyle modifications. As regarding dietary interventions, calorie restriction may influence the minimisation of BP. Body weight reduction, less alcohol consumption, salt restriction, potassium and calcium supplementation can enhance the process of lowering BP. The role of magnesium in hypertension is debatable. Serum cholesterol level is commonly elevated in hypertensive patients and its reduction reduces the risk of non-fatal coronary events. Diet rich in plant fibres either alone or with a low fat, low sodium could lower the BP by about 5 mm Hg in hypertensives. The omega-3-polyunsaturated fatty acids found in highest concentrations in cold water fishes have a modest antihypertensive effect. Caffeine contained in two cups of coffee may raise the BP by 5 mm Hg in infrequent users but in habitual users, caffeine has no role. Deficiency of vitamin C might lead to hypertension. As regarding behavioural changes, stopping smoking, regular physical exercise, relaxation therapies like yoga, etc, have definite beneficial effect on hypertensives. The antihypertensive effect of lifestyle modifications may obviate drug therapy. For this one or more of the lifestyle modifications should be tried initially in all hypertensive patients.

Mobile application to induce lifestyle modifications in type 2 diabetic patients: prototype based on international guidelines

NASA Astrophysics Data System (ADS)

García-Jaramillo, M.; Delgado, J. S.; León-Vargas, F.

2015-12-01

This paper describes a prototype app to induce lifestyle modifications in newly diagnosed type 2 diabetic patients. The app design is based on International Diabetes Federation guidelines and recommendations from clinical studies related to diabetes health-care. Two main approaches, lifestyle modification and self-management education are used owing to significant benefits reported. The method used is based on setting goals under medical support related to physical activity, nutritional habits and weight loss, in addition to educational messages. This is specially implemented to address the main challenges that have limited the success of similar mobile applications already validated on diabetic patients. A traffic light is used to show the overall state of the goals compliance. This state could be understood as excellent (green), there are aspects to improve (yellow), or some individual goals are not carrying out (red). An example of how works this method is presented in results. Furthermore, the app provides recommendations to the user in case the overall state was in yellow or red. The recommendations pretend to induce the user to make changes in their eating habits and physical activity. According to international guidelines and clinical studies, a prototype of mobile application to induce a lifestyle modification in order to prevent adverse risk factors related to diabetes was presented. The resulting application is apparently consistent with clinical judgments, but a formal clinical validation is required. The effectiveness of this app is currently under consideration for the Colombian population with type 2 diabetes.

Lessons from obesity prevention for the prevention of mental disorders: the primordial prevention approach.

PubMed

Hayward, Joshua; Jacka, Felice N; Waters, Elizabeth; Allender, Steven

2014-09-10

Emerging evidence supports a relationship between risk factors for obesity and the genesis of the common mental disorders, depression and anxiety. This suggests common mental disorders should be considered as a form of non-communicable disease, preventable through the modification of lifestyle behaviours, particularly diet and physical activity. Obesity prevention research since the 1970's represents a considerable body of knowledge regarding strategies to modify diet and physical activity and so there may be clear lessons from obesity prevention that apply to the prevention of mental disorders. For obesity, as for common mental disorders, adolescence represents a key period of vulnerability. In this paper we briefly discuss relationships between modifiable lifestyle risk factors and mental health, lifestyle risk factor interventions in obesity prevention research, the current state of mental health prevention, and the implications of current applications of systems thinking in obesity prevention research for lifestyle interventions. We propose a potential focus for future mental health promotion interventions and emphasise the importance of lessons available from other lifestyle modification intervention programmes.

Targeting Lifestyle Behavior Change in Adults with NAFLD During a 20-min Consultation: Summary of the Dietary and Exercise Literature.

PubMed

Hallsworth, Kate; Avery, Leah; Trenell, Michael I

2016-03-01

Non-alcoholic fatty liver disease (NAFLD) is largely linked to poor diet, lack of physical activity/exercise, and being overweight. In the absence of approved pharmaceutical agents, lifestyle modification, encompassing dietary change and increased physical activity/exercise to initiate weight loss, is the recommended therapy for NAFLD. Despite this, the use of lifestyle therapy within clinical settings is lacking with limited guidance available about what it should involve, how it should be delivered, and whether it can be feasibly delivered as part of standard care. This paper highlights the evidence for the use of lifestyle modification in NAFLD. While there is evidence to support use of behavioral strategies to support lifestyle behavior change in other clinical populations, these are yet to be assessed in people with NAFLD. However, there is sufficient evidence to suggest that behavioral intervention targeting diet and physical activity to promote weight loss in general is effective and a number of practical strategies are presented on how this could be achieved.

Clinical assessment of dietary interventions and lifestyle modifications in Madhumeha (type- 2 Diabetes Mellitus)

PubMed Central

Gupta, Archana; Agarwal, Neeraj Kumar; Byadgi, Parameswarappa S.

2014-01-01

Background: India leads the world with maximum number of diabetes patients being termed as the “diabetes capital of the world.” Certain risk factors including unsatisfactory diet, overweight, and a sedentary lifestyle are potentially reversible. Acharayas have widely described the role of diet and activities to control Madhumeha (type 2 diabetes mellitus [T2DM]) along with medications. Habitual consumption of roasted or dry Barley (Hordeum vulgare L.) flour, Mudga (Phaseolus aureus Roxb.) and Amalaki (Emblica officinalis Gaertn.) prevents the manifestation of Prameha. Aim: To assess the clinical effects of dietary interventions and life style modifications in Madhumeha patients. Materials and Methods: Present study was carried out on 56 patients of Madhumeha from S.S. Hospital, Banaras Hindu University, Varanasi. Dietary interventions and life style modifications schedule was prepared based on Ayurvedic principles and patients were advised to follow this regimen. Three consecutive follow-ups were done for 3 months at the interval of one month each. Results: Significant improvement was observed in clinical signs and symptoms along with plasma glucose and glycosylated hemoglobin (HbA1c) in Madhumeha patients after these interventions (P < 0.001). Conclusion: Dietary interventions and life style modifications are two important tools by which adequate glycemic control can be obtained, especially in newly diagnosed T2DM patients and in patients who are on antidiabetic medication, but not properly controlled. PMID:26195901

Acceptability and feasibility of the 'DASH for Asthma' intervention in a randomized controlled trial pilot study.

PubMed

Blonstein, Andrea C; Lv, Nan; Camargo, Carlos A; Wilson, Sandra R; Buist, A Sonia; Rosas, Lisa G; Strub, Peg; Ma, Jun

2016-08-01

'DASH for Asthma' (n 90) was a 6-month randomized controlled trial that demonstrated potential benefits of a DASH (Dietary Approaches to Stop Hypertension) behavioural intervention for improving diet quality and asthma control by comparing intervention to usual care in adults with uncontrolled asthma. The present study examined acceptability and feasibility of the intervention from the perspective of intervention participants and lifestyle coaches. Grounded in Social Cognitive Theory, the 3-month intensive stage, including three individual and eight group sessions, focused on diet modifications and behavioural self-regulation. The 3-month maintenance stage contained telephone consultations. Participants and lifestyle coaches completed surveys including 5-point Likert scales and open-ended questions. We analysed data using descriptive and inductive content analyses. Forty-six intervention participants (survey response rate was 65-72 %) and two lifestyle coaches. Participants and lifestyle coaches were highly satisfied (all mean ratings >4) with individual and group sessions. Participants identified mastery of knowledge and skills (awareness, goal setting, self-monitoring, problem solving), social learning (class members sharing experiences and ideas) and good coaching skills (reflective listening, empathy, motivational counselling) as important contributors to self-efficacy and programme satisfaction. Participants also valued personalized feedback received in individual sessions. Lifestyle coaches viewed participant engagement as a facilitator to effective sessions. Finally, participants and lifestyle coaches identified food tasting as beneficial for observational learning and facilitation of participant engagement. High class attendance and self-monitoring rate also reflected the high engagement among participants. The DASH behavioural intervention was feasible and highly acceptable to participants with uncontrolled asthma and lifestyle coaches.

Alimentary habits, physical activity, and Framingham global risk score in metabolic syndrome.

PubMed

Soares, Thays Soliman; Piovesan, Carla Haas; Gustavo, Andréia da Silva; Macagnan, Fabrício Edler; Bodanese, Luiz Carlos; Feoli, Ana Maria Pandolfo

2014-04-01

Metabolic syndrome is a complex disorder represented by a set of cardiovascular risk factors. A healthy lifestyle is strongly related to improve Quality of Life and interfere positively in the control of risk factors presented in this condition. To evaluate the effect of a program of lifestyle modification on the Framingham General Cardiovascular Risk Profile in subjects diagnosed with metabolic syndrome. A sub-analysis study of a randomized clinical trial controlled blind that lasted three months. Participants were randomized into four groups: dietary intervention + placebo (DIP), dietary intervention + supplementation of omega 3 (fish oil 3 g/day) (DIS3), dietary intervention + placebo + physical activity (DIPE) and dietary intervention + physical activity + supplementation of omega 3 (DIS3PE). The general cardiovascular risk profile of each individual was calculated before and after the intervention. The study included 70 subjects. Evaluating the score between the pre and post intervention yielded a significant value (p < 0.001). We obtained a reduction for intermediate risk in 25.7% of subjects. After intervention, there was a significant reduction (p < 0.01) on cardiovascular age, this being more significant in groups DIP (5.2%) and DIPE (5.3%). Proposed interventions produced beneficial effects for reducing cardiovascular risk score. This study emphasizes the importance of lifestyle modification in the prevention and treatment of cardiovascular diseases.

Lifestyle modifications in an adolescent dormitory: a clinical trial.

PubMed

Abu-Kishk, Ibrahim; Alumot-Yehoshua, Michal; Reisler, Gadi; Efrati, Shai; Kozer, Eran; Doenyas-Barak, Keren; Feldon, Michal; Dagan, Zahi; Reifen, Rami; Berkovitch, Matitiahu

2014-12-01

Childhood obesity is an increasing public health issue worldwide. We examined dietary patterns among adolescents in a dormitory school, identified obese adolescents and tried to intervene to improve food habits and physical activity. We conducted an experimental prospective longitudinal study based on 36 obese (body mass index [BMI]≥95th percentile) adolescents (aged 12-18 years) compared with controls (healthy children: normal age-appropriate BMI (BMI≤85th percentile). Six months' intervention included lifestyle-modification counseling (once a week by a clinical dietician), and an exercise regimen twice a week, 60 minutes each time, instructed by a professional pediatric trainer). Both groups underwent baseline measurements at the beginning of the study and 6 months later (arterial stiffness, blood pressure, pulse, weight and height, hemoglobin, creatinine, liver enzymes, highly sensitive C-reactive protein and complete lipid profile). Twenty-one participants completed the study. Low compliance from participants, school staff and parents was observed (participation in planned meetings; 71%-83%). BMI significantly decreased from 32.46±3.93 kg/m(2) to 30.32±3.4 kg/m(2) (P=0.002) in the study group. Arterial stiffness was not significantly different between the 2 groups and did not change significantly after 6 months' intervention (P=0.494). No significant changes in CRP and lipid profile were observed after the intervention. Making lifestyle modifications among adolescents in a dormitory school is a complex task. Active intervention indeed ameliorates BMI parameters. However, in order to maximize the beneficial effects, a multidisciplinary well-trained team is needed, with emphasis on integrating parents and the school environment.

Influence of the 48867A>C (Asp358Ala) IL6R polymorphism on response to a lifestyle modification intervention in individuals with metabolic syndrome.

PubMed

Vargas, V R A; Bonatto, S L; Macagnan, F E; Feoli, A M P; Alho, C S; Santos, N D V; Schmitt, V M

2013-02-28

We evaluated the response of individuals with metabolic syndrome to lifestyle modification intervention and examined the influence of the 48867A>C (Asp358Ala) IL6R (rs2228145) polymorphism on this response. Participants were randomly divided into two groups: NI, nutritional intervention; NIE, nutritional intervention and exercise practice. Intervention lasted three months and participants completed a comprehensive evaluation and had blood collected for biochemical measurements. Eighty-two sedentary individuals with at least three criteria for metabolic syndrome were included. Comparing metabolic syndrome parameters before and after intervention, a reduction of waist circumference was observed, although significant only for AA and AC genotypes. Also, a decrease in triglyceride levels was observed (significant for AA genotype individuals; for the AC genotype, only in the NIE group). Significant reduction of fasting glucose level was observed in all AA genotype individuals; for the AC genotype, only in the NI group. Systolic blood pressure showed significant reduction in AA and AC genotype individuals. After three months of lifestyle modification intervention, improvement in some of the metabolic syndrome parameters was observed, some associated with the IL6R genotype. At enrollment, participants with genotypes AA and AC showed more severe conditions regarding metabolic syndrome inclusion criteria, supporting previous reports that the A allele is a genetic risk factor. These individuals, however, had a better response to intervention compared to individuals with the CC genotype, suggesting that nutritional control and exercise practice could prevent risks associated with metabolic syndrome more efficiently in individuals bearing the A allele.

Lifestyle modifications and the resolution of obstructive sleep apnea syndrome: a case report

PubMed Central

Gala, Thaddeus R.; Seaman, David R.

2011-01-01

Objective This purpose of this case study is to describe a natural method to help in management of obstructive sleep apnea syndrome (OSAS), which is known to be a common and debilitating condition. Clinical Features Obstructive sleep apnea syndrome is typically managed with a continuous positive airway pressure (CPAP) device, which the patient wears during sleep to help maintain respiration. This report describes the chiropractic management and resolution of OSAS with dietary modifications in a 55-year-old man who wore a CPAP for 10 years. Intervention and Outcome After adhering to dietary modifications for 3 months, the patient no longer required the use of the CPAP device and continues to have a normal active lifestyle almost 7 years later. Conclusion Dietary modifications may be an effective tool to improve the management of OSAS. PMID:22014867

Impaired glucose tolerance and impaired fasting glucose--a review of diagnosis, clinical implications and management.

PubMed

Petersen, John L; McGuire, Darren K

2005-02-01

The diagnostic categories of impaired glucose tolerance (IGT) and impaired fasting glucose (IFG) were stablished in an effort to identify populations at risk for developing type 2 diabetes mellitus (T2DM). Both IGT and IFG are associated with increased risk of developing T2DM, but recent analyses found that the thresholds of risk vary among different populations and an even lower diagnostic threshold of IFG may be appropriate. IGT has been linked with an increased risk of cardiovascular events and some analyses have demonstrated an increased mortality risk compared with patients with normal glucose tolerance. In contrast, a continuum of increased risk of microvascular manifestations of T2DM has been demonstrated with IFG but an association of IFG with cardiovascular events has not been well established. Although both IGT and IFG are associated with resistance to insulin and increased insulin secretion, they do not identify the identical patient populations and are not equivalent in predicting development of T2DM or cardiovascular events. IFG and IGT have been associated with other features of insulin resistance, including dyslipidaemia, hypertension, abdominal obesity, microalbuminuria, endothelial dysfunction, and markers of inflammation and hypercoagulability, traits collectively referred to as the metabolic syndrome. Analyses of combinations of these components have also been associated with progression to T2DM, cardiovascular disease and increased mortality. The foundation of treatment for IGT, IFG, and the metabolic syndrome is lifestyle modification, including both dietary change and routine exercise. To date, several clinical trials have found that lifestyle modification is the most efficacious strategy to prevent progression to T2DM. Alternative treatments include pharmacotherapy with metformin or acarbose, both of which have been demonstrated to decrease the development of T2DM. Ongoing clinical trials are evaluating newer pharmacotherapies, including angiotensin converting enzyme inhibitors, angiotensin receptor antagonists, metglitinides and thiazolidinediones, to prevent both T2DM and cardiovascular events. In combination with lifestyle modification, these therapies offer hope for effective prevention of T2DM and its consequences in high-risk patients.

Randomized Controlled Trial of Preconception Interventions in Infertile Women With Polycystic Ovary Syndrome.

PubMed

Legro, Richard S; Dodson, William C; Kris-Etherton, Penny M; Kunselman, Allen R; Stetter, Christy M; Williams, Nancy I; Gnatuk, Carol L; Estes, Stephanie J; Fleming, Jennifer; Allison, Kelly C; Sarwer, David B; Coutifaris, Christos; Dokras, Anuja

2015-11-01

Lifestyle modification is recommended in women with polycystic ovary syndrome (PCOS) prior to conception but there are few randomized trials to support its implementation or benefit. This study aimed to determine the relative efficacy of preconception intervention on reproductive and metabolic abnormalities in overweight/obese women with PCOS. This was a randomized controlled trial of preconception and infertility treatment at Academic Health Centers in women with infertility due to PCOS, age 18-40 y and body mass index 27-42 kg/m(2). Women were randomly assigned to receive either 16 weeks of 1) continuous oral contraceptive pills (OCPs) (ethinyl estradiol 20 mcg/1 mg norethindrone acetate) ("OCP"); 2) lifestyle modification consisting of caloric restriction with meal replacements, weight loss medication (either sibutramine, or orlistat), and increased physical activity to promote a 7% weight loss ("Lifestyle"); or 3) combined treatment with both OCP and lifestyle modification ("Combined"). After preconception intervention, women underwent standardized ovulation induction with clomiphene citrate and timed intercourse for four cycles. Pregnancies were followed with trimester visits until delivery. Weight, ovulation, and live birth were measured. We consented 216 and randomly assigned 149 women (Lifestyle: n = 50; OCP: n = 49; Combined: n = 50). We achieved significant weight loss with both Lifestyle (mean weight loss, -6.2%; 95% confidence interval (CI), -7.4--5.0; and Combined (mean weight loss, -6.4%; 95% CI, -7.6--5.2) compared with baseline and OCP (both P < .001). There was a significant increase in the prevalence of metabolic syndrome at the end of preconception treatment compared with baseline within OCP (odds ratio [OR, 2.47; 95% CI, 1.42-4.27) whereas no change in metabolic syndrome was detected in the Lifestyle (OR, 1.18; 95% CI, 0.63-2.19) or Combined (OR, 0.72; 95% CI, 0.44-1.17) groups. Cumulative ovulation rates were superior after weight loss: OCP, 46%; Lifestyle, 60%; and Combined, 67% (P < .05). Live birth rates were OCP, 12%; Lifestyle, 26%; and Combined, 24% (P = .13). A preconception weight loss intervention eliminates the adverse metabolic oral contraceptive effects and, compared with oral contraceptive pretreatment, leads to higher ovulation rates.

First report of nonpsychotic self-cannibalism (autophagy), tongue splitting, and scar patterns (scarification) as an extreme form of cultural body modification in a western civilization.

PubMed

Benecke, M

1999-09-01

As part of her current lifestyle, a 28-year-old Caucasian woman routinely injures and allows subsequent healing of her skin and other tissues. Her body modifications include a "split tongue" (a tongue split to the base), which does not interfere with speaking and eating. Other modifications include large scarification patterns produced by branding and cutting. This woman has been known to eat parts of her skin that were previously cut out of her body. She also performs "needle play" by allowing medical syringe needles to be lodged temporarily under her skin. The patient had a normal childhood, is currently employed full-time as an office manager, and is psychologically stable. Although one other case of self-induced penoscrotal hypospadias is known, this is the only report of extensive, nonpsychotic, autodestructive behavior. However, this may not be the case in the future as an increasing number of young individuals have become interested in body modifications.

[Post-polio syndrome. Part II. Therapeutic management].

PubMed

Matyja, Ewa

2012-01-01

The care of patients with post-polio syndrome ought to be carried out by a multidisciplinary team of specialists, including medical professionals, specialists of rehabilitation, psychologists and social workers. Many therapeutic strategies might be employed to reduce the late effects of polio. Today, the management of post-polio syndrome is based on non-pharmacological intervention, including lifestyle modification, decrease of physical activity, rest periods during the day and an individually tailored training program.

Dietary supplementation contributes to lifestyle improvement in hypercholesterolemic patients in real-life contexts.

PubMed

Bruckert, E; Masana, L; Chapman, M J; Descamps, O; Bosi, E; Allaert, F A

2014-07-01

Assess the evolution of cardiovascular lifestyle behaviors in hypercholesterolemic patients concomitantly with changes in their daily intake of phytosterol-supplemented yoghurt (Phyto-SY). Nationwide prospective observational study conducted in general practices across France and Spain. Each practitioner suggested lifestyle changes to five consecutive patients with hypercholesterolemia (whether or not they were taking hypocholesterolemic drugs) and recommended daily consumption of Phyto-SY. The study design involved an inclusion visit, a patient's self-monitoring assessment after 1 month, and a final visit after 4 months. Primary evaluation criterion: changes in dietary habits assessed by a standardized Nutritional Lifestyle score. Secondary criteria: changes in lipid profile, anthropometry (waist circumference) and lifestyle behavior. A total of 2376 hypercholesterolemic patients (of whom 54.8% were women) were included. The average age was 56.2 years old. The Nutritional Lifestyle score improved from 15.4 ± 5.4 to 8.7 ± 4.0 (p < 0.0001). Total cholesterol decreased by 10.6% (<0.0001), HDL-C increased by 8.0% (<0.0001), and LDL-C fell by 12.7% (<0.0001). Similar results were observed in patients treated with statins and those who were not. Frequency of walking (>30 min) increased from 59.3% to 78.3% (p < 0.0001). The overweight rate decreased from 22.8% to 17.5% (p < 0.0001) and waist circumference from 94.6 ± 13.3 cm to 93.0 ± 12.8 cm (p < 0.0001). Nutritional Lifestyles and other lifestyle markers' improvement were parallel to adherence to Phyto-SY adherence. Improvements in Nutritional Lifestyle scores, which included regular consumption of Phyto-SY over 4 months, was significantly linked to healthier lifestyles and to beneficial modifications in atherogenic lipid profiles, which reflected patient empowerment in a 'real life' context.

Behavioral and pharmacologic therapies for obesity

PubMed Central

Vetter, Marion L.; Faulconbridge, Lucy F.; Webb, Victoria L.; Wadden, Thomas A.

2011-01-01

This article reviews novel developments in the behavioral and pharmacologic treatment of obesity and explores the potential contribution of genomics research to weight control. A comprehensive program of lifestyle modification, comprised of diet, physical activity and behavior therapy, induces a mean loss of 7–10% of initial weight in individuals with obesity. Two trials demonstrated that weight loss of this magnitude, combined with increased physical activity, substantially reduced the risk of developing type 2 diabetes mellitus in individuals with impaired glucose tolerance. A third trial is now investigating whether a lifestyle intervention will reduce cardiovascular morbidity and mortality in overweight individuals who already have diabetes mellitus. Pharmacotherapy is recommended, in some patients, as an adjunct to lifestyle modification. Two medications—orlistat and sibutramine—are currently approved in the US for long-term weight loss. Both are efficacious when combined with lifestyle modification, although health concerns have been raised about the use of sibutramine. Several novel combination therapies, which target multiple hypothalamic pathways that regulate appetite and body weight, are currently under investigation. Genomic studies provide further evidence for the role of these pathways in the regulation of body weight. Identification of new genes controlling satiety and energy expenditure may yield valuable clues for the development of novel pharmacologic treatments. PMID:20680034

Prevalence of vaginal infections and associated lifestyles of students in the university of Cape Coast, Ghana

PubMed Central

Aubyn, Gloria Baaba; Tagoe, Daniel Nii Aryee

2013-01-01

Objective To determine the prevalence of vaginal infections and associated lifestyles of students visiting the University of Cape Coast Hospital. Methods Fifty female students presenting with clinical symptoms of vaginitis were sampled. One hundred samples made up of 50 urine and 50 higher vaginal swabs (HVS) were obtained from patients and questionnaire administered. Samples were wet prepared, examined microscopically, and cultured on blood and chocolate agars for 24 h at (35±2) °C. Colonial morphology, Gram reactions and biochemical tests were used for the identification of isolates. Results There were high percentages of pus cells (64%), epithelial cells (62%) and yeast cells (56%) in all urine samples. Bacterial isolates included Staphylococcus aureus (28%) and (22%), Klebsiella spp. (6%) and (4%) in urine and HVS samples respectively; Escherichia coli in urine (18%) and Candida in HVS (16%). The overall prevalence of vaginitis was 66%, including bacterial vaginosis 28%, Candida infection 22% and co-infection of bacterial and Candida 16%. Lifestyle data showed all sampled students were sexually active, 48% used contraceptives, 54% used antimicrobial agents, and 92% prefered wearing of trousers and shorts. Conclusions The present study indicates prevalence of vaginal infection among female students, which strongly correlates with student lifestyle. Education on lifestyle modifications will go a long way in reducing the prevalence of vaginitis.

The concept of lifestyle factors, based on the teaching of avicenna (ibn sina).

PubMed

Choopani, Rasool; Emtiazy, Majid

2015-01-01

According to the definition stated in the beginning of the "Al-Qanun fi al-Tibb" (the Qanun of Medicine); medicine is a science, from which one learns the states of the human body; health and disease and what causes them, in order to preserve good health when it exists, and restore it when it is lacking. Based on this issue, Avicenna believes that medical science belongs to all human without any limitation, and maintenance of health is one of its prime objectives. He states that many disorders are related to errors in the 6 factors, which are essential for maintaining health and preventing diseases. Avicenna described these six essential factors (lifestyle factors) in his masterpiece, Qanun of Medicine, as "Asbab-e-Settah-e-Zaruriah." Based on the teaching of Avicenna, the first step for maintaining health and approaches to treatment is modification of lifestyle factors, including of nutrition, physical activity, etc.

Acculturation, Medication Adherence, Lifestyle Behaviors, and Blood Pressure Control Among Arab Americans.

PubMed

Tailakh, Ayman K; Evangelista, Lorraine S; Morisky, Donald E; Mentes, Janet C; Pike, Nancy A; Phillips, Linda R

2016-01-01

The aim of this study was to examine the relationship between acculturation, medication adherence, lifestyle behaviors (e.g., physical activity, nutrition, weight control), and blood pressure control among hypertensive Arab Americans. The study utilized a cross-sectional descriptive design. A convenience sample of 126 participants completed questionnaires and had measures of blood pressure, weight, and height. Forty-six participants were hypertensive and were included in the analysis. Only 29.2% of participants reported high medication adherence. High medication adherence was associated with lower diastolic blood pressure, eating a healthy diet, and following lifestyle modifications. Acculturation was significantly associated with physical activity and body mass index. Our study found that acculturated participants were more adherent to medications and physical activity and had better blood pressure control. Further studies are needed to explore how acculturation improves adherence and what factors contribute to better adherence in order to design culturally sensitive interventions. © The Author(s) 2014.

Acculturation, Medication Adherence, Lifestyle Behaviors, and Blood Pressure Control Among Arab Americans

PubMed Central

Tailakh, Ayman K.; Evangelista, Lorraine S.; Morisky, Donald E.; Mentes, Janet C.; Pike, Nancy A.; Phillips, Linda R.

2015-01-01

Purpose The aim of this study was to examine the relationship between acculturation, medication adherence, lifestyle behaviors (e.g., physical activity, nutrition, weight control), and blood pressure control among hypertensive Arab Americans. Design The study utilized a cross-sectional descriptive design. A convenience sample of 126 participants completed questionnaires and had measures of blood pressure, weight, and height. Forty-six participants were hypertensive and were included in the analysis. Results Only 29.2% of participants reported high medication adherence. High medication adherence was associated with lower diastolic blood pressure, eating a healthy diet, and following lifestyle modifications. Acculturation was significantly associated with physical activity and body mass index. Conclusion Our study found that acculturated participants were more adherent to medications and physical activity and had better blood pressure control. Further studies are needed to explore how acculturation improves adherence and what factors contribute to better adherence in order to design culturally sensitive interventions. PMID:24848347

The role of lifestyle in preventing low birth weight.

PubMed

Chomitz, V R; Cheung, L W; Lieberman, E

1995-01-01

Lifestyle behaviors such as cigarette smoking, weight gain during pregnancy, and use of other drugs play an important role in determining fetal growth. The relationship between lifestyle risk factors and low birth weight is complex and is affected by psychosocial, economic, and biological factors. Cigarette smoking is the largest known risk factor for low birth weight. Approximately 20% of all low birth weight could be avoided if women did not smoke during pregnancy. Reducing heavy use of alcohol and other drugs during pregnancy could also reduce the rate of low birth weight births. Pregnancy and the prospect of pregnancy provide an important window of opportunity to improve women's health and the health of children. The adoption before or during pregnancy of more healthful lifestyle behaviors, such as ceasing to smoke, eating an adequate diet and gaining enough weight during pregnancy, and ceasing heavy drug use, can positively affect the long-term health of women and the health of their infants. Detrimental lifestyles can be modified, but successful modification will require large-scale societal changes. In the United States, these societal changes should include a focus on preventive health, family-centered workplace policies, and changes in social norms.

Lifestyle intervention using Internet of Things (IoT) for the elderly: A study protocol for a randomized control trial (the BEST-LIFE study).

PubMed

Kato, Sawako; Ando, Masahiko; Kondo, Takaaki; Yoshida, Yasuko; Honda, Hiroyuki; Maruyama, Shoichi

2018-05-01

Modification of lifestyle habits, including diet and physical activity, is essential for the prevention and control of type 2 diabetes mellitus (T2DM) in elderly patients. However, individualized treatment is more critical for the elderly than for general patients. This study aimed to determine lifestyle interventions that resulted in lowering hemoglobin A 1c (HbA 1c ) in Japanese pre- and early diabetic elderly subjects. The BEST-LIFE trial is an ongoing, open-label, 6-month, randomized (1:1) parallel group trial. Subjects with HbA 1c of ≥5.6%-randomly assigned to the intervention or control group -use wearable monitoring devices loaded with Internet of things (IoT) systems that aids them with self-management and obtaining monthly remote health guidance from a public health nurse. The primary outcome is changes in HbA 1c after a 6-month intervention relative to the baseline values. The secondary outcome is the change of behavior modification stages. The background, rationale, and study design of this trial are also presented. One hundred forty-five subjects have already been enrolled in this lifestyle intervention program, which will end in 2019. The BEST-LIFE trial will provide new evidence regarding the effectiveness and safety of our program on lowering HbA 1c in elderly subjects with T2DM. It will also investigate whether information communication technology tools and monitoring devices loaded with IoT can support health care in elderly subjects. The trial registration number is UMIN-CTR: UMIN 000023356.

The impact of lifestyle modifications, diet, and vitamin supplementation on natural fertility.

PubMed

Collins, Gretchen Garbe; Rossi, Brooke V

2015-01-01

Infertility is a relatively common condition. When patients are confronted with this diagnosis, there are medical, psychological, and financial sequelae. Patients often wonder if there is anything they can do to optimize their natural fertility or increase the effectiveness of infertility treatments. If there is a clear impact on fertility, such as with smoking and alcohol, cessation should be advised. Similarly, weight loss should be recommended if the BMI is in the overweight and obese category, and weight gain should be recommended for an underweight BMI. The evidence surrounding other lifestyle modifications is less clear. There are conflicting data regarding an optimal fertility diet and consumption of vitamins and supplements. Antioxidants seem to improve semen parameters in men, but the effect on female fertility is less clear. If conflicting evidence exists, such as with caffeine consumption or exercise, moderation should be emphasized. Finally, the diagnosis of infertility and subsequent fertility treatments are stressful for both partners. The psychological aspects should not be ignored and methods such as yoga and cognitive behavioral therapy may be beneficial. Continued research will determine the optimal lifestyle modifications to achieve pregnancy.

A descriptive study of adherence to lifestyle modificationfactors among hypertensive patients.

PubMed

Alhalaiqa, Fadwa; Al-Nawafleh, Ahmad; Batiha, Abdul-Monim; Masa'deh, Rami; Abd Al-Razek, Aida

2017-02-27

Healthy life style recommendations (e.g., physical activity, healthy diet, and decreased cholesterol levels) play an important role in controlling blood pressure (BP). This study aimed to assess lifestyle modification factors among patients diagnosed with hypertension. A descriptive-survey design was used. Data were collected using four questionnaires; one was the Beliefs about Medication questionnaire (BMQ) and the rest were developed to collect data about demographic and clinical characteristics and lifestyle modification factors. In total 312 questionnaires were completed. The results revealed that our participants did not follow the healthy lifestyle recommendations; for example, the mean blood sugar (BS) level, body mass index (BMI), and cholesterol levels were 155 mg/dL (standard deviation (SD) = 71.9), 29 kg/m2 (SD = 5.4), and 197 mg/dL (SD = 86.6), respectively. A significant correlation was shown between age and BP (P = 0.000). Increase in diastolic BP (DBP) correlated with a significant increase in cholesterol level (P = 0.002) and BMI (P = 0.006). Our study showed that somewhat hypertensive patients in Jordan did not follow a healthy lifestyle. Therefore, urgent action by addressing behavioral risk factors has a positive impact on preventing and controlling hypertension.

The CEMHaVi program: control, evaluation, and modification of lifestyles in obese youth.

PubMed

Vanhelst, Jérémy; Marchand, Frédéric; Fardy, Paul; Zunquin, Gautier; Loeuille, Guy-André; Renaut, Hervé; Mikulovic, Jacques; Hurdiel, Rémy; Béghin, Laurent; Theunynck, Denis

2010-01-01

Obesity in children has increased in recent years. Many studies with differing methodologies have been undertaken to treat obesity. The Control, Evaluation, and Modification of Lifestyles in Obese Youth (CEMHaVi) program is a unique 2-year health-wellness program of physical activity and health education for obese youth. Findings of this study represent results at 1-year follow-up. The purpose of this study was to evaluate the effects of the CEMHaVi program. Physician-referred subjects (N = 26) participated in the study, 14 girls (13.4 +/- 2.9 years) and 12 boys (12.3 +/- 2.8 years). Measurements included height, weight, body mass index (BMI), academic performance, sleep habits, and health knowledge. The intervention consisted of a unique program of physical activity, including a variety of games specifically selected to be enjoyable, maintain interest, and motivate subjects to adhere. Activity sessions were offered once per week, 2 hours each session, for 12 months. A health education program was offered once every 3 months for 2 hours per session. Health knowledge, academic performance, self-esteem, and sleep were assessed before and after the intervention. Means were calculated at baseline and following intervention and were compared by paired t tests. Findings suggest significant improvements in academic performance (P < .001), quality and quantity of sleep (P < .05), and obesity (P < .05). The program reduced BMI and improved health knowledge, sleep, and academic performance in obese children. The feasibility of a beneficial lifestyle intervention program is encouraging in addressing obesity and related issues in young boys and girls.

Nonalcoholic Fatty Liver Disease Management: Dietary and Lifestyle Modifications.

PubMed

Nguyen, Vi; George, Jacob

2015-08-01

Nonalcoholic fatty liver disease (NAFLD) encompasses a spectrum of abnormalities that can range from bland liver fat (steatosis), to hepatic inflammation and liver injury (steatohepatitis). It is estimated that NAFLD will become the principal cause of liver disease in Western nations and the leading indication for liver transplantation. Advancements in disease recognition and management are therefore paramount. Although the development of new, reliable drug therapies is vital, lifestyle interventions remain the most effective treatment modality. In addition to weight loss as a primary measure of treatment success, there is growing recognition that other endpoints, including the prevention or delay of diabetes onset, reduced cardiovascular events, prevention of cancer, and improved overall mortality, are equally important outcomes that can be independently modified by lifestyle change. Moreover, NAFLD is inextricably part of a complex, systemic disease process that is linked with deeply entrenched maladaptive lifestyle behaviors. Thus, a holistic, multidisciplinary, and individualized approach to disease management will be the key to achieving any realistic population-level change. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Transcultural Diabetes Nutrition Algorithm: A Malaysian Application

PubMed Central

Hamdy, Osama; Chin Chia, Yook; Lin Lim, Shueh; Kumari Natkunam, Santha; Yeong Tan, Ming; Sulaiman, Ridzoni; Nisak, Barakatun; Chee, Winnie Siew Swee; Marchetti, Albert; Hegazi, Refaat A.; Mechanick, Jeffrey I.

2013-01-01

Glycemic control among patients with prediabetes and type 2 diabetes mellitus (T2D) in Malaysia is suboptimal, especially after the continuous worsening over the past decade. Improved glycemic control may be achieved through a comprehensive management strategy that includes medical nutrition therapy (MNT). Evidence-based recommendations for diabetes-specific therapeutic diets are available internationally. However, Asian patients with T2D, including Malaysians, have unique disease characteristics and risk factors, as well as cultural and lifestyle dissimilarities, which may render international guidelines and recommendations less applicable and/or difficult to implement. With these thoughts in mind, a transcultural Diabetes Nutrition Algorithm (tDNA) was developed by an international task force of diabetes and nutrition experts through the restructuring of international guidelines for the nutritional management of prediabetes and T2D to account for cultural differences in lifestyle, diet, and genetic factors. The initial evidence-based global tDNA template was designed for simplicity, flexibility, and cultural modification. This paper reports the Malaysian adaptation of the tDNA, which takes into account the epidemiologic, physiologic, cultural, and lifestyle factors unique to Malaysia, as well as the local guidelines recommendations. PMID:24385984

Transcultural diabetes nutrition algorithm: a malaysian application.

PubMed

Hussein, Zanariah; Hamdy, Osama; Chin Chia, Yook; Lin Lim, Shueh; Kumari Natkunam, Santha; Hussain, Husni; Yeong Tan, Ming; Sulaiman, Ridzoni; Nisak, Barakatun; Chee, Winnie Siew Swee; Marchetti, Albert; Hegazi, Refaat A; Mechanick, Jeffrey I

2013-01-01

Glycemic control among patients with prediabetes and type 2 diabetes mellitus (T2D) in Malaysia is suboptimal, especially after the continuous worsening over the past decade. Improved glycemic control may be achieved through a comprehensive management strategy that includes medical nutrition therapy (MNT). Evidence-based recommendations for diabetes-specific therapeutic diets are available internationally. However, Asian patients with T2D, including Malaysians, have unique disease characteristics and risk factors, as well as cultural and lifestyle dissimilarities, which may render international guidelines and recommendations less applicable and/or difficult to implement. With these thoughts in mind, a transcultural Diabetes Nutrition Algorithm (tDNA) was developed by an international task force of diabetes and nutrition experts through the restructuring of international guidelines for the nutritional management of prediabetes and T2D to account for cultural differences in lifestyle, diet, and genetic factors. The initial evidence-based global tDNA template was designed for simplicity, flexibility, and cultural modification. This paper reports the Malaysian adaptation of the tDNA, which takes into account the epidemiologic, physiologic, cultural, and lifestyle factors unique to Malaysia, as well as the local guidelines recommendations.

Lifestyle Modification for Resistant Hypertension: The TRIUMPH Randomized Clinical Trial

PubMed Central

Blumenthal, James A.; Sherwood, Andrew; Smith, Patrick J.; Mabe, Stephanie; Watkins, Lana; Lin, Pao-Hwa; Craighead, Linda W.; Babyak, Michael; Tyson, Crystal; Young, Kenlyn; Ashworth, Megan; Kraus, William; Liao, Lawrence; Hinderliter, Alan

2015-01-01

Background Resistant hypertension (RH) is a growing health burden in this country affecting as many as one in five adults being treated for hypertension. RH is associated with increased risk of adverse cardiovascular disease (CVD) events and all-cause mortality. Strategies to reduce blood pressure in this high risk population are a national priority. Methods TRIUMPH is a single site, prospective, randomized clinical trial (RCT) to evaluate the efficacy of a center-based lifestyle intervention consisting of exercise training, reduced sodium and calorie DASH eating plan, and weight management compared to standardized education and physician advice in treating patients with RH. Patients (N=150) will be randomized in a 2:1 ratio to receive either a 4-month supervised lifestyle intervention delivered in the setting of a cardiac rehabilitation center or to a standardized behavioral counseling session to simulate real-world medical practice. The primary end point is clinic blood pressure; secondary endpoints include ambulatory blood pressure and an array of CVD biomarkers including left ventricular hypertrophy, arterial stiffness, baroreceptor reflex sensitivity, insulin resistance, lipids, sympathetic nervous system activity, and inflammatory markers. Lifestyle habits, blood pressure and CVD risk factors also will be measured at one year follow-up. Conclusions The TRIUMPH randomized clinical trial (ClinicalTrials.gov NCT02342808) is designed to test the efficacy of an intensive, center-based lifestyle intervention compared to a standardized education and physician advice counseling session on blood presssure and CVD biomarkers in patients with RH after 4 months of treatment, and will determine whether lifestyle changes can be maintained for a year. PMID:26542509

Lifestyle modifications in an adolescent dormitory: a clinical trial

PubMed Central

Alumot-Yehoshua, Michal; Reisler, Gadi; Efrati, Shai; Kozer, Eran; Doenyas-Barak, Keren; Feldon, Michal; Dagan, Zahi; Reifen, Rami; Berkovitch, Matitiahu

2014-01-01

Purpose Childhood obesity is an increasing public health issue worldwide. We examined dietary patterns among adolescents in a dormitory school, identified obese adolescents and tried to intervene to improve food habits and physical activity. Methods We conducted an experimental prospective longitudinal study based on 36 obese (body mass index [BMI]≥95th percentile) adolescents (aged 12-18 years) compared with controls (healthy children: normal age-appropriate BMI (BMI≤85th percentile). Six months' intervention included lifestyle-modification counseling (once a week by a clinical dietician), and an exercise regimen twice a week, 60 minutes each time, instructed by a professional pediatric trainer). Both groups underwent baseline measurements at the beginning of the study and 6 months later (arterial stiffness, blood pressure, pulse, weight and height, hemoglobin, creatinine, liver enzymes, highly sensitive C-reactive protein and complete lipid profile). Results Twenty-one participants completed the study. Low compliance from participants, school staff and parents was observed (participation in planned meetings; 71%-83%). BMI significantly decreased from 32.46±3.93 kg/m2 to 30.32±3.4 kg/m2 (P=0.002) in the study group. Arterial stiffness was not significantly different between the 2 groups and did not change significantly after 6 months' intervention (P=0.494). No significant changes in CRP and lipid profile were observed after the intervention. Conclusion Making lifestyle modifications among adolescents in a dormitory school is a complex task. Active intervention indeed ameliorates BMI parameters. However, in order to maximize the beneficial effects, a multidisciplinary well-trained team is needed, with emphasis on integrating parents and the school environment. PMID:25653685

Lifestyle interventions for improving health and health behaviours in women with type 2 diabetes: A systematic review of the literature 2011-2017.

PubMed

Seib, Charrlotte; Parkinson, Joy; McDonald, Nicole; Fujihira, Haruka; Zietek, Stephanie; Anderson, Debra

2018-05-01

The development and maintenance of healthy lifestyle behaviours are among the most promising strategies for reducing complications and premature death among women living with type 2 diabetes mellitus (T2DM). However, despite the potential benefits of these interventions, they have had varying success and the sustained uptake of the recommended lifestyle modifications is limited. This paper reviews research on the impact of lifestyle interventions aimed at improving health and health behaviours in women with T2DM. In a systematic review of the literature, empirical literature from 2011 to 2017 is examined to explore the effects of various lifestyle interventions on a number of objective and subjective health indicators in women with T2DM. A total of 18 intervention studies in women aged between 21 and 75 years were included in this narrative review. Interventions included education/counselling, exercise, diet, or combined components of varying duration. The included studies used a variety of objective indicators, including glycaemic control, lipid profile and anthropometric indices, as well as a number of diabetes-specific and generic subjective scales (for example, the Diabetes Problem Solving Inventory and the Short Form 36). Significant heterogeneity was noted in the interventions and also the study findings, although exercise interventions tended to yield the most consistent benefit in relation to glycaemic control, while exercise/dietary interventions generally improved anthropometric indices. The findings from this review did not consistently suggest the greater value of any one type of intervention. Future research should consider interventions that target multiple health behaviours and emphasize health literacy, self-efficacy, and problem-solving skills. Copyright © 2018 Elsevier B.V. All rights reserved.

Association of diabetes diagnosis with dietary changes and weight reduction.

PubMed

Kim, Daeho; Koh, Kanghyock; Swaminathan, Shailender; Trivedi, Amal N

2018-04-26

Lifestyle modifications are associated with better outcomes for patients with diabetes. Patients' awareness of having diabetes may promote lifestyle changes, but there is limited evidence to support this assertion. This study examined whether a report of physician-diagnosed diabetes is associated with dietary changes and efforts to lose weight. Cross-sectional comparison of individuals with and without diabetes or prediabetes diagnosis, matched on glycosylated hemoglobin (HbA1c) level, socio-demographic characteristics, and health status using propensity-score matching analysis. Non-pregnant US adult participants (aged 20 and older with an HbA1c level between 5.7% and 7.5%) in the 1999-2014 National Health and Nutrition Examination Survey were included (N = 10,781). Compared with matched controls who did not report having diabetes or prediabetes (N = 1,769), persons with a diagnosis of diabetes or prediabetes (N = 1,769) reported less sugar consumption (14.9 grams [95% CI: 8.9 to 21.0]); less carbohydrate consumption (11.6 grams [95% CI: 1.7 to 21.5]); higher rates of trying to lose weight (12.3 percentage points [95% CI: 5.3 to 19.2]); and a greater one-year weight reduction (4.8 ounces [95% CI: 3.3 to 6.4]). Awareness of a diagnosis of diabetes or prediabetes from a health profession is associated with the uptake of recommended life-style modifications.

Role of advanced glycation end products in cellular signaling☆

PubMed Central

Ott, Christiane; Jacobs, Kathleen; Haucke, Elisa; Navarrete Santos, Anne; Grune, Tilman; Simm, Andreas

2014-01-01

Improvements in health care and lifestyle have led to an elevated lifespan and increased focus on age-associated diseases, such as neurodegeneration, cardiovascular disease, frailty and arteriosclerosis. In all these chronic diseases protein, lipid or nucleic acid modifications are involved, including cross-linked and non-degradable aggregates, such as advanced glycation end products (AGEs). Formation of endogenous or uptake of dietary AGEs can lead to further protein modifications and activation of several inflammatory signaling pathways. This review will give an overview of the most prominent AGE-mediated signaling cascades, AGE receptor interactions, prevention of AGE formation and the impact of AGEs during pathophysiological processes. PMID:24624331

Management of Dyslipidemia in Women in the Post–hormone Therapy Era

PubMed Central

Mosca, Lori

2005-01-01

OBJECTIVE Cardiovascular disease (CVD) is the leading cause of death for women in the United States and is largely preventable. The American Heart Association has recently released evidence-based guidelines for the prevention of CVD in women; these include gender-specific recommendations for the management of dyslipidemia. This article reviews these recommendations and the evidence supporting them. DESIGN This was a qualitative review of a systematic literature search related to lipid guidelines for women and discussion of rationale and evidence for new clinical recommendations. MAIN RESULTS Lifestyle modifications are the cornerstone of lipid management. Substantial evidence from randomized clinical trials supports the use of low-density lipoprotein cholesterol–lowering therapy (primarily statins) in all high-risk women and the use of niacin or fibrates when high-density lipoprotein cholesterol is low or non-high-density lipoprotein cholesterol is elevated. Fewer data are available for women at lower or intermediate risk. CONCLUSIONS Encouragement of lifestyle modification and appropriate use of lipid-altering therapy will have a substantial impact on reducing the burden of cardiovascular disease in women. PMID:15836536

The safety of pharmacologic treatment for pediatric obesity.

PubMed

Chao, Ariana M; Wadden, Thomas A; Berkowitz, Robert I

2018-04-01

Pediatric obesity is a serious public health concern. Five medications have been approved by the Food and Drug Administration (FDA) for chronic weight management in adults with obesity, when used as an adjunct to lifestyle modification. Orlistat is the only FDA-approved medication for pediatric patients aged 12 years and above. Areas covered: This paper summarizes safety and efficacy data from clinical trials of weight loss medications conducted among pediatric samples. Relevant studies were identified through searches in PubMed. Expert opinion: Orlistat, as an adjunct to lifestyle modification, results in modest weight losses and may be beneficial for some pediatric patients with obesity. However, gastrointestinal side effects are common and may limit use. In adults taking orlistat, rare but severe adverse events, including liver and renal events, have been reported. Recent pediatric pharmacokinetic studies of liraglutide have demonstrated similar safety and tolerability profiles as found in adults, with gastrointestinal disorders being the most common adverse events. Clinical trials are needed of liraglutide, as well as other medications for obesity, that systematically evaluate their risks and benefits in pediatric patients.

Long-term weight loss maintenance for obesity: a multidisciplinary approach

PubMed Central

Montesi, Luca; El Ghoch, Marwan; Brodosi, Lucia; Calugi, Simona; Marchesini, Giulio; Dalle Grave, Riccardo

2016-01-01

The long-term weight management of obesity remains a very difficult task, associated with a high risk of failure and weight regain. However, many people report that they have successfully managed weight loss maintenance in the long term. Several factors have been associated with better weight loss maintenance in long-term observational and randomized studies. A few pertain to the behavioral area (eg, high levels of physical activity, eating a low-calorie, low-fat diet; frequent self-monitoring of weight), a few to the cognitive component (eg, reduced disinhibition, satisfaction with results achieved, confidence in being able to lose weight without professional help), and a few to personality traits (eg, low novelty seeking) and patient–therapist interaction. Trials based on the most recent protocols of lifestyle modification, with a prolonged extended treatment after the weight loss phase, have also shown promising long-term weight loss results. These data should stimulate the adoption of a lifestyle modification-based approach for the management of obesity, featuring a nonphysician lifestyle counselor (also called “lifestyle trainer” or “healthy lifestyle practitioner”) as a pivotal component of the multidisciplinary team. The obesity physicians maintain a primary role in engaging patients, in team coordination and supervision, in managing the complications associated with obesity and, in selected cases, in the decision for drug treatment or bariatric surgery, as possible more intensive, add-on interventions to lifestyle treatment. PMID:27013897

Mortality in Japanese with life-styles similar to Seventh-Day Adventists: strategy for risk reduction by life-style modification.

PubMed

Hirayama, T

1985-12-01

Using 16 years of follow-up results of a prospective cohort study for 122,261 men, 95% of the census population, aged 40 years and older in 29 Health Center Districts in Japan as subjects, we compared the age-standardized mortality rates for cancer of each site and other causes of death in Japanese with life-styles similar to those of Seventh-Day Adventists (SDA), i.e., no smoking, no drinking, no meat consumption daily and eating green and yellow vegetables daily, with those of Japanese with opposite life-styles. Compared with the latter Japanese, the risks were one-fifth or less in Japanese with SDA-like life-styles for cancers of the mouth, pharynx, esophagus, and lung, and subarachnoid hemorrhage. Risks were less than one-half for cancers of all sites, stomach, and liver, and for peptic ulcer and heart disease. As a single factor, the addition of daily smoking was observed to elevate the risk most strikingly in Japanese who followed SDA life patterns. Influences of further addition of habits of daily drinking of alcohol and dietary changes were significant for cancers of the esophagus, liver, and bladder and other selected diseases. Strategies for cancer prevention by means of life-style modification, e.g., increased consumption of green and yellow vegetables, were discussed.

Beliefs, Barriers, and Preferences of European Overweight Women to Adopt a Healthier Lifestyle in Pregnancy to Minimize Risk of Developing Gestational Diabetes Mellitus: An Explorative Study

PubMed Central

Jelsma, Judith G. M.; van Leeuwen, Karen M.; Oostdam, Nicolette; Bunn, Christopher; Simmons, David; Desoye, Gernot; Corcoy, Rosa; Adelantado, Juan M.; Kautzky-Willer, Alexandra; Harreiter, Jürgen; van Assche, Frans Andre; Devlieger, Roland; Timmerman, Dirk; Hill, David; Damm, Peter; Mathiesen, Elisabeth R.; Wender-Ozegowska, Ewa; Zawiejska, Agnieszka; Rebollo, Pablo; Lapolla, Annunziata; Dalfrà, Maria G.; del Prato, Stefano; Bertolotto, Alessandra; Dunne, Fidelma; Jensen, Dorte M.; Andersen, Lise Lotte T.; Snoek, Frank J.; van Poppel, Mireille N. M.

2016-01-01

Introduction. We explored beliefs, perceived barriers, and preferences regarding lifestyle changes among overweight European pregnant women to help inform the development of future lifestyle interventions in the prevention of gestational diabetes mellitus. Methods. An explorative mixed methods, two-staged study was conducted to gather information from pregnant European women (BMI ≥ 25 kg/m2). In three European countries 21 interviews were conducted, followed by 71 questionnaires in six other European countries. Content analysis and descriptive and chi-square statistics were applied (p < 0.05). Results. Women preferred to obtain detailed information about their personal risk. The health of their baby was a major motivating factor. Perceived barriers for physical activity included pregnancy-specific issues such as tiredness and experiencing physical complaints. Insufficient time was a barrier more frequently reported by women with children. Abstaining from snacking was identified as a challenge for the majority of women, especially for those without children. Women preferred to obtain support from their partner, as well as health professionals and valued flexible lifestyle programs. Conclusions. Healthcare professionals need to inform overweight pregnant women about their personal risk, discuss lifestyle modification, and assist in weight management. Lifestyle programs should be tailored to the individual, taking into account barriers experienced by overweight first-time mothers and multipara women. PMID:26885396

Effects of Tailored Health Education Program on Overweight Elementary School Students’ Obesity-Related Lifestyle: A School-Based Interventional Study

PubMed Central

Haghani, Sharareh; Shahnazi, Hossein; Hassanzadeh, Akbar

2017-01-01

Objectives Overweight and obesity are regarded as one of the most serious health and nutrition issues worldwide. This is immediately recognizable in both children and adolescents. In this study, we aimed to determine the effects of tailored education on lifestyle modification in elementary school students in Isfahan. Methods In a quasi-experimental study, two elementary schools in Isfahan District 3, Iran, were randomly selected to determine the intervention and comparison groups. Subsequently, 32 students from each school, 64 in total, were chosen arbitrarily and included in the study. They filled out the standardized questionnaire of physical activity and dietary behaviors before the intervention. Following one and four months’ educational intervention, they were asked to complete the questionnaires once more. Results The average general lifestyle score, one and four months after education, was significantly different between the groups (p < 0.001). However, this difference was not significant before the intervention 
(p = 0.660). Furthermore, the average lifestyle scores related to nutrition and physical activity one and four months after education showed a significant difference between the groups (p < 0.001). Conclusions Providing overweight elementary school students with education about a healthy lifestyle improves their general lifestyle and reduces weight. Therefore, it is recommended that such interventions are applied to prevent complications associated with being overweight in children. PMID:28439385

Exercise, an Active Lifestyle, and Obesity. Making the Exercise Prescription Work.

ERIC Educational Resources Information Center

Andersen, Ross E.

1999-01-01

An active lifestyle is important in helping overweight people both lose and manage their weight. Exercise has many health benefits beyond weight control. The traditional exercise prescription of regular bouts of continuous vigorous exercise may need modification to increase rates of adoption and compliance, with people needing encouragement to…

Impact of combined lifestyle factors on metabolic syndrome in Korean men.

PubMed

Lee, Jung Ah; Cha, Young Hwa; Kim, Sun Hee; Park, Hye Soon

2017-03-01

The purpose of this study was to determine the relationship between combined poor lifestyle factors and metabolic syndrome (MetS) in Korean men. Data from the Korean National Health and Nutrition Examination Survey 2010 were classified according to the number and combination patterns of poor lifestyle factors, namely, current smoking, high-risk alcohol use, low physical activity and poor dietary habits. We analyzed the association between the combined poor lifestyle factors and MetS. The definition of MetS was based on the joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention in 2009. A total of 1408 men aged 20-75 were included in this study. Approximately one-third of the 30-49 age group had ≥3 combined poor lifestyle factors. Compared with those with no poor lifestyle factors, the ORs for MetS were 3.57 (95% CI 1.16-11.02), 3.62 (95% CI 1.18-11.08) and 6.31 (95% CI 2.08-19.26) in subjects with one, two and three or more poor lifestyle factors, respectively. When current smoking, high-risk alcohol use and low physical activity were concurrently present, the ORs for MetS, hyperglycemia, and hypertriglyceridemia were 14.32 (95% CI 3.64-56.30), 4.49 (95% CI 1.62-12.40), and 5.07 (95% CI 2.18-11.81), respectively. Comprehensive lifestyle modifications need to be stressed in public health programs. © The Author 2016. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Lifestyle, pregnancy and epigenetic effects.

PubMed

Barua, Subit; Junaid, Mohammed A

2015-01-01

Rapidly growing evidences link maternal lifestyle and prenatal factors with serious health consequences and diseases later in life. Extensive epidemiological studies have identified a number of factors such as diet, stress, gestational diabetes, exposure to tobacco and alcohol during gestation as influencing normal fetal development. In light of recent discoveries, epigenetic mechanisms such as alteration of DNA methylation, chromatin modifications and modulation of gene expression during gestation are believed to possibly account for various types of plasticity such as neural tube defects, autism spectrum disorder, congenital heart defects, oral clefts, allergies and cancer. The purpose of this article is to review a number of published studies to fill the gap in our understanding of how maternal lifestyle and intrauterine environment influence molecular modifications in the offspring, with an emphasis on epigenetic alterations. To support these associations, we highlighted laboratory studies of rodents and epidemiological studies of human based on sampling population cohorts.

Functional foods and dietary supplements for the management of dyslipidaemia.

PubMed

Hunter, Paola M; Hegele, Robert A

2017-05-01

Dyslipidaemia is characterized by increased blood levels of total or LDL cholesterol and triglycerides, or decreased HDL cholesterol levels, and is a risk factor for cardiovascular disease. Dyslipidaemia has a high worldwide prevalence, and many patients are turning to alternatives to pharmacotherapy to manage their lipid levels. Lifestyle modification should be emphasized in all patients to reduce cardiovascular risk and can be initiated before pharmacotherapy in primary prevention of cardiovascular disease. Many functional foods and natural health products have been investigated for potential lipid-lowering properties. Those with good evidence for a biochemical effect on plasma lipid levels include soy protein, green tea, plant sterols, probiotic yogurt, marine-derived omega-3 fatty acids and red yeast rice. Other products such as seaweed, berberine, hawthorn and garlic might confer some limited benefit in certain patient groups. Although none of these products can reduce lipid levels to the same extent as statins, most are safe to use in addition to other lifestyle modifications and pharmacotherapy. Natural health products marketed at individuals with dyslipidaemia, such as policosanol, guggulsterone and resveratrol, have minimal definitive evidence of a biochemical benefit. Additional research is required in this field, which should include large, high-quality randomized controlled trials with long follow-up periods to investigate associations with cardiovascular end points.

Diagnosis and treatment of gastroesophageal reflux disease

PubMed Central

Badillo, Raul; Francis, Dawn

2014-01-01

Gastroesophageal reflux disease (GERD) is a common disease with a prevalence as high as 10%-20% in the western world. The disease can manifest in various symptoms which can be grouped into typical, atypical and extra-esophageal symptoms. Those with the highest specificity for GERD are acid regurgitation and heartburn. In the absence of alarm symptoms, these symptoms can allow one to make a presumptive diagnosis and initiate empiric therapy. In certain situations, further diagnostic testing is needed to confirm the diagnosis as well as to assess for complications or alternate causes for the symptoms. GERD complications include erosive esophagitis, peptic stricture, Barrett’s esophagus, esophageal adenocarcinoma and pulmonary disease. Management of GERD may involve lifestyle modification, medical therapy and surgical therapy. Lifestyle modifications including weight loss and/or head of bed elevation have been shown to improve esophageal pH and/or GERD symptoms. Medical therapy involves acid suppression which can be achieved with antacids, histamine-receptor antagonists or proton-pump inhibitors. Whereas most patients can be effectively managed with medical therapy, others may go on to require anti-reflux surgery after undergoing a proper pre-operative evaluation. The purpose of this review is to discuss the current approach to the diagnosis and treatment of gastroesophageal reflux disease. PMID:25133039

Can a trial of motivational lifestyle counseling be effective for controlling childhood obesity and the associated cardiometabolic risk factors?

PubMed

Kelishadi, Roya; Malekahmadi, Mohammad; Hashemipour, Mahin; Soghrati, Mehrnaz; Soghrati, Mojgan; Mirmoghtadaee, Parisa; Ghatrehsamani, Shohreh; Poursafa, Parinaz; Khavarian, Noushin

2012-04-01

This study was conducted to assess the effectiveness of a simple office-based program for encouraging healthy lifestyle on controlling childhood obesity and associated cardiometabolic risk factors. This non-randomized 24-week lifestyle modification trial was conducted among 457 obese children and adolescents, aged 2-18 years, who had at least one cardiometabolic risk factor in addition to obesity. This trial included three components of exercise, diet education and behavior modification, with all recommendations provided by a pediatrician, two general physicians and a nurse. Instead of strict inhibitory recommendations, healthier lifestyle was encouraged. Overall 448 (98.04%) of enrolled children completed the trial with a mean age of 9.6 ± 2.9 years. After the trial, the mean of anthropometric measures and cardiometabolic risk factors decreased significantly, the mean high-density lipoprotein cholesterol (HDL-C) increased significantly, and the prevalence of the metabolic syndrome decreased from 20.8% to 1.8%. Triglycerides, LDL-C, diastolic blood pressure and WC had the highest decrease in all age groups, with the most prominent changes in the 14-18-year age group. By each -1SD decline in BMI and WC, risk factors had significant improvement. Motivational office-based counseling can be effective in treatment of childhood obesity and its associated cardio-metabolic risk factors. Such approach can be implemented in the primary health care system; and can be of special concern in low- and middle-income countries with limited human and financial resources. We suggest that expanding the roles of non-physician clinicians such as nurse practitioners can help to increase the amount of time available for such services. Copyright © 2012. Published by Elsevier B.V.

Lifestyle causes of male infertility.

PubMed

Durairajanayagam, Damayanthi

2018-03-01

To examine the potential effects of lifestyle factors on male reproductive health. Evidence of a global decline in human sperm quality over recent decades has been accumulating. Environmental, occupational, and modifiable lifestyle factors may contribute to this decline. This review focuses on key lifestyle factors that are associated with male infertility such as smoking cigarettes, alcohol intake, use of illicit drugs, obesity, psychological stress, advanced paternal age, dietary practices, and coffee consumption. Other factors such as testicular heat stress, intense cycling training, lack of sleep and exposure to electromagnetic radiation from mobile phone use are briefly discussed. A comprehensive literature search was performed to identify and synthesise all relevant information, mainly from within the last decade, on the major lifestyle factors associated with male infertility and semen quality. Database searches were limited to reports published in English only. A manual search of bibliographies of the reports retrieved was conducted to identify additional relevant articles. In all, 1012 articles were identified from the database search and after reviewing the titles and abstract of the reports, 104 articles met the inclusion criteria. Of these, 30 reports were excluded as the full-text could not be retrieved and the abstract did not have relevant data. The remaining 74 reports were reviewed for data on association between a particular lifestyle factor and male infertility and were included in the present review. The major lifestyle factors discussed in the present review are amongst the multiple potential risk factors that could impair male fertility. However, their negative impact may well be mostly overcome by behaviour modification and better lifestyle choices. Greater awareness and recognition of the possible impact of these lifestyle factors are important amongst couples seeking conception.

Rationale, Design, and Baseline Characteristics of Beijing Prediabetes Reversion Program: A Randomized Controlled Clinical Trial to Evaluate the Efficacy of Lifestyle Intervention and/or Pioglitazone in Reversion to Normal Glucose Tolerance in Prediabetes

PubMed Central

Luo, Yingying; Paul, Sanjoy K.; Zhou, Xianghai; Chang, Cuiqing; Guo, Xiaohui; Yang, Jinkui

2017-01-01

Background. Patients with prediabetes are at high risk for diabetes and cardiovascular disease (CVD). No study has explored whether intervention could revert prediabetes to normal glycemic status as the primary outcome. Beijing Prediabetes Reversion Program (BPRP) would evaluate whether intensive lifestyle modification and/or pioglitazone could revert prediabetic state to normoglycemia and improve the risk factors of CVD as well. Methods. BPRP is a randomized, multicenter, 2 × 2 factorial design study. Participants diagnosed as prediabetes were randomized into four groups (conventional/intensive lifestyle intervention and 30 mg pioglitazone/placebo) with a three-year follow-up. The primary endpoint was conversion into normal glucose tolerance. The trial would recruit 2000 participants (500 in each arm). Results. Between March 2007 and March 2011, 1945 participants were randomized. At baseline, the individuals were 53 ± 10 years old, with median BMI 26.0 (23.9, 28.2) kg/m2 and HbA1c 5.8 (5.6, 6.1)%. 85% of the participants had IGT and 15% had IFG. Parameters relevant to glucose, lipids, blood pressure, lifestyle, and other metabolic markers were similar between conventional and intensive lifestyle intervention group at baseline. Conclusion. BPRP was the first study to determine if lifestyle modification and/or pioglitazone could revert prediabetic state to normoglycemia in Chinese population. Major baseline parameters were balanced between two lifestyle intervention groups. This trial is registered with www.chictr.org.cn: ChiCTR-PRC-06000005. PMID:28168204

Rationale, Design, and Baseline Characteristics of Beijing Prediabetes Reversion Program: A Randomized Controlled Clinical Trial to Evaluate the Efficacy of Lifestyle Intervention and/or Pioglitazone in Reversion to Normal Glucose Tolerance in Prediabetes.

PubMed

Luo, Yingying; Paul, Sanjoy K; Zhou, Xianghai; Chang, Cuiqing; Chen, Wei; Guo, Xiaohui; Yang, Jinkui; Ji, Linong; Wang, Hongyuan

2017-01-01

Background . Patients with prediabetes are at high risk for diabetes and cardiovascular disease (CVD). No study has explored whether intervention could revert prediabetes to normal glycemic status as the primary outcome. Beijing Prediabetes Reversion Program (BPRP) would evaluate whether intensive lifestyle modification and/or pioglitazone could revert prediabetic state to normoglycemia and improve the risk factors of CVD as well. Methods . BPRP is a randomized, multicenter, 2 × 2 factorial design study. Participants diagnosed as prediabetes were randomized into four groups (conventional/intensive lifestyle intervention and 30 mg pioglitazone/placebo) with a three-year follow-up. The primary endpoint was conversion into normal glucose tolerance. The trial would recruit 2000 participants (500 in each arm). Results . Between March 2007 and March 2011, 1945 participants were randomized. At baseline, the individuals were 53 ± 10 years old, with median BMI 26.0 (23.9, 28.2) kg/m 2 and HbA1c 5.8 (5.6, 6.1)%. 85% of the participants had IGT and 15% had IFG. Parameters relevant to glucose, lipids, blood pressure, lifestyle, and other metabolic markers were similar between conventional and intensive lifestyle intervention group at baseline. Conclusion . BPRP was the first study to determine if lifestyle modification and/or pioglitazone could revert prediabetic state to normoglycemia in Chinese population. Major baseline parameters were balanced between two lifestyle intervention groups. This trial is registered with www.chictr.org.cn: ChiCTR-PRC-06000005.

Maternal outcomes and follow-up after gestational diabetes mellitus.

PubMed

Kim, C

2014-03-01

Gestational diabetes mellitus reflects impaired maternal insulin secretion relative to demand prior to pregnancy, as well as temporary metabolic stressors imposed by the placenta and fetus. Thus, after delivery, women with gestational diabetes have increased risk of diabetes and recurrent gestational diabetes because of their underlying impairment, which may be further exacerbated by fat accretion during pregnancy and post-partum deterioration in lifestyle behaviours. This hypothetical model is discussed in greater detail, particularly the uncertainty regarding pregnancy as an accelerator of β-cell decline and the role of gestational weight gain. This report also presents risk estimates for future glucose intolerance and diabetes and reviews modifiable risk factors, particularly body mass and lifestyle alterations, including weight loss and breastfeeding. Non-modifiable risk factors such as race/ethnicity and insulin use during pregnancy are also discussed. The review concludes with current literature on lifestyle modification, recommendations for post-partum glucose screening, and future directions for research to prevent maternal disease. © 2013 The Author. Diabetic Medicine © 2013 Diabetes UK.

Maternal outcomes and follow-up after gestational diabetes mellitus

PubMed Central

Kim, C.

2014-01-01

Gestational diabetes mellitus reflects impaired maternal insulin secretion relative to demand prior to pregnancy, as well as temporary metabolic stressors imposed by the placenta and fetus. Thus, after delivery, women with gestational diabetes have increased risk of diabetes and recurrent gestational diabetes because of their underlying impairment, which may be further exacerbated by fat accretion during pregnancy and post-partum deterioration in lifestyle behaviours. This hypothetical model is discussed in greater detail, particularly the uncertainty regarding pregnancy as an accelerator of β-cell decline and the role of gestational weight gain. This report also presents risk estimates for future glucose intolerance and diabetes and reviews modifiable risk factors, particularly body mass and lifestyle alterations, including weight loss and breastfeeding. Non-modifiable risk factors such as race/ethnicity and insulin use during pregnancy are also discussed. The review concludes with current literature on lifestyle modification, recommendations for post-partum glucose screening, and future directions for research to prevent maternal disease. PMID:24341443

Randomized Controlled Trial of Preconception Interventions in Infertile Women With Polycystic Ovary Syndrome

PubMed Central

Dodson, William C.; Kris-Etherton, Penny M.; Kunselman, Allen R.; Stetter, Christy M.; Williams, Nancy I.; Gnatuk, Carol L.; Estes, Stephanie J.; Fleming, Jennifer; Allison, Kelly C.; Sarwer, David B.; Coutifaris, Christos; Dokras, Anuja

2015-01-01

Context: Lifestyle modification is recommended in women with polycystic ovary syndrome (PCOS) prior to conception but there are few randomized trials to support its implementation or benefit. Objective: This study aimed to determine the relative efficacy of preconception intervention on reproductive and metabolic abnormalities in overweight/obese women with PCOS. Design, Setting, and Participants: This was a randomized controlled trial of preconception and infertility treatment at Academic Health Centers in women with infertility due to PCOS, age 18–40 y and body mass index 27–42 kg/m2. Intervention: Women were randomly assigned to receive either 16 weeks of 1) continuous oral contraceptive pills (OCPs) (ethinyl estradiol 20 mcg/1 mg norethindrone acetate) (“OCP”); 2) lifestyle modification consisting of caloric restriction with meal replacements, weight loss medication (either sibutramine, or orlistat), and increased physical activity to promote a 7% weight loss (“Lifestyle”); or 3) combined treatment with both OCP and lifestyle modification (“Combined”). After preconception intervention, women underwent standardized ovulation induction with clomiphene citrate and timed intercourse for four cycles. Pregnancies were followed with trimester visits until delivery. Main Outcome Measures: Weight, ovulation, and live birth were measured. Results: We consented 216 and randomly assigned 149 women (Lifestyle: n = 50; OCP: n = 49; Combined: n = 50). We achieved significant weight loss with both Lifestyle (mean weight loss, −6.2%; 95% confidence interval (CI), −7.4–−5.0; and Combined (mean weight loss, −6.4%; 95% CI, −7.6–−5.2) compared with baseline and OCP (both P < .001). There was a significant increase in the prevalence of metabolic syndrome at the end of preconception treatment compared with baseline within OCP (odds ratio [OR, 2.47; 95% CI, 1.42–4.27) whereas no change in metabolic syndrome was detected in the Lifestyle (OR, 1.18; 95% CI, 0.63–2.19) or Combined (OR, 0.72; 95% CI, 0.44–1.17) groups. Cumulative ovulation rates were superior after weight loss: OCP, 46%; Lifestyle, 60%; and Combined, 67% (P < .05). Live birth rates were OCP, 12%; Lifestyle, 26%; and Combined, 24% (P = .13). Conclusions: A preconception weight loss intervention eliminates the adverse metabolic oral contraceptive effects and, compared with oral contraceptive pretreatment, leads to higher ovulation rates. PMID:26401593

Exploring Wellness Interventions in Progressive Multiple Sclerosis: an Evidence-Based Review.

PubMed

Venasse, Myriam; Edwards, Thomas; Pilutti, Lara A

2018-04-10

There has been recent interest in the role of lifestyle and wellness-based approaches in the treatment and management of multiple sclerosis (MS). These approaches may be particularly relevant for patients with progressive MS, considering limited therapeutic options currently available. The purpose of this review is to examine the role of wellness-based interventions including exercise training, emotional well-being therapies, and dietary modification in patients with progressive MS. We conducted a literature search on the efficacy of wellness-based interventions in patients with progressive MS published between 1985 and July 2017. The level of evidence for each trial was evaluated using the American Academy of Neurology criteria. Overall, 21 articles reporting on 16 wellness-based interventions were identified: ten trials involved exercise training, three involved emotional wellness therapies, two involved dietary modification, and one was a combined wellness intervention. There is level C evidence (possibly effective; one class II study) for the efficacy of aerobic exercise training on cardiorespiratory fitness in patients with progressive MS. There is level B evidence (probably effective; one class I study) for the efficacy of mindfulness training on psychological distress, depression, anxiety, pain, and quality of life in patients with progressive MS. There is inadequate evidence (level U) for efficacy of dietary modification (one class III study and one class IV study) and combined wellness interventions involving exercise training, meditation, and dietary modification (one class IV study). High-quality research is needed to provide evidence-based recommendations for wellness behaviors and lifestyle change in patients with progressive MS.

Choosing Pre-conception Planning for Women/Families: Counselling and Informed Consent (Part 2) - Pre-conception Reproductive Planning, Lifestyle, Immunization, and Psychosocial Issues.

PubMed

Wilson, R Douglas

2017-12-06

To inform reproductive and other health care providers about pre-conception evaluation, including considerations for reproductive planning, lifestyle modification, immunization status and attitudes, and psychosocial issues. This counselling information can be used for patient education and planning and possible pre-conception and/or prenatal testing. This information may allow for improved risk assessment when pre-conception counselling for individual patients and their families is used. CONSIDERATIONS FOR PRE-CONCEPTION CARE (PART 2) REGARDING PRE-CONCEPTION REPRODUCTIVE PLANNING, LIFESTYLE, IMMUNIZATIONS, AND PSYCHOSOCIAL ISSUES: CONSIDERATION FOR CARE STATEMENTS: For this review article, the Consideration for Care Statements use the Grading of Recommendations, Assessment, Development and Evaluations strength and quality principles because they are comparable for the clinician and the patient/public user. For example, "Strong" for clinicians is defined as "the recommendation would apply to most individuals. Formal discussion aids are not likely to be needed to help individuals make decisions consistent with their values and preferences." For patients/the public, "Strong" is defined as, "we believe most people in this situation would want the recommended course of actions and only a small number would not." Quality of evidence (High, Moderate, Low) is based on the confidence that the true effect lies close to that of the estimate of the effect. In addition, the Canadian Task Force on Preventive Health Care key to evidence statements and grading of recommendations are included. PubMed, Medline, and the Cochrane Database were searched until May 2017, using appropriate key words (i.e., preconception, reproductive planning, lifestyle modification, immunization risks and benefits, psychosocial pregnancy factors/issues). Grey (unpublished) literature was identified through searching websites of health technology assessment and health technology assessment-related agencies, clinical practice guideline collections, and national and international medical specialty societies. The benefits for the patient and her family from receiving this pre-conception counseling would include an increased understanding of the relevant issues for both pre-conception and in early pregnancy as well as better pregnancy outcomes. Harm includes potential increased anxiety or psychological stress associated with the possibility of identifying maternal pregnancy risks. Copyright © 2017 Society of Obstetricians and Gynaecologists of Canada. Published by Elsevier Inc. All rights reserved.

Risk factors for mobility limitation in community-dwelling older adults: a social ecological perspective.

PubMed

Yeom, Hye A; Fleury, Julie; Keller, Colleen

2008-01-01

Although a variety of risk factors for mobility limitation in older adults have been examined, a collective review of relevant literature has not been reported. The purposes of this review are to report the intrapersonal, interpersonal, environmental, and organizational risk factors related to mobility limitation using a social ecological perspective and to discuss the direction of future clinical practice consistent with current literature on mobility limitation of community-dwelling older adults. Intrapersonal risk factors related to mobility limitation include advanced age, female gender, low socioeconomic status, comorbidity, lack of motivation (i.e., dependent personality, decreased self-efficacy), lifestyle factors (i.e., sedentary lifestyle, smoking, obesity), and physiological factors (i.e., vitamin D deficiency, inflammation, poor nutritional status). Interpersonal risk factors related to mobility limitation include weak social networks and limited social activities. Geriatric clients may also experience a decline in mobility when they encounter environmental challenges such as an inconvenient home environment and lack of availability of services in their community, as well as lack of organizational resources stemming from social policy. Potential intervention strategies focused on modifiable risk factors may include lifestyle modifications, social networking programs, and enhancing awareness of environmental and organizational resources in the community for older adults at risk for mobility limitation.

A Review on the Assessment of the Efficacy of Common Treatments in Polycystic Ovarian Syndrome on Prevention of Diabetes Mellitus

PubMed Central

Dashti, Sareh; Latiff, Latiffah Abdul; Zulkefli, Nor Afiah Binti Mohd; Baharom, Anisah Binti; Minhat, Halimatus Sakdiah; Hamid, Habibah Abdul; Ismail, Maimunah; Jafarzadeh Esfehani, Ali; Abu Bakar, Azrin Shah; Binti Sabri, Nur Amirah Inani

2017-01-01

Objective: Polycystic ovarian syndrome (PCOS) is a common condition amongst women of reproductive age that can result in increased mortality and morbidity in women due to increased risk of diabetes mellitus and cardiovascular diseases. The aim of this systematic review was to assess the effectiveness of common treatments of PCOS on the predictors of diabetes in non-diabetic PCOS women. Materials and methods: An extensive search was performed on the publications in three medical databases including pubmed, scopus and google scholar from 1995 till 2017. The articles were screened based on their quality and included in this systematic review. A total of 25 articles including cohort, randomised controlled trial, review and meta-analysis were included in the review. Results: This systematic review revealed that the effect of lifestyle modification might be low in PCOS subjects due to high drop-out rate while the benefits of this intervention including weight and fat reduction may not be achieved by medical interventions. Metformin treatment may result in improvements in insulin sensitivity while its weight reduction effect is still not documented in PCOS subjects. Thiazolidendiones might be tolerated by the PCOS subjects and may result in similar effects as metformin but this effect should be documented by further studies. Conclusion: Combination of lifestyle modification with metformin or thiazolidinedions might improve the outcome of the prevention strategies. On the other hand this study revealed a different response to treatments in non-obese compared with obese PCOS subjects. PMID:29282412

Factors influencing participation in a vascular disease prevention lifestyle program among participants in a cluster randomized trial.

PubMed

Laws, Rachel A; Fanaian, Mahnaz; Jayasinghe, Upali W; McKenzie, Suzanne; Passey, Megan; Davies, Gawaine Powell; Lyle, David; Harris, Mark F

2013-05-31

Previous research suggests that lifestyle intervention for the prevention of diabetes and cardiovascular disease (CVD) are effective, however little is known about factors affecting participation in such programs. This study aims to explore factors influencing levels of participation in a lifestyle modification program conducted as part of a cluster randomized controlled trial of CVD prevention in primary care. This concurrent mixed methods study used data from the intervention arm of a cluster RCT which recruited 30 practices through two rural and three urban primary care organizations. Practices were randomly allocated to intervention (n = 16) and control (n = 14) groups. In each practice up to 160 eligible patients aged between 40 and 64 years old, were invited to participate. Intervention practice staff were trained in lifestyle assessment and counseling and referred high risk patients to a lifestyle modification program (LMP) consisting of two individual and six group sessions over a nine month period. Data included a patient survey, clinical audit, practice survey on capacity for preventive care, referral and attendance records at the LMP and qualitative interviews with Intervention Officers facilitating the LMP. Multi-level logistic regression modelling was used to examine independent predictors of attendance at the LMP, supplemented with qualitative data from interviews with Intervention Officers facilitating the program. A total of 197 individuals were referred to the LMP (63% of those eligible). Over a third of patients (36.5%) referred to the LMP did not attend any sessions, with 59.4% attending at least half of the planned sessions. The only independent predictors of attendance at the program were employment status - not working (OR: 2.39 95% CI 1.15-4.94) and having high psychological distress (OR: 2.17 95% CI: 1.10-4.30). Qualitative data revealed that physical access to the program was a barrier, while GP/practice endorsement of the program and flexibility in program delivery facilitated attendance. Barriers to attendance at a LMP for CVD prevention related mainly to external factors including work commitments and poor physical access to the programs rather than an individuals' health risk profile or readiness to change. Improving physical access and offering flexibility in program delivery may enhance future attendance. Finally, associations between psychological distress and attendance rates warrant further investigation. ACTRN12607000423415.

Behavior Modification: A Patient and Physician's Perspective.

PubMed

Swanson, Elizabeth; Primack, Craig

2017-03-01

This article, co-authored by a patient affected by obesity and an obesity medicine specialist, discusses the patient's experience of living with the disease and using many different weight loss approaches until finding a lifestyle program that was appropriate for her metabolism. The physician discusses the scientific basis of insulin resistance, and why the chosen lifestyle program worked so well for this individual.

Food Pattern, Lifestyle and Diabetes Mellitus

PubMed Central

Rahati, Sara; Shahraki, Mansour; Arjomand, Golnaz; Shahraki, Touran

2014-01-01

Background: Prevalence of Type 2 diabetes is increasing rapidly worldwide. Recent data is reprehensive of increasing diabetes prevalence from 285 millions in 2010 (6.4%) to 439 millions in 2030 in adults aged 20 to 79 in different countries. Lifestyle and particularly dietary habits play an important role in the development of diabetes. Additionally, specific individual food groups and diet components such as monounsaturated fatty acids, fruits, vegetables, whole grain cereals, dietary fiber, fish, magnesium and nuts may protect against the development of diabetes, possibly through the amelioration of insulin sensitivity and its anti-inflammatory actions, while consumption of red and processed meats and saturated fat may increase the risk of type 2 diabetes. Objectives: In this section, we studied dietary and other factors related to the effect of lifestyle in type 2 diabetes. These factors may affect the incidence of type 2 diabetes which could be corrected by lifestyle modifications. Results: Unfortunately, dietary habits in the developed and developing countries are changing towards an unhealthier direction. Consequently, emphasis should be given on encouraging at population and individual levels for adopting a healthier lifestyle, including dietary habits, to prevent the development of type 2 diabetes. Here we reviewed epidemiologic and clinical trial evidence regarding nutrients, foods and dietary patterns to diabetes risk and involved possible mechanisms. Conclusions: Type 2 diabetes is increasingly growing in young population of developing countries, which causes a large burden on individuals and the society. PMID:24971303

Lifestyle modification intervention among infertile overweight and obese women with polycystic ovary syndrome.

PubMed

Mahoney, Diane

2014-06-01

To implement an evidence-based lifestyle modification intervention, guided by motivational interviewing, among a sample of infertile overweight and obese women with polycystic ovary syndrome to increase chances of conception while improving overall health. A prospective quantitative design was utilized (n = 12). Infertile overweight and obese women with polycystic ovary syndrome at an infertility practice completed questionnaires to assess diet and exercise practices at study onset and completion. Body mass index and weight measurements were obtained on participants at study onset and completion of intervention. Menstrual history was assessed by interview. There was a mean weight loss (p = .005) of 7(±5) pounds although a 5% weight reduction did not occur. Mean daily calorie (p = .005), fat (p = .006), and carbohydrate intake (p = .014) were significantly reduced. Frequency in brisk walking exercise significantly increased (p = .024). Frequency in home or gym exercise increased (p = .050). Menstrual cyclicity improved by 50% among prior amenorrheic subjects. An evidence-based lifestyle modification guideline could prove to be a cost effective intervention for infertile women with polycystic ovary syndrome (PCOS) who desire pregnancy. This intervention could be integrated into the primary care and reproductive medicine visits as sole therapy or in conjunction with infertility treatment. ©2013 The Author(s) ©2013 American Association of Nurse Practitioners.

Therapeutic implications of diabetes in cardiovascular disease.

PubMed

Cherian, Biju; Meka, Naga; Katragadda, Srikanth; Arora, Rohit

2009-01-01

Insulin-resistant diabetes is becoming more prevalent among the general U.S. population. Approximately 20 million people had diabetes in 2005, of which one third of the population had impaired fasting glucose. The prevalence rate is 9%, a more alarming rate in the 20- to 39-year age group, which suggests a significant degree of how even the young are affected. We review how the prediabetic stage (impaired glucose tolerance-impaired fasting glucose and impaired glucose tolerance-impaired glucose tolerance) plays a vital role as a risk factor for cardiovascular disease, and the effectiveness of lifestyle modifications with drug therapy reduces the cardiovascular risk of early diabetes and its complications. A lifestyle modification like effective weight loss and exercise, with or without antidiabetic drugs, prevents the proatherogenic effects of diabetes. Controlled, randomized studies have shown that progression to diabetes among those with prediabetes is not inevitable; people with prediabetes who lose weight and increase their physical activity can prevent or delay diabetes and could even return their blood glucose levels to normal. Although prevention of prediabetes is a huge challenge, a tight glycemic control with lifestyle modifications and antihyperglycemics like thiazolidinediones play a vital role in increasing the insulin sensitivity of tissues and decreasing the cardiovascular risk factor of diabetes.

Longitudinal Changes in Cholesterol Efflux Capacities in Patients With Coronary Artery Disease Undergoing Lifestyle Modification Therapy.

PubMed

Boyer, Marjorie; Lévesque, Valérie; Poirier, Paul; Marette, André; Mitchell, Patricia L; Mora, Samia; Mathieu, Patrick; Després, Jean-Pierre; Larose, Éric; Arsenault, Benoit J

2018-06-01

Our objective was to identify the determinants of high-density lipoprotein cholesterol efflux capacity (HDL-CEC) changes in patients with coronary artery disease who participated in a lifestyle modification program aimed at increasing physical activity levels and improving diet quality. A total of 86 men with coronary artery disease aged between 35 and 80 years participated in a 1-year lifestyle modification program that aimed to achieve a minimum of 150 minutes of aerobic physical activity weekly and improve diet quality. HDL-CECs were measured before and after the 1-year intervention using 3 H-cholesterol-labeled J774 and HepG2 cells. Visceral, subcutaneous, and cardiac adipose tissue levels were assessed before and after the intervention using magnetic resonance imaging. Lipoprotein particle size and concentrations were measured by proton nuclear magnetic resonance spectroscopy and a complete lipoprotein-lipid profile was obtained. At baseline, the best correlate of HDL-CECs were apolipoprotein AI ( R 2 =0.35, P <0.0001) and high-density lipoprotein cholesterol ( R 2 =0.21, P <0.0001) for J774-HDL-CECs and HepG2-HDL-CECs, respectively. Baseline and longitudinal changes in HDL-CECs were associated with several lipoprotein size and concentration indices, although high-density lipoprotein cholesterol was the best predictor of longitudinal changes in J774-HDL-CECs ( R 2 =0.18, P =0.002) and apolipoprotein AI was found to be the best predictor of longitudinal changes in HepG2 cholesterol efflux capacities ( R 2 =0.21, P =0.002). Results of this study suggest that increases in high-density lipoprotein cholesterol and apolipoprotein AI levels typically observed in patients with coronary artery disease undergoing healthy lifestyle modification therapy may be indicative of higher plasma concentrations of functional high-density lipoprotein particles. © 2018 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

Impact of a University-Based Program on Obese College Students' Physical Activity Behaviors, Attitudes, and Self-Efficacy

ERIC Educational Resources Information Center

Ickes, Melinda J.; McMullen, Jennifer; Pflug, Courtney; Westgate, Philip M.

2016-01-01

Background: More than one third of college students are either overweight or obese, making college campuses an ideal setting to target at risk behaviors while tailoring programs to the evolving lifestyle of college students. Purpose: The purpose of this study was to determine the impact of a 15-week, campus-based lifestyle modification program on…

Prevention and treatment of the metabolic syndrome in the elderly.

PubMed

Firdaus, Muhammad

2005-02-01

The metabolic syndrome is a term used to indicate the presence of a cluster of conditions associated with increased risk for type 2 diabetes, hypertension, coronary artery disease, stroke, and early mortality. A fairly common condition in the elderly, it is caused primarily by physical inactivity and excessive calorie intake and characterized by abdominal obesity, insulin resistance, impaired fasting glucose, dyslipidemia, and prehypertension. Numerous clinical trials have demonstrated that a lifestyle of moderate-intensity, physical activity for 30 minutes a day, most days of the week, combined with weight loss of 5-7%, can reverse individual components of the metabolic syndrome. When lifestyle modifications are insufficient, a multidrug regimen may be necessary to treat different components of the metabolic syndrome. This paper reviews current literature on the metabolic syndrome, including its causes, incidence and approaches for successful treatment.

[Systemic arterial hypertension in child and adolescent].

PubMed

Rosas-Peralta, Martín; Medina-Concebida, Luz Elena; Borrayo-Sánchez, Gabriela; Madrid-Miller, Alejandra; Ramírez-Arias, Erick; Pérez-Rodríguez, Gilberto

2016-01-01

The epidemic of childhood obesity, the risk of developing left ventricular hypertrophy, and evidence of the early development of atherosclerosis in children would make the detection of and intervention in childhood hypertension important to reduce long-term health risks; however, supporting data are lacking. Secondary hypertension is more common in preadolescent children, with most cases caused by renal disease. Primary or essential hypertension is more common in adolescents and has multiple risk factors, including obesity and a family history of hypertension. Evaluation involves a through history and physical examination, laboratory tests, and specialized studies. Management is multifaceted. Nonpharmacologic treatments include weight reduction, exercise, and dietary modifications. Although the evidence of first line therapy for hypertension is still controversial, the recommendations for pharmacologic treatment are based on symptomatic hypertension, evidence of end-organ damage, stage 2 of hypertension, or stage 1 of hypertension unresponsive to lifestyle modifications, and hypertension with diabetes mellitus where is the search for microalbuminuria justified.

Risk of future cardiovascular disease in women with prior preeclampsia: a focus group study.

PubMed

Seely, Ellen W; Rich-Edwards, Janet; Lui, Janet; Nicklas, Jacinda M; Saxena, Aditi; Tsigas, Eleni; Levkoff, Sue E

2013-12-21

A history of preeclampsia is a risk factor for the future development of hypertension and cardiovascular disease (CVD). The objective of this study was to assess, in women with prior preeclampsia, the level of knowledge regarding the link between preeclampsia and CVD, motivators for and barriers to lifestyle change and interest in a lifestyle modification program to decrease CVD risk following a pregnancy complicated by preeclampsia. Twenty women with a history of preeclampsia participated in 5 phone-based focus groups. Focus groups were recorded, transcribed, and analyzed. Qualitative content analysis was used to identify common themes across focus groups. Consensus was reached on a representative set of themes describing the data. Women with prior preeclampsia were in general unaware of the link between preeclampsia and future CVD but eager to learn about this link and motivated to achieve a healthy lifestyle. Major perceived barriers to lifestyle change were lack of time, cost of healthy foods and family responsibilities. Perceived facilitators included knowledge of the link between preeclampsia and CVD, a desire to stay healthy, and creating a healthy home for their children. Women with prior preeclampsia were interested in the idea of a web-based program focused on lifestyle strategies to decrease CVD risk in women. Women with prior preeclampsia were eager to learn about the link between preeclampsia and CVD and to take steps to reduce CVD risk. A web-based program to help women with prior preeclampsia adopt a healthy lifestyle may be an appropriate strategy for this population.

Technology-supported dietary and lifestyle interventions in healthy pregnant women: a systematic review.

PubMed

O'Brien, O A; McCarthy, M; Gibney, E R; McAuliffe, F M

2014-07-01

Overweight and obesity are associated with increased risk of adverse maternal and fetal outcomes. However, the actuality of delivering effective lifestyle interventions in clinical practice is hampered by a high demand for resources. The use of technology to assist lifestyle interventions needs to be explored as a valid method of reducing strain on resources, and enhancing the effectiveness and population reach of interventions. The aim was to systematically review the literature on the use of technology-supported lifestyle interventions for healthy pregnant women and their impact on maternal outcomes. Online databases and registries were searched in March 2013. Primary outcomes of selected English language studies were fasting maternal glucose, incidence of gestational diabetes mellitus (GDM) and maternal gestational weight gain. Secondary outcomes were intervention uptake and acceptance, and dietary or physical activity modification. Studies whose subjects were diagnosed with GDM prior to intervention were excluded. The minimal number of eligible studies and varying outcomes precluded formal meta-analysis of the data. Initially, 203 articles were identified and screened. Seven articles, including five randomised controlled trials, met inclusion criteria for the current review. Results demonstrate several potential benefits associated with technology-supported interventions in pregnancy, despite minimal search results. Although communication technology holds potential as a safe therapeutic tool for the support of lifestyle interventions in pregnancy, there is a paucity of data on its effectiveness. Further RCTs examining the effectiveness of communication technology are required, particularly among those most likely to benefit from lifestyle interventions, such as overweight and obese pregnant women.

[Practice guideline. Diagnosis and treatment of type 2 diabetes mellitus].

PubMed

Gil-Velázquez, Luisa Estela; Sil-Acosta, María Juana; Domínguez-Sánchez, Elia R; Torres-Arreola, Laura del Pilar; Medina-Chávez, Juan Humberto

2013-01-01

Our objective was to develop a guide based on the best available evidence that allow family physicians to establish criteria for screening, diagnosis, prevention, treatment of disease, early detection and management of complications; to standardize the organizing processes of the diabetic patient's care in the primary care level; and to achieve lifestyle modification for patients and promote self-care. Clinical questions were stated according to the diagram and structured patient-intervention-comparison-outcome. We used a mixed methodology-adoption adjustment, and include 32 guides. For recommendations not included in these, the search process was conducted in PubMed and Cochrane Library Plus with these terms: diabetes mellitus type 2, epidemiology, detection and diagnosis, classification, drug therapy, effects, prevention, control and complication. The clinical practice guideline emphasizes the fundamental change in lifestyle (diet and exercise), self-care and proactive participation of the patient, in addition to the dynamic prescription of medications that would achieve metabolic control in order to reduce late complications.

What's new since Hippocrates? Preventing type 2 diabetes by physical exercise and diet.

PubMed

Hawley, J A; Gibala, M J

2012-03-01

Since the work of Eriksson and Lindgärde, published over two decades ago (Diabetologia 1991;34:891-898), we have known that type 2 diabetes can be prevented or delayed by supervised lifestyle interventions (physical exercise and diet modification) in persons at risk of the disease. Here we discuss a novel, time-efficient approach to physical exercise prescription, low-volume, high-intensity interval training (LVHIT), and its efficacy for inducing a range of health benefits in a variety of populations at risk of inactivity-related diseases. We look to the future and suggest that current guidelines for exercise may need to be revised to include different training techniques to deliver the optimum exercise prescription. Indeed, we predict that subsequent exercise guidelines will include LVHIT as part of a comprehensive 'fitness menu' that allows individuals to select the exercise regimen that best fulfils their medical needs, is suited to their lifestyle and daily time restraints, and meets their personal goals.

Training peers to deliver a church-based diabetes prevention program.

PubMed

Tang, Tricia S; Nwankwo, Robin; Whiten, Yolanda; Oney, Christina

2012-01-01

The purpose of this study was to examine the feasibility and acceptability of training peers to function as lifestyle coaches and to deliver a church-based lifestyle modification program. We recruited 6 African-American adults to participate in an 8-hour peer lifestyle coach (PLC) training program followed by a subsequent 2-hour booster session. The PLC training program addressed several key areas, including: (1) developing empowerment-based facilitation, active listening, and behavior change skills; (2) learning self-management strategies (eg, reading food labels, counting calories); (3) practicing session delivery; and (4) interpreting clinical lab results. Training evaluation was conducted retrospectively (immediately following the delivery of the diabetes prevention intervention rather than after the 8-hour training session) and measured program satisfaction and efficacy from the perspective of participants. Peer lifestyle coaches' confidence levels for performing core skills (eg, asking open-ended questions, 5-step behavioral goal-setting process) and advanced skills (eg, addressing resistance, discussing sensitive topics) were uniformly high. Similarly, PLCs were very satisfied with the length of training, balance between content and skills development, and preparation for leading group- and individual-based support activities. Findings suggest that it is feasible to customize a PLC training program that is acceptable to participants and that equips participants with the knowledge and skills to facilitate a church-based diabetes prevention intervention.

Lifestyle and dietary habits of patients with gout followed in rheumatology settings.

PubMed

Manara, M; Carrara, G; Scirè, C A; Cimmino, M A; Govoni, M; Montecucco, C; Matucci-Cerinic, M; Minisola, G; Study Group, The King

2015-12-23

Diet and lifestyles modification are core aspects of the non-pharmacological management of gout, but a poor consistency with suggested guidelines is reported. This study aimed to investigate dietary and lifestyle habits of patients with gout followed in rheumatology settings. Data were retrieved from the baseline dataset of the KING study, a multicentre cohort study of patients with gout followed in rheumatology settings. Dietary habits were assessed with the Italian National Institute of Statistics (ISTAT) food-frequency questionnaire and compared with reported data about general population. The relative increase of exposure was estimated by standardized prevalence ratios adjusted for gender, age and geographical distribution. The study population included 446 patients, with a mean age of 63.9 years and a M/F ratio of 9:1. Compared to the Italian population, gouty patients showed a higher prevalence of obesity [1.82 (1.52-2.18)] and a higher consumption of wine [1.85 (1.48-2.32)] and beer [2.21 (1.68-2.90)], but a lower prevalence of smoking and a lower intake of liquor. They showed a lower intake of red meat [0.80 (0.71-0.91)], but a similar intake of other tested dietary factors. Gouty patients' lifestyle is still partially different from the recommended.

Management of coronary artery disease

NASA Astrophysics Data System (ADS)

Safri, Z.

2018-03-01

Coronary Artery Disease (CAD) is associated with significant morbidity and mortality, therefore it’s important to early and accurate detection and appropriate management. Diagnosis of CAD include clinical examination, noninvasive techniques such as biochemical testing, a resting ECG, possibly ambulatory ECG monitoring, resting echocardiography, chest X-ray in selected patients; and catheterization. Managements of CAD patients include lifestyle modification, control of CAD risk factors, pharmacologic therapy, and patient education. Revascularization consists of percutaneous coronary angioplasty and coronary artery bypass grafting. Cardiac rehabilitation should be considered in all patients with CAD. This comprehensive review highlights strategies of management in patients with CAD.

Predictors of primary care referrals to a vascular disease prevention lifestyle program among participants in a cluster randomised trial.

PubMed

Passey, Megan E; Laws, Rachel A; Jayasinghe, Upali W; Fanaian, Mahnaz; McKenzie, Suzanne; Powell-Davies, Gawaine; Lyle, David; Harris, Mark F

2012-08-03

Cardiovascular disease accounts for a large burden of disease, but is amenable to prevention through lifestyle modification. This paper examines patient and practice predictors of referral to a lifestyle modification program (LMP) offered as part of a cluster randomised controlled trial (RCT) of prevention of vascular disease in primary care. Data from the intervention arm of a cluster RCT which recruited 36 practices through two rural and three urban primary care organisations were used. In each practice, 160 eligible high risk patients were invited to participate. Practices were randomly allocated to intervention or control groups. Intervention practice staff were trained in screening, motivational interviewing and counselling and encouraged to refer high risk patients to a LMP involving individual and group sessions. Data include patient surveys; clinical audit; practice survey on capacity for preventive care; referral records from the LMP. Predictors of referral were examined using multi-level logistic regression modelling after adjustment for confounding factors. Of 301 eligible patients, 190 (63.1%) were referred to the LMP. Independent predictors of referral were baseline BMI ≥ 25 (OR 2.87 95%CI:1.10, 7.47), physical inactivity (OR 2.90 95%CI:1.36,6.14), contemplation/preparation/action stage of change for physical activity (OR 2.75 95%CI:1.07, 7.03), rural location (OR 12.50 95%CI:1.43, 109.7) and smaller practice size (1-3 GPs) (OR 16.05 95%CI:2.74, 94.24). Providing a well-structured evidence-based lifestyle intervention, free of charge to patients, with coordination and support for referral processes resulted in over 60% of participating high risk patients being referred for disease prevention. Contrary to expectations, referrals were more frequent from rural and smaller practices suggesting that these practices may be more ready to engage with these programs. ACTRN12607000423415.

A Pilot Feasibility Study of Whole-systems Ayurvedic Medicine and Yoga Therapy for Weight Loss.

PubMed

Rioux, Jennifer; Thomson, Cynthia; Howerter, Amy

2014-01-01

To develop and test the feasibility of a whole-systems lifestyle intervention for obesity treatment based on the practices of Ayurvedic medicine/ Yoga therapy. A pre-post weight loss intervention pilot study using conventional and Ayurvedic diagnosis inclusion criteria, tailored treatment within a standardized treatment algorithm, and standardized data collection instruments for collecting Ayurvedic outcomes. A convenience sample of overweight/obese adult community members from Tucson, Arizona interested in a "holistic weight loss program" and meeting predetermined inclusion/exclusion criteria. A comprehensive diet, activity, and lifestyle modification program based on principles of Ayurvedic medicine/yoga therapy with significant self-monitoring of lifestyle behaviors. The 3-month program was designed to change eating and activity patterns and to improve self-efficacy, quality of life, well-being, vitality, and self-awareness around food choices, stress management, and barriers to weight loss. Changes in body weight, body mass index; body fat percentage, fat/lean mass, waist/hip circumference and ratio, and blood pressure. Diet and exercise self-efficacy scales; perceived stress scale; visual analog scales (VAS) of energy, appetite, stress, quality of life, well-being, and program satisfaction at all time points. Twenty-two adults attended an in-person Ayurvedic screening; 17 initiated the intervention, and 12 completed the 3-month intervention. Twelve completed follow-up at 6 months and 11 completed follow-up at 9 months. Mean weight loss at 3 months was 3.54 kg (SD 4.76); 6 months: 4.63 kg, (SD 6.23) and 9 months: 5.9 kg (SD 8.52). Self-report of program satisfaction was more than 90% at all time points. An Ayurveda-/yoga-based lifestyle modification program is an acceptable and feasible approach to weight management. Data collection, including self-monitoring and conventional and Ayurvedic outcomes, did not unduly burden participants, with attrition similar to that of other weight loss studies.

Implementation of cardiovascular disease prevention in primary health care: enhancing understanding using normalisation process theory.

PubMed

Volker, Nerida; Williams, Lauren T; Davey, Rachel C; Cochrane, Thomas; Clancy, Tanya

2017-02-24

The reorientation of primary health care towards prevention is fundamental to addressing the rising burden of chronic disease. However, in Australia, cardiovascular disease prevention practice in primary health care is not generally consistent with existing guidelines. The Model for Prevention study was a whole-of-system cardiovascular disease prevention intervention, with one component being enhanced lifestyle modification support and addition of a health coaching service in the general practice setting. To determine the feasibility of translating intervention outcomes into real world practice, implementation work done by stakeholders was examined using Normalisation Process Theory as a framework. Data was collected through interviews with 40 intervention participants and included general practitioners, practice nurses, practice managers, lifestyle advisors and participants. Data analysis was informed by normalisation process theory constructs. Stakeholders were in agreement that, while prevention is a key function of general practice, it was not their usual work. There were varying levels of engagement with the intervention by practice staff due to staff interest, capacity and turnover, but most staff reconfigured their work for required activities. The Lifestyle Advisors believed staff had varied levels of interest in and understanding of, their service, but most staff felt their role was useful. Patients expanded their existing relationships with their general practice, and most achieved their lifestyle modification goals. While the study highlighted the complex nature of the change required, many of the new or enhanced processes implemented as part of the intervention could be scaled up to improve the systems approach to prevention. Overcoming the barriers to change, such as the perception of CVD prevention as a 'hard sell', is going to rely on improving the value proposition for all stakeholders. The study provided a detailed understanding of the work required to implement a complex cardiovascular disease prevention intervention within general practice. The findings highlighted the need for multiple strategies that engage all stakeholders. Normalisation process theory was a useful framework for guiding change implementation.

Beliefs and perceptions about the causes of breast cancer: a case-control study.

PubMed

Thomson, Allyson K; Heyworth, Jane S; Girschik, Jennifer; Slevin, Terry; Saunders, Christobel; Fritschi, Lin

2014-08-21

Attributions of causality are common for many diseases, including breast cancer. The risk of developing breast cancer can be reduced by modifications to lifestyle and behaviours to minimise exposure to specific risk factors, such as obesity. However, these modifications will only occur if women believe that certain behaviours/lifestyle factors have an impact on the development of breast cancer. The Breast Cancer, Environment and Employment Study is a case-control study of breast cancer conducted in Western Australia between 2009 and 2011. As part of the study 1109 women with breast cancer and 1633 women without the disease completed a Risk Perception Questionnaire in which they were asked in an open-ended question for specific cause/s to the development of breast cancer in themselves or in others. The study identified specific causal beliefs, and assessed differences in the beliefs between women with and without breast cancer. The most common attributions in women without breast cancer were to familial or inherited factors (77.6%), followed by lifestyle factors, such as poor diet and smoking (47.1%), and environmental factors, such as food additives (45.4%). The most common attributions in women with breast cancer were to mental or emotional factors (46.3%), especially stress, followed by lifestyle factors (38.6%) and physiological factors (37.5%), particularly relating to hormonal history. While the majority of participants in this study provided one or more causal attributions for breast cancer, many of the reported risk factors do not correspond to those generally accepted by the scientific community. These misperceptions could be having a significant impact on the success of prevention and early detection programs that seek to minimise the pain and suffering caused by this disease. In particular, women who have no family history of the disease may not work to minimise their exposure to the modifiable risk factors.

Engaging women with an embodied conversational agent to deliver mindfulness and lifestyle recommendations: A feasibility randomized control trial.

PubMed

Gardiner, Paula M; McCue, Kelly D; Negash, Lily M; Cheng, Teresa; White, Laura F; Yinusa-Nyahkoon, Leanne; Jack, Brian W; Bickmore, Timothy W

2017-09-01

This randomized controlled trial evaluates the feasibility of using an Embodied Conversational Agent (ECA) to teach lifestyle modifications to urban women. Women were randomized to either 1) an ECA (content included: mindfulness, stress management, physical activity, and healthy eating) or 2) patient education sheets mirroring same content plus a meditation CD/MP3 once a day for one month. General outcome measures included: number of stress management techniques used, physical activity levels, and eating patterns. Sixty-one women ages 18 to 50 were enrolled. On average, 51% identified as white, 26% as black, 23% as other races; and 20% as Hispanic. The major stress management techniques reported at baseline were: exercise (69%), listening to music (70%), and social support (66%). After one month, women randomized to the ECA significantly decreased alcohol consumption to reduce stress (p=0.03) and increased daily fruit consumption by an average of 2 servings compared to the control (p=0.04). It is feasible to use an ECA to promote health behaviors on stress management and healthy eating among diverse urban women. Compared to patient information sheets, ECAs provide promise as a way to teach healthy lifestyle behaviors to diverse urban women. Copyright © 2017 Elsevier B.V. All rights reserved.

Impact of literacy and numeracy on motivation for behavior change after diabetes genetic risk testing.

PubMed

Vassy, Jason L; O'Brien, Kelsey E; Waxler, Jessica L; Park, Elyse R; Delahanty, Linda M; Florez, Jose C; Meigs, James B; Grant, Richard W

2012-01-01

Type 2 diabetes genetic risk testing might motivate at-risk patients to adopt diabetes prevention behaviors. However, the influence of literacy and numeracy on patient response to diabetes genetic risk is unknown. The authors investigated the association of health literacy, genetic literacy, and health numeracy with patient responses to diabetes genetic risk. and Measurements Overweight patients at high phenotypic risk for type 2 diabetes were recruited for a clinical trial of diabetes genetic risk testing. At baseline, participants predicted how their motivation for lifestyle modification to prevent diabetes might change in response to hypothetical scenarios of receiving "high" and "low" genetic risk results. Responses were analyzed according to participants' health literacy, genetic literacy, and health numeracy. Two-thirds (67%) of participants (n = 175) reported very high motivation to prevent diabetes. Despite high health literacy (92% at high school level), many participants had limited health numeracy (30%) and genetic literacy (38%). Almost all (98%) reported that high-risk genetic results would increase their motivation for lifestyle modification. In contrast, response to low-risk genetic results varied. Higher levels of health literacy (P = 0.04), genetic literacy (P = 0.02), and health numeracy (P = 0.02) were associated with an anticipated decrease in motivation for lifestyle modification in response to low-risk results. While patients reported that high-risk genetic results would motivate them to adopt healthy lifestyle changes, response to low-risk results varied by patient numeracy and literacy. However, anticipated responses may not correlate with true behavior change. If future research justifies the clinical use of genetic testing to motivate behavior change, it may be important to assess how patient characteristics modify that motivational effect.

A randomised translational trial of lifestyle intervention using a 3-tier shared care approach on pregnancy outcomes in Chinese women with gestational diabetes mellitus but without diabetes.

PubMed

Yang, Xilin; Tian, Huiguang; Zhang, Fuxia; Zhang, Cuiping; Li, Yi; Leng, Junhong; Wang, Leishen; Liu, Gongshu; Liu, Gongsu; Dong, Ling; Yu, Zhijie; Hu, Gang; Chan, Juliana Cn

2014-10-28

There are no randomised controlled trials to demonstrate whether lifestyle modifications can improve pregnancy outcomes of gestational diabetes mellitus (GDM) diagnosed by the International Association of Diabetes and Pregnancy Study Group's (IADPSG) criteria. We tested the effectiveness of lifestyle modifications implemented in a 3-tier's shared care (SC) on pregnancy outcomes of GDM. Between December 2010 and October 2012, we randomly assigned 700 women with IADPSG-defined GDM but without diabetes at 26.3 (interquartile range: 25.4-27.3) gestational weeks in Tianjin, China, to receive SC or usual care (UC). The SC group received individual consultations and group sessions and performed regular self-monitoring of blood glucose compared to one hospital-based education session in the UC group. The outcomes were macrosomia defined as birth weight ≥ 4.0 kg and the pregnancy-induced hypertension (PIH). Women in the SC (n = 339) and UC (n = 361) groups delivered their infants at similar gestational weeks. Birth weight of infants in the SC group was lower than that in the UC group (3469 vs. 3371 grams, P = 0.021). The rate of macrosomia was 11.2% (38/339) in the SC group compared to 17.5% (63/361) in the UC group with relative risk (RR) of 0.64 (95% CI: 0.44-0.93). The rate of PIH was 8.0% (27/339) in the SC compared to 4.4% (16/361) in the UC with RR of 1.80 (0.99-3.28). Apgar score at 1 min < 7 was lower but preeclampsia was higher in the SC than in the UC. Lifestyle modifications using a SC system improved pregnancy outcomes in Chinese women with GDM. Clinicaltrials.gov; NCT01565564.

Effect of Omega-3 PUFAs Supplementation with Lifestyle Modification on Anthropometric Indices and Vo2 max in Overweight Women.

PubMed

Haghravan, Simin; Keshavarz, Seyed Ali; Mazaheri, Reza; Alizadeh, Zahra; Mansournia, Mohammad Ali

2016-05-01

Despite the fact that the recommendations of counteracting obesity advocate for changing lifestyle and physical activity habits, the prevalence of obesity continues to rise. The aim of the study was to investigate the effect of omega-3 PUFAs supplementation with lifestyle modification on anthropometric indices and Vo2max in overweight women. Fifty overweight women aged between 20 to 45 years were recruited in this interventional study. Women randomly were divided into two experimental groups (n = 25). Group 1 received omega-3 supplement, aerobic exercise program, and a healthy diet education. Group 2 was similar to group 1, except in that patients received placebo instead of omega-3 capsules. Experimental and placebo group subjects were asked to take one supplementary capsule every day, for 8 weeks. Anthropometric indices were measured in the fourth and eighth weeks of the trial. The maximum aerobic capacity (Vo2max) was determined using a gas analysis device. The level of significance for comparing the results before and after the trial was considered at P < 0.05. According to the data, body weight, body fat percentage, waist circumference, and abdominal skinfold thickness significantly reduced in the omega-3 treated group compared to the control group during 8 weeks after the initiation of the study (P < 0.05). In addition, supplementation of omega-3, significantly improved the VO2max outcome compared to that of the control group (P = 0.03). According to the results, it seems that omega-3 PUFAS supplementation with lifestyle modification has positive effects on anthropometric indices and Vo2max in overweight women.

Myopathies

MedlinePlus

... symptoms through medication, lifestyle modifications, or use of orthopedic and respiratory equipment. This booklet focuses on the ... problems can usually be corrected by use of orthopedic devices or by surgery. Your doctor or MDA ...

Prediabetes and Lifestyle Modification: Time to Prevent a Preventable Disease

PubMed Central

Tuso, Phillip

2014-01-01

More than 100 million Americans have prediabetes or diabetes. Prediabetes is a condition in which individuals have blood glucose levels higher than normal but not high enough to be classified as diabetes. People with prediabetes have an increased risk of Type 2 diabetes. An estimated 34% of adults have prediabetes. Prediabetes is now recognized as a reversible condition that increases an individual’s risk for development of diabetes. Lifestyle risk factors for prediabetes include overweight and physical inactivity. Increasing awareness and risk stratification of individuals with prediabetes may help physicians understand potential interventions that may help decrease the percentage of patients in their panels in whom diabetes develops. If untreated, 37% of the individuals with prediabetes may have diabetes in 4 years. Lifestyle intervention may decrease the percentage of prediabetic patients in whom diabetes develops to 20%. Long-term data also suggest that lifestyle intervention may decrease the risk of prediabetes progressing to diabetes for as long as 10 years. To prevent 1 case of diabetes during a 3-year period, 6.9 persons would have to participate in the lifestyle intervention program. In addition, recent data suggest that the difference in direct and indirect costs to care for a patient with prediabetes vs a patient with diabetes may be as much as $7000 per year. Investment in a diabetes prevention program now may have a substantial return on investment in the future and help prevent a preventable disease. PMID:25102521

Globalization of diabetes: the role of diet, lifestyle, and genes.

PubMed

Hu, Frank B

2011-06-01

Type 2 diabetes is a global public health crisis that threatens the economies of all nations, particularly developing countries. Fueled by rapid urbanization, nutrition transition, and increasingly sedentary lifestyles, the epidemic has grown in parallel with the worldwide rise in obesity. Asia's large population and rapid economic development have made it an epicenter of the epidemic. Asian populations tend to develop diabetes at younger ages and lower BMI levels than Caucasians. Several factors contribute to accelerated diabetes epidemic in Asians, including the "normal-weight metabolically obese" phenotype; high prevalence of smoking and heavy alcohol use; high intake of refined carbohydrates (e.g., white rice); and dramatically decreased physical activity levels. Poor nutrition in utero and in early life combined with overnutrition in later life may also play a role in Asia's diabetes epidemic. Recent advances in genome-wide association studies have contributed substantially to our understanding of diabetes pathophysiology, but currently identified genetic loci are insufficient to explain ethnic differences in diabetes risk. Nonetheless, interactions between Westernized diet and lifestyle and genetic background may accelerate the growth of diabetes in the context of rapid nutrition transition. Epidemiologic studies and randomized clinical trials show that type 2 diabetes is largely preventable through diet and lifestyle modifications. Translating these findings into practice, however, requires fundamental changes in public policies, the food and built environments, and health systems. To curb the escalating diabetes epidemic, primary prevention through promotion of a healthy diet and lifestyle should be a global public policy priority.

Towards prevention of ovarian cancer.

PubMed

Ali, Aus Tariq

2018-01-01

Ovarian cancer is the leading cause of death of all gynaecological cancers. To date, there is no reliable, specific screening procedure for detecting ovarian cancer. The risk factors of ovarian cancer include modifiable and non-modifiable factors. The main goal of the ovarian cancer prevention program is to significantly reduce the risk of development of ovarian cancer and other cancers such as breast and/or peritoneal cancer. The application of non-surgical preventive approaches such as oral contraceptives, parity and breastfeeding has been shown to be highly protective against ovarian cancer development. Targeting inflammation has been also reported to be associated with a protective trend against ovarian cancer and can be achieved through either non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin or lifestyle modifications or both. Lifestyle modification that includes regular exercise, healthy diet supplemented with anti-oxidants and anti-inflammatory elements reduces the risk of the disease even further. Surgical protective approaches include; tubal ligation, hysterectomy and prophylactic bilateral salpingo-oophorectomy and the former is the most effective approach to protect against ovarian cancer. A better understanding of the risk factors of ovarian cancer and the current approaches to prevent it may increase the awareness and help to decrease the incidence of ovarian cancer, increase the five-year survival rate and decrease the mortality rate significantly in the general population especially among those at high risk for ovarian cancer. This review is an attempt to outline a potential program of ovarian cancer prevention and the potential challenges. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

The impact of human activities and lifestyles on the interlinked microbiota and health of humans and of ecosystems.

PubMed

Flandroy, Lucette; Poutahidis, Theofilos; Berg, Gabriele; Clarke, Gerard; Dao, Maria-Carlota; Decaestecker, Ellen; Furman, Eeva; Haahtela, Tari; Massart, Sébastien; Plovier, Hubert; Sanz, Yolanda; Rook, Graham

2018-06-15

Plants, animals and humans, are colonized by microorganisms (microbiota) and transiently exposed to countless others. The microbiota affects the development and function of essentially all organ systems, and contributes to adaptation and evolution, while protecting against pathogenic microorganisms and toxins. Genetics and lifestyle factors, including diet, antibiotics and other drugs, and exposure to the natural environment, affect the composition of the microbiota, which influences host health through modulation of interrelated physiological systems. These include immune system development and regulation, metabolic and endocrine pathways, brain function and epigenetic modification of the genome. Importantly, parental microbiotas have transgenerational impacts on the health of progeny. Humans, animals and plants share similar relationships with microbes. Research paradigms from humans and other mammals, amphibians, insects, planktonic crustaceans and plants demonstrate the influence of environmental microbial ecosystems on the microbiota and health of organisms, and indicate links between environmental and internal microbial diversity and good health. Therefore, overlapping compositions, and interconnected roles of microbes in human, animal and plant health should be considered within the broader context of terrestrial and aquatic microbial ecosystems that are challenged by the human lifestyle and by agricultural and industrial activities. Here, we propose research priorities and organizational, educational and administrative measures that will help to identify safe microbe-associated health-promoting modalities and practices. In the spirit of an expanding version of "One health" that includes environmental health and its relation to human cultures and habits (EcoHealth), we urge that the lifestyle-microbiota-human health nexus be taken into account in societal decision making. Copyright © 2018 The Authors. Published by Elsevier B.V. All rights reserved.

Nutritionist’s Variation in Counseling Style and the Effect on Weight Change of Patients Attending a Community Based Lifestyle Modification Program

PubMed Central

Lok, Kris Y. W.; Chan, Ruth S. M.; Sea, Mandy M. M.; Woo, Jean

2010-01-01

Information concerning the nature of nutritionist-patient relationships is very limited. This qualitative and quantitative study examined nutritionist’s skills, attributes, and beliefs towards nutrition counseling during a lifestyle modification intervention program, and whether this affected the patient’s weight outcome. 24 nutrition consultations were observed during the program and the nutritionists were interviewed for their perception on practice (n = 4). A statistically significant difference was observed between the nutritionists in regard to patient’s weight change after adjustment for age and baseline weight (p < 0.001). Key nutritionist skills identified that influenced weight outcome were meticulous investigation of the underlying obesity cause, identification of the subject’s stage of change, and psychological support. PMID:20616982

Role of lifestyle modifications for patients with laryngeal granuloma caused by gastro-esophageal reflux: comparison between conservative treatment and the surgical approach.

PubMed

Kobayashi, Rika; Tsunoda, Koichi; Ueha, Rumi; Fujimaki, Yoko; Nito, Takaharu; Yamasoba, Tatsuya

2017-03-01

It is considered that a regimen combining pharmacologic management and lifestyle modifications is the most effective treatment for laryngeal granulomas caused by GER. This study compared the results of the combination therapy and surgery to determine the best treatment of laryngeal granuloma caused by gastro-esophageal reflux in 51 patients. Prospective study. In the conservative treatment group, the CR rate was 89.7% and recurrence rate was 2.6%, while the lesions remained in patients (7.7%). This study compared the CR and recurrence rates between conservative treatment and surgery for granuloma. The results showed that the laryngeal granuloma recurrence rate was significantly lower with the conservative treatment regimen compared with surgery (p = .0016).

Effective secondary prevention through cardiac rehabilitation after coronary revascularization and predictors of poor adherence to lifestyle modification and medication. Results of the ICAROS Survey.

PubMed

Griffo, Raffaele; Ambrosetti, Marco; Tramarin, Roberto; Fattirolli, Francesco; Temporelli, Pier Luigi; Vestri, Anna Rita; De Feo, Stefania; Tavazzi, Luigi

2013-08-20

Secondary prevention is a priority after coronary revascularization. We investigate the impact of a cardiac rehabilitation (CR) program on lifestyle, risk factors and medication modifications and analyze predictors of poor behavioral changes and events in patients after coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI). Multicenter (n=62), prospective, longitudinal survey in post-CABG or -PCI consecutive patients after a comprehensive CR program. Cardiac risk factors, lifestyle habits, medication and 1 year cardiovascular events were collected. Logistic regression analyzed the association between risk factors, events and predictors of non-adherence to treatment and lifestyle. At 1 year, of the 1262 patients (66 ± 10 years, CABG 69%, PCI 31%), 94% were taking antiplatelet agents (vs. 91.8% at CR admission and 91.7% at CR discharge, p=ns), 87% statins (vs. 67.5%, p<.0001, and 86.3%, p=ns), 80.7% beta-blockers (vs. 67.4%, p<.0001, and 88.8%, p=ns), and 81.1% ACE inhibitors (vs. 57.5% p<.0001, and 77.7%, p=ns). 89.9% of the patients showed good adherence to treatment, 72% adhered to diet and 51% to exercise recommendations; 74% of smokers stopped smoking. Younger age was predictive of smoking resumption (OR 8.9, CI 3.5-22.8). Pre-event sedentary lifestyle (OR 3.3, CI 1.3-8.7) was predictive of poor diet. Older patients with comorbidity (OR 3.1; CI, 1.8-5.2) tended to persist in sedentary lifestyle and discontinue therapy and diet recommendations. Age, diabetes, smoking and PCI indication were predictors of recurrent CV events which occurred in 142 patients. Participation in CR results in excellent treatment after revascularization, as well as a good lifestyle and medication adherence at 1 year and provides further confirmation of the benefit of secondary prevention. Several clinical characteristics may predict poor behavioral changes. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Insulin and the polycystic ovary syndrome.

PubMed

Macut, Djuro; Bjekić-Macut, Jelica; Rahelić, Dario; Doknić, Mirjana

2017-08-01

Polycystic ovary syndrome (PCOS) is the most prevalent endocrinopathy among women during reproductive age. PCOS is characterised by hyperandrogenaemia, hyperinsulinaemia, and deranged adipokines secretion from the adipose tissue. In addition to the reduced insulin sensitivity, PCOS women exhibit β-cell dysfunction as well. Low birth weight and foetal exposure to androgens may contribute to the development of the PCOS phenotype during life. Further metabolic complications lead to dyslipidaemia, worsening obesity and glucose tolerance, high prevalence of metabolic syndrome, and greater susceptibility to diabetes. PCOS women show age-related existence of hypertension, and subtle endothelial and vascular changes. Adverse reproductive outcomes include anovulatory infertility, and unrecognised potentiation of the hormone-dependent endometrial cancer. The main therapeutic approach is lifestyle modification. Metformin is the primary insulin-sensitising drug to be used as an adjuvant therapy to lifestyle modification in patients with insulin resistance and impaired glucose tolerance, as well as in those referred to infertility treatment. Thiazolidinediones should be reserved for women intolerant of or refractory to metformin, while glucagon-like peptide 1 analogues has a potential therapeutic use in obese PCOS women. Randomised clinical trials and repetitive studies on different PCOS phenotypes for the preventive actions and therapeutic options are still lacking, though. Copyright © 2017 Elsevier B.V. All rights reserved.

Glycemic load, exercise, and monitoring blood glucose (GEM): A paradigm shift in the treatment of type 2 diabetes mellitus.

PubMed

Cox, Daniel J; Taylor, Ann G; Singh, Harsimran; Moncrief, Matthew; Diamond, Anne; Yancy, William S; Hegde, Shefali; McCall, Anthony L

2016-01-01

This preliminary RCT investigated whether an integrated lifestyle modification program that focuses on reducing postprandial blood glucose through replacing high with low glycemic load foods and increasing routine physical activities guided by systematic self-monitoring of blood glucose (GEM) could improve metabolic control of adults with type 2 diabetes mellitus, without compromising other physiological parameters. Forty-seven adults (mean age 55.3 years) who were diagnosed with type 2 diabetes mellitus for less than 5 years (mean 2.1 years), had HbA1c ≥ 7% (mean 8.4%) and were not taking blood glucose lowering medications, were randomized to routine care or five 1-h instructional sessions of GEM. Assessments at baseline and 6 months included a physical exam, metabolic and lipid panels, and psychological questionnaires. The GEM intervention led to significant improvements in HbA1c (decreasing from 8.4 to 7.4% [69-57 mmol/mol] compared with 8.3 to 8.3% [68-68 mmol/mol] for routine care; Interaction p<.01) and psychological functioning without compromising other physiological parameters. Consistent with a patient-centered approach, GEM appears to be an effective lifestyle modification option for adults recently diagnosed with type 2 diabetes mellitus. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Environmental Epigenetics: Crossroad between Public Health, Lifestyle, and Cancer Prevention

PubMed Central

Romani, Massimo; Pistillo, Maria Pia; Banelli, Barbara

2015-01-01

Epigenetics provides the key to transform the genetic information into phenotype and because of its reversibility it is considered an ideal target for therapeutic interventions. This paper reviews the basic mechanisms of epigenetic control: DNA methylation, histone modifications, chromatin remodeling, and ncRNA expression and their role in disease development. We describe also the influence of the environment, lifestyle, nutritional habits, and the psychological influence on epigenetic marks and how these factors are related to cancer and other diseases development. Finally we discuss the potential use of natural epigenetic modifiers in the chemoprevention of cancer to link together public health, environment, and lifestyle. PMID:26339624

Translation of lifestyle modification programs focused on physical activity and dietary habits delivered in community settings.

PubMed

Stoutenberg, Mark; Stanzilis, Katie; Falcon, Ashley

2015-06-01

Lifestyle modification programs (LMPs) can provide individuals with behavioral skills to sustain long-term changes to their physical activity (PA) levels and dietary habits. Yet, there is much work to be done in the translation of these programs to community settings. This review identified LMPs that focused on changing both PA and dietary behaviors and examined common features and barriers faced in their translation to community settings. A search of multiple online databases was conducted to identify LMPs that included participants over the age of 18 who enrolled in LMPs, offered in community settings, and had the goal of improving both PA and dietary behaviors. Data were extracted on participant demographics, study design characteristics, and study outcome variables including changes in PA, dietary habits, body weight, and clinical outcomes. We identified 27 studies that met inclusion criteria. Despite high levels of retention and adherence to the interventions, varying levels of success were observed in increasing PA levels, improving dietary habits, reducing body weight, and improving clinic outcomes. LMPs addressing issues of PA and dietary habits can be successfully implemented in a community setting. However, inconsistent reporting of key components in the translation of these studies (participant recruitment, utilization of behavioral strategies) may limit their replication and advancement of future programs. Future efforts should better address issues such as identifying barriers to participation and program implementation, utilization of community resources, and evaluating changes across multiple health behaviors.

Comparison of Drospirenone- with Cyproterone Acetate-Containing Oral Contraceptives, Combined with Metformin and Lifestyle Modifications in Women with Polycystic Ovary Syndrome and Metabolic Disorders: A Prospective Randomized Control Trial.

PubMed

Wang, Qiu-Yi; Song, Yong; Huang, Wei; Xiao, Li; Wang, Qiu-Shi; Feng, Gui-Mei

2016-04-20

While combined oral contraceptives (COCs) are commonly used to treat polycystic ovary syndrome (PCOS), comparative data regarding metabolic effects of different progestogens on this patient population are missing. This study aimed to compare the different effects of drospirenone (DRP)-containing COCs with cyproterone acetate (CPA)-containing COCs, combined with metformin and lifestyle modifications in women with PCOS and metabolic disorders. Ninety-nine women with PCOS and a metabolic disorder between January 2011 and January 2013 were enrolled into this prospective randomized clinical trial. Participants were randomized into two groups such as DRP-containing COCs, and CPA-containing COCs. Participants took COCs cyclically for 6 months, combined with metformin administration (1.5 g/d) and lifestyle modifications (diet and exercise). Clinical measures and biochemical and hormone profiles were compared. Comparisons for continuous variables were evaluated with paired and unpaired Student's t-tests. The Wilcoxon signed rank test was used when the data were not normally distributed. Analysis of covariance was used to control for age, body mass index (BMI), and baseline data of each analyzed parameter when compared between the two groups. A total of 68 patients have completed the study. The combination regimen of COCs, metformin, and lifestyle modifications in these patients resulted in a significant decrease in BMI, acne, and hirsutism scores when compared to baseline levels in both groups (P < 0.05). Blood pressure (BP) was significantly different in the CPA group when compared to baseline (75.14 ± 6.77 mmHg vs. 80.70 ± 5.60 mmHg, P < 0.01), and after 6 months of treatment, only the change in systolic BP was significantly different between the two groups (4.00 [-6.00, 13.00] mmHg vs. -3.50 [-13.00, 9.00] mmHg, P = 0.009). Fasting glucose, fasting insulin, and homeostasis model assessment-insulin resistance decreased significantly in the DRP group (5.40 ± 0.41 mmol/L vs. 5.21 ± 0.32 mmol/L, P = 0.041; 13.90 [10.50, 18.40] μU/ml vs. 10.75 [8.60, 13.50] μU/ml, P = 0.020; 3.74 [2.85, 4.23] vs. 2.55 [1.92, 3.40], P = 0.008) but did not differ between the two groups. While individual lipid profiles increased in both groups, no statistically significant difference was observed. DRP-containing COCs combined with metformin and lifestyle modifications could better control BP and correct carbohydrate metabolism in women with PCOS and metabolic disorders compared with CPA-containing COCs. Chinese Clinical Trial Registry, ChiCTR-TRC-11001143; http://www.chictr.org.cn/showproj.aspx?proj=8395.

Male infertility: lifestyle factors and holistic, complementary, and alternative therapies.

PubMed

Yao, David F; Mills, Jesse N

2016-01-01

While we may be comfortable with an allopathic approach to male infertility, we are also responsible for knowledge about lifestyle modifications and holistic, complementary, and alternative therapies that are used by many of our patients. This paper provides an evidence-based review separating fact from fiction for several of these therapies. There is sufficient literature to support weight reduction by diet and exercise, smoking cessation, and alcohol moderation. Supplements that have demonstrated positive effects on male fertility on small randomized controlled trial (RCT) include aescin, coenzyme Q 10 , glutathione, Korean red ginseng, L-carnitine, nigella sativa, omega-3, selenium, a combination of zinc and folate, and the Menevit antioxidant. There is no support for the use of Vitamin C, Vitamin E, or saffron. The data for Chinese herbal medications, acupuncture, mind-body practice, scrotal cooling, and faith-based healing are sparse or inconclusive.

Effect of sustaining lifestyle modifications (nonsmoking, weight reduction, physical activity, and mediterranean diet) after healing of myocardial infarction, percutaneous intervention, or coronary bypass (from the REasons for Geographic and Racial Differences in Stroke Study).

PubMed

Booth, John N; Levitan, Emily B; Brown, Todd M; Farkouh, Michael E; Safford, Monika M; Muntner, Paul

2014-06-15

Guidelines recommend lifestyle modification for patients with coronary heart disease (CHD). Few data demonstrate which lifestyle modifications, if sustained, reduce recurrent CHD and mortality risk in cardiac patients after the postacute rehabilitation phase. We determined the association between ideal lifestyle factors and recurrent CHD and all-cause mortality in REasons for Geographic and Racial Differences in Stroke study participants with CHD (n = 4,174). Ideal lifestyle factors (physical activity ≥4 times/week, nonsmoking, highest quartile of Mediterranean diet score, and waist circumference <88 cm for women and <102 cm for men) were assessed through questionnaires and an in-home study visit. There were 447 recurrent CHD events and 745 deaths over a median 4.3 and 4.5 years, respectively. After multivariable adjustment, physical activity ≥4 versus no times/week and non-smoking versus current smoking were associated with reduced hazard ratios (HRs; 95% confidence interval [CI]) for recurrent CHD (HR 0.69, 95% CI 0.54 to 0.89 and HR 0.50, 95% CI 0.39 to 0.64, respectively) and death (HR 0.71, 95% CI 0.59 to 0.86 and HR 0.53, 95% CI 0.44 to 0.65, respectively). The multivariable-adjusted HRs (and 95% CIs) for recurrent CHD and death comparing the highest versus lowest quartile of Mediterranean diet adherence were 0.77 (95% CI 0.55 to 1.06) and 0.84 (95% CI 0.67 to 1.07), respectively. Neither outcome was associated with waist circumference. Comparing participants with 1, 2, and 3 versus 0 ideal lifestyle factors (non-smoking, physical activity ≥4 times/week, and highest quartile of Mediterranean diet score), the HRs (and 95% CIs) were 0.60 (95% CI 0.44 to 0.81), 0.49 (95% CI 0.36 to 0.67), and 0.38 (95% CI 0.21 to 0.67), respectively, for recurrent CHD and 0.65 (95% CI 0.51 to 0.83), 0.57 (95% CI 0.43 to 0.74), and 0.41 (95% CI 0.26 to 0.64), respectively, for death. In conclusion, maintaining smoking cessation, physical activity, and Mediterranean diet adherence is important for secondary CHD prevention. Copyright © 2014 Elsevier Inc. All rights reserved.

Physicians' health habits are associated with lifestyle counseling for hypertensive patients.

PubMed

Hung, Olivia Y; Keenan, Nora L; Fang, Jing

2013-02-01

The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VII) recommended lifestyle interventions, either with or without pharmacologic treatment, for all patients with high blood pressure. The objective of this study is to determine the association of physicians' personal habits with their attitudes and behaviors regarding JNC VII lifestyle modification guidelines. One thousand primary care physicians completed DocStyles 2010, a voluntary web-based survey designed to provide insight into physician attitudes and behaviors regarding various health issues. The respondents' average age was 45.3 years, and 68% were male. In regards to physician behavior, 4.0% smoked at least once a week, 38.6% ate ≥5 cups of fruits and/or vegetables ≥5 days/week, and 27.4% exercised ≥5 days/week. When asked about specific types of advice offered to their hypertensive patients, physicians reported recommending that their patients eat a healthy diet (92.2%), or cut down on salt (96.1%), or attain or maintain a healthy weight (94.8%), or limit the use of alcohol (75.4%), or be physically active (94.4%). Collectively, 66.5% made all 5 lifestyle modification recommendations. Nonsmoking physicians were more likely to recommend each lifestyle intervention to their hypertensive patients. Those who exercised at least 1 day per week were more likely to recommend limiting alcohol use. The probability of recommending all 5 JNC VII interventions was greater for physicians who were nonsmoking and who exercised at least 1 day a week.

Combined Lifestyle and Herbal Medicine in Overweight Women with Polycystic Ovary Syndrome (PCOS): A Randomized Controlled Trial

PubMed Central

Smith, Caroline A.; Abbott, Jason; Fahey, Paul; Cheema, Birinder S.; Bensoussan, Alan

2017-01-01

Polycystic ovary syndrome (PCOS) is a common, complex reproductive endocrinopathy characterized by menstrual irregularities, hyperandrogenism and polycystic ovaries. Lifestyle modification is a first‐line intervention; however, there are barriers to success for this form of self‐care, and women often seek adjunct therapies including herbal medicines. This pragmatic, randomized controlled trial, delivered in communities of Australia in overweight women with PCOS, compared the effectiveness and safety of a lifestyle intervention plus herbal medicine against lifestyle alone. All participants were helped to construct a personalized lifestyle plan. The herbal intervention consisted of two tablets. Tablet 1 contained Cinnamomum verum, Glycyrrhiza glabra, Hypericum perforatum and Paeonia lactiflora. Tablet 2 contained Tribulus terrestris. The primary outcome was oligomenorrhoea/amenorrhoea. Secondary outcomes were hormones; anthropometry; quality of life; depression, anxiety and stress; pregnancy; birth outcomes; and safety. One hundred and twenty‐two women gave their consent. At 3 months, women in the combination group recorded a reduction in oligomenorrhoea of 32.9% (95% confidence interval 23.3–42.6, p < 0.01) compared with controls, estimated as a large effect (ηp 2 = 0.11). Other significant improvements were found for body mass index (p < 0.01); insulin (p = 0.02) and luteinizing hormone (p = 0.04); blood pressure (p = 0.01); quality of life (p < 0.01); depression, anxiety and stress (p < 0.01); and pregnancy rates (p = 0.01). This trial provides evidence of improved effectiveness and safety for lifestyle intervention when combined with herbal medicines in women with PCOS. © 2017 The Authors. Phytotherapy Research published by John Wiley & Sons Ltd PMID:28685911

Combined Lifestyle and Herbal Medicine in Overweight Women with Polycystic Ovary Syndrome (PCOS): A Randomized Controlled Trial.

PubMed

Arentz, Susan; Smith, Caroline A; Abbott, Jason; Fahey, Paul; Cheema, Birinder S; Bensoussan, Alan

2017-09-01

Polycystic ovary syndrome (PCOS) is a common, complex reproductive endocrinopathy characterized by menstrual irregularities, hyperandrogenism and polycystic ovaries. Lifestyle modification is a first-line intervention; however, there are barriers to success for this form of self-care, and women often seek adjunct therapies including herbal medicines. This pragmatic, randomized controlled trial, delivered in communities of Australia in overweight women with PCOS, compared the effectiveness and safety of a lifestyle intervention plus herbal medicine against lifestyle alone. All participants were helped to construct a personalized lifestyle plan. The herbal intervention consisted of two tablets. Tablet 1 contained Cinnamomum verum, Glycyrrhiza glabra, Hypericum perforatum and Paeonia lactiflora. Tablet 2 contained Tribulus terrestris. The primary outcome was oligomenorrhoea/amenorrhoea. Secondary outcomes were hormones; anthropometry; quality of life; depression, anxiety and stress; pregnancy; birth outcomes; and safety. One hundred and twenty-two women gave their consent. At 3 months, women in the combination group recorded a reduction in oligomenorrhoea of 32.9% (95% confidence interval 23.3-42.6, p < 0.01) compared with controls, estimated as a large effect (η p 2  = 0.11). Other significant improvements were found for body mass index (p < 0.01); insulin (p = 0.02) and luteinizing hormone (p = 0.04); blood pressure (p = 0.01); quality of life (p < 0.01); depression, anxiety and stress (p < 0.01); and pregnancy rates (p = 0.01). This trial provides evidence of improved effectiveness and safety for lifestyle intervention when combined with herbal medicines in women with PCOS. © 2017 The Authors. Phytotherapy Research published by John Wiley & Sons Ltd. © 2017 The Authors. Phytotherapy Research published by John Wiley & Sons Ltd.

Diet and lifestyle intervention among patients with colorectal adenomas: rationale and design of a Malaysian study.

PubMed

Kandiah, Mirnalini; Ramadas, Amutha; Shariff, Zalilah Mohd; Yusof, Rokiah Mohd; Gul, Yunus Gul Alif

2005-01-01

Comprehensive evaluation of the large body of consistent evidence from laboratory, epidemiologic and clinical studies has led to the conclusion that modification of the dietary and lifestyle patterns of populations has considerable potential for reducing cancer risk. This paper describes a randomized-controlled trial involving a diet and lifestyle intervention for patients with history of colorectal adenomas. The primary aim of this trial is to evaluate the effectiveness of the intervention with reference to recurrence of adenomatous polyps over a two year period--the first year being the intervention period and the second year of the study allowing for post-intervention follow-up. Subjects found to fit the inclusion criteria are recruited and randomized to two groups: the intervention group and the control group. The intervention group subjects will attend a monthly lecture-discussion session for 10 months and small group counseling on modification of lifestyle behavior and diet as well as receive educational materials which were adapted from the WCRF Diet and Health Recommendations for Cancer Prevention. Control subjects will be provided with the usual care given to such patients. One hundred and sixteen patients who were diagnosed with colorectal adenomatous polyps in the previous twelve months at the Hospital Kuala Lumpur have already been enrolled in this trial. Baseline data collection is on-going.

Self-reported health-related behaviors and dietary habits in patients with metabolic syndrome.

PubMed

Piotrowicz, Katarzyna; Pałkowska, Ewelina; Bartnikowska, Elżbieta; Krzesiński, Paweł; Stańczyk, Adam; Biecek, Przemysław; Skrobowski, Andrzej; Gielerak, Grzegorz

2015-01-01

There is an ongoing debate about factors affecting the maintenance of a healthy lifestyle especially in the population without coronary artery disease (CAD) symptoms and with one or several risk factors. The study was aimed at describing self-reported health-related behaviors and dietary habits in patients with metabolic syndrome (MetS). Consecutive patients with an outpatient diagnosis of MetS admitted to our cardiology department underwent clinical examination and cardiovascular risk assessment based on the SCORE scale. Self-reported intensity of pro-healthy behaviors was described using the Health Behavior Inventory (HBI) developed by Juczynski. Diet quality was assessed using the 24-h dietary recall method, diet history questionnaire and the Healthy Eating Index-2010 (HEI). A total of 113 patients were recruited (90 males, mean age 48 ± 9 years) including 85% of patients with at least moderate cardiovascular risk (SCORE ≥ 1%). Central obesity was confirmed in 100%, family history of CAD in 75%, LDL exceeding 115 mg/dL in 68% of the patients. A total of 66% of the patients had already been on antihypertensive and 30% on lipid-lowering treatment without previous counselling on lifestyle modification. Most patients reported high or medium level health-related behaviors (23% and 45%, respectively). However, 91% led sedentary lifestyle and none of the patients followed cardioprotective diet recommendations. According to the HEI, 73% required partial and 27% complete diet modification. There is a significant discrepancy between health perception and medical recommendations in patients with MetS. Effective patient education, taking into account a revision of the patient's knowledge on the principles of prophylaxis, may form the fundament for the changes in patient behavior, and cardiovascular risk reduction.

Effects of a lifestyle programme on ambulatory blood pressure and drug dosage in treated hypertensive patients: a randomized controlled trial.

PubMed

Burke, Valerie; Beilin, Lawrie J; Cutt, Hayley E; Mansour, Jacqueline; Wilson, Amy; Mori, Trevor A

2005-06-01

To assess effects of multifactorial lifestyle modification on antihypertensive drug needs in treated hypertensive individuals. Randomized controlled trial. Research studies unit. Overweight hypertensive patients, receiving one or two antihypertensive drugs, were recruited by advertising, and allocated randomly to a usual care group (controls; n = 118) or a lifestyle modification group (programme group; n = 123). A 4-month programme of weight loss, a low-sodium 'Dietary Approaches to Stop Hypertension'-type diet with added fish, physical activity and moderation of alcohol intake. After 4 months, if mean 24-h ambulatory blood pressure (ABP) was less than 135/85 mmHg, antihypertensive drugs were withdrawn over 4 weeks and long-term home blood pressure monitoring was begun. Antihypertensive drug requirements, ABP, weight, waist girth at 4 months and 1-year follow-up. Ninety control group and 102 programme group participants completed the study. Mean 24-h ABP changed after 4 months by -1.0/-0.3 +/- 0.5/0.4 mmHg in controls and -4.1/-2.1 +/- 0.7/0.5 mmHg with the lifestyle programme (P < 0.01). At follow-up, changes in the two groups were not significantly different (4.1/1.3 +/- 1.1/1.0 mmHg in controls; 2.5/-0.1 +/- 1.1/0.8 mmHg in the programme group; P = 0.73). At 4 months, drug withdrawal differed significantly between the groups (P = 0.038) in men (control 44%; programme 66%) but not in women (65 and 64%, respectively; P = 0.964). At follow-up, sex-related differences were not significant, and 41% in the control group and 43% in the programme group maintained drug-withdrawal status. With the programme, net weight loss was 3.3 kg (P < 0.001) at 4 months and 3.0 kg (P < 0.001) at follow-up; respective net decreases in waist girth were 3.3 cm (P < 0.001) and 3.5 cm (P < 0.001). A 4-month multifactorial lifestyle modification in patients with treated hypertension reduced blood pressure in the short-term. Decreased central obesity persisted 1 year later and could reduce overall cardiovascular risk.

Online Lifestyle Modification Intervention: Survey of Primary Care Providers' Attitudes and Views.

PubMed

Hanna, Reem M; Fischer, Gary; Conroy, Molly B; Bryce, Cindy; Hess, Rachel; McTigue, Kathleen

2018-06-08

Online tools are a convenient and effective method of delivering lifestyle interventions to obese adult primary care patients. A referral model allows physicians to efficiently direct their patients to the intervention during a primary care visit. However, little is known of physicians' perspectives and utilization of the referral model for an online lifestyle modification intervention. The aim was to evaluate the response of primary care providers (PCPs) to a referral model for implementing a year-long online intervention for weight loss to obese adult patients. The PCPs at six primary care clinics were asked to refer adult obese patients to a year-long online lifestyle intervention providing self-management support for weight loss. Following the 1-year intervention, all providers at the participating practices were surveyed regarding their views of the program. Respondents completed survey items assessing their attitudes regarding the 1-year intensive weight loss intervention and identifying resources they would find helpful for assisting patients with weight loss. Referring physicians were asked about their level of satisfaction with implementing the counseling services using standard electronic health record referral processes. Attitudes toward obesity counseling among referring and nonreferring providers were compared. Impressions of how smoothly the referral model of obesity treatment integrated with the clinical workflow were also quantified. Of the 67 providers who completed the surveys, nonreferring providers (n=17) were more likely to prefer counseling themselves (P=.04) and to report having sufficient time to do so (P=.03) than referring providers (n=50) were. Nonreferring providers were more likely to report that their patients lacked computer skills (76%, 13/17 vs 34%, 17/50) or had less access to the Internet (65%, 11/17 vs 32%, 16/50). Understanding providers' views and barriers regarding the integration of online tools will facilitate widespread implementation of an online lifestyle modification intervention. ©Reem M Hanna, Gary Fischer, Molly B Conroy, Cindy Bryce, Rachel Hess, Kathleen McTigue. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 08.06.2018.

A web-based lifestyle intervention for women with recent gestational diabetes mellitus: a randomized controlled trial.

PubMed

Nicklas, Jacinda M; Zera, Chloe A; England, Lucinda J; Rosner, Bernard A; Horton, Edward; Levkoff, Sue E; Seely, Ellen W

2014-09-01

To test the feasibility and effectiveness of a Web-based lifestyle intervention based on the Diabetes Prevention Program modified for women with recent gestational diabetes mellitus to reduce postpartum weight retention. We randomly allocated 75 women with recent gestational diabetes mellitus to either a Web-based lifestyle program (Balance after Baby) delivered over the first postpartum year or to a control group. Primary outcomes were change in body weight at 12 months from 1) first postpartum measured weight; and 2) self-reported prepregnancy weight. There were no significant differences in baseline characteristics between groups including age, body mass index, race, and income status. Women assigned to the Balance after Baby program (n=36, three lost to follow-up) lost a mean of 2.8 kg (95% confidence interval -4.8 to -0.7) from 6 weeks to 12 months postpartum, whereas the control group (n=39, one lost to follow-up) gained a mean of 0.5 kg (-1.4 to +2.4) (P=.022). Women in the intervention were closer to prepregnancy weight at 12 months postpartum (mean change -0.7 kg; -3.5 to +2.2) compared with women in the control arm (+4.0 kg; +1.3 to +6.8) (P=.035). A Web-based lifestyle modification program for women with recent gestational diabetes mellitus decreased postpartum weight retention. ClinicalTrials.gov, www.clinicaltrials.gov, NCT01158131. I.

A review of treatment and management modalities for premenstrual dysphoric disorder.

PubMed

Kelderhouse, Kelli; Taylor, Julie Smith

2013-01-01

Premenstrual dysphoric disorder (PMDD) affects 5 to 8 percent of women and can significantly decrease their quality of life. Symptoms generally present during the late luteal phase of the menstrual cycle and can affect women emotionally, behaviorally, cognitively and physiologically. This article reviews the clinical literature on PMDD and the evidence behind various methods of symptom management. Evidence suggests that a holistic approach, including lifestyle modifications, pharmacotherapy and cognitive behavioral therapy, is most beneficial for symptom reduction and improvement in daily functioning and quality of life. © 2013 AWHONN.

[The effect of lifestyle modification on chronic constipation].

PubMed

Borre, Mette; Qvist, Niels; Raahave, Dennis; Worsøe, Jonas; Ærthøj, Jørgen Peter; Christensen, Peter; Krogh, Klaus

2015-04-06

First-line treatment of constipation includes dietary fibre, fluid and exercise. The evidence for these recommendations is, however, scarce. Increased intake of fibre will reduce colonic transit time and improve the frequency and consistency of stools in 50% of patients. Bloating and flatulence are common side effects to highly fermentable fibres. Daily intake of 2 l of water enhances the positive effects of fibre and 30 min. exercise per day also alleviates symptoms. Conservative treatment is usually insufficient and should be supplemented with laxatives or motility enhancing drugs.

Hypogonadism as a possible link between metabolic diseases and erectile dysfunction in aging men.

PubMed

Corona, Giovanni; Bianchini, Silvia; Sforza, Alessandra; Vignozzi, Linda; Maggi, Mario

2015-01-01

There is evidence demonstrating that sexual complaints represent the most specific symptoms associated with late onset hypogonadism, while central obesity is the most specific sign. In obese men, hypogonadism can further worsen the metabolic profile and increase abdominal fat. In addition, although hypogonadism can exacerbate obesity-associated erectile dysfunction (ED), recent data suggest that a direct contribution of fat-derived factors could be hypothesized. In particular, an animal model recently documented that fat accumulation induces several hepatic pro-inflammatory genes closely linked to corpora cavernosa endothelial dysfunction. Lifestyle modifications and weight loss are the first steps in the treatment of ED patients with obesity or metabolic diseases. In symptomatic hypogonadal men with metabolic impairment and obesity, combining the effect of testosterone substitution with lifestyle modifications could result in better outcomes.

Effectiveness of a Group Support Lifestyle Modification (GSLiM) Programme among Obese Adults in Workplace: A Randomised Controlled Trial

PubMed Central

Azmi Mohamed, Mohd Nahar; Mukhtar, Firdaus

2016-01-01

Background There was an increasing trend in the prevalence of obesity and its comorbidities over the past decades in Malaysia. Effective intervention for obesity remains limited. This study aimed to compare the effectiveness of a group based lifestyle modification programme amongst obese individuals with an existing dietary counseling programme. Methods We recruited one hundred and ninety four overweight and obese (BMI>27.5 kg/m2) employees from a local university. They were randomly allocated to either Group Support Lifestyle Modification (GSLiM) (intervention)(n = 97) or dietary counseling (comparison)(n = 97). The GSLIM activities included self monitoring, cognitive-behaviour sessions, exercise as well as dietary change advocacy, which were conducted through seminars and group sessions over 24 weeks. The comparison group was given dietary counselling once in 12 weeks. Both groups were followed up for additional 12 weeks to check for intervention effect sustenance. Anthropometric and biochemical parameters were measured at baseline, 12, 24 and 36 weeks; while dietary intake, physical activities, psychological measures and quality of life measured at baseline, 24 and 36 weeks. Data analysis was conducted using ANOVA repeated measures with intention to treat principle. Results The participants were predominantly women with mean (standard deviation) age of 40.5 (9.3) years. A total of 19.6% of the participants in GSLiM achieved 6% weight loss compared to 4.1% in the comparison group (Risk Ratio 4.75; 95% CI: 1.68, 13.45). At 24 weeks, the retention rate was 83.5% for GSLiM and 82.5% for comparison group. GSLiM participants also achieved significant improvement in total weight self-efficacy score, negative emotions and physical discomfort subscales, MDPSS friend subscale and all domains in quality of life. Participants in the comparison group experienced reduction in negative self-thoughts. Conclusion The GSLiM programme proved to be more effective in achieving targeted weight loss, improving weight self-efficacy, friend social support, and quality of life compared to dietary counseling. Trial Registration Iranian Registry of Clinical Trials IRCT201104056127N1 PMID:27537687

Effectiveness of a Group Support Lifestyle Modification (GSLiM) Programme among Obese Adults in Workplace: A Randomised Controlled Trial.

PubMed

Jamal, Siti Noraida; Moy, Foong Ming; Azmi Mohamed, Mohd Nahar; Mukhtar, Firdaus

2016-01-01

There was an increasing trend in the prevalence of obesity and its comorbidities over the past decades in Malaysia. Effective intervention for obesity remains limited. This study aimed to compare the effectiveness of a group based lifestyle modification programme amongst obese individuals with an existing dietary counseling programme. We recruited one hundred and ninety four overweight and obese (BMI>27.5 kg/m2) employees from a local university. They were randomly allocated to either Group Support Lifestyle Modification (GSLiM) (intervention)(n = 97) or dietary counseling (comparison)(n = 97). The GSLIM activities included self monitoring, cognitive-behaviour sessions, exercise as well as dietary change advocacy, which were conducted through seminars and group sessions over 24 weeks. The comparison group was given dietary counselling once in 12 weeks. Both groups were followed up for additional 12 weeks to check for intervention effect sustenance. Anthropometric and biochemical parameters were measured at baseline, 12, 24 and 36 weeks; while dietary intake, physical activities, psychological measures and quality of life measured at baseline, 24 and 36 weeks. Data analysis was conducted using ANOVA repeated measures with intention to treat principle. The participants were predominantly women with mean (standard deviation) age of 40.5 (9.3) years. A total of 19.6% of the participants in GSLiM achieved 6% weight loss compared to 4.1% in the comparison group (Risk Ratio 4.75; 95% CI: 1.68, 13.45). At 24 weeks, the retention rate was 83.5% for GSLiM and 82.5% for comparison group. GSLiM participants also achieved significant improvement in total weight self-efficacy score, negative emotions and physical discomfort subscales, MDPSS friend subscale and all domains in quality of life. Participants in the comparison group experienced reduction in negative self-thoughts. The GSLiM programme proved to be more effective in achieving targeted weight loss, improving weight self-efficacy, friend social support, and quality of life compared to dietary counseling. Iranian Registry of Clinical Trials IRCT201104056127N1.

The Fit Family Challenge: A Primary Care Childhood Obesity Pilot Intervention.

PubMed

Jortberg, Bonnie T; Rosen, Raquel; Roth, Sarah; Casias, Luke; Dickinson, L Miriam; Coombs, Letoynia; Awadallah, Nida S; Bernardy, Meaghann K; Dickinson, W Perry

2016-01-01

Childhood obesity has increased dramatically over several decades, and the American Academy of Pediatrics has recommended primary care practices as ideal sites for the identification, education, and implementation of therapeutic interventions. The objective of this study was to describe the implementation and results for the Fit Family Challenge (FFC), a primary care-based childhood obesity intervention. A single-intervention pilot project that trains primary care practices on childhood obesity guidelines and implementation of a family-focused behavior modification curriculum. A total of 29 family medicine and pediatric community practices in Colorado participated. Participants included 290 patients, aged 6 to 12 years, with a body mass index (BMI) above the 85th percentile. The main outcome measure included the feasibility of implementation of a childhood obesity program in primary care; secondary outcomes were changes in BMI percentile, BMI z-scores, blood pressure, and changes in lifestyle factors related to childhood obesity. Implementation of FFC is feasible, statically significant changes were seen for decreases in BMI percentile and BMI z-scores for participants who completed 9 to 15 months of follow-up; lifestyle factors related to childhood obesity in proved Spanish-speaking families and food insecurity were associated with less follow-up time (P < .01). A primary care-based childhood obesity intervention may result in significant clinical and lifestyle changes. © Copyright 2016 by the American Board of Family Medicine.

Change in daily ambulatory activity and cardiovascular events in people with impaired glucose tolerance.

PubMed

Popp Switzer, Maryna; Elhanafi, Sherif; San Juan, Zinnia T

2015-03-01

Patients with pre-diabetes have a tenfold higher risk of developing Type 2 DM and a twofold higher risk of developing coronary heart disease compared to non-diabetics. Interventions targeted at those in an early stage of impaired glucose metabolism can delay or prevent diabetes. Effects of these interventions on cardiovascular outcome are unknown. This article aims to review current and available data on lifestyle intervention, specifically physical activity, on cardiovascular outcomes in populations at risk for diabetes. We searched PubMed database from 1990 to present with focus on more recent literature published over the last 2 years. Various permutations of keywords used included glucose intolerance, pre-diabetes, diabetes, lifestyle modifications, physical activity, and cardiovascular disease. Intensive glycemic control, specific medications, and lifestyle intervention including increase in physical activity have been evaluated in diabetes and pre-diabetes. Most studies we reviewed showed that these interventions prevented progression of pre-diabetes to diabetes and improved cardiovascular risk surrogate measures. Direct decrease in cardiovascular mortality, non-fatal stroke, and non-fatal myocardial infarctions was shown in one recent trial. Increase in physical activity has a positive effect on decreasing cardiovascular risk by modifying several important risk factors and may decrease risk of events in pre-diabetics. More randomized high power trials are needed to verify and characterize these effects.

Unhealthy Lifestyle Behaviors in Korean People with Metabolic Syndrome.

PubMed

Moon, Seongmi

2017-01-01

This study identified factors associated with unhealthy lifestyle behaviors in people with metabolic syndrome in South Korea. The sample consisted of 1,207 subjects with metabolic syndrome from the Sixth Korea National Health and Nutrition Examination Survey conducted in 2014. High-risk alcohol consumption, smoking, aerobic physical activity, leisure physical activity, excessive carbohydrate intake, and fat intake were measured. A secondary data analysis was performed using chi-square tests and logistic regression. Gender was associated with all unhealthy behaviors. The number of metabolic syndrome components, a poor perceived health status, and attempts to control weight were associated with physical inactivity. Those findings may be helpful to develop a tailored lifestyle modification programs for people with metabolic syndrome.

Evidence of lifestyle modification in the management of hypercholesterolemia.

PubMed

Mannu, G S; Zaman, M J S; Gupta, A; Rehman, H U; Myint, P K

2013-02-01

Coronary heart disease (CHD) is the leading cause of morbidity and mortality worldwide. The growth of ageing populations in developing countries with progressively urbanized lifestyles are major contributors. The key risk factors for CHD such as hypercholesterolemia, diabetes mellitus, and obesity are likely to increase in the future. These risk factors are modifiable through lifestyle. To review current literature on the potential benefit of cholesterol lowering in CHD risk reduction with a particular focus on the evidence of non-pharmacological/lifestyle management of hypercholesterolemia. Medline/PubMed systematic search was conducted using a two-tier approach limited to all recent English language papers. Primary search was conducted using key words and phrases and all abstracts were subsequently screened and relevant papers were selected. The next tier of searching was conducted by (1) reviewing the citation lists of the selected papers and (2) by using PubMed weblink for related papers. Over 3600 reports were reviewed. Target cholesterol levels set out in various guidelines could be achieved by lifestyle changes, including diet, weight reduction, and increased physical activity with the goal of reducing total cholesterol to <200 mg/dL and LDL-C<100 mg/dL. Various dietary constituents such as green tea, plant sterols, soy protein have important influences on total cholesterol. Medical intervention should be reserved for those patients who have not reached this goal after 3 months of non-pharmacological approach. CHD remains as a leading cause of death worldwide and hypercholesterolemia is an important cause of CHD. Non-pharmacological methods provide initial as well as long-term measures to address this issue.

Chronic Cough Due to Gastroesophageal Reflux in Adults: CHEST Guideline and Expert Panel Report.

PubMed

Kahrilas, Peter J; Altman, Kenneth W; Chang, Anne B; Field, Stephen K; Harding, Susan M; Lane, Andrew P; Lim, Kaiser; McGarvey, Lorcan; Smith, Jaclyn; Irwin, Richard S

2016-12-01

We updated the 2006 ACCP clinical practice guidelines for management of reflux-cough syndrome. Two population, intervention, comparison, outcome (PICO) questions were addressed by systematic review: (1) Can therapy for gastroesophageal reflux improve or eliminate cough in adults with chronic and persistently troublesome cough? and (2) Are there minimal clinical criteria to guide practice in determining that chronic cough is likely to respond to therapy for gastroesophageal reflux? We found no high-quality studies pertinent to either question. From available randomized controlled trials (RCTs) addressing question #1, we concluded that (1) there was a strong placebo effect for cough improvement; (2) studies including diet modification and weight loss had better cough outcomes; (3) although lifestyle modifications and weight reduction may be beneficial in suspected reflux-cough syndrome, proton pump inhibitors (PPIs) demonstrated no benefit when used in isolation; and (4) because of potential carryover effect, crossover studies using PPIs should be avoided. For question #2, we concluded from the available observational trials that (1) an algorithmic approach to management resolved chronic cough in 82% to 100% of instances; (2) cough variant asthma and upper airway cough syndrome (UACS) (previously referred to as postnasal drip syndrome) from rhinosinus conditions were the most commonly reported causes; and (3) the reported prevalence of reflux-cough syndrome varied widely. The panelists (1) endorsed the use of a diagnostic/therapeutic algorithm addressing causes of common cough, including symptomatic reflux; (2) advised that although lifestyle modifications and weight reduction may be beneficial in suspected reflux-cough syndrome, PPIs demonstrated no benefit when used in isolation; and (3) suggested that physiological testing be reserved for refractory patients being considered for antireflux surgery or for those in whom there is strong clinical suspicion warranting diagnostic testing. Copyright © 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

Australian association for exercise and sports science position statement on exercise and hypertension.

PubMed

Sharman, James E; Stowasser, Michael

2009-03-01

Hypertension (high blood pressure; BP) is a leading contributor to premature death and disability from cardiovascular disease. Lifestyle modification that includes regular physical activity is often recommended to patients with hypertension as one of the first line treatments for lowering BP, as well as improving overall risk for cardiovascular events. It is recognised that allied health care professionals play an important role in helping patients to achieve BP control by influencing and reinforcing appropriate lifestyle behavior. The minimum amount of exercise that is recommended in patients with hypertension comprises a mix of moderate to vigorous aerobic (endurance) activity (up to 5 days/week) in addition to resistance (strength) training (on 2 or more non-consecutive days/week). However, due to the dose-response relationship between physical activity and health, exercise levels performed beyond the minimum recommendations are expected to confer additional health benefits. Vigorous exercise training is generally safe and well tolerated by most people, including those with hypertension, although some special considerations are required and these are discussed in this review.

Mind-body medicine and lifestyle modification in supportive cancer care: A cohort study on a day care clinic program for cancer patients.

PubMed

Jeitler, Michael; Jaspers, Jessica; von Scheidt, Christel; Koch, Barbara; Michalsen, Andreas; Steckhan, Nico; Kessler, Christian S

2017-12-01

We developed an integrative day care clinic program for cancer patients focusing on mind-body techniques and health-promoting lifestyle modification (7-hour once-per-week group sessions over 12 weeks). A cohort study design with a waiting group was implemented. Outcome parameters were assessed at the beginning, at the end of the active program, and at a 6-month follow-up. Patients waiting >4 and <12 weeks before treatment start were allocated to the waiting group and additionally assessed at the start of their day care program. Outcome measures included quality of life (FACT-G, FACT-B/C, WHO-5), fatigue (FACIT-F), depression/anxiety (HADS), and mood states (ASTS). A per protocol analysis using mixed linear models was performed. One hundred patients were screened on-site for eligibility. Eighty-six cancer survivors (83% female; mean age 53.7 ± 9.7 years; 49% breast cancer) were included into the study. Sixty-two patients were allocated to the intervention group and 24 patients, to the waiting group (mean waiting time 5 ± 1 weeks). Sixty-six data sets were included in the final analysis. Significant improvements were observed in favor of the intervention group after 12 weeks compared with the waiting group at the end of the waiting period for quality of life, anxiety/depression, and fatigue. Results from the 6-month follow-up for the whole study population showed lasting improvement of quality of life. The program can be considered as an effective means to improve quality of life, fatigue, and mental health of cancer patients. Moreover, it appears to have a sustainable effect, which has to be proved in randomized trials. Copyright © 2017 John Wiley & Sons, Ltd.

Prevalence and Management of Systemic Hypertension in Athletes.

PubMed

Caselli, Stefano; Vaquer Sequì, Antonia; Lemme, Erika; Quattrini, Filippo; Milan, Alberto; D'Ascenzi, Flavio; Spataro, Antonio; Pelliccia, Antonio

2017-05-15

The aim of the present study was to evaluate the prevalence, determinants, and clinical management of systemic hypertension in a large cohort of competitive athletes: 2,040 consecutive athletes (aged 25 ± 6 years, 64% men) underwent clinical evaluation including blood test, electrocardiogram, exercise test, echocardiography, and ophthalmic evaluation. Sixty-five athletes (3%) were identified with hypertension (men = 57; 87%) including 5 with a secondary cause (thyroid dysfunction in 3, renal artery stenosis in 1, and drug induced in 1). The hypertensive athletes had greater left ventricular hypertrophy and showed more often a concentric pattern than normotensive ones. Moreover, they showed a mildly reduced physical performance and were characterized by a higher cardiovascular risk profile compared with normotensive athletes. Multivariate logistic regression analysis showed that family hypertension history (odds ratio 2.05; 95% confidence interval 1.21 to 3.49; p = 0.008) and body mass index (odds ratio 1.32; 95% confidence interval 1.23 to 1.40; p <0.001) were the strongest predictors of hypertension. Therapeutic intervention included successful lifestyle modification in 57 and required additional pharmacologic treatment in 3 with essential hypertension. Secondary hypertension was treated according to the underlying disorder. After a mean follow-up of 18 ± 6 months, all hypertensive athletes had achieved and maintained optimal control of the blood pressure, without restriction to sport participation. In conclusion, the prevalence of hypertension in athletes is low (3%) and largely related to family history and overweight. In the vast majority of hypertensives, lifestyle modifications were sufficient to achieve an optimal control of blood pressure values. Copyright © 2017 Elsevier Inc. All rights reserved.

75 FR 47458 - TRICARE; Diabetic Education

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-06

... counseling for socioeconomic purposes, stress management, lifestyle modification. Services provided by a...: Joy Saly, Medical Benefits and Reimbursement Branch, TRICARE Management Activity, telephone (303) 676... education. Diabetes self-management training (DSMT) is an interactive, collaborative process involving...

Mudskippers and Their Genetic Adaptations to an Amphibious Lifestyle

PubMed Central

You, Xinxin; Sun, Min; Li, Jia; Bian, Chao; Chen, Jieming; Yu, Hui; Shi, Qiong

2018-01-01

Simple Summary Mudskippers are an interesting group of goggle-eyed amphibious fish that can live both in water and on land. They are a useful model for obtaining insights into the genetic mechanisms underlying the terrestrial adaptations of amphibious fish. This review summarizes the morphological and physiological modifications of representative mudskippers, and focuses on the recent advancement of genomic studies on their genetic adaptations to the amphibious lifestyle. Abstract Mudskippers are the largest group of amphibious teleost fish that are uniquely adapted to live on mudflats. During their successful transition from aqueous life to terrestrial living, these fish have evolved morphological and physiological modifications of aerial vision and olfaction, higher ammonia tolerance, aerial respiration, improved immunological defense against terrestrial pathogens, and terrestrial locomotion using protruded pectoral fins. Comparative genomic and transcriptomic data have been accumulated and analyzed for understanding molecular mechanisms of the terrestrial adaptations. Our current review provides a general introduction to mudskippers and recent research advances of their genetic adaptations to the amphibious lifestyle, which will be helpful for understanding the evolutionary transition of vertebrates from water to land. Our insights into the genomes and transcriptomes will also support molecular breeding, functional identification, and natural compound screening. PMID:29414871

Autonomy-supportive, Web-based lifestyle modification for cardiometabolic risk in postmenopausal women: Randomized trial.

PubMed

Kim, Hye-Ryoung; Kim, Hee-Seung

2017-12-01

The management of cardiometabolic risk factors, such as abdominal obesity, dyslipidemia, hypertension, and hyperglycemia, is essential for the health of postmenopausal women. In this study, we identified the effects of autonomy-supportive, Web-based lifestyle modification for the management cardiometabolic risk of postmenopausal women, and assessed the mediation effect of intrinsic motivation. This study was a randomized trial involving 71 postmenopausal Korean women. For the intervention group, we provided the Web-based autonomy supports for 12 weeks; however, for the control group, individual consultations on healthy lifestyle was conducted at the first meeting. In the intervention group, cardiometabolic risks ameliorated as follows: waist circumference and waist-to-height ratio decreased by 3.9 cm and 0.03 cm, respectively; triglycerides decreased by 8.5 mg/dl; triglycerides-to-high-density-lipoprotein cholesterol ratio decreased by 0.21; systolic blood pressure decreased by 3.3 mmHg, and the visceral adiposity index decreased. Among the subdomain of intrinsic motivation, perceived competence, effort/importance, and perceived choice showed an association with waist circumference changes. Web-based autonomy supports can be effective in implementation and maintenance, and the amelioration of cardiometabolic risk in postmenopausal women. © 2017 John Wiley & Sons Australia, Ltd.

Comparison of Drospirenone- with Cyproterone Acetate-Containing Oral Contraceptives, Combined with Metformin and Lifestyle Modifications in Women with Polycystic Ovary Syndrome and Metabolic Disorders: A Prospective Randomized Control Trial

PubMed Central

Wang, Qiu-Yi; Song, Yong; Huang, Wei; Xiao, Li; Wang, Qiu-Shi; Feng, Gui-Mei

2016-01-01

Background: While combined oral contraceptives (COCs) are commonly used to treat polycystic ovary syndrome (PCOS), comparative data regarding metabolic effects of different progestogens on this patient population are missing. This study aimed to compare the different effects of drospirenone (DRP)-containing COCs with cyproterone acetate (CPA)-containing COCs, combined with metformin and lifestyle modifications in women with PCOS and metabolic disorders. Methods: Ninety-nine women with PCOS and a metabolic disorder between January 2011 and January 2013 were enrolled into this prospective randomized clinical trial. Participants were randomized into two groups such as DRP-containing COCs, and CPA-containing COCs. Participants took COCs cyclically for 6 months, combined with metformin administration (1.5 g/d) and lifestyle modifications (diet and exercise). Clinical measures and biochemical and hormone profiles were compared. Comparisons for continuous variables were evaluated with paired and unpaired Student's t-tests. The Wilcoxon signed rank test was used when the data were not normally distributed. Analysis of covariance was used to control for age, body mass index (BMI), and baseline data of each analyzed parameter when compared between the two groups. Results: A total of 68 patients have completed the study. The combination regimen of COCs, metformin, and lifestyle modifications in these patients resulted in a significant decrease in BMI, acne, and hirsutism scores when compared to baseline levels in both groups (P < 0.05). Blood pressure (BP) was significantly different in the CPA group when compared to baseline (75.14 ± 6.77 mmHg vs. 80.70 ± 5.60 mmHg, P < 0.01), and after 6 months of treatment, only the change in systolic BP was significantly different between the two groups (4.00 [–6.00, 13.00] mmHg vs. –3.50 [–13.00, 9.00] mmHg, P = 0.009). Fasting glucose, fasting insulin, and homeostasis model assessment-insulin resistance decreased significantly in the DRP group (5.40 ± 0.41 mmol/L vs. 5.21 ± 0.32 mmol/L, P = 0.041; 13.90 [10.50, 18.40] μU/ml vs. 10.75 [8.60, 13.50] μU/ml, P = 0.020; 3.74 [2.85, 4.23] vs. 2.55 [1.92, 3.40], P = 0.008) but did not differ between the two groups. While individual lipid profiles increased in both groups, no statistically significant difference was observed. Conclusions: DRP-containing COCs combined with metformin and lifestyle modifications could better control BP and correct carbohydrate metabolism in women with PCOS and metabolic disorders compared with CPA-containing COCs. Trial Registration: Chinese Clinical Trial Registry, ChiCTR-TRC-11001143; http://www.chictr.org.cn/showproj.aspx?proj=8395. PMID:27064030

Benefits and costs of intensive lifestyle modification programs for symptomatic coronary disease in Medicare beneficiaries.

PubMed

Zeng, Wu; Stason, William B; Fournier, Stephen; Razavi, Moaven; Ritter, Grant; Strickler, Gail K; Bhalotra, Sarita M; Shepard, Donald S

2013-05-01

This study reports outcomes of a Medicare-sponsored demonstration of two intensive lifestyle modification programs (LMPs) in patients with symptomatic coronary heart disease: the Cardiac Wellness Program of the Benson-Henry Mind Body Institute (MBMI) and the Dr Dean Ornish Program for Reversing Heart Disease® (Ornish). This multisite demonstration, conducted between 2000 and 2008, enrolled Medicare beneficiaries who had had an acute myocardial infarction or a cardiac procedure within the preceding 12 months or had stable angina pectoris. Health and economic outcomes are compared with matched controls who had received either traditional or no cardiac rehabilitation following similar cardiac events. Each program included a 1-year active intervention of exercise, diet, small-group support, and stress reduction. Medicare claims were used to examine 3-year outcomes. The analysis includes 461 elderly, fee-for-service, Medicare participants and 1,795 controls. Cardiac and non-cardiac hospitalization rates were lower in participants than controls in each program and were statistically significant in MBMI (P < .01). Program costs of $3,801 and $4,441 per participant for the MBMI and Ornish Programs, respectively, were offset by reduced health care costs yielding non-significant three-year net savings per participant of about $3,500 in MBMI and $1,000 in Ornish. A trend towards lower mortality compared with controls was observed in MBMI participants (P = .07). Intensive, year-long LMPs reduced hospitalization rates and suggest reduced Medicare costs in elderly beneficiaries with symptomatic coronary heart disease. Copyright © 2013 Mosby, Inc. All rights reserved.

Preliminary development and evaluation of an appearance-based dissonance induction intervention for reducing UV exposure.

PubMed

Chait, Sari R; Thompson, J Kevin; Jacobsen, Paul B

2015-01-01

The current study examined the feasibility of an appearance-based dissonance induction approach for the modification of tanning and sunscreen use behaviors. Undergraduate female students were randomized to: a healthy lifestyle condition, an appearance-based dissonance condition, or an appearance-based psychoeducation condition. Reports of tanning and sunscreen use were collected immediately before and 1 month following intervention (N=225). Relative to the healthy lifestyle condition, participants in the dissonance condition reported a significant reduction in daily hours spent tanning. Additionally, sunscreen use on the body decreased significantly for the healthy lifestyle group, but did not change for the dissonance group. The psychoeducation condition did not differ from the healthy lifestyle condition on any measure. These findings should encourage additional research into the use of dissonance induction as an appearance-based strategy for promoting reductions in UV exposure. Copyright © 2014 Elsevier Ltd. All rights reserved.

The Impact of an Immersive Elective on Learners’ Understanding of Lifestyle Medicine and Its Role in Patients’ Lives

PubMed Central

Nemec, Eric C.

2014-01-01

Objective. To design an immersive, active learning, lifestyle medicine (LM) elective and evaluate its impact on a pharmacy learners’ ability to understand the challenges of implementing lifestyle changes. Design. A 3-credit elective was developed that incorporated goal setting and immersion into the realm of LM as experienced by both the patient and the practitioner. Learners were assessed via a survey instrument, formal assignments, reflections, and the Presidential Fitness Challenge. Assessment. Learners reported that their ability to initiate LM as a primary intervention within a care plan significantly increased after taking this course. They also improved their overall health. Conclusion. By identifying and implementing self-identified lifestyle modifications, learners increased confidence in their abilities to produce evidence-based outcomes for patients. Learners were able to understand the challenges of trying to change their daily habits as they undertook their own personal goals. PMID:25386019

Weight management for type 2 diabetes mellitus: global cardiovascular risk reduction.

PubMed

Lee, Michelle; Aronne, Louis J

2007-02-19

Most patients with type 2 diabetes mellitus are overweight or obese, and the relation between obesity, especially of the visceral compartment, and the risk for developing diabetes is well recognized. Excessive adipose tissue is associated with insulin resistance as well as the increased expression of proinflammatory cytokines and prothrombotic factors, all of which contribute to elevating the risk for coronary artery disease (CAD). In particular, abdominal obesity, or excess visceral adiposity, has been linked to a cluster of risk factors (high blood pressure, hypertriglyceridemia, low levels of high-density lipoprotein cholesterol, and impaired fasting glucose) that constitute the metabolic syndrome, the presence of which confers an increased risk for type 2 diabetes and cardiovascular disease. In fact, a large waist circumference, a surrogate measure of abdominal adiposity, is 1 of the main criteria for diagnosing the metabolic syndrome. Lifestyle modification is the first-line approach to the management of obesity and the metabolic syndrome. However, if patients are unable to achieve a weight loss of 5%-10% of initial body weight and improve cardiometabolic risk factors with lifestyle modification alone, physicians should consider using adjunctive long-term pharmacotherapy. A variety of approved and investigational pharmacologic agents, including sibutramine, orlistat, metformin, and rimonabant, have been shown to reduce weight and ameliorate metabolic syndrome components, thereby reducing cardiovascular risk. Such global risk reduction is crucial for patients with diabetes, in whom CAD is a major cause of mortality.

Obesity and Headache/Migraine: The Importance of Weight Reduction through Lifestyle Modifications

PubMed Central

Verrotti, Alberto; Di Fonzo, Alessia; Agostinelli, Sergio

2014-01-01

The aim of this study is to determine a possible relationship between prevalence, frequency, and severity of migraine and obesity. All pertinent data from the literature have been critically examined and reviewed in order to assess the possible relationship between obesity and migraine, in particular migraine frequency and disability in children, as well as in adult population studies. Prevalence, frequency, and severity of migraine appear to increase in relation to the body mass index, although this evidence is not supported by all the studies examined. Data from literature suggest that obesity can be linked with migraine prevalence, frequency, and disability both in pediatric and adult subjects. These data have important clinical implications and suggest that clinicians should have a special interest for weight reduction of obese children suffering from migraine, prescribing and supporting intensive lifestyle modifications (dietary, physical activities, and behavioral) for the patient and the entire family. PMID:24800223

Metabolic syndrome pathophysiology and clinical presentation.

PubMed

Handelsman, Yehuda

2009-01-01

Metabolic syndrome is a relatively new definition, designed to help the health care practitioner to easily identify people at risk for the development of cardiovascular disease and diabetes. With the obesity epidemic, we are witnessing an epidemic of multiple-risk patients. Insulin resistance is the perceived pathophysiology of metabolic syndrome and defines its clinical presentation. Hypertension, dyslipedemia, polycystic ovarian syndrome, fatty liver disease, pre-diabetes, sleep and breathing disorder, certain cancers, and cognitive impairment are many of the presentations of the syndrome; patients with any of these conditions are at a high risk of developing cardiovascular disease and diabetes. The metabolic syndrome helps identify people at risk to allow early intervention for prevention. Lifestyle modification is the most important part of the management of people with the syndrome. Lately medications--though none approved by the U.S. Food and Drug Administration (FDA)--have been recommended by major medical societies when lifestyle modification is not enough or when it fails.

What are colorectal cancer survivors' preferences for dietary advice? A best-worst discrete choice experiment.

PubMed

Wright, Stuart J; Gibson, Debbie; Eden, Martin; Lal, Simon; Todd, Chris; Ness, Andy; Burden, Sorrel

2017-12-01

Studies on healthy lifestyle interventions in survivors of colorectal cancer have been disappointing, demonstrating only modest changes. This study aims to quantify people's preferences for different aspects of dietary intervention. A best-worst discrete choice experiment was designed and incorporated into a questionnaire including participants' characteristics and a self-assessment of lifestyle. The response rate was 68% and 179 questionnaires were analysed. When analysing aggregate preferences, the modes of information provision selected as the most preferred were "face-to-face" (willingness to pay (WTP) £63.97, p ≤ 0.001) and "telephone" (WTP £62.36, p < 0.001) discussions whereas group discussions were preferred least (WTP -£118.96, p ≤ 0.001). Scenarios that included hospitals were most preferred (WTP £17.94, p = 0.031), and the favoured provider was bowel cancer nurses (WTP £75.11, p ≤ 0.001). When investigating preference heterogeneity, three sub-groups were identified: Firstly, "technophiles" preferring email (WTP £239.60, p ≤ 0.001) were male, were younger and had fewer risk factors. Secondly, a "one-to-one" group had strong preference for interventions over the telephone or at their local doctors and were older (WTP £642.13, p ≤ 0.001). Finally, a "person-centred" group preferred face-to-face individual or group sessions (WTP £358.79, p < 0.001) and had a high risk lifestyle. For survivors of colorectal cancer, there is not one approach that suits all when it comes to providing dietary advice. This is important information to consider when planning healthy lifestyle interventions which include dietary advice for survivors of colorectal cancer. Aligning services to individuals' preferences has the potential to improve patient experience and outcomes by increasing uptake of healthy lifestyle advice services and promoting a more tailored approach to dietary modifications, acknowledging sub-groups of people within the total population of colorectal cancer survivors.

An evaluation of Croí MyAction community lifestyle modification programme compared to standard care to reduce progression to diabetes/pre-diabetes in women with prior gestational diabetes mellitus (GDM): study protocol for a randomised controlled trial

PubMed Central

2013-01-01

Background Universal screening using the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria has identified a prevalence of gestational diabetes mellitus (GDM) of 12.4% in women living in Ireland. Women with prior GDM are at increased risk of developing type 2 diabetes later in life. A number of risk factors linked to the development of type 2 diabetes are potentially modifiable through lifestyle and behaviour changes, and medical management. No previous Irish studies have adequately investigated the efficacy of lifestyle intervention programmes in reducing these risk factors in women with prior GDM. Through a two-group, parallel randomised controlled trial (RCT), this study aims to assess the clinical impact, cost-effectiveness and psychological experience of the Croí MyAction intensive lifestyle modification programme for women with prior GDM. Methods/Design A total of 54 women with a history of GDM and persistent post-partum glucose dysfunction (impaired glucose tolerance (IGT) or impaired fasting glucose (IFG)), are randomly assigned to a control arm (n = 27) or to the Croí MyAction intervention group (n = 27). The control arm receives usual health care advice - written information on diet and lifestyle changes for reducing diabetes risks and visits with general practitioners as required. The intervention group receives usual health care as per the control group in addition to attending a 12-week intensive lifestyle modification programme known as Croí MyAction. Croí MyAction involves 2.5 hour sessions once per week (for 12 weeks) comprising a group exercise programme, group health promotion or education seminars, and one-to-one meetings with a multidisciplinary health care team to personalise risk factor reductions. Randomisation and allocation to the intervention arms is carried out by an independent researcher, ensuring that the allocation sequence is concealed from study researchers until the interventions are assigned. The primary analysis is based on glucose dysfunction, comparing a mean reduction in fasting plasma glucose (FPG) levels on a 75 gram oral glucose tolerance test (OGTT) in the two groups at a one-year, post-intervention follow-up. The trial is funded by the Irish Health Research Board (HRB). Ethics approval was obtained on 27 March 2012 from the Clinical Research Ethics Committee, Galway University Hospitals, Health Service Executive of Ireland (Ref: C.A.691). Trial registration Current Controlled Trials ISRCTN41202110. PMID:23782471

An evaluation of Croí MyAction community lifestyle modification programme compared to standard care to reduce progression to diabetes/pre-diabetes in women with prior gestational diabetes mellitus (GDM): study protocol for a randomised controlled trial.

PubMed

Infanti, Jennifer J; Dunne, Fidelma P; O'Dea, Angela; Gillespie, Paddy; Gibson, Irene; Glynn, Liam G; Noctor, Eoin; Newell, John; McGuire, Brian E

2013-05-02

Universal screening using the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria has identified a prevalence of gestational diabetes mellitus (GDM) of 12.4% in women living in Ireland. Women with prior GDM are at increased risk of developing type 2 diabetes later in life. A number of risk factors linked to the development of type 2 diabetes are potentially modifiable through lifestyle and behaviour changes, and medical management. No previous Irish studies have adequately investigated the efficacy of lifestyle intervention programmes in reducing these risk factors in women with prior GDM. Through a two-group, parallel randomised controlled trial (RCT), this study aims to assess the clinical impact, cost-effectiveness and psychological experience of the Croí MyAction intensive lifestyle modification programme for women with prior GDM. A total of 54 women with a history of GDM and persistent post-partum glucose dysfunction (impaired glucose tolerance (IGT) or impaired fasting glucose (IFG)), are randomly assigned to a control arm (n=27) or to the Croí MyAction intervention group (n=27). The control arm receives usual health care advice--written information on diet and lifestyle changes for reducing diabetes risks and visits with general practitioners as required. The intervention group receives usual health care as per the control group in addition to attending a 12-week intensive lifestyle modification programme known as Croí MyAction. Croí MyAction involves 2.5 hour sessions once per week (for 12 weeks) comprising a group exercise programme, group health promotion or education seminars, and one-to-one meetings with a multidisciplinary health care team to personalise risk factor reductions. Randomisation and allocation to the intervention arms is carried out by an independent researcher, ensuring that the allocation sequence is concealed from study researchers until the interventions are assigned. The primary analysis is based on glucose dysfunction, comparing a mean reduction in fasting plasma glucose (FPG) levels on a 75 gram oral glucose tolerance test (OGTT) in the two groups at a one-year, post-intervention follow-up. The trial is funded by the Irish Health Research Board (HRB). Ethics approval was obtained on 27 March 2012 from the Clinical Research Ethics Committee, Galway University Hospitals, Health Service Executive of Ireland (Ref: C.A.691). Current Controlled Trials ISRCTN41202110.

Effects of an eight-week supervised, structured lifestyle modification programme on anthropometric, metabolic and cardiovascular risk factors in severely obese adults.

PubMed

Crowe, Catherine; Gibson, Irene; Cunningham, Katie; Kerins, Claire; Costello, Caroline; Windle, Jane; O Shea, Paula M; Hynes, Mary; McGuire, Brian; Kilkelly, Katriona; Griffin, Helena; O Brien, Tim; Jones, Jenni; Finucane, Francis M

2015-08-01

Lifestyle modification is fundamental to obesity treatment, but few studies have described the effects of structured lifestyle programmes specifically in bariatric patients. We sought to describe changes in anthropometric and metabolic characteristics in a cohort of bariatric patients after participation in a nurse-led, structured lifestyle programme. We conducted a retrospective, observational cohort study of adults with a body mass index (BMI) ≥ 40 kgm(-2) (or ≥ 35 kgm(-2) with significant co-morbidity) who were attending a regional bariatric service and who completed a single centre, 8-week, nurse-led multidisciplinary lifestyle modification programme. Weight, height, waist circumference, blood pressure, HbA1c, fasting glucose and lipid profiles as well as functional capacity (Incremental Shuttle Walk Test) and questionnaire-based anxiety and depression scores before and after the programme were compared in per-protocol analyses. Of 183 bariatric patients enrolled, 150 (81.9%) completed the programme. Mean age of completers was 47.9 ± 1.2 years. 34.7% were male. There were statistically significant reductions in weight (129.6 ± 25.9 v 126.9 ± 26.1 kg, p < 0.001), BMI (46.3 ± 8.3 v 44.9 ± 9.0 kgm(-2), p < 0.001), waist circumference (133.0 ± 17.1 v 129.3 ± 17.5 cm in women and 143.8 ± 19.0 v 135.1 ± 17.9 cm in men, both p < 0.001) as well as anxiety and depression scores, total- and LDL-cholesterol and triglyceride levels, with an increase in functional capacity (5.9 ± 1.7 v 6.8 ± 2.1 metabolic equivalents of thermogenesis (METS), p < 0.001) in completers at the end of the programme compared to the start. Blood pressure improved, with reductions in systolic and diastolic blood pressure from 135 ± 16.2 to 131.6 ± 17.1 (p = 0.009) and 84.7 ± 10.2 to 81.4 ± 10.9 mmHg (p < 0.001), respectively. The proportion of patients achieving target blood pressure increased from 50.3 to 59.3% (p = 0.04). The proportion of patients with diabetes achieving HbA1c <53 mmol/mol increased from 28.6 to 42.9%, p = 0.02. Bariatric patients completing an 8 week, nurse-led structured lifestyle programme had improved adiposity, fitness, lipid profiles, psychosocial health, blood pressure and glycaemia. Further assessment of this programme in a pragmatic randomised controlled trial seems warranted.

[Lifestyle of elderly patients with diabetes mellitus].

PubMed

Fukuoka, Yuki; Yamada, Yuichiro

2013-11-01

In elderly people, glucose tolerance is deteriorated and the incidence of diabetes mellitus is increased, due to decreased muscle mass and physical activity, declining pancreatic beta cell function, and other factors. Diabetes mellitus is an important risk factor for arteriosclerosis development in the elderly. Precise diagnosis and adequate treatment are necessary to prevent cerebrovascular and ischemic heart diseases. Elderly patients with diabetes mellitus are characteristically afflicted with more complications, impaired activities of daily living, cognitive function decline, and family environment problems, as compared with young and middle-aged diabetics. Therefore, tailor-made rather than uniform therapy becomes important. Lifestyle modification is the basis of diabetes treatment. Herein, we describe "prevention and management" of diabetes mellitus, focusing on the lifestyles of elderly diabetics.

Changes in malondialdehyde and C-reactive protein concentrations after lifestyle modification are related to different metabolic syndrome-associated pathophysiological processes.

PubMed

Moreto, Fernando; Kano, Hugo T; Torezan, Gabriel A; de Oliveira, Erick P; Manda, Rodrigo M; Teixeira, Okesley; Michelin, Edilaine; Correa, Camila R; Burini, Roberto C

2015-01-01

Metabolic syndrome (MetS) is often accompanied by pro-oxidative and pro-inflammatory processes. Lifestyle modification (LiSM) may act as primary treatment for these processes. This study aimed to elucidate influencing factors on changes of malondialdehyde (MDA) and C-reactive protein (CRP) concentrations after a LiSM intervention. Sixty subjects (53 yrs, 84% women) clinically approved to attend a 20 weeks LiSM-program were submitted to weekly nutritional counseling and physical activities combining aerobic (3 times/week) and resistance (2 times/week) exercises. Before and after intervention they were assessed for anthropometric, clinical, cardiorespiratory fitness test (CRF) and laboratory markers. Statistical analyses performed were multiple regression analysis and backward stepwise with p<0.05 and R(2) as influence index. LiSM was responsible for elevations in CRF, healthy eating index (HEI), total plasma antioxidant capacity (TAP) and HDL-C along with reductions in waist circumference measures and MetS (47-40%) prevalence. MDA and CRP did not change after LiSM, however, we observed that MDA concentrations were positively influenced (R(2)=0.35) by fasting blood glucose (β=0.64) and HOMA-IR (β=0.58) whereas CRP concentrations were by plasma gamma-glutamyltransferase activity (β=0.54; R(2)=0.29). Pro-oxidant and pro-inflammatory states of MetS can be attenuated after lifestyle modification if glucose metabolism homeostasis were recovered and if liver inflammation were reduced, respectively. Copyright © 2015 Diabetes India. Published by Elsevier Ltd. All rights reserved.

Genetic predictors of weight loss and weight regain after intensive lifestyle modification, metformin treatment, or standard care in the Diabetes Prevention Program.

PubMed

Delahanty, Linda M; Pan, Qing; Jablonski, Kathleen A; Watson, Karol E; McCaffery, Jeanne M; Shuldiner, Alan; Kahn, Steven E; Knowler, William C; Florez, Jose C; Franks, Paul W

2012-02-01

We tested genetic associations with weight loss and weight regain in the Diabetes Prevention Program, a randomized controlled trial of weight loss-inducing interventions (lifestyle and metformin) versus placebo. Sixteen obesity-predisposing single nucleotide polymorphisms (SNPs) were tested for association with short-term (baseline to 6 months) and long-term (baseline to 2 years) weight loss and weight regain (6 months to study end). Irrespective of treatment, the Ala12 allele at PPARG associated with short- and long-term weight loss (-0.63 and -0.93 kg/allele, P ≤ 0.005, respectively). Gene-treatment interactions were observed for short-term (LYPLAL1 rs2605100, P(lifestyle*SNP) = 0.032; GNPDA2 rs10938397, P(lifestyle*SNP) = 0.016; MTCH2 rs10838738, P(lifestyle*SNP) = 0.022) and long-term (NEGR1 rs2815752, P(metformin*SNP) = 0.028; FTO rs9939609, P(lifestyle*SNP) = 0.044) weight loss. Three of 16 SNPs were associated with weight regain (NEGR1 rs2815752, BDNF rs6265, PPARG rs1801282), irrespective of treatment. TMEM18 rs6548238 and KTCD15 rs29941 showed treatment-specific effects (P(lifestyle*SNP) < 0.05). Genetic information may help identify people who require additional support to maintain reduced weight after clinical intervention.

Pediatric Headache: An Overview.

PubMed

Langdon, Raquel; DiSabella, Marc T

2017-03-01

Headache represents the most common neurologic disorder in the general population including children and is increasingly being recognized as a major source of morbidity in youth related to missed school days and activities. In this article, we take a holistic approach to the child presenting with headache with a focus on the detailed headache history, physical and neurologic examinations, and diagnostic evaluation of these patients. Clinical presentations and classification schema of multiple primary and secondary headache types in children are discussed using the International Headache Criteria (IHCD-3) as a guide, and a summary provided of the various treatment modalities employed for pediatric headache including lifestyle modifications, behavioral techniques, and abortive and preventive medications. Copyright © 2017 Mosby, Inc. All rights reserved.

What do most erectile dysfunction guidelines have in common? No evidence-based discussion or recommendation of heart-healthy lifestyle changes and/or Panax ginseng

PubMed Central

Moyad, Mark A; Park, Kwangsung

2012-01-01

Sexual health or erectile dysfunction (ED) state of the art guidelines provide a thorough overview of conventional prescription or other notable extrinsic treatment options. Yet, over the past 10–15 years, a plethora of international researchers have established that individual and comprehensive lifestyle changes can prevent and potentially improve ED. We review the lifestyle evidence that should equate to grade A or level 1 evidence recommendations for ED. We also review the evidence for Panax ginseng, an over-the-counter (OTC) dietary supplement with a 35-year history of laboratory investigations, multiple positive randomized trials over approximately 15 years and several independent meta-analyses and systematic reviews. Perhaps it is time to at least discuss and even emphasize lifestyle and other non-conventional interventions in ED guidelines so that patients can explore a diversity of potentially synergistic choices with their physicians and can improve their quality and quantity of life. Ignoring the consistent, positive data on lifestyle modifications in ED guidelines, for example, is tantamount to ignoring diet and lifestyle changes to reduce the risk of or ameliorate cardiovascular diseases. PMID:23001440

Globalization of Diabetes

PubMed Central

2011-01-01

Type 2 diabetes is a global public health crisis that threatens the economies of all nations, particularly developing countries. Fueled by rapid urbanization, nutrition transition, and increasingly sedentary lifestyles, the epidemic has grown in parallel with the worldwide rise in obesity. Asia's large population and rapid economic development have made it an epicenter of the epidemic. Asian populations tend to develop diabetes at younger ages and lower BMI levels than Caucasians. Several factors contribute to accelerated diabetes epidemic in Asians, including the “normal-weight metabolically obese” phenotype; high prevalence of smoking and heavy alcohol use; high intake of refined carbohydrates (e.g., white rice); and dramatically decreased physical activity levels. Poor nutrition in utero and in early life combined with overnutrition in later life may also play a role in Asia's diabetes epidemic. Recent advances in genome-wide association studies have contributed substantially to our understanding of diabetes pathophysiology, but currently identified genetic loci are insufficient to explain ethnic differences in diabetes risk. Nonetheless, interactions between Westernized diet and lifestyle and genetic background may accelerate the growth of diabetes in the context of rapid nutrition transition. Epidemiologic studies and randomized clinical trials show that type 2 diabetes is largely preventable through diet and lifestyle modifications. Translating these findings into practice, however, requires fundamental changes in public policies, the food and built environments, and health systems. To curb the escalating diabetes epidemic, primary prevention through promotion of a healthy diet and lifestyle should be a global public policy priority. PMID:21617109

Primary Prevention of Colorectal Cancer

PubMed Central

Chan, Andrew T.; Giovannucci, Edward L.

2010-01-01

Colorectal cancer has been strongly associated with a Western lifestyle. In the past several decades, much has been learned about the dietary, lifestyle, and medication risk factors for this malignancy. Although there is controversy about the role of specific nutritional factors, consideration of the dietary pattern as a whole appears useful for formulating recommendations. For example, several studies have shown that high intake of red and processed meats, highly refined grains and starches, and sugars is related to increased risk of colorectal cancer. Replacing these factors with poultry, fish, and plant sources as the primary source of protein; unsaturated fats as the primary source of fat; and unrefined grains, legumes and fruits as the primary source of carbohydrates is likely to lower risk of colorectal cancer. Although a role for supplements, including vitamin D, folate, and vitamin B6, remains uncertain, calcium supplementation is likely to be at least modestly beneficial. With respect to lifestyle, compelling evidence indicates that avoidance of smoking and heavy alcohol use, prevention of weight gain, and the maintenance of a reasonable level of physical activity are associated with markedly lower risks of colorectal cancer. Medications such as aspirin and non-steroidal anti-inflammatory drugs and post-menopausal hormones for women are associated with significant reductions in colorectal cancer risk, though their utility is affected by associated risks. Taken together, modifications in diet and lifestyle should substantially reduce the risk of colorectal cancer and could complement screening in reducing colorectal cancer incidence. PMID:20420944

The design of maternal centered life-style modification program for weight gain management during pregnancy - a study protocol.

PubMed

Farajzadegan, Ziba; Pozveh, Zahra Amini

2013-08-01

Abnormal weight gain during pregnancy increases the adverse health outcomes during the pregnancy, delivery, and the postpartum period. Most of the pregnant women develop weight gain more than the recommended limits; therefore, interventions to manage such disproportionate weight gain are needed. In this paper, the design of the maternal centered life-style intervention study is described, which focuses on controlling weight gaining during pregnancy for all body mass index (BMI) groups. In our randomized field trial, 160 pregnant women with 6-10 weeks of gestational age who visit one of the participating Isfahan four urban public-health centers and 4 private obstetric offices are included. The maternal centered life-style intervention carried out by trained midwives is standardized in a protocol. All the participants are visited at 6-10, 11-15, 16-20, 21-25, 26-30, 31-34, 35-37, 38, 39, and 40 weeks of pregnancy. The women who are randomized in the intervention group receive maternal centered educational package of prenatal care for the pregnant woman and a log book in the first visit. Counselors accompany the pregnant women to maintain or develop a healthy life-style. Data collection will perform monthly measuring body weight, BMI. Because, we don't have structured protocol for weight management during pregnancy especially, in private sectors if the maternal centered life-style intervention proves to be effective, it will be suggested to merge this package to routine care. Therewith by empowering women to manage their weight the public-health burden can be reduced. Beside that private obstetricians also have structured protocol for their client management.

Night shift work and modifiable lifestyle factors.

PubMed

Pepłońska, Beata; Burdelak, Weronika; Krysicka, Jolanta; Bukowska, Agnieszka; Marcinkiewicz, Andrzej; Sobala, Wojciech; Klimecka-Muszyńska, Dorota; Rybacki, Marcin

2014-10-01

Night shift work has been linked to some chronic diseases. Modification of lifestyle by night work may partially contribute to the development of these diseases, nevertheless, so far epidemiological evidence is limited. The aim of the study was to explore association between night shift work and lifestyle factors using data from a cross-sectional study among blue-collar workers employed in industrial plants in Łódź, Poland. The anonymous questionnaire was self-administered among 605 employees (236 women and 369 men, aged 35 or more) - 434 individuals currently working night shifts. Distribution of the selected lifestyle related factors such as smoking, alcohol drinking, physical activity, body mass index (BMI), number of main meals and the hour of the last meal was compared between current, former, and never night shift workers. Adjusted ORs or predicted means were calculated, as a measure of the associations between night shift work and lifestyle factors, with age, marital status and education included in the models as covariates. Recreational inactivity (defined here as less than one hour per week of recreational physical activity) was associated with current night shift work when compared to never night shift workers (OR = 2.43, 95% CI: 1.13-5.22) among men. Alcohol abstinence and later time of the last meal was associated with night shift work among women. Statistically significant positive relationship between night shift work duration and BMI was observed among men (p = 0.029). This study confirms previous studies reporting lower exercising among night shift workers and tendency to increase body weight. This finding provides important public health implication for the prevention of chronic diseases among night shift workers. Initiatives promoting physical activity addressed in particular to the night shift workers are recommended.

Role modeling as an early childhood obesity prevention strategy: effect of parents and teachers on preschool children's healthy lifestyle habits.

PubMed

Natale, Ruby A; Messiah, Sarah E; Asfour, Lila; Uhlhorn, Susan B; Delamater, Alan; Arheart, Kris L

2014-01-01

To assess the effectiveness of a child care center-based parent and teacher healthy lifestyle role-modeling program on child nutrition and physical activity outcomes. Child care centers (N = 28) serving low-income families were randomized to intervention or control arms. Intervention centers (N = 12) implemented (1) menu modifications, (2) a child's healthy lifestyle curriculum, and (3) an adult (teacher- and parent-focused) healthy lifestyle role-modeling curriculum. Control centers (N = 16) received an attention control safety curriculum. Nutrition and physical activity data were collected at the beginning (T1) and at the end (T2) of the school year. Exploratory factor analysis identified positive and negative nutrition and physical activity practices by children, parents, and teachers. Intervention parents' baseline (β = .52, p < .0001) and school year consumption (β = .47, p < .0001) of fruits/vegetables significantly increased their children's consumption of fruits/vegetables from T1 to T2. Intervention parents significantly influenced a decrease in children's junk food consumption (β = -.04, p < .05), whereas control parents significantly influenced an increase in their children's junk food consumption (β = .60, p < .001) from T1 to T2. Control children showed a significant increase in junk food consumption (β = .11, p = .01) and sedentary behavior (β = .09, p < .005) from T1 to T2. Teachers did not significantly influence preschool-age children's nutrition or physical activity patterns from T1 to T2. Parent nutrition and physical activity patterns significantly influence their preschool-age children's consumption of fruits/vegetables, junk food, and level of sedentary behavior. Future obesity prevention intervention efforts targeting this age group should include parents as healthy lifestyle role models for their children.

Intensive lifestyle intervention improves cardiometabolic and exercise parameters in metabolically healthy obese and metabolically unhealthy obese individuals.

PubMed

Dalzill, Claudie; Nigam, Anil; Juneau, Martin; Guilbeault, Valérie; Latour, Elise; Mauriège, Pascale; Gayda, Mathieu

2014-04-01

The effects of an intensive lifestyle intervention including Mediterranean diet nutritional counselling and high-intensity interval training (HIIT) on body composition, cardiometabolic, and exercise parameters were studied in metabolically unhealthy obese (NMHO) and metabolically healthy but obese (MHO) subjects. Fifty-five MHO (51 ± 8 years; waist circumference, 109 ± 13 cm) and 79 NMHO subjects (54 ± 9 years; waist circumference, 112 ± 13 cm) participated in an intensive lifestyle modification program based on Mediterranean diet nutritional counselling and HIIT 2-3 times per week. Body composition, cardiometabolic, and exercise parameters were measured at baseline and after 9 months. Initially, MHO patients had a lower blood pressure (BP), fasting glycemia, triglycerides, and a higher high-density lipoprotein cholesterol and peak oxygen uptake (VO2 peak) (P < 0.05) vs NMHO patients. Body mass (P < 0.05), waist circumference (P < 0.0001), total and trunk fat mass (P < 0.001), systolic and diastolic BP (P < 0.001), fasting glucose (P < 0.0001), insulin sensitivity (P < 0.05), VO2 peak and muscle endurance (P < 0.0001) were similarly improved in both groups after the program. Prevalence of NMHO was reduced by 17.91% (P < 0.01) after the program. Similar improvements in body composition, BP, and exercise parameters were found for MHO and NMHO men and women (P < 0.05). In all patients, improvement of VO2 peak was negatively correlated with improvements in body composition, systolic blood pressure, and resting heart rate (HR) (R = -0.61 to -0.24; P < 0.05). A long-term intensive lifestyle program including Mediterranean diet nutritional counselling and HIIT is an appropriate intervention in MHO and NMHO subjects with similar potential clinical health benefits including an improved body composition, BP, fasting glycemia, insulin sensitivity, VO2 peak, and muscle endurance. Copyright © 2014 Canadian Cardiovascular Society. All rights reserved.

Modifications of coronary risk factors.

PubMed

Albu, Jeanine; Gottlieb, Sheldon H; August, Phyllis; Nesto, Richard W; Orchard, Trevor J

2006-06-19

In addition to the revascularization and glycemic management interventions assigned at random, the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) design includes the uniform control of major coronary artery disease risk factors, including dyslipidemia, hypertension, smoking, central obesity, and sedentary lifestyle. Target levels for risk factors were adjusted throughout the trial to comply with changes in recommended clinical practice guidelines. At present, the goals are low-density lipoprotein cholesterol <2.59 mmol/L (<100 mg/dL) with an optional goal of <1.81 mmol/L (<70 mg/dL); plasma triglyceride level <1.70 mmol/L (<150 mg/dL); blood pressure level <130 mm Hg systolic and <80 mm Hg diastolic; and smoking cessation treatment for all active smokers. Algorithms were developed for the pharmacologic management of dyslipidemia and hypertension. Dietary prescriptions for the management of glycemia, plasma lipid profiles, and blood pressure levels were adapted from existing clinical practice guidelines. Patients with a body mass index >25 were prescribed moderate caloric restriction; after the trial was under way, a lifestyle weight-management program was instituted. All patients were formally prescribed both endurance and resistance/flexibility exercises, individually adapted to their level of disability and fitness. Pedometers were distributed as a biofeedback strategy. Strategies to achieve the goals for risk factors were designed by BARI 2D working groups (lipid, cardiovascular and hypertension, and nonpharmacologic intervention) and the ongoing implementation of the strategies is monitored by lipid, hypertension, and lifestyle intervention management centers.

Modifications of Coronary Risk Factors

PubMed Central

Albu, Jeanine; Gottlieb, Sheldon H.; August, Phyllis; Nesto, Richard W.; Orchard, Trevor J.

2009-01-01

In addition to the revascularization and glycemic management interventions assigned at random, the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) design includes the uniform control of major coronary artery disease risk factors, including dyslipidemia, hypertension, smoking, central obesity, and sedentary lifestyle. Target levels for risk factors were adjusted throughout the trial to comply with changes in recommended clinical practice guidelines. At present, the goals are low-density lipoprotein cholesterol <2.59 mmol/L (<100 mg/dL) with an optional goal of <1.81 mmol/L (<70 mg/dL); plasma triglyceride level <1.70 mmol/L (<150 mg/dL); blood pressure level <130 mm Hg systolic and <80 mm Hg diastolic; and smoking cessation treatment for all active smokers. Algorithms were developed for the pharmacologic management of dyslipidemia and hypertension. Dietary prescriptions for the management of glycemia, plasma lipid profiles, and blood pressure levels were adapted from existing clinical practice guidelines. Patients with a body mass index >25 were prescribed moderate caloric restriction; after the trial was under way, a lifestyle weight-management program was instituted. All patients were formally prescribed both endurance and resistance/flexibility exercises, individually adapted to their level of disability and fitness. Pedometers were distributed as a biofeedback strategy. Strategies to achieve the goals for risk factors were designed by BARI 2D working groups (lipid, cardiovascular and hypertension, and nonpharmacologic intervention) and the ongoing implementation of the strategies is monitored by lipid, hypertension, and lifestyle intervention management centers. PMID:16813737

[An health education program for patients admitted to CCU for an acute coronary event].

PubMed

Amodeo, Raffaello; De Ponti, Anna; Sorbara, Loredana; Imperatore, Patrizia Fusar; Berizzi, Margherita; Di Rocco, Egidia; Saltarel, Ivan; Marigliani, Catia; Avanzini, Fausto

2006-01-01

In spite of the broad recognition of the importance of health education, time for structured one-to -one initiatives of health education during the hospital stay is limited. The organization of an health education meeting for patients admitted to CCU for an acute coronary event is described. The planning and implementation of the initiative lasted two years and involved 7 nurses and one doctor. The organization required efforts related to the event itself (preparation of training aids, identification or contents and methods for delivery) but also organizative changes. Dietitians in fact had to be involved because the healthy diet recommended was different from the hospital diet. The assessment of the effectiveness of the health education was also planned: administration of a questionnaire to explore lifestyles and knowledge of the illness before and after the meeting; phone interviews after 3, 6 and 12 months from the meeting. Since may 2003, in the first 3 years 74 meetings have been organised, involving 507 patients and 329 relatives. Each meeting lasts 2 hours and contents delivered encompass the coronary event, risk factors and their modification, healthy lifestyles. Initial preliminary results on the impact of the meeting on lifestyle changes are promising. Initiatives are ongoing to include this activity among officially recognised nursing activities.

Transcultural Diabetes Nutrition Algorithm (tDNA): Venezuelan Application

PubMed Central

Nieto-Martínez, Ramfis; Hamdy, Osama; Marante, Daniel; Inés Marulanda, María; Marchetti, Albert; Hegazi, Refaat A.; Mechanick, Jeffrey I.

2014-01-01

Medical nutrition therapy (MNT) is a necessary component of comprehensive type 2 diabetes (T2D) management, but optimal outcomes require culturally-sensitive implementation. Accordingly, international experts created an evidence-based transcultural diabetes nutrition algorithm (tDNA) to improve understanding of MNT and to foster portability of current guidelines to various dysglycemic populations worldwide. This report details the development of tDNA-Venezuelan via analysis of region-specific cardiovascular disease (CVD) risk factors, lifestyles, anthropometrics, and resultant tDNA algorithmic modifications. Specific recommendations include: screening for prediabetes (for biochemical monitoring and lifestyle counseling); detecting obesity using Latin American cutoffs for waist circumference and Venezuelan cutoffs for BMI; prescribing MNT to people with prediabetes, T2D, or high CVD risk; specifying control goals in prediabetes and T2D; and describing regional differences in prevalence of CVD risk and lifestyle. Venezuelan deliberations involved evaluating typical food-based eating patterns, correcting improper dietary habits through adaptation of the Mediterranean diet with local foods, developing local recommendations for physical activity, avoiding stigmatizing obesity as a cosmetic problem, avoiding misuse of insulin and metformin, circumscribing bariatric surgery to appropriate indications, and using integrated health service networks to implement tDNA. Finally, further research, national surveys, and validation protocols focusing on CVD risk reduction in Venezuelan populations are necessary. PMID:24699193

Information and Risk Modification Trial (INFORM): design of a randomised controlled trial of communicating different types of information about coronary heart disease risk, alongside lifestyle advice, to achieve change in health-related behaviour.

PubMed

Silarova, Barbora; Lucas, Joanne; Butterworth, Adam S; Di Angelantonio, Emanuele; Girling, Christine; Lawrence, Kathryn; Mackintosh, Stuart; Moore, Carmel; Payne, Rupert A; Sharp, Stephen J; Shefer, Guy; Tolkien, Zoe; Usher-Smith, Juliet; Walker, Matthew; Danesh, John; Griffin, Simon

2015-09-07

Cardiovascular disease (CVD) remains the leading cause of death globally. Primary prevention of CVD requires cost-effective strategies to identify individuals at high risk in order to help target preventive interventions. An integral part of this approach is the use of CVD risk scores. Limitations in previous studies have prevented reliable inference about the potential advantages and the potential harms of using CVD risk scores as part of preventive strategies. We aim to evaluate short-term effects of providing different types of information about coronary heart disease (CHD) risk, alongside lifestyle advice, on health-related behaviours. In a parallel-group, open randomised trial, we are allocating 932 male and female blood donors with no previous history of CVD aged 40-84 years in England to either no intervention (control group) or to one of three active intervention groups: i) lifestyle advice only; ii) lifestyle advice plus information on estimated 10-year CHD risk based on phenotypic characteristics; and iii) lifestyle advice plus information on estimated 10-year CHD risk based on phenotypic and genetic characteristics. The primary outcome is change in objectively measured physical activity. Secondary outcomes include: objectively measured dietary behaviours; cardiovascular risk factors; current medication and healthcare usage; perceived risk; cognitive evaluation of provision of CHD risk scores; and psychological outcomes. The follow-up assessment takes place 12 weeks after randomisation. The experiences, attitudes and concerns of a subset of participants will be also studied using individual interviews and focus groups. The INFORM study has been designed to provide robust findings about the short-term effects of providing different types of information on estimated 10-year CHD risk and lifestyle advice on health-related behaviours. Current Controlled Trials ISRCTN17721237 . Registered 12 January 2015.

Non-adherence to life-style modification and its factors among type 2 diabetic patients.

PubMed

Mumu, Shirin Jahan; Saleh, Farzana; Ara, Ferdous; Afnan, Fadia; Ali, Liaquat

2014-01-01

Non-adherence to preventive and therapeutic life-style recommendations among patients with diabetes is special challenge in the management of these patients. This study aimed to measure the proportion of non-adherence to life-style modification and factors associated with these among a group of Bangladeshi type 2 diabetic patients. Under an analytical cross-sectional design 374 type 2 diabetic patients (age >20 years), diagnosed for at least 1 year, were selected from different health care centers operated by the Diabetic Association of Bangladesh. Non-adherence rate were assessed for: Diet (88%), exercise (25%), routine blood glucose testing (32%), foot care (70%), smoking (6%) and betel quid chewing habit (25%). Binary logistic regression suggests that higher education group (P = 0.013), rural area (P = 0.013) and attendance to diabetes education classes (P = 0.043) showed good adherence to diet and non-attendance to diabetes education class (P = 0.014), older age (P = 0.037) are associated to non-adherence to exercise. Unemployed patients showed more non-adherence to blood glucose testing (P = 0.045) than others. Non-attendance to diabetes education class (P = 0.037) and business occupation group (P = 0.039) showed significant association to smoking and betel quid intake habit respectively.

Outcome Evaluation of a Policy-Mandated Lifestyle and Environmental Modification Program in a National Job Training Center.

PubMed

Jimenez, Elizabeth Yakes; Harris, Amanda; Luna, Donald; Velasquez, Daniel; Slovik, Jonathan; Kong, Alberta

2017-06-01

Excess weight gain is common when adolescents become young adults, but there are no obesity prevention or weight management interventions that have been tested for emerging adults who follow non-traditional post-secondary paths, such as enrolling in job training programs. We evaluated Healthy Eating & Active Lifestyles (HEALs), a policy-mandated lifestyle education/environmental modification program, at a job training center for low-income 16-24 year olds. We examined average change in body mass index (BMI) z-score from baseline to 6 months for emerging adults (aged 16-24 years) in pre-HEALs implementation (n = 125) and post-HEALs implementation (n = 126) cohorts living at the job training center, by baseline weight status. In both cohorts, average BMI z-score significantly increased from baseline to 6 months for students with BMI < 25. Average BMI z-score significantly decreased for the overweight (BMI 25 to <30; -0.11, p = .03) and obese (BMI ≥ 30; -0.11, p = .001) students only within the post-HEALs cohort; changes within the pre-HEALs cohort and between cohorts were not significant. HEALs may promote positive weight-related trends for overweight/obese students, but prevention efforts for non-overweight/obese students need to be improved.

The talent study: a multicentre randomized controlled trial assessing the impact of a 'tailored lifestyle self-management intervention' (talent) on weight reduction.

PubMed

Melchart, Dieter; Doerfler, Wolfgang; Eustachi, Axel; Wellenhofer-Li, Yanqing; Weidenhammer, Wolfgang

2015-01-01

Overweight is considered an important risk factor for diseases in the context of metabolic syndrome. Lifestyle modifications are the means of choice to reduce weight in persons with a Body Mass Index of 28 to 35. The study examines whether there are any differences between two intervention strategies regarding weight reduction in overweight persons. The study is a multicentre randomized controlled trial with observation duration of 12 months. Eight study centres are involved to include a minimal sample size of 150 participants. Randomization ratio is 2:1. Feasible persons are checked according to inclusion and exclusion criteria and after given informed consent are assigned randomly to one of two intervention programs: A) intervention group: comprehensive lifestyle modification program (Individual Health Management IHM) with 3 months reduction phase plus 9 months maintaining phase, B) control group: written information with advice for healthy food habits (Usual care UC). Participants of the IHM group have access to a web-based health portal and join 3 full-day and 10 two-hour training sessions during the first 3 months. During the remaining 9 months four refresh trainings will be performed. There are 3 different diet strategies (fasting, two-day diet, meal replacement) for free choice. Participants of the control group are provided with acknowledged rules for healthy food according to the German Nutrition Society (DGE). Examinations are conducted at baseline, after 3, 6, 9 and 12 months. They include body weight, waist circumference, blood pressure, laboratory findings and a bio-impedance analysis to measure body composition. Statistical analysis of the primary outcome 'change of body weight after 12 months' is based on ITT population including analysis of variance of the weight differences between month 0 and 12 with the factors 'group', 'baseline value' and 'study centre'. Secondary outcomes will be analyzed exploratively. The monitoring of the study will implement different measures to enhance compliance, avoid attrition and ensure data quality. Based on a blended learning concept and using web-based e-health tools the program promises to achieve sustainable effects in weight reduction. German Clinical Trials Register Freiburg (DRKS): DRKS00006736 (date registered 20/09/2014).

Patient-related barriers to hypertension control in a Nigerian population

PubMed Central

Okwuonu, Chimezie Godswill; Ojimadu, Nnamdi Ezekiel; Okaka, Enajite Ibiene; Akemokwe, Fatai Momodu

2014-01-01

Background Hypertension control is a challenge globally. Barriers to optimal control exist at the patient, physician, and health system levels. Patient-related barriers in our environment are not clear. The aim of this study was to identify patient-related barriers to control of hypertension among adults with hypertension in a semiurban community in South-East Nigeria. Methods This was a cross-sectional descriptive study of patients with a diagnosis of hypertension and on antihypertensive medication. Results A total of 252 participants were included in the survey, and comprised 143 males (56.7%) and 109 females (43.3%). The mean age of the participants was 56.6±12.7 years, with a diagnosis of hypertension for a mean duration of 6.1±3.3 years. Among these patients, 32.9% had controlled blood pressure, while 39.3% and 27.8%, respectively, had stage 1 and stage 2 hypertension according to the Seventh Report of the Joint National Committee on Prevention, Detection and Evaluation of High Blood Pressure. Only 23.4% knew the consequences of poor blood pressure control and 64% were expecting a cure from treatment even when the cause of hypertension was not known. Furthermore, 68.7% showed low adherence to medication, the reported reasons for which included forgetfulness (61.2%), financial constraints (56.6%), high pill burden (22.5%), side effects of medication (17.3%), and low measured blood pressure (12.1%). Finally, knowledge and practice of the lifestyle modifications necessary for blood pressure control was inadequate among the participants. Conclusion Poor knowledge regarding hypertension, unrealistic expectations of treatment, poor adherence with medication, unawareness of lifestyle modification, and failure to apply these were identified as patient-related barriers to blood pressure control in this study. PMID:25061335

The effect of communicating the genetic risk of cardiometabolic disorders on motivation and actual engagement in preventative lifestyle modification and clinical outcome: a systematic review and meta-analysis of randomised controlled trials.

PubMed

Li, Sherly X; Ye, Zheng; Whelan, Kevin; Truby, Helen

2016-09-01

Genetic risk prediction of chronic conditions including obesity, diabetes and CVD currently has limited predictive power but its potential to engage healthy behaviour change has been of immense research interest. We aimed to understand whether the latter is indeed true by conducting a systematic review and meta-analysis investigating whether genetic risk communication affects motivation and actual behaviour change towards preventative lifestyle modification. We included all randomised controlled trials (RCT) since 2003 investigating the impact of genetic risk communication on health behaviour to prevent cardiometabolic disease, without restrictions on age, duration of intervention or language. We conducted random-effects meta-analyses for perceived motivation for behaviour change and clinical changes (weight loss) and a narrative analysis for other outcomes. Within the thirteen studies reviewed, five were vignette studies (hypothetical RCT) and seven were clinical RCT. There was no consistent effect of genetic risk on actual motivation for weight loss, perceived motivation for dietary change (control v. genetic risk group standardised mean difference (smd) -0·15; 95 % CI -1·03, 0·73, P=0·74) or actual change in dietary behaviour. Similar results were observed for actual weight loss (control v. high genetic risk SMD 0·29 kg; 95 % CI -0·74, 1·31, P=0·58). This review found no clear or consistent evidence that genetic risk communication alone either raises motivation or translates into actual change in dietary intake or physical activity to reduce the risk of cardiometabolic disorders in adults. Of thirteen studies, eight were at high or unclear risk of bias. Additional larger-scale, high-quality clinical RCT are warranted.

Women's Management of Recurrent Bacterial Vaginosis and Experiences of Clinical Care: A Qualitative Study.

PubMed

Bilardi, Jade; Walker, Sandra; McNair, Ruth; Mooney-Somers, Julie; Temple-Smith, Meredith; Bellhouse, Clare; Fairley, Christopher; Chen, Marcus; Bradshaw, Catriona

2016-01-01

Few data are available on how women manage recurring bacterial vaginosis (BV) and their experiences of the clinical care of this condition. This study aimed to explore women's recurrent BV management approaches and clinical care experiences, with a view to informing and improving the clinical management of BV. A descriptive, social constructionist approach was chosen as the framework for the study. Thirty-five women of varying sexual orientation who had experienced recurrent BV in the past 5 years took part in semi-structured interviews. The majority of women reported frustration and dissatisfaction with current treatment regimens and low levels of satisfaction with the clinical management of BV. Overall, women disliked taking antibiotics regularly, commonly experienced adverse side effects from treatment and felt frustrated at having symptoms recur quite quickly after treatment. Issues in clinical care included inconsistency in advice, misdiagnosis and inappropriate diagnostic approaches and insensitive or dismissive attitudes. Women were more inclined to report positive clinical experiences with sexual health physicians than primary care providers. Women's frustrations led most to try their own self-help remedies and lifestyle modifications in an attempt to treat symptoms and prevent recurrences, including well-known risk practices such as douching. In the face of considerable uncertainty about the cause of BV, high rates of recurrence, unacceptable treatment options and often insensitive and inconsistent clinical management, women are trying their own self-help remedies and lifestyle modifications to prevent recurrences, often with little effect. Clinical management of BV could be improved through the use of standardised diagnostic approaches, increased sensitivity and understanding of the impact of BV, and the provision of evidence based advice about known BV related risk factors.

How can primary care providers manage pediatric obesity in the real world?

PubMed

Hopkins, Kristy F; Decristofaro, Claire; Elliott, Lydia

2011-06-01

To provide information regarding evidence-based interventions and clinical practice guidelines as a basis for a clinical toolkit utilizing a step management approach for the primary care provider in managing childhood obesity. Evidence-based literature including original clinical trials, literature reviews, and clinical practice guidelines. Interventions can be stratified based on initial screening of children and adolescents so that selection of treatment options is optimized. For all treatments, lifestyle modifications include attention to diet and activity level. Levels of initial success, as well as maintenance of target body mass index, may be related to the intensity and duration of interventions; involvement of family may increase success rates. For failed lifestyle interventions, or for patients with extreme obesity and/or certain comorbidities, pharmacologic or surgical options should be considered. Many intensive programs have shown success, but the resources required for these approaches may be unavailable to the typical community provider and family. However, using current guidelines, the primary care provider can initiate and manage ongoing interventions in pediatric obesity. A toolkit for primary care implementation and maintenance interventions is provided. ©2011 The Author(s) Journal compilation ©2011 American Academy of Nurse Practitioners.

Lifestyle and risk of premature sexual activity in a high school population of Seventh-Day Adventists: Valuegenesis 1989.

PubMed

Weinbender, M L; Rossignol, A M

1996-01-01

In the past 20 years, sexually transmitted diseases (STDs), including AIDS, and the physical, psychological, and economic difficulties associated with unwanted pregnancy have increased steadily among American adolescents. The objective of this study was to evaluate Adventist lifestyle as a modification of popular American culture which reduces the risk of early sexual activity in adolescents and thus also reduces the risk for both STDs and teen pregnancy. The study was based on 8,321 respondents to a questionnaire concerning specific behaviors, beliefs, and attitudes among Seventh-Day Adventist youth attending 58 high schools in North American. Analysis of the data demonstrated that a wide variety of behaviors were associated with premature sexual activity, including previously reported high-risk behaviors such as drug or alcohol use. In addition, several behaviors that are discouraged within Adventist culture, such as going to a movie theater or participating in competitive sports, also were associated with early sexual activity. It is hypothesized that these latter behaviors may predict the emergence of other high-risk behaviors, such as early sexual activity, in both Adventist and popular cultures, and thus may be "transition-marking behaviors" as described by Jessor and Jessor (1975).

Healthy lifestyle behaviors among individuals with chronic obstructive pulmonary disease in urban and rural communities in China: a large community-based epidemiological study

PubMed Central

Yan, Ruohua; Wang, Yang; Bo, Jian; Li, Wei

2017-01-01

Background Lifestyle modification is one of the most cost-effective strategies in self-management and secondary prevention of chronic obstructive pulmonary disease (COPD). However, the prevalence of healthy lifestyle behaviors in COPD patients in China remains unclear. The objective of this study was to examine the rates of healthy lifestyle behaviors including smoking cessation, regular exercise, and healthy diet in community population with COPD in China. Methods We recruited 46,285 individuals aged 35–70 years from 115 urban and rural communities in 12 provinces of China from 2005 to 2009. We recorded the smoking status, physical activity intensity, and quality of diet for all spirometry-diagnosed COPD patients by standardized questionnaires. Results Among 3,690 individuals with COPD, 18.2% (95% confidence interval [CI], 13.0–24.9) quitted smoking, 27.1% (95% CI, 24.7–29.7) exercised often, and 34.8% (95% CI, 31.8–38.0) ate high-quality diet. More than half of the individuals followed one or less key healthy lifestyle, and only 8.4% (95% CI, 7.0–10.0) followed all of the three healthy behaviors. Urban residents had significant higher rates of smoking cessation (23.5% [95% CI, 17.3–31.1] vs 14.4% [95% CI, 9.9–20.5], p=0.0008), regular exercise (45.6% [95% CI, 42.4–48.8] vs 14.0% [95% CI, 12.1–16.2], p<0.0001), and healthy diet (38.5% [95% CI, 35.5–41.6] vs 32.2% [95% CI, 29.2–35.4], p=0.0013) than rural residents. Age, sex, education level, body mass index, respiratory symptoms, and family income were associated with healthy living, and the strength of associations varied between urban and rural areas. Conclusion There is a large gap between the anticipated rate and the real participation in healthy lifestyle behaviors in Chinese adults with COPD, especially in rural communities. Simple and effective strategies are warranted to improve patients’ lifestyle in China. PMID:29180861

Treatment of NAFLD with diet, physical activity and exercise.

PubMed

Romero-Gómez, Manuel; Zelber-Sagi, Shira; Trenell, Michael

2017-10-01

Lifestyle intervention can be effective when treating non-alcoholic fatty liver diseases (NAFLD) patients. Weight loss decreases cardiovascular and diabetes risk and can also regress liver disease. Weight reductions of ⩾10% can induce a near universal non-alcoholic steatohepatitis resolution and fibrosis improvement by at least one stage. However, modest weight loss (>5%) can also produce important benefits on the components of the NAFLD activity score (NAS). Additionally, we need to explore the role of total calories and type of weight loss diet, micro- and macronutrients, evidence-based benefits of physical activity and exercise and finally support these modifications through established behavioural change models and techniques for long-term maintenance of lifestyle modifications. Following a Mediterranean diet can reduce liver fat even without weight loss and is the most recommended dietary pattern for NAFLD. The Mediterranean diet is characterised by reduced carbohydrate intake, especially sugars and refined carbohydrates (40% of the calories vs. 50-60% in a typical low fat diet), and increased monounsaturated and omega-3 fatty acid intake (40% of the calories as fat vs. up-to 30% in a typical low fat diet). Both TV sitting (a reliable marker of overall sedentary behaviour) and physical activity are associated with cardio-metabolic health, NAFLD and overall mortality. A 'triple hit behavioural phenotype' of: i) sedentary behaviour, ii) low physical activity, and iii) poor diet have been defined. Clinical evidence strongly supports the role of lifestyle modification as a primary therapy for the management of NAFLD and NASH. This should be accompanied by the implementation of strategies to avoid relapse and weight regain. Copyright © 2017 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.

Increasing Knowledge and Confidence in Behavioral Change: A Pilot Study.

PubMed

Frates, Elizabeth P; Xiao, Ryan C; Simeon, Kate; McCargo, Tracie; Guo, Michelle; Stern, Theodore A

2016-11-24

To assess whether and how effectively an interactive presentation about lifestyle medicine could impact the knowledge and attitudes of medical students to prepare them for managing chronic conditions in their patients. Chronic diseases are increasingly prevalent and problematic. Although chronic disease management involves lifestyle modification, few physicians are adequately trained in effective motivational interventions. We surveyed first- and second-year Harvard Medical School students in October 2015 before and after a presentation on lifestyle medicine and quantified changes in their knowledge, attitudes/confidence, and skills. Medical students learned the basics of behavioral change after a 1-hour presentation, and their confidence with regard to implementing interventions increased. Median scores of confidence in counseling patients on lifestyle changes improved as did their ability to counsel patients on exercise, nutrition, sleep, stress management, and smoking cessation. After a brief intervention, medical students can learn principles of behavioral management and how to implement the skills with patients suffering from chronic illnesses. © Copyright 2016 Physicians Postgraduate Press, Inc.

Health promotion services for patients having non-comminicable diseases: Feedback from patients and health care providers in Cape Town, South Africa

PubMed Central

2012-01-01

Background Due to a paucity of data regarding the availability and efficacy of equipment, health promotion methods and materials currently used by health professionals for the management of patients with non-communicable diseases (NCDs) at primary health care (PHC) facilities in Cape Town, an audit was undertaken. Methods A multi-centre cross-sectional study was undertaken to interview patients (n = 580) with NCDs at 30 PHC facilities. A questionnaire was used to obtain information on preferences for health promotion methods for lifestyle modification. Individual semi-structured interviews were conducted with selected health professionals (n = 14) and captured using a digital recorder. Data were transferred to the Atlas ti software programme and analysed using a thematic content analysis approach. Results Blood pressure measurement (97.6%) was the most common diagnostic test used, followed by weight measurement (88.3%), urine (85.7%) and blood glucose testing (80.9%). Individual lifestyle modification counselling was the preferred health education method of choice for the majority of patients. Of the 64% of patients that selected chronic clubs/support groups as a method of choice, only a third rated this as their first choice. Pamphlets, posters and workshops/group counselling sessions were the least preferred methods with only 9%, 13% and 11% of patients choosing these as their first choice, respectively. In an individual counselling setting 44.7% of patients reported that they would prefer to be counselled by a doctor, followed by a nurse (16.9%), health educator (8.8%) and nutrition advisor (4.8%). Health professionals identified numerous barriers to education and counselling. These can be summarised as a lack of resources, including time, space and equipment; staff-related barriers such as staff shortage and staff turnover; and patient-related barriers such as patient load and patient non-compliance. Conclusion The majority of patients attending PHC facilities want to receive lifestyle modification education. There is not however, one specific method that can be regarded as the gold standard. Patients’ preferences regarding health education methods differ, and they are more likely to be susceptible to methods that do not involve much reading. Health education materials such as posters, pamphlets and booklets should be used to supplement information received during counselling or support group sessions. PMID:22762453

Differential Impact of Weight Loss on Nonalcoholic Fatty Liver Resolution in a North American Cohort with Obesity.

PubMed

Rachakonda, Vikrant; Wills, Rachel; DeLany, James P; Kershaw, Erin E; Behari, Jaideep

2017-08-01

Nonalcoholic fatty liver disease (NAFLD) is closely associated with obesity. In this study, a North American cohort with obesity enrolled in a lifestyle modification program was examined to determine the impact of weight loss on NAFLD resolution and sarcopenia. Nondiabetic individuals with World Health Organization Class II/III obesity enrolled in a 6-month weight loss intervention were included. Steatosis was measured using computed tomography (CT)-derived liver:spleen attenuation ratio. Body composition was assessed using dual X-ray absorptiometry, air-displacement plethysmography, and CT anthropometry. At baseline, participants with NAFLD had greater visceral adipose tissue (VAT) but similar skeletal muscle area compared to those without NAFLD. After intervention, weight loss was similar in the two groups, but participants with NAFLD lost more VAT than those without NAFLD (-38.81 [-55.98 to -21.63] cm 2 vs. -13.82 [-29.65 to -2.02] cm 2 ; P = 0.017). In the subset with NAFLD at baseline, participants with NAFLD resolution after intervention lost more VAT than those with persistent NAFLD (-57.23 [-88.63 to -25.84) cm 2 vs. -26.92 [-52.14 to -26.92] cm 2 , P = 0.039). In a Western cohort with obesity, NAFLD was not associated with sarcopenia. After lifestyle modification, there was a differential impact on NAFLD resolution, with twofold greater VAT loss in participants who resolved NAFLD compared with those with persistent NAFLD despite similar weight loss. © 2017 The Obesity Society.

2016 Consensus statement on prevention of atherosclerotic cardiovascular disease in the Hong Kong population.

PubMed

Cheung, B My; Cheng, C H; Lau, C P; Wong, C Ky; Ma, R Cw; Chu, D Ws; Ho, D Hk; Lee, K Lf; Tse, H F; Wong, A Sp; Yan, B Py; Yan, V Wt

2017-04-01

In Hong Kong, the prevalence of atherosclerotic cardiovascular disease has increased markedly over the past few decades, and further increases are expected. In 2008, the Hong Kong Cardiovascular Task Force released a consensus statement on preventing cardiovascular disease in the Hong Kong population. The present article provides an update on these recommendations. A multidisciplinary group of clinicians comprising the Hong Kong Cardiovascular Task Force-10 cardiologists, an endocrinologist, and a family physician-met in September 2014 and June 2015 in Hong Kong. Guidelines from the American College of Cardiology/American Heart Association, the European Society of Hypertension/European Society of Cardiology, and the Eighth Joint National Committee for the Management of High Blood Pressure were reviewed. Group members reviewed the 2008 Consensus Statement and relevant international guidelines. At the meetings, each topical recommendation of the 2008 Statement was assessed against the pooled recommendations on that topic from the international guidelines. A final recommendation on each topic was generated by consensus after discussion. It is recommended that a formal risk scoring system should be used for risk assessment of all adults aged 40 years or older who have at least one cardiovascular risk factor. Individuals can be classified as having a low, moderate, or high risk of developing atherosclerotic cardiovascular disease, and appropriate interventions selected accordingly. Recommended lifestyle modifications include adopting a healthy eating pattern; maintaining a low body mass index; quitting smoking; and undertaking regular, moderate-intensity physical activity. Pharmacological interventions should be selected as appropriate after lifestyle modification.

Efficacy of docosahexaenoic acid-choline-vitamin E in paediatric NASH: a randomized controlled clinical trial.

PubMed

Zöhrer, Evelyn; Alisi, Anna; Jahnel, Jörg; Mosca, Antonella; Della Corte, Claudia; Crudele, Annalisa; Fauler, Günter; Nobili, Valerio

2017-09-01

Nonalcoholic steatohepatitis (NASH), a progressive form of nonalcoholic fatty liver disease, is one of the most common hepatic diseases in children. We conducted a randomized controlled clinical trial on children with biopsy-proven NASH based on a combinatorial nutritional approach compared with placebo. Participants were assigned to lifestyle modification plus placebo or lifestyle modification plus a mix containing docosahexaenoic acid, choline, and vitamin E (DHA-CHO-VE). Forty children and adolescents participated in the entire trial. The primary outcome was the improvement of liver hyperechogenicity. Secondary outcomes included alterations of alanine aminotransferase (ALT) and other metabolic parameters. Furthermore, changes of serum bile acids (BA) and plasma fibroblast growth factor 19 (FGF19) levels were evaluated as inverse biomarkers of disease severity. At the end of the study, we observed a significant decrease in severe steatosis in the treatment group (50% to 5%, p = 0.001). Furthermore, although the anthropometric and biochemical measurements in the placebo and DHA-CHO-VE groups were comparable at baseline, at the end of the study ALT and fasting glucose levels improved only in the treatment group. Finally, we found that BA levels were not influenced whereas FGF19 levels were significantly increased by DHA-CHO-VE. The results suggest that a combination of DHA, VE, and CHO could improve steatosis and reduce ALT and glucose levels in children with NASH. However, further studies are needed to assess the impact of a DHA and VE combination on repair of liver damage in paediatric NASH.

Understanding the Effect of Obesity on Fertility Among Reproductive-Age Women.

PubMed

Mitchell, Allison; Fantasia, Heidi Collins

2016-01-01

Obesity is a major public health concern, and obesity among women of childbearing age can have a negative impact on fertility. The mechanism of action between obesity and infertility is complex and includes hormonal factors, alterations in ovulation, and changes in the menstrual cycle. Maternal obesity has also been linked to spontaneous abortion and poorer maternal and fetal health outcomes. Many interventions exist to help childbearing women achieve a lower body mass index. These include lifestyle modifications (diet/physical activity) and surgical and pharmacologic interventions. This article reviews the pathophysiology of the relationship between obesity and infertility and discusses evidence-based interventions for improving fertility among obese childbearing women. © 2016 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses.

Prevention of age-related macular degeneration.

PubMed

Wong, Ian Yat Hin; Koo, Simon Chi Yan; Chan, Clement Wai Nang

2011-02-01

Age-related macular degeneration (AMD) is one of the leading causes of blindness in the developed world. Although effective treatment modalities such as anti-VEGF treatment have been developed for neovascular AMD, there is still no effective treatment for geographical atrophy, and therefore the most cost-effective management of AMD is to start with prevention. This review looks at current evidence on preventive measures targeted at AMD. Modalities reviewed include (1) nutritional supplements such as the Age-Related Eye Disease Study (AREDS) formula, lutein and zeaxanthin, omega-3 fatty acid, and berry extracts, (2) lifestyle modifications, including smoking and body-mass-index, and (3) filtering sunlight, i.e. sunglasses and blue-blocking intraocular lenses. In summary, the only proven effective preventive measures are stopping smoking and the AREDS formula.

The relationship between work ability and oxidative stress in Japanese workers.

PubMed

Ohta, Masanori; Kumashiro, Masaharu; Eguchi, Yasumasa; Morita, Yusaku; Konno, Yoshimasa; Yamato, Hiroshi

2014-01-01

Work ability is based on the balance between personal resources and work demand. This study focused on the personal resources component of work ability. The aims of this study were to elucidate the association between work ability and cardiovascular (CV) risk factors, particularly oxidative stress, and to estimate the effect of a community-implemented lifestyle modification programme on work ability and CV risk factors. Urinary 8-iso-prostaglandin F2α (PGF2α), a biomarker of oxidative stress, was negatively correlated with psychological resources, as measured by the Work Ability Index (WAI). Overall WAI score was unchanged following the programme, while CV risk factors and antioxidative activity improved. A reduction in PGF2α levels was correlated with an improvement in subjective work ability relative to job demands, as assessed by a WAI item. Taken together, the results suggest that lifestyle modification programmes enhance the personal resources component of work ability and are associated with a reduction in oxidative stress.

Dietary modification in a workplace health promotion program in Kuala Lumpur, Malaysia.

PubMed

Moy, Foong Ming; Ab Sallam, Atiya; Wong, Mee Lian

2008-10-01

Lifestyle modification is effective in the prevention of cardiovascular diseases. This study aimed to promote healthy lifestyle behaviours to prevent cardiovascular disease. This study was a quasi-experimental trial with a follow up of two years. The intervention group (n = 102) received intensive individual and group counselling on diet and physical activity. The comparison group (n = 84) was given minimal education through mail and group counselling. Following the intervention, both groups reduced their total fat intake through a replacement in carbohydrate intake. The saturated fat and cholesterol intake was also reduced with a larger magnitude in the intervention group. Fruits and vegetables consumption was increased within the intervention group. The intervention group showed a statistically significant reduction in their mean total cholesterol levels with an intervention effect of -0.38 (95% C.I. = -0.63, -0.14) mmol/l. This study has achieved moderate improvement in dietary intakes as well as the total cholesterol of the participants.

Menopause and Cancers.

PubMed

Einstein, Mark H; Levine, Nanci F; Nevadunsky, Nicole S

2015-09-01

Cancer is a disease of aging, and therefore is more prevalent after menopause. Menopausal symptoms resulting from cancer treatments are an important survivorship issue in cancer care. This article reviews the preventive strategies, utilization of health resources, and management of menopausal symptoms after cancer treatment. Preventive screening as informed by genetic and lifestyle risk, and lifestyle modification, may mitigate the risk of cancer and cancer mortality. Despite potential benefits to quality of life, hormone replacement is rarely prescribed to survivors of gynecologic malignancies. Special considerations are needed for the treatment and supportive care of menopausal symptoms in cancer survivors. Copyright © 2015 Elsevier Inc. All rights reserved.

Rationale and design of the Baptist Employee Healthy Heart Study: a randomized trial assessing the efficacy of the addition of an interactive, personalized, web-based, lifestyle intervention tool to an existing health information web platform in a high-risk employee population.

PubMed

Post, Janisse M; Ali, Shozab S; Roberson, Lara L; Aneni, Ehimen C; Shaharyar, Sameer; Younus, Adnan; Jamal, Omar; Ahmad, Rameez; Aziz, Muhammad A; Malik, Rehan; Spatz, Erica S; Feldman, Theodore; Fialkow, Jonathan; Veledar, Emir; Cury, Ricardo C; Agatston, Arthur S; Nasir, Khurram

2016-07-01

Metabolic syndrome (MetS) and diabetes confer a high risk for developing subsequent cardiovascular disease (CVD). Persons with MetS constitute 24-34 % of the employee population at Baptist Health South Florida (BHSF), a self-insured healthcare organization. The Baptist Employee Healthy Heart Study (BEHHS) aims to assess the addition of a personalized, interactive, web-based, nutrition-management and lifestyle-management program to the existing health-expertise web platform available to BHSF employees in reducing and/or stabilizing CVD and lifestyle risk factors and markers of subclinical CVD. Subjects with MetS or Type II Diabetes will be recruited from an employee population at BHSF and randomized to either an intervention or a control arm. The intervention arm will be given access to a web-based personalized diet-modification and weight-modification program. The control arm will be reminded to use the standard informational health website available and accessible to all BHSF employees. Subjects will undergo coronary calcium testing, carotid intima-media thickness scans, peripheral arterial tonometry, and advanced lipid panel testing at visit 1, in addition to lifestyle and medical history questionnaires. All tests will be repeated at visits 2 and 4 with the exception of the coronary calcium test, which will only be performed at baseline and visit 4. Visit 3 will capture vitals, anthropometrics, and responses to the questionnaires only. Results of this study will provide information on the effectiveness of personalized, web-based, lifestyle-management tools in reducing healthcare costs, promoting healthy choices, and reducing cardiovascular risk in an employee population. It will also provide information about the natural history of carotid atherosclerosis and endothelial dysfunction in asymptomatic but high-risk populations. ClinicalTrials.gov registry, NCT01912209 . Registered on 3 July 2013.

Feasibility Study of Increasing Social Support to Enhance a Healthy Lifestyle Intervention for Individuals with Serious Mental Illness

PubMed Central

Aschbrenner, Kelly A.; Mueser, Kim T.; Naslund, John A.; Gorin, Amy A.; Kinney, Allison; Daniels, Lucas; Bartels, Stephen J.

2016-01-01

Objective Healthy lifestyle interventions addressing obesity in people with serious mental illness (SMI) lead to modest weight losses that tend not to be sustained over time. By augmenting lifestyle interventions with family and peer support targeting health behavior change, greater weight loss might be obtained and sustained in this population. The purpose of this study was to assess the feasibility of increasing support from family and friends to enhance a healthy lifestyle intervention (In SHAPE) adapted for individuals with SMI. Method A sample of 7 dyads (14 total participants) participated in this small-scale open-feasibility trial of social support strategies to enhance health promotion. Weekly 1-hour health coaching sessions were augmented by sessions designed to increase support for healthy eating and exercise through active learning and didactic instruction. Feasibility was assessed by program participation and by examining participants’ satisfaction and exploring suggestions for improving the model post-intervention. Results The majority of participants (57%) nominated a friend, followed by adult child-parent pairs (28%) and sibling pairs (14%) to participate as support partners in the study. All participant-partner dyads (100%) completed 12 sessions within 16 weeks. Participants reported high satisfaction and perceived benefits from the program. Recommend modifications by the dyads included more interactive sessions, a combination of group and dyadic sessions, and hands-on cooking classes. Conclusions This formative research showed that the study design is feasible and that the intervention can facilitate social support for health behavior change in people with SMI. Further research is needed to evaluate the effectiveness of this intervention. PMID:28168015

Diet, Physical Activity, Lifestyle Behaviors, and Prevalence of Childhood Obesity in Irish Children: The Cork Children's Lifestyle Study Protocol.

PubMed

Keane, Eimear; Kearney, Patricia M; Perry, Ivan J; Browne, Gemma M; Harrington, Janas M

2014-08-19

Childhood obesity is complex, and its aetiology is known to be multifaceted. The contribution of lifestyle behaviors, including poor diet and physical inactivity, to obesity remains unclear. Due to the current high prevalence, childhood obesity is an urgent public health priority requiring current and reliable data to further understand its aetiology. The objective of this study is to explore the individual, family, and environmental factors associated with childhood overweight and obesity, with a specific focus on diet and physical activity. A secondary objective of the study is to determine the average salt intake and distribution of blood pressure in Irish children. A cross-sectional survey was conducted of children 8-11 years old in primary schools in Cork, Ireland. Urban schools were selected using a probability proportionate to size sampling strategy, and a complete sample of rural schools from one area in Cork County were invited to participate. Information collected included physical measurement data (anthropometric measurements, blood pressure), early morning spot and 24 hour urine samples, a 3 day estimated food diary, and 7 days of accelerometer data. Principal- (school head) reported, parent/guardian-reported, and child-reported questionnaires collected information on lifestyle behaviors and environmental attributes. The Cork Children's Lifestyle Study (CCLaS) was designed by the Department of Epidemiology and Public Health in University College Cork, Ireland in 2011 and 2012. Piloting and modification of study methods was undertaken. Data collection took place between April 2012 and June 2013. Overall, 27/46 schools and 1075/1641 children, of which 623 were boys, participated. Preliminary data analysis is underway. It is anticipated that the results of the CCLaS study will be available in late 2014. The CCLaS study has collected in-depth data on a wide range of individual, family, social, and environmental correlates which will allow us to access multilevel influences on childhood obesity. This study will contribute to the evidence base by highlighting current knowledge and gaps regarding the predominant drivers of childhood obesity.

Obesity in the Workplace: Impact, Outcomes, and Recommendations.

PubMed

Yarborough, Charles M; Brethauer, Stacy; Burton, Wayne N; Fabius, Raymond J; Hymel, Pamela; Kothari, Shanu; Kushner, Robert F; Morton, John Magaña; Mueller, Kathryn; Pronk, Nicolaas P; Roslin, Mitchell S; Sarwer, David B; Svazas, Brian; Harris, Jeffrey S; Ash, Garrett I; Stark, Jamie T; Dreger, Marianne; Ording, Julie

2018-01-01

To conduct a comprehensive literature review to develop recommendations for managing obesity among workers to improve health outcomes and to explore the impact of obesity on health costs to determine whether a case can be made for surgical interventions and insurance coverage. We searched PubMed from 2011 to 2016, and CINAHL, Scopus, and Cochrane Registry of Clinical Trials for interventions addressing obesity in the workplace. A total of 1419 articles were screened, resulting in 275 articles being included. Several areas were identified that require more research and investigation. Our findings support the use of both lifestyle modification and bariatric surgery to assist appropriate patients in losing weight.

Polycystic ovary syndrome: a review for dermatologists: Part II. Treatment.

PubMed

Buzney, Elizabeth; Sheu, Johanna; Buzney, Catherine; Reynolds, Rachel V

2014-11-01

Dermatologists are in a key position to treat the manifestations of polycystic ovary syndrome (PCOS). The management of PCOS should be tailored to each woman's specific goals, reproductive interests, and particular constellation of symptoms. Therefore, a multidisciplinary approach is recommended. In part II of this continuing medical education article, we present the available safety and efficacy data regarding treatments for women with acne, hirsutism, and androgenetic alopecia. Therapies discussed include lifestyle modification, topical therapies, combined oral contraceptives, antiandrogen agents, and insulin-sensitizing drugs. Treatment recommendations are made based on the current available evidence. Copyright © 2014 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

Update on Prevention of Cardiovascular Disease in Adults With Type 2 Diabetes Mellitus in Light of Recent Evidence: A Scientific Statement From the American Heart Association and the American Diabetes Association

PubMed Central

Golden, Sherita Hill; Anderson, Cheryl; Bray, George A.; Burke, Lora E.; de Boer, Ian H.; Deedwania, Prakash; Eckel, Robert H.; Ershow, Abby G.; Fradkin, Judith; Inzucchi, Silvio E.; Kosiborod, Mikhail; Nelson, Robert G.; Patel, Mahesh J.; Pignone, Michael; Quinn, Laurie; Schauer, Philip R.; Selvin, Elizabeth; Vafiadis, Dorothea K.

2015-01-01

Cardiovascular disease risk factor control as primary prevention in patients with type 2 diabetes mellitus has changed substantially in the past few years. The purpose of this scientific statement is to review the current literature and key clinical trials pertaining to blood pressure and blood glucose control, cholesterol management, aspirin therapy, and lifestyle modification. We present a synthesis of the recent literature, new guidelines, and clinical targets, including screening for kidney and subclinical cardiovascular disease for the contemporary management of patients with type 2 diabetes mellitus. PMID:26246459

[Locomotive syndrome and frailty. Locomotive syndrome due to the underlying disease of degenerative arthritis].

PubMed

Chosa, Etsuo

2012-04-01

Japan became a superaging society. We have been putting a new focus on locomotive syndrome and frailty. The prevention and treatment of locomotive syndromes, such as osteoarthritis, degenerative spondylosis, lumbar canal stenosis, osteoporosis, upper extremity diseases, rheumatoid arthritis, and many other disorders of the locomotive organs are important. Because, the locomotive syndrome results in deterioration of the exercise function and loss of mental and physical health. The aim of locomotive syndrome exercises are: to reduce pain, to restore and improve joint function. We need to take a comprehensive approach to locomotive syndrome, including lifestyle modification, muscle exercise, stretching and therapeutic exercise.

Effect of changes on body weight and lifestyle in nonalcoholic fatty liver disease.

PubMed

Suzuki, Ayako; Lindor, Keith; St Saver, Jenny; Lymp, James; Mendes, Flavia; Muto, Ayako; Okada, Toshihide; Angulo, Paul

2005-12-01

The effects of lifestyle modifications in nonalcoholic fatty liver disease (NAFLD) are incompletely defined. We aimed at determining the association of changes in body weight and lifestyle with changes in serum ALT levels. We analyzed annual health checkup data from 1546 employees. Of 469 subjects with elevated ALT, we selected 348 male subjects by excluding those who had other causes of liver disease. They were followed for one year to assess the association of change in lifestyle with change in serum ALT. The 136 subjects who had ALT normalization were followed for two years to assess the association between lifestyle management and persistently normal ALT. In adjusted analysis, weight loss and regular exercise were significantly associated with improvement in serum ALT and increased the odds of ALT normalization, while starting smoking was significantly associated with deterioration in serum ALT. Subjects achieving > or = 5% weight reduction showed improvement in serum ALT. Reduction in alcohol consumption was not associated with changes in serum ALT. Maintaining reduced weight (<5% gain) was significantly associated with persistently normal ALT. Reducing weight by at least 5% with subsequent weight control and exercising regularly may be beneficial in treating NAFLD.

Leptin receptor Lys656Asn polymorphism is associated with decreased leptin response and weight loss secondary to a lifestyle modification in obese patients.

PubMed

de Luis Roman, Daniel; de la Fuente, Rocio Aller; Sagrado, Manuel Gonzalez; Izaola, Olatz; Vicente, Rosa Conde

2006-10-01

Human obesity is characterized by high levels of leptin, and it has been suggested that obese patients may be leptin resistant. The aim of our study was to investigate the influence of Lys656Asn polymorphism in the leptin receptor gene on leptin response and weight loss secondary to a lifestyle modification (Mediterranean hypocaloric diet and exercise) in obese patients. A population of 67 obese (body mass index >30) nondiabetic outpatients was analyzed in a prospective way. Before and after 3 months of lifestyle modification program, bipolar electrical bioimpedance, blood pressure, and a serial assessment of nutritional intake with 3 days written food records and biochemical analysis were performed. The lifestyle modification program consisted of a hypocaloric diet (1520 kcal, 52% carbohydrates, 25% lipids and 23% proteins). The exercise program consisted of aerobic exercise for at least three times per week (60 min each). Statistical analysis was performed for the combined Lys656/Asn656 and Asn656/Asn656 as mutant group and type Lys656/Lys 656 as wild-type second group. Sixty seven patients gave informed consent and were enrolled in the study. The mean age was 45.7 +/- 16.6 years and the mean BMI 34.1 +/- 5.1, with 18 males (26.9%) and 49 females (73.1%). Thirty six patients (10 males/26 females) (46.8%) had the genotype Lys656/Lys 656 (wild-type group) and 31 patients (8 males/23 females) (46.3%) Lys656/Asn656 (n = 28, 41.8%) or Asn656/Asn656 (n = 3, 4.5%) (mutant group). The percentage of responders (weight loss) was similar in both groups (91.7 vs. 87.1%). In wild-type group (responders and nonresponders), BMI, weight, fat mass, systolic blood pressure and waist circumference decreased. In mutant group, BMI, weight and waist circumference decreased. No differences were detected between basal values in both groups. Only leptin levels decreased significantly in wild-type group (11.5%; p <0.05) (57.3 +/- 31.5 ng/mL vs. 45.8 +/- 29.3 ng/mL; p <0.05). In mutant group, leptin increased without statistical differences (0.44%; ns). Patients with Asn656 allele of LEPR gene have a different response than wild-type patients, and Lys656Lys patients have a significant decrease in weight, BMI, fat mass, waist circumference, systolic blood pressure and leptin levels.

Combination pharmacotherapy to prevent cardiovascular disease: present status and challenges.

PubMed

Yusuf, Salim; Attaran, Amir; Bosch, Jackie; Joseph, Philip; Lonn, Eva; McCready, Tara; Mente, Andrew; Nieuwlaat, Robby; Pais, Prem; Rodgers, Anthony; Schwalm, J-D; Smith, Richard; Teo, Koon; Xavier, Denis

2014-02-01

Combination pills containing aspirin, multiple blood pressure (BP) lowering drugs, and a statin have demonstrated safety, substantial risk factor reductions, and improved medication adherence in the prevention of cardiovascular disease (CVD). The individual medications in combination pills are already recommended for use together in secondary CVD prevention. Therefore, current information on their pharmacokinetics, impact on the risk factors, and tolerability should be sufficient to persuade regulators and clinicians to use fixed-dose combination pills in high-risk individuals, such as in secondary prevention. Long-term use of these medicines, in a polypill or otherwise, is expected to reduce CVD risk by at least 50-60% in such groups. This risk reduction needs confirmation in prospective randomized trials for populations for whom concomitant use of the medications is not currently recommended (e.g. primary prevention). Given their additive benefits, the combined estimated relative risk reduction (RRR) in CVD from both lifestyle modification and a combination pill is expected to be 70-80%. The first of several barriers to the widespread use of combination therapy in CVD prevention is physician reluctance to use combination pills. This reluctance may originate from the belief that lifestyle modification should take precedence, and that medications should be introduced one drug at a time, instead of regarding combination pills and lifestyle modification as complementary and additive. Second, widespread availability of combination pills is also impeded by the reluctance of large pharmaceutical companies to invest in development of novel co-formulations of generic (or 'mature') drugs. A business model based on 'mass approaches' to drug production, packaging, marketing, and distribution could make the combination pill available at an affordable price, while at the same time providing a viable profit for the manufacturers. A third barrier is regulatory approval for novel multidrug combination pills, as there are few precedents for the approval of combination products with four or more components for CVD. Acceptance of combination therapy in other settings suggests that with concerted efforts by academics, international health agencies, research funding bodies, governments, regulators, and pharmaceutical manufacturers, combination pills for prevention of CVD in those with disease or at high risk (e.g. those with multiple risk factors) can be made available worldwide at affordable prices. It is anticipated that widespread use of combination pills with lifestyle modifications can lead to substantial risk reductions (as much as an 80% estimated RRR) in CVD. Heath care systems need to deploy these strategies widely, effectively, and efficiently. If implemented, these strategies could avoid several millions of fatal and non-fatal CVD events every year worldwide.

Lifestyle changes lower FABP4 plasma concentration in patients with cardiovascular risk.

PubMed

Lázaro, Iolanda; Ferré, Raimon; Plana, Núria; Aragonès, Gemma; Girona, Josefa; Merino, Jordi; Heras, Mercedes; Cabré, Anna; Masana, Lluís

2012-02-01

To analyze the impact of lifestyle changes on adipocyte fatty acid-binding protein (FABP4) plasma levels in patients with cardiovascular risk. A 1-year prospective study enrolled 140 patients with cardiovascular risk but without previous cardiovascular disease to evaluate the impact of therapeutic lifestyle changes on cardiovascular risk, focusing on tobacco, nutrition education, and physical activity. The FABP4 variation was inversely associated to physical activity changes (MET·h/wk). FABP4 significantly decreased in patients with increased physical activity, whereas it increased with physical activity reduction. These FABP4 changes were also associated with modifications in body mass index and insulin resistance parameters; however, the correlations between physical activity and FABP4 remained after adjusting for these confounding variables. Changes in physical activity were the main predictors of FABP4 modifications. FABP4 reductions were directly associated with low-density lipoprotein-cholesterol and apolipoprotein B reductions. Neither tobacco cessation nor diet composition modified FABP4 concentrations. Increasing aerobic physical activity can decrease FABP4 plasma levels, independently of weight reduction. If a causal role of FABP4 in metabolic and vascular alterations could be established, our results would add new positive effects on metabolic and cardiovascular risk of both physical activity and avoiding obesity. Copyright © 2011 Sociedad Española de Cardiología. Published by Elsevier Espana. All rights reserved.

Readiness for diabetes prevention and barriers to lifestyle change in women with a history of gestational diabetes mellitus: rationale and study design.

PubMed

Lipscombe, Lorraine L; Banerjee, Ananya Tina; McTavish, Sarah; Mukerji, Geetha; Lowe, Julia; Ray, Joel; Evans, Marilyn; Feig, Denice S

2014-10-01

Women with gestational diabetes mellitus (GDM) have a high risk of future diabetes, which can be prevented with lifestyle modification. Prior diabetes prevention programmes in this population have been limited by lack of adherence. The aim of this study is to evaluate readiness for behaviour change at different time points after GDM diagnosis and identify barriers and facilitators, to inform a lifestyle modification programme specifically designed for this group. The objective of this paper is to present the rationale and methodological design of this study. The ongoing prospective cohort study has recruited a multi-ethnic cohort of 1353 women with GDM from 7 Ontario, Canada hospitals during their pregnancy. A questionnaire was developed to evaluate stage of readiness for behaviour change, and sociodemographic, psychosocial, and clinical predictors of healthy diet and physical activity. Thus far, 960 women (71%) have completed a baseline survey prior to delivery. Prospective postpartum follow-up is ongoing. We are surveying women at 2 time-points after delivery: 3-12 months postpartum, and 13-24 months postpartum. Survey data will be linked to health care administrative databases for long-term follow-up for diabetes. Qualitative interviews were conducted in a subset of women to gain a deeper understanding of barriers and facilitators to lifestyle change. Our study is a fundamental first step in effectively addressing diabetes prevention in women with GDM. Our findings will aid in the design of a diabetes prevention intervention specifically targeted to women with recent GDM, which can then be evaluated in a clinical trial. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Perceived exercise barriers are reduced and benefits are improved with lifestyle modification in overweight and obese women with polycystic ovary syndrome: a randomised controlled trial.

PubMed

Thomson, Rebecca L; Buckley, Jonathan D; Brinkworth, Grant D

2016-03-09

This study assessed the perceived benefits and barriers to exercise participation in overweight and obese women with polycystic ovary syndrome (PCOS) and monitored changes in response to a lifestyle intervention. Forty-three overweight/obese PCOS women (Age, 30.3(6.2) yrs; BMI, 36.4(5.6) kg/m(2)) were randomised to one of three 20-week lifestyle programs: diet only (DO, n = 13), diet and aerobic exercise (DA, n = 11) and diet and combined aerobic-resistance exercise (DC, n = 19). Exercise Benefits/Barriers Scale (EBBS), weight, aerobic fitness, depression and PCOS specific health-related quality of life were measured. Barriers score was related to depression (r = 0.45, P = 0.002) and aerobic fitness (r = -0.32, P = 0.04), while benefits score was related to aerobic fitness (r = 0.41, P = 0.007). EBBS, benefits and barriers scores improved overtime (P ≤ 0.001). Benefits subscales psychological outlook and social interaction increased (P ≤ 0.001) and life enhancement and preventative health did not change (P ≥ 0.3). Physical performance increased only in DA (P = 0.009). There were no differences between treatments for any of the other subscales (P ≥ 0.2). Barriers subscales exercise milieu, time expenditure and physical exertion reduced (P ≤ 0.003) and family discouragement did not change (P = 0.6). This study demonstrated that lifestyle modification consisting of an energy-restricted diet with or without exercise training improved the perceived benefits from and barriers to exercise. Australian New Zealand Clinical Trials Register ACTRN12606000198527, registered 26 May 2006.

Impact of lifestyle habits on the prevalence of the metabolic syndrome among Greek adults from the ATTICA study.

PubMed

Panagiotakos, Demosthenes B; Pitsavos, Christos; Chrysohoou, Christine; Skoumas, John; Tousoulis, Dimitris; Toutouza, Marina; Toutouzas, Pavlos; Stefanadis, Christodoulos

2004-01-01

Individuals with the metabolic syndrome (MS) are at high risk for coronary heart disease and may benefit from aggressive lifestyle modification. In this study, we evaluated the effect of leisure time physical activity (PA) and the Mediterranean diet (MD) on the prevalence of the MS. The ATTICA study is a health and nutritional survey. On the basis of a multistage, random sampling, 1128 men and 1154 women (>18 years old) without any evidence of cardiovascular disease or diabetes mellitus were enrolled from the greater Athens area during 2001 to 2002. The MS was defined according to the National Cholesterol Education Program (NCEP) Adult Treatment Panel (ATP) III criteria. PA was determined from a detailed questionnaire and graded according to the kcal/min expanded. MD was assessed through a validated nutrient questionnaire. The overall prevalence of the MS was 453 of 2282 subjects (19.8%). Of these subjects, 284 (25.2%) were men and 169 (14.6%) were women (P <.001). The prevalence of the MS increased accordingly to age (P for trend <.001). With multiple logistic regression analysis, the odds ratio of having the MS when the participant consumed the MD was 0.81 (95% CI, 0.68-0.976), and when even a little to moderate PA (<7 kcal/min)was reported, the odds ratio was 0.75 (95% CI, 0.65-0.86). The higher levels of inflammation and coagulation markers among participants with MS did not explain much of the aforementioned effect of lifestyle modification. MS is common in Greece and is becoming even more common in the middle-aged population. The suggested therapeutic lifestyle approach may contribute to the reduction of the prevalence of the MS, beyond the levels of several lipid, inflammation, and coagulation markers.

Lifestyle Risk Factors Among People Who Have Had Cancer Genetic Testing.

PubMed

Quillin, John M

2016-10-01

Hereditary cancer genetic counseling often focuses on medically intensive risk-reduction strategies, like imaging and risk-reducing surgeries. Lifestyle factors also influence cancer risk, but health behavior counseling is not common in genetic counseling. Information about typical lifestyle risk factors among patients seeking hereditary cancer risk is sparse. The current study describes cancer risk-relevant lifestyle factors for people who have had cancer genetic testing. Data came from the Health Information National Trends Survey (HINTS 4) collected in 2013. Analytic variables represented American Cancer Society nutrition and physical activity guidelines. Lifestyle factors were assessed for people who had undergone testing for BRCA1, BRCA2, or Lynch Syndrome genes. Among 3016 HINTS respondents, 135 had cancer genetic testing. Of these, 58 % were overweight or obese. Eighteen percent reported no moderate-intensity physical activity. Average sedentary screen-time was 3.4 h (SE = 0.472) daily. Sixty-three percent drank non-diet soda, and 23 % of these people drank soda every day. Between 18 and 36 % consumed less than 2 ½ cups fruits/vegetables daily. Twenty-four percent were current smokers. Lifestyle risk factors were not different between people who had genetic testing and those who had not. In conclusion, most people who had genetic testing for cancer susceptibility have at least one modifiable risk factor. Genetic counselors have opportunities to impact a counselee's cancer risk not only through risk-tailored medical procedures, but also through lifestyle modification recommendations. Results of the current study may foster a broader discussion of genetic counselors' roles in healthy lifestyle education.

Pelvic Muscle Rehabilitation: A Standardized Protocol for Pelvic Floor Dysfunction

PubMed Central

Pedraza, Rodrigo; Nieto, Javier; Ibarra, Sergio; Haas, Eric M.

2014-01-01

Introduction. Pelvic floor dysfunction syndromes present with voiding, sexual, and anorectal disturbances, which may be associated with one another, resulting in complex presentation. Thus, an integrated diagnosis and management approach may be required. Pelvic muscle rehabilitation (PMR) is a noninvasive modality involving cognitive reeducation, modification, and retraining of the pelvic floor and associated musculature. We describe our standardized PMR protocol for the management of pelvic floor dysfunction syndromes. Pelvic Muscle Rehabilitation Program. The diagnostic assessment includes electromyography and manometry analyzed in 4 phases: (1) initial baseline phase; (2) rapid contraction phase; (3) tonic contraction and endurance phase; and (4) late baseline phase. This evaluation is performed at the onset of every session. PMR management consists of 6 possible therapeutic modalities, employed depending on the diagnostic evaluation: (1) down-training; (2) accessory muscle isolation; (3) discrimination training; (4) muscle strengthening; (5) endurance training; and (6) electrical stimulation. Eight to ten sessions are performed at one-week intervals with integration of home exercises and lifestyle modifications. Conclusions. The PMR protocol offers a standardized approach to diagnose and manage pelvic floor dysfunction syndromes with potential advantages over traditional biofeedback, involving additional interventions and a continuous pelvic floor assessment with management modifications over the clinical course. PMID:25006337

Designing the user interfaces of a behavior modification intervention for obesity & eating disorders prevention.

PubMed

Moulos, Ioannis; Maramis, Christos; Mourouzis, Alexandros; Maglaveras, Nicos

2015-01-01

The recent immense diffusion of smartphones has significantly upgraded the role of mobile user interfaces in interventions that build and/or maintain healthier lifestyles. Indeed, high-quality, user-centered smartphone applications are able to serve as advanced front-ends to such interventions. These smartphone applications, coupled with portable or wearable sensors, are being employed for monitoring day to day health-related behaviors, including eating and physical activity. Some of them take one step forward by identifying unhealthy behaviors and contributing towards their modification. This work presents the design as well as the preliminary implementation of the mobile user interface of SPLENDID, a novel, sensor-oriented intervention for preventing obesity and eating disorders in young populations. This is implemented by means of an Android application, which is able to monitor the eating and physical activity behaviors of young individuals at risk for obesity and/or eating disorders, subsequently guiding them towards the modification of those behaviors that put them at risk. Behavior monitoring is based on multiple data provided by a set of communicating sensors and self-reported information, while guidance is facilitated through a feedback/encouragement provision and goal setting mechanism.

Health consequences of postsocialist transition: dietary and lifestyle determinants of plasma lipids in Yakutia.

PubMed

Sorensen, M V; Snodgrass, J J; Leonard, W R; Tarskaia, A; Ivanov, K I; Krivoshapkin, V G; Spitsyn, V A

2005-01-01

The rapid social and cultural changes introduced by the collapse of the Soviet Union have resulted in important differences in cardiovascular health for indigenous Siberians. This study investigated diet and lifestyle determinants of plasma lipids in the Yakut, an indigenous Siberian herding population. The study used a cross-sectional design with data on 201 subjects in three urbanized towns and three rural communities in northeastern Siberia. Data on sociodemographic characteristics, dietary intake, and material lifestyle were collected, and lipids were analyzed from venous whole blood. Diet was analyzed using patterns of dietary intake based on principal components analysis of a dietary intake (food frequency) questionnaire. We identified three diet patterns: a traditional subsistence diet, a market foods diet, and a mixed diet. The effect of lifestyle on cardiovascular risk factors was measured using an ethnographically defined lifestyle index, with two orthogonal dimensions: subsistence lifestyle and modern lifestyle. Total cholesterol (TC) and low-density lipoprotein (LDL) were significantly higher among those consuming a traditional subsistence diet of meat and dairy products. A modern lifestyle was associated with lower TC and LDL but higher adiposity and higher risk of obesity. LDL and TC were higher in rural communities and lower in urbanized towns. The significantly higher lipid levels associated with a subsistence diet and indirectly with a subsistence lifestyle indicate the emergence of a significant health problem associated with the social and cultural changes occurring in Yakutia today. These findings underscore the need for dietary modification and promotion of physical activity among those most at risk for cardiovascular disease (CVD). Moreover, these results differ from those commonly seen in "modernizing" populations, in that elements of subsistence lifestyle are associated with an elevated rather than reduced risk of CVD. Such variable responses to lifestyle change emphasize the need to better understand the distinct social and historical events that may influence health changes among populations in transition. Copyright 2005 Wiley-Liss, Inc

Lifestyle modification to promote weight loss in the absence of energy restriction

USDA-ARS?s Scientific Manuscript database

With the obesity epidemic showing no signs of abating, there is ongoing interest in altering energy balance (i.e., decreasing energy intake and/or increasing energy expenditure) to promote weight, specifically fat, loss. However, short- and long-term outcomes of, and adherence to, decreasing energy ...

75 FR 80057 - Proposed Data Collections Submitted for Public Comment and Recommendations

Federal Register 2010, 2011, 2012, 2013, 2014

2010-12-21

... lifestyle modifications leading to weight loss and increased physical activity can prevent or delay type 2... activity of the National Diabetes Prevention Program, housed in the Division of Diabetes Translation. The... technology. Written comments should be received within 60 days of this notice. Proposed Project CDC Diabetes...

Prediabetes as a toxic environment for the initiation of microvascular and macrovascular complications

PubMed Central

Brannick, Ben; Wynn, Anne

2016-01-01

Prediabetes is a state characterized by impaired fasting glucose or impaired glucose tolerance. Evidence is increasingly demonstrating that prediabetes is a toxic state, in addition to being a harbinger of future development of diabetes mellitus. This minireview discusses the pathophysiology and clinical significance of prediabetes, and approach to its management, in the context of the worldwide diabetes epidemic. The pathophysiologic defects underlying prediabetes include insulin resistance, β cell dysfunction, increased lipolysis, inflammation, suboptimal incretin effect, and possibly hepatic glucose overproduction. Recent studies have revealed that the long-term complications of diabetes may manifest in some people with prediabetes; these complications include classical microvascular and macrovascular disorders, and our discussion explores the role of glycemia in their development. Finally, landmark intervention studies in prediabetes, including lifestyle modification and pharmacologic treatment, are reviewed. PMID:27302176

A practice-based approach to the 2012 position statement of the American Diabetes Association and the European Association for the Study of Diabetes.

PubMed

Schwartz, Stanley S

2013-07-01

The position statement on the management of hyperglycemia in patients with type 2 diabetes mellitus issued in 2012 by the American Diabetes Association and the European Association for the Study of Diabetes contains significant improvements over the 2009 version, including an emphasis on patient-centered care, enhanced strategies for lifestyle modification, a focus on comprehensive cardiovascular risk reduction, and increased pharmacotherapy choices. As diabetes management evolves over time, further improvements may be made in future consensus statements, including a focus on prevention and early treatment and improved glycemic control in all patients, including those with comorbidities. These goals will be achievable by waning use of therapies known to cause hypoglycemia and weight gain and the increased use of therapies that do not carry these risks.

Diarrhea in the International Traveler.

PubMed

Duchini; Rodgers

1999-06-01

International travelers to developing countries have a 40% risk of developing a diarrheal illness, usually acute and occasionally chronic. Preventive measures, including diet and lifestyle modifications, are highly recommended but may not be sufficient. Prophylaxis with bismuth subsalicylate or an antimicrobial should be considered in travelers with immunodeficiencies, co-morbid conditions, achlorhydria, or those who cannot afford a loss of time. Oral rehydration is the primary goal of therapy. Bismuth-subsalicylate is a first-line agent for treatment of milder cases with less than three watery bowel movements per day and prominent nausea. Use of an antibiotic is indicated for more severe cases or in the presence of fever, dysentery, or severe dehydration. A short course of a quinolone is highly effective, safe and well tolerated. Antimicrobial resistance among enteropathogens is growing and appropriate therapeutic modifications should be considered according to specific geographic areas. Metronidazole may be empirically added in those cases that do not respond to quinolones. Specific guidelines for particular pathogens are highlighted.

Gas and Bloating

PubMed Central

2006-01-01

Gaseous symptoms including eructation, flatulence, and bloating occur as a consequence of excess gas production, altered gas transit, or abnormal perception of normal amounts of gas within the gastrointestinal tract. There are many causes of gas and bloating including aerophagia, luminal obstructive processes, carbohydrate intolerance syndromes, small intestinal bacterial overgrowth, diseases of gut motor activity, and functional bowel disorders including irritable bowel syndrome (IBS). Because of the prominence of gaseous complaints in IBS, recent investigations have focused on new insights into pathogenesis and novel therapies of bloating. The evaluation of the patient with unexplained gas and bloating relies on careful exclusion of organic disease with further characterization of the underlying condition with directed functional testing. Treatment of gaseous symptomatology should be targeted to pathophysiologic defects whenever possible. Available therapies include lifestyle alterations, dietary modifications, enzyme preparations, adsorbents and agents which reduce surface tension, treatments that alter gut flora, and drugs that modulate gut transit. PMID:28316536

Prevention of age-related macular degeneration

PubMed Central

Koo, Simon Chi Yan; Chan, Clement Wai Nang

2010-01-01

Age-related macular degeneration (AMD) is one of the leading causes of blindness in the developed world. Although effective treatment modalities such as anti-VEGF treatment have been developed for neovascular AMD, there is still no effective treatment for geographical atrophy, and therefore the most cost-effective management of AMD is to start with prevention. This review looks at current evidence on preventive measures targeted at AMD. Modalities reviewed include (1) nutritional supplements such as the Age-Related Eye Disease Study (AREDS) formula, lutein and zeaxanthin, omega-3 fatty acid, and berry extracts, (2) lifestyle modifications, including smoking and body-mass-index, and (3) filtering sunlight, i.e. sunglasses and blue-blocking intraocular lenses. In summary, the only proven effective preventive measures are stopping smoking and the AREDS formula. PMID:20862519

Impacts on employment, finances, and lifestyle for working age people facing an expected premature death: A systematic review.

PubMed

Kochovska, Slavica; Luckett, Tim; Agar, Meera; Phillips, Jane L

2018-06-01

ABSTRACTObjective:The working ages (25-65 years) are a period when most people have significant work, financial, and family responsibilities. A small proportion of working age people will face an expected premature death from cancer or other life-limiting illness. Understanding the impact an expected premature death has on this population is important for informing support. The current study set out to summarize research describing the effects that facing an expected premature death has on employment, financial, and lifestyle of working age people and their families. A systematic review using narrative synthesis approach. Four electronic databases were searched in July 2016 for peer-reviewed, English language studies focusing on the financial, employment, and lifestyle concerns of working age adults living with an advanced life-limiting illness and/or their carers and/or children. Fifteen quantitative and 12 qualitative studies were included. Two-thirds (n = 18) were focused on cancer. All studies identified adverse effects on workforce participation, finances, and lifestyle. Many patients were forced to work less or give up work/retire early because of symptoms and reduced functioning. In addition to treatment costs, patients and families were also faced with child care, travel, and home/car modification costs. Being younger was associated with greater employment and financial burden, whereas having children was associated with lower functional well-being. Changes in family roles were identified as challenging regardless of diagnosis, whereas maintaining normalcy and creating stability was seen as a priority by parents with advanced cancer. This review is limited by the smaller number of studies focussing on the needs of working age people with nonmalignant disease. Working age people facing an expected premature death and their families have significant unmet financial, employment, and lifestyle needs. Comparing and contrasting their severity, timing, and priority for people with nonmalignant conditions is required to better understand their unique needs.

The Obesity-Fertility Protocol: a randomized controlled trial assessing clinical outcomes and costs of a transferable interdisciplinary lifestyle intervention, before and during pregnancy, in obese infertile women.

PubMed

Duval, Karine; Langlois, Marie-France; Carranza-Mamane, Belina; Pesant, Marie-Hélène; Hivert, Marie-France; Poder, Thomas G; Lavoie, Hélène B; Ainmelk, Youssef; St-Cyr Tribble, Denise; Laredo, Sheila; Greenblatt, Ellen; Sagle, Margaret; Waddell, Guy; Belisle, Serge; Riverin, Daniel; Jean-Denis, Farrah; Belan, Matea; Baillargeon, Jean-Patrice

2015-01-01

Obesity in infertile women increases the costs of fertility treatments, reduces their effectiveness and increases significantly the risks of many complications of pregnancy and for the newborn. Studies suggest that even a modest loss of 5-10 % of body weight can restore ovulation. However, there are gaps in knowledge regarding the benefits and cost-effectiveness of a lifestyle modification program targeting obese infertile women and integrated into the fertility clinics. This study will evaluate clinical outcomes and costs of a transferable interdisciplinary lifestyle intervention, before and during pregnancy, in obese infertile women. We hypothesize that the intervention will: 1) improve fertility, efficacy of fertility treatments, and health of mothers and their children; and 2) reduce the cost per live birth, including costs of fertility treatments and pregnancy outcomes. Obese infertile women (age: 18-40 years; BMI ≥30 kg/m(2) or ≥27 kg/m(2) with polycystic ovary syndrome) will be randomised to either a lifestyle intervention followed by standard fertility treatments after 6 months if no conception has been achieved (intervention group) or standard fertility treatments only (control group). The intervention and/or follow-up will last for a maximum of 18 months or up to the end of pregnancy. Evaluation visits will be planned every 6 months where different outcome measures will be assessed. The primary outcome will be live-birth rates at 18 months. The secondary outcomes will be sub-divided into four categories: lifestyle and anthropometric, fertility, pregnancy complications, and neonatal outcomes. Outcomes and costs will be also compared to similar women seen in three fertility clinics across Canada. Qualitative data will also be collected from both professionals and obese infertile women. This study will generate new knowledge about the implementation, impacts and costs of a lifestyle management program in obese infertile women. This information will be relevant for decision-makers and health care professionals, and should be generalizable to North American fertility clinics. ClinicalTrials.gov NCT01483612. Registered 25 November 2011.

Disorders of childhood growth and development: childhood obesity.

PubMed

Mendez, Robert; Grissom, Maureen

2013-07-01

The incidence of childhood obesity in the United States is estimated at 17%, or 12 million children ages 2 to 19 years. Obesity is a multifactorial condition with syndromic and nonsyndromic variants. Genetic, social, ethnic, endocrinologic, and behavioral issues are all potential etiologic factors. Preventive efforts should begin with monitoring from birth and include breastfeeding until age 6 months, avoiding juices, and promoting fruit and vegetable consumption and adequate exercise. Childhood obesity is diagnosed based on body mass index; a child is considered overweight at the 85th to 95th percentiles and obese at or above the 95th percentile. After obesity is diagnosed, testing should include blood pressure levels, fasting lipid profile, diabetes screening, and liver function tests. The physician should obtain a detailed history of the physical activity level and food intake and assess possible complications of obesity, including depression and hypertension, annually. Lifestyle interventions with family involvement are the mainstay of management, with pharmacotherapy or bariatric surgery considered for adolescents only if intensive lifestyle modifications have failed and in the presence of comorbidities. Intervention by multiple disciplines (ie, medicine, nutrition, psychology) is recommended, and family physicians are encouraged to become more involved in encouraging physical activity and improved nutrition for children. Written permission from the American Academy of Family Physicians is required for reproduction of this material in whole or in part in any form or medium.

The Effectiveness of Smartphone Apps for Lifestyle Improvement in Noncommunicable Diseases: Systematic Review and Meta-Analyses.

PubMed

Lunde, Pernille; Nilsson, Birgitta Blakstad; Bergland, Astrid; Kværner, Kari Jorunn; Bye, Asta

2018-05-04

Noncommunicable diseases (NCDs) account for 70% of all deaths in a year globally. The four main NCDs are cardiovascular diseases, cancers, chronic pulmonary diseases, and diabetes mellitus. Fifty percent of persons with NCD do not adhere to prescribed treatment; in fact, adherence to lifestyle interventions is especially considered as a major challenge. Smartphone apps permit structured monitoring of health parameters, as well as the opportunity to receive feedback. The aim of this study was to review and assess the effectiveness of app-based interventions, lasting at least 3 months, to promote lifestyle changes in patients with NCDs. In February 2017, a literature search in five databases (EMBASE, MEDLINE, CINAHL, Academic Research Premier, and Cochrane Reviews and Trials) was conducted. Inclusion criteria was quantitative study designs including randomized and nonrandomized controlled trials that included patients aged 18 years and older diagnosed with any of the four main NCDs. Lifestyle outcomes were physical activity, physical fitness, modification of dietary habits, and quality of life. All included studies were assessed for risk of bias using the Cochrane Collaboration`s risk of bias tool. Meta-analyses were conducted for one of the outcomes (glycated hemoglobin, HbA 1c ) by using the estimate of effect of mean post treatment with SD or CI. Heterogeneity was tested using the I 2 test. All studies included in the meta-analyses were graded. Of the 1588 records examined, 9 met the predefined criteria. Seven studies included diabetes patients only, one study included heart patients only, and another study included both diabetes and heart patients. Statistical significant effect was shown in HbA 1c in 5 of 8 studies, as well in body weight in one of 5 studies and in waist circumference in one of 3 studies evaluating these outcomes. Seven of the included studies were included in the meta-analyses and demonstrated significantly overall effect on HbA 1c on a short term (3-6 months; P=.02) with low heterogeneity (I 2 =41%). In the long term (10-12 months), the overall effect on HbA 1c was statistical significant (P=.009) and without heterogeneity (I 2 =0%). The quality of evidence according to Grading of Recommendations Assessment, Development and Evaluation was low for short term and moderate for long term. Our review demonstrated limited research of the use of smartphone apps for NCDs other than diabetes with a follow-up of at least 3 months. For diabetes, the use of apps seems to improve lifestyle factors, especially to decrease HbA 1c . More research with long-term follow-up should be performed to assess the effect of smartphone apps for NCDs other than diabetes. ©Pernille Lunde, Birgitta Blakstad Nilsson, Astrid Bergland, Kari Jorunn Kværner, Asta Bye. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 04.05.2018.

Efficacy of a 3-month lifestyle intervention program using a Japanese-style healthy plate on body weight in overweight and obese diabetic Japanese subjects: a randomized controlled trial.

PubMed

Yamauchi, Keiko; Katayama, Tomomi; Yamauchi, Takahiro; Kotani, Kazuhiko; Tsuzaki, Kokoro; Takahashi, Kaoru; Sakane, Naoki

2014-11-24

The portion size of food is a determinant of energy intake, linking with obese traits. A healthy plate for portion control has recently been made in a Japanese style. The aim of the current study was to assess the efficacy of a lifestyle intervention program using the Japanese-style healthy plate on weight reduction in overweight and obese diabetic Japanese subjects. We randomized overweight and obese diabetic subjects (n = 19, 10 women) into an intervention group including educational classes on lifestyle modification incorporating the healthy plate (n = 10) or a waiting-list control group (n = 9). The intervention period was three months, and the educational classes using the healthy plate were conducted monthly in a group session for the intervention group. The body weight, blood glycemic and metabolic measures, and psychosocial variables were measured at the baseline and after the 3-month intervention in both groups. The impression of the intervention was interviewed using a structured questionnaire. There was one drop-out in the control group. No adverse events were reported in the groups. Subjects in the intervention group had a greater weight change from baseline to the end of the 3-month intervention period (-3.7 +/- 2.5 [SD] kg in the intervention group vs. -0.1 +/- 1.4 kg in the control group, P = 0.002). Most subjects recorded that the use of a healthy plate could be recommended to other people. The lifestyle intervention program using the Japanese-style healthy plate, which was developed for portion control, may effectively reduce body weight in overweight and obese diabetic subjects in Japan. Further studies are needed to establish the efficacy of this methodology on weight management.

Determinants of Lifestyle Behavior in Iranian Adults with Prediabetes: Applying the Theory of Planned Behavior.

PubMed

Rahmati-Najarkolaei, Fatemeh; Pakpour, Amir H; Saffari, Mohsen; Hosseini, Mahboobeh Sadat; Hajizadeh, Fereshteh; Chen, Hui; Yekaninejad, Mir Saeed

2017-04-01

Prediabetic condition can lead to development of type 2 diabetes, especially in individuals who do not adhere to a healthy lifestyle. The aim of the present study was to investigate the socio-cognitive factors using the Theory of Planned Behavior (TPB) that may be associated with the choice of lifestyle in prediabetic patients. A prospective study with one-month follow up was designed to collect data from 350 individuals with prediabetic conditions. A questionnaire was used to collect the information, including demographic variables, exercise behavior, food consumption, as well as the constructs of the TPB (attitude, subjective norms, perceived behavioral control, and behavioral intention) regarding physical activity and dietary choice. The correlations between TPB variables and the dependent variables (dietary choice, physical activity) were assessed using Spearman correlation and multiple regression models. In total, 303 people participated. The mean age of the participants was 53.0 (SD 11.5) years and 42% were males. Significant correlations were found between all TPB constructs and both dependent variables (healthy eating and exercise behaviors) both at baseline and after one month (P < 0.01). The predictive validity of the TPB over time was proved for both dependent variables where past and future behaviors were significantly correlated with the constructs. Nearly 87% of the variance in exercise behavior and 72% of the variance in healthy eating behavior were explainable by TPB constructs. The TPB may be a useful model to predict behaviors of physical activity and dietary choice among prediabetic people. Therefore, it may be used to monitor lifestyle modification to prevent development of diabetes among people with prediabetic conditions.

Healthy Lifestyle and Risk of Cancer in the European Prospective Investigation Into Cancer and Nutrition Cohort Study.

PubMed

McKenzie, Fiona; Biessy, Carine; Ferrari, Pietro; Freisling, Heinz; Rinaldi, Sabina; Chajès, Veronique; Dahm, Christina C; Overvad, Kim; Dossus, Laure; Lagiou, Pagona; Trichopoulos, Dimitrios; Trichopoulou, Antonia; Bueno-de-Mesquita, H Bas; May, Anne; Peeters, Petra H; Weiderpass, Elisabete; Sanchez, Maria-Jose; Navarro, Carmen; Ardanaz, Eva; Ericson, Ulrika; Wirfält, Elisabet; Travis, Ruth C; Romieu, Isabelle

2016-04-01

It has been estimated that at least a third of the most common cancers are related to lifestyle and as such are preventable. Key modifiable lifestyle factors have been individually associated with cancer risk; however, less is known about the combined effects of these factors. This study generated a healthy lifestyle index score (HLIS) to investigate the joint effect of modifiable factors on the risk of overall cancers, alcohol-related cancers, tobacco-related cancers, obesity-related cancers, and reproductive-related cancers. The study included 391,608 men and women from the multinational European Prospective Investigation into Cancer and Nutrition (EPIC) cohort. The HLIS was constructed from 5 factors assessed at baseline (diet, physical activity, smoking, alcohol consumption, and anthropometry) by assigning scores of 0 to 4 to categories of each factor, for which higher values indicate healthier behaviors. Hazard ratios (HR) were estimated by Cox proportional regression and population attributable fractions (PAFs) estimated from the adjusted models. There was a 5% lower risk (adjusted HR 0.952, 95% confidence interval (CI): 0.946, 0.958) of all cancers per point score of the index for men and 4% (adjusted HR 0.961, 95% CI: 0.956, 0.966) for women. The fourth versus the second category of the HLIS was associated with a 28% and 24% lower risk for men and women respectively across all cancers, 41% and 33% for alcohol-related, 49% and 46% for tobacco-related, 41% and 26% for obesity-related, and 21% for female reproductive cancers. Findings suggest simple behavior modifications could have a sizeable impact on cancer prevention, especially for men.

Compliance with lifestyle recommendations in kidney allograft recipients.

PubMed

Kobus, G; Małyszko, J; Małyszko, J S; Puza, E; Bachórzewska-Gajewska, H; Myśliwiec, M

2011-10-01

Many factors affect long-term graft and patient survival. Compliance with lifestyle recommendation may be an important factor. Lifestyle modifications may play a therapeutic and protective role against graft failure and possible death. The aim of this work was to assess compliance with lifestyle recommendations among 110 kidney allograft recipients. All patients were asked to complete a questionnaire regarding life style, frequency of outpatient visits, self-control, diet, physical activity and addictions. The mean age of the population was 48.79±13.18 years, and their mean time after transplantation was 69±44.5 years with a mean serum creatinine value of 1.45±0.7 mg/dL. Physicians were the major source of information (40%) for patients while in the hospital; nurses informed patients in only 5.5% of cases. The majority of patients (97.5%) attended regular outpatient clinic visits. A similar percentage of subjects regularly measured their blood pressure at home. One-fifth of the patient wrote a self-control diary. Only 55.5% of patients knew the immunosuppressive regimen, including the doses of the medications. An overweight condition was diagnosed in 39%, with obesity in 22%; 16% of the patients were smokers; one-fourth of the patients drank alcohol at least several times a month; 85.3% of patients did not change their diet after kidney transplantation; and one-half of the patients (64.2%) were not aware of dietary recommendations after kidney transplantation. The majority of patients regularly attended the outpatient clinic and ingested immunosuppressive medications. However, their knowledge regarding diet, cancer prophylaxis, and self-control was insufficient. Therefore, there is a need to introduce more intense organizational and educational activities to improve patient knowledge. Copyright © 2011 Elsevier Inc. All rights reserved.

Secondary prevention lifestyle interventions initiated within 90 days after TIA or 'minor' stroke: a systematic review and meta-analysis of rehabilitation programmes.

PubMed

Heron, Neil; Kee, Frank; Cardwell, Christopher; Tully, Mark A; Donnelly, Michael; Cupples, Margaret E

2017-01-01

Strokes are often preceded by a transient ischaemic attack (TIA) or 'minor' stroke. The immediate period after a TIA/minor stroke is a crucial time to initiate secondary prevention. However, the optimal approach to prevention, including non-pharmacological measures, after TIA is not clear. To systematically review evidence about the effectiveness of delivering secondary prevention, with lifestyle interventions, in comprehensive rehabilitation programmes, initiated within 90 days of a TIA/minor stroke. Also, to categorise the specific behaviour change techniques used. The review identified randomised controlled trials by searching the Cochrane Library, Ovid MEDLINE, Ovid EMBASE, Web of Science, EBSCO CINAHL and Ovid PsycINFO. Two review authors independently screened titles and abstracts for eligibility (programmes initiated within 90 days of event; outcomes reported for TIA/minor stroke) and extracted relevant data from appraised studies; a meta-analysis was used to synthesise the results. A total of 31 potentially eligible papers were identified and four studies, comprising 774 patients post-TIA or minor stroke, met the inclusion criteria; two had poor methodological quality. Individual studies reported increased aerobic capacity but meta-analysis found no significant change in resting and peak systolic blood pressure, resting heart rate, aerobic capacity, falls, or mortality. The main behaviour change techniques were goal setting and instructions about how to perform given behaviours. There is limited evidence of the effectiveness of early post-TIA rehabilitation programmes with preventive lifestyle interventions. Further robust randomised controlled trials of comprehensive rehabilitation programmes that promote secondary prevention and lifestyle modification immediately after a TIA are needed. © British Journal of General Practice 2017.

[Analysis of lifestyle and risk factors of atherosclerosis in students of selected universities in Krakow].

PubMed

Skrzypek, Agnieszka; Szeliga, Marta; Stalmach-Przygoda, Agata; Kowalska, Bogumila; Jabłoński, Konrad; Nowakowski, Michal

Reduction of risk factors of atherosclerosis, lifestyle modification significantly cause the reduction in the incidence, morbidity and mortality of cardiovascular diseases (CVDs). Objective: To evaluate cardiovascular risk factors and analyze the lifestyle of students finishing the first year of studies at selected universities in Krakow. The study was performed in 2015roku. 566 students finishing the first year of study, including 319 (56.4%) men and 247 (43.6%) women were examined. The students were in age from 18 to 27 years, an average of 20.11± 1.15 years. They represented 6 different universities in Cracow. In order to assess eating habits, lifestyle and analysis of risk factors of cardiovascular disease was used method of diagnostic survey using the survey technique. BMI was calculated from anthropometric measurements. The program Statistica 12.0 were used in statistical analysis. The analysis showed that most fruits and vegetables consume UR students and AWF, least of AGH. Only 34.8% of students regularly consume fish of the sea, there were no significant differences between universities. Sports frequently cultivate the students of AWF (93% of the students of this university). Academy of Fine Arts students drink the most coffee. Students of AGH frequently consume alcohol. 60% of all students never tried drugs, but only 25.7% of student of Fine Arts never tried drugs. Overweight occurs in 12.6% of students, and obesity in 1.1%. The most risk factors of atherosclerosis occur in students of AGH and ASP. The results of the study clearly indicate on the necessity of implementation of prevention and improvement of health behaviors in students of AGH and ASP universities.

Development of 'Twazon': An Arabic App for Weight Loss.

PubMed

Alnasser, Aroub; Sathiaseelan, Arjuna; Al-Khalifa, Abdulrahman; Marais, Debbi

2016-05-16

Weight gain and its related illnesses have become a major public health issue across the world, with Saudi Arabia and other Gulf countries seeing dramatic increases in obesity and overweight, and yet there is very little information on how to intervene with this demographic due to cultural and linguistic barriers. As the use of smartphones and apps has also increased in the region, information communication technologies could be a cost-effective means of facilitating the delivery of behavior-modification interventions directly to the target population. Although there are existing apps that offer lifestyle-modification tools, they do not give consideration to the evidence-based practices for weight management. This offers an opportunity to create an Arabic language weight loss app that offers localized content and adheres to evidence-informed practices that are needed for effective weight loss. This paper describes the process of developing an Arabic weight loss app designed to facilitate the modification of key nutritional and physical activity behaviors among Saudi adults, while taking into consideration cultural norms. The development of the Twazon app involved: (1) reviewing all available Arabic weight loss apps and compared with evidence-based practices for weight loss, (2) conducting a qualitative study with overweight and obese Saudi women to ascertain their preferences, (3) selecting which behavioral change strategies and guidelines to be used in the app, (4) creating the Saudi Food Database, (5) deciding on graphic design for both iPhone operating system and Android platforms, including user interface, relational database, and programming code, and (6) testing the beta version of the app with health professionals and potential users. The Twazon app took 23 months to develop and included the compilation of an original Saudi Food database. Eight subjects gave feedback regarding the content validity and usability of the app and its features during a pilot study. The predominant issue among the group was the lack of information explaining how to use the app. This has since been resolved through the implementation of a tutorial. No other changes were required to be made. Information communication technologies, such as smartphone apps, may be an effective tool for facilitating the modification of unhealthy lifestyle habits in Saudi; however, consideration must be given to the target population, cultural norms, and changing trends in the global market. The effectiveness of the app will be better determined during a 6-month intervention with 200 overweight and obese Saudi women.

Lifestyle in progression from hypertensive disorders of pregnancy to chronic hypertension in Nurses' Health Study II: observational cohort study.

PubMed

Timpka, Simon; Stuart, Jennifer J; Tanz, Lauren J; Rimm, Eric B; Franks, Paul W; Rich-Edwards, Janet W

2017-07-12

Objectives  To study the association between lifestyle risk factors and chronic hypertension by history of hypertensive disorders of pregnancy (HDP: gestational hypertension and pre-eclampsia) and investigate the extent to which these risk factors modify the association between HDP and chronic hypertension. Design  Prospective cohort study. Setting  Nurses' Health Study II (1991-2013). Participants  54 588 parous women aged 32 to 59 years with data on reproductive history and without previous chronic hypertension, stroke, or myocardial infarction. Main outcome measure  Chronic hypertension diagnosed by a physician and indicated through nurse participant self report. Multivariable Cox proportional hazards models were used to investigate the development of chronic hypertension contingent on history of HDP and four lifestyle risk factors: post-pregnancy body mass index, physical activity, adherence to the Dietary Approaches to Stop Hypertension (DASH) diet, and dietary sodium/potassium intake. Potential effect modification (interaction) between each lifestyle factor and previous HDP was evaluated with the relative excess risk due to interaction. Results  10% (n=5520) of women had a history of HDP at baseline. 13 971 cases of chronic hypertension occurred during 689 988 person years of follow-up. Being overweight or obese was the only lifestyle factor consistently associated with higher risk of chronic hypertension. Higher body mass index, in particular, also increased the risk of chronic hypertension associated with history of HDP (relative excess risk due to interaction P<0.01 for all age strata). For example, in women aged 40-49 years with previous HDP and obesity class I (body mass index 30.0-34.9), 25% (95% confidence interval 12% to 37%) of the risk of chronic hypertension was attributable to a potential effect of obesity that was specific to women with previous HDP. There was no clear evidence of effect modification by physical activity, DASH diet, or sodium/potassium intake on the association between HDP and chronic hypertension. Conclusion  This study suggests that the risk of chronic hypertension after HDP might be markedly reduced by adherence to a beneficial lifestyle. Compared with women without a history of HDP, keeping a healthy weight seems to be especially important with such a history.

Infant growth outcomes from birth to 12 months of age: findings from the Delta Healthy Sprouts comparative impact trial

USDA-ARS?s Scientific Manuscript database

Objective: Multicomponent lifestyle modification interventions designed for gestational and early postnatal periods may be key to preventing obesity in children. The primary objective of the study was to determine if infant growth outcomes differed between treatment arms of an 18-month, maternal, i...

Working towards Men's Health: Findings from the Sefton Men's Health Project

ERIC Educational Resources Information Center

Robinson, Mark; Robertson, Steve; McCullagh, Jo; Hacking, Sue

2010-01-01

Objective: To evaluate a health improvement initiative aimed at enhancing the health of men in deprived areas. Design: A healthy lifestyle programme was undertaken with men to increase their health knowledge, and encourage behaviour modification and access to health improvement services. A peer mentoring programme was implemented and a training…

Applying PRECEDE-PROCEED to Develop an Intuitive Eating Nondieting Approach to Weight Management Pilot Program

ERIC Educational Resources Information Center

Cole, Renee E.; Horacek, Tanya

2009-01-01

Objective: To describe the use of a consolidated version of the PRECEDE-PROCEED participatory program planning model to collaboratively design an intuitive eating program with Fort Drum military spouses tailored to their readiness to reject the dieting mentality and make healthful lifestyle modifications. Design: A consolidated version of…

The effectiveness of traditional Chinese medicine-based lifestyle interventions on biomedical, psychosocial, and behavioral outcomes in individuals with type 2 diabetes: A systematic review with meta-analysis.

PubMed

Yu, Xingfeng; Chau, Janita P C; Huo, Lanting

2018-04-01

Integrative diabetes care, which combines conventional diabetes therapy with traditional Chinese medicine (TCM)-based interventions, has gained popularity worldwide. Numerous TCM-based lifestyle modification approaches have been proposed for individuals with type 2 diabetes (T2DM). To synthesize and present the best available evidence on the effectiveness of TCM-based lifestyle interventions in individuals with T2DM. We undertook a systematic review of randomized controlled trials or controlled clinical trials. Six English and four Chinese electronic databases were searched from their inceptions to December 2016. Trials investigating the effectiveness of various TCM-based lifestyle interventions among adults with T2DM were reviewed. Studies were excluded if TCM-based lifestyle interventions were only part of the intervention regimen. Two reviewers independently selected studies according to pre-specified inclusion and exclusion criteria and appraised the risk of bias of the included studies. One reviewer extracted details of the included studies and the second reviewer checked the extracted data critically. When feasible, data were statistically pooled for meta-analysis. Otherwise, narrative summaries were used. Twenty-four studies were included. The pooled analysis of the eight studies on tai chi showed tai chi practice for at least 150 min per week was beneficial in lowering glycosylated hemoglobin (mean difference, -1.48%; 95%CI, -2.58% to -0.39%; p < 0.001). Tai chi was effective in reducing fasting blood glucose (mean difference, -1.14 mmol/L; 95%CI, -1.78 to -0.50 mmol/L; p < 0.001) and body mass index (mean difference, -0.62; 95%CI, -1.14 to -0.11; p = 0.02), and improving quality of life. The effects of tai chi on blood pressure and waist circumference were inconclusive due to the limited number of studies. The meta-analysis of the 12 studies on ba duan jin demonstrated beneficial effects on glycosylated hemoglobin (mean difference, -0.77%; 95%CI, -0.97% to -0.56%; p < 0.001), fasting blood glucose (mean difference, -0.82 mmol/L; 95%CI, -1.05 to -0.59 mmol/L; p < 0.001), body mass index (mean difference, -2.77; 95%CI, -4.11 to -1.43; p < 0.001), and depression (mean difference, -4.53; 95%CI, -7.12 to -1.94; p < 0.001). Conclusions on the effects of ba duan jin on quality of life cannot be drawn because only two studies measured the outcome. Evidence regarding the effectiveness of other TCM-based lifestyle interventions is limited. Tai chi and ba duan jin are potentially effective options for individuals with T2DM to improve biomedical and psychosocial well-being. Further well-designed studies are needed to explore the optimal intervention dose and to investigate the effectiveness of other TCM-based lifestyle interventions. Copyright © 2018 Elsevier Ltd. All rights reserved.

Metabolic syndrome: pathophysiology, management, and modulation by natural compounds

PubMed Central

Rochlani, Yogita; Pothineni, Naga Venkata; Kovelamudi, Swathi; Mehta, Jawahar L.

2017-01-01

Metabolic syndrome (MetS) represents a cluster of metabolic abnormalities that include hypertension, central obesity, insulin resistance, and atherogenic dyslipidemia, and is strongly associated with an increased risk for developing diabetes and atherosclerotic and nonatherosclerotic cardiovascular disease (CVD). The pathogenesis of MetS involves both genetic and acquired factors that contribute to the final pathway of inflammation that leads to CVD. MetS has gained significant importance recently due to the exponential increase in obesity worldwide. Early diagnosis is important in order to employ lifestyle and risk factor modification. Here, we review the epidemiology and pathogenesis of MetS, the role of inflammation in MetS, and summarize existing natural therapies for MetS. PMID:28639538

Update on Prevention of Cardiovascular Disease in Adults With Type 2 Diabetes Mellitus in Light of Recent Evidence: A Scientific Statement From the American Heart Association and the American Diabetes Association.

PubMed

Fox, Caroline S; Golden, Sherita Hill; Anderson, Cheryl; Bray, George A; Burke, Lora E; de Boer, Ian H; Deedwania, Prakash; Eckel, Robert H; Ershow, Abby G; Fradkin, Judith; Inzucchi, Silvio E; Kosiborod, Mikhail; Nelson, Robert G; Patel, Mahesh J; Pignone, Michael; Quinn, Laurie; Schauer, Philip R; Selvin, Elizabeth; Vafiadis, Dorothea K

2015-08-25

Cardiovascular disease risk factor control as primary prevention in patients with type 2 diabetes mellitus has changed substantially in the past few years. The purpose of this scientific statement is to review the current literature and key clinical trials pertaining to blood pressure and blood glucose control, cholesterol management, aspirin therapy, and lifestyle modification. We present a synthesis of the recent literature, new guidelines, and clinical targets, including screening for kidney and subclinical cardiovascular disease for the contemporary management of patients with type 2 diabetes mellitus. © 2015 American Heart Association, Inc.

Review of Anti-Inflammatory Herbal Medicines

PubMed Central

Ghasemian, Mona; Owlia, Sina; Owlia, Mohammad Bagher

2016-01-01

Medicinal plants and their secondary metabolites are progressively used in the treatment of diseases as a complementary medicine. Inflammation is a pathologic condition that includes a wide range of diseases such as rheumatic and immune-mediated conditions, diabetes, cardiovascular accident, and etcetera. We introduce some herbs which their anti-inflammatory effects have been evaluated in clinical and experimental studies. Curcuma longa, Zingiber officinale, Rosmarinus officinalis, Borago officinalis, evening primrose, and Devil's claw are some of the introduced medicinal herbs in this review. Since the treatment of inflammation is not a one-dimensional remedy, this review tries to reach a multidimensional therapeutic approach to inflammation with the help of herbal medicine and modification in lifestyle. PMID:27247570

Metabolic Syndrome: Nonalcoholic Fatty Liver Disease.

PubMed

Williams, Tracy

2015-08-01

Although nonalcoholic fatty liver disease (NAFLD) is not one of the defining criteria for metabolic syndrome, it is a common hepatic manifestation. NAFLD includes a spectrum of histologic findings ranging from simple steatosis, known as nonalcoholic fatty liver, to nonalcoholic steatohepatitis (NASH). To make the diagnosis of NAFLD, other etiologies of steatosis or hepatitis, such as hepatotoxic drugs, excessive alcohol intake, congenital errors of metabolism, or viral hepatitis, must be ruled out. After ruling out other conditions, the diagnosis of NAFLD often is made clinically, but a definitive diagnosis of NASH requires liver biopsy. As with other complications of metabolic syndrome, insulin resistance is thought to be an underlying etiology of NAFLD. Management strategies attempt to reverse or improve insulin resistance while minimizing liver damage. The strongest evidence supports lifestyle modifications with weight loss, but there is some evidence to support bariatric surgery, medical therapy with insulin-sensitizing agents, and/or pharmacotherapy to promote weight loss. Cardiovascular disease is the major cause of mortality in patients with NAFLD, so management must include modification of cardiovascular risk factors. Written permission from the American Academy of Family Physicians is required for reproduction of this material in whole or in part in any form or medium.

Lifetime cardiovascular risk of childhood obesity.

PubMed

Raghuveer, Geetha

2010-05-01

An increase in the incidence and an earlier onset of coronary artery disease is expected because of the increased prevalence of childhood obesity. Comorbidities of obesity, such as dyslipidemia, insulin resistance syndrome, hypertension, associated nutritional deficiencies, and a sedentary lifestyle or associated lifestyle factors such as tobacco smoke exposure, are likely to account for this increase because these are all independent risk factors for accelerated atherosclerosis. Because clinical atherosclerotic cardiovascular disease does not manifest in obese children, assessment of the subclinical markers of atherosclerosis may help in the evaluation of the progression of atherosclerosis, in further stratification of risk, and in monitoring the effects of intervention. Furthermore, because multiple risk factors with poorly understood interplay might be present in obese children, assessment of the vasculature directly, and perhaps the assignment of a "vascular age," may be a useful method to quantify the "end organ" effect of exposure to these various risks. Obese children may show favorable changes in their behaviors that result in an improvement in clinically measurable risk factors with various clinic-based and behavior modification therapies, but the vascular benefits of such interventions need to be studied further. Broad social, cultural, legislative, and policy changes that support healthy lifestyles within families and communities need to be implemented to decrease the prevalence of childhood obesity and its cardiovascular consequences in communities. The effect of risk factor modification on the vasculature will continue to be a resource for the direction of evidence-based therapy in obese children.

Exploring Partners' Experiences in Living with Patients Who Undergo Bariatric Surgery.

PubMed

Wallwork, Anna; Tremblay, Lynn; Chi, Monica; Sockalingam, Sanjeev

2017-08-01

Bariatric surgery is effective in assisting persons with severe obesity in achieving significant weight loss and improved health; however, success depends on one's lifelong commitment to lifestyle modifications post-operatively. Life partners can be essential to the success of bariatric patients as they can serve as a primary resource to patients and healthcare teams. This study aimed to explore bariatric patients' partner's experiences in order to help inform clinical practice in bariatric care to better address patient and partner needs. This study utilized a grounded theory analysis of ten semi-structured interviews of male partners of bariatric surgery patients to form a general explanatory framework of the partner experience. Participants described three interconnected processes of change that followed after their spouses surgeries: (1) effort put forth to engage in the surgical process with their spouses, (2) adoption of the behavioural changes made by their spouses and (3) adjustment to a "new normal". For those who engaged in all three processes, optimism for the future and an enriching and synergistic harmonized lifestyle with their spouse was reached. Bariatric surgery in one partner can impact couples' dietary behaviours, physical and leisure activities, physical and emotional intimacy and relationship quality as a whole. Pursuing bariatric surgery as a couple is a unique process. This study highlights the necessity to approach bariatric care in a way that targets the whole spousal unit as engaging both members in lifestyle modification may improve the quality of both their health and relationship overall.

Long-term safety and efficacy of TAK-085 in Japanese subjects with hypertriglyceridemia undergoing lifestyle modification: the omega-3 fatty acids randomized long-term (ORL) study.

PubMed

Tatsuno, Ichiro; Saito, Yasushi; Kudou, Kentarou; Ootake, Jun

2013-01-01

TAK-085 is an omega-3 preparation that contains eicosapentaenoic acid ethyl-ester (EPA-E) and docosahexaenoic acid-ethyl ester used in the management of hypertriglyceridemia. The aim of the study was to evaluate the long-term safety (adverse events [AEs], laboratory parameters, vital signs, weight, and electrocardiograms) and effects on lipid profiles, especially triglyceride levels, of TAK-085 in Japanese patients with hypertriglyceridemia (triglyceride levels ≥150 mg/dL and <750 mg/dL). In this multicenter, open-label, randomized study, adults with hypertriglyceridemia undergoing lifestyle modification received TAK-085 2 g (2 g once daily; n = 165) or 4 g (2 g twice daily; n = 171), or EPA-E 1.8 g (0.6 g three times daily; n = 167) for 52 weeks. Patients were stratified for co-administration of a statin. TAK-085 was well tolerated throughout the 52-week study. Overall, no substantial differences were found in the tolerability of TAK-085 2 g, TAK-085 4 g, and EPA-E 1.8 g with incidence rates for AEs of 83.6%, 86.0%, and 89.2%, respectively. Most AEs were mild or moderate in severity. Triglyceride levels decreased from baseline in all groups by week 4, and the decreases were maintained throughout the study. At week 52 the reduction in triglycerides with TAK-085 2 g (-13.9%) was similar to that with EPA-E 1.8 g (-12.1%), whereas the reduction seen with TAK-085 4 g (-25.5%) was greater than that with EPA-E 1.8 g, as assessed by point estimates and 95% confidence intervals. TAK-085 was safe and well tolerated for up to 52 weeks of treatment in Japanese patients with hypertriglyceridemia undergoing lifestyle modification. Reductions in triglyceride levels achieved after 4 weeks were maintained at 52 weeks. Copyright © 2013 National Lipid Association. Published by Elsevier Inc. All rights reserved.

Health behavior of patients after heart transplantation as an indicator of patient compliance.

PubMed

Siwińska, J; Lesiak-Kalukin, M; Przybyłowski, P; Sadowski, J

2011-10-01

Life after heart transplantation (HTX) does not only mean adherence to medical recommendations, but also implementation of healthy habits each day. It is necessary to change health-related customs, diet, and lifestyle, as well as to maintain a high standard of hygiene. Some patients make the necessary lifestyle modifications prior to surgery, as a result of pre-heart failure conditions, such as coronary heart disease or hypertension or diabetes. People who suddenly fall ill must make these changes immediately after the operation. The transplantation team working with patients after HTX since 1988 performs a program of secondary prophylaxis. Patients work with a physician, psychologist, physiotherapist, nursing team, and dietitian. The program is based on the processual model of health behavior Health Action Process Approach by Ralf Schwarzer. The goal of the study was to describe and assess compliance to a healthy lifestyle among patients living with a heart transplant. The study was conducted using the Health Behavior Inventory developed and standardized by Z. Juczyński. The scale examined three types of behavior lowering/raising the risk of illness as associated with compliance to medical recommendations, maintaining health, and reducing disease risk. Participants included 100 HTX patients including 23 women and 77 men of overall age range 21-75 years (average=53.5). The results are as follows: General indicator of health behaviors--7.3 sten. Subscales: proper nutrition habits--3.5; prophylactic behavior--4.1; positive psychological attitude--3 health practices--3.8. Heart transplant patients require professional, interdisciplinary assistance to shape healthy behaviors with motivational and volitional phases. Patients who follow medical recommendations experience a much better quality of life, protecting the new heart from negative effects of bad habits. Copyright © 2011 Elsevier Inc. All rights reserved.

Sleep Duration and Diabetes Risk in American Indian and Alaska Native Participants of a Lifestyle Intervention Project.

PubMed

Nuyujukian, Daniel S; Beals, Janette; Huang, Haixiao; Johnson, Ann; Bullock, Ann; Manson, Spero M; Jiang, Luohua

2016-11-01

We examine the association between self-reported sleep duration and diabetes incidence in a national sample of American Indians/ Alaska Natives (AI/ANs) with prediabetes. Data were derived from the Special Diabetes Program for Indians Diabetes Prevention demonstration project. This longitudinal analysis included 1,899 participants with prediabetes recruited between January 1, 2006 and July 31, 2009 who reported sleep duration and completed all 16 classes of the lifestyle intervention consisting of diet, exercise, and behavior modification sessions to promote weight loss. Three years of follow-up data were included to fit Cox regression models to compute hazard ratios (HRs) for diabetes incidence across sleep duration categories. The crude diabetes incidence rate was 4.6 per 100 person-years among short sleepers (≤ 6 h per night) compared to 3.2 among those sleeping 7 h and 3.3 among those sleeping 8 h or more. After adjustment for age and sex, short sleep (≤ 6 h vs. others) was associated with increased diabetes risk (HR 1.55 [95% confidence interval 1.11-2.17]); risk remained significantly elevated after controlling for socioeconomic characteristics, health behaviors, and health status. When adjusting for body mass index and percent weight loss, the short sleep-diabetes relationship was attenuated (HR 1.32 [95% confidence interval 0.92-1.89]). No significant long sleep-diabetes association was found. Further, short sleepers lost significantly less weight than others (3.7% vs. 4.3%, P = 0.003). Short sleep duration, but not long duration, was significantly associated with increased diabetes risk and less weight loss among AI/ANs in a lifestyle intervention. Further exploration of the complex factors underlying short sleep duration is warranted. © 2016 Associated Professional Sleep Societies, LLC.

Effects of controlled school-based multi-component model of nutrition and lifestyle interventions on behavior modification, anthropometry and metabolic risk profile of urban Asian Indian adolescents in North India.

PubMed

Singhal, N; Misra, A; Shah, P; Gulati, S

2010-04-01

To study the effectiveness of a multi-component intervention model of nutrition and lifestyle education on behavior modification, anthropometry and metabolic risk profile of urban Asian-Indian adolescents in North India. Two schools matched for student strength and middle socioeconomic strata were randomly allocated to intervention and control group. Changes in nutrition-related knowledge, attitude, lifestyle practices, food frequency and body image of eleventh-grade students (15-17 years) in both schools were tested using a validated questionnaire. Anthropometric and biochemical measurements were made using standard methods. Segmental body composition analysis was carried out using an 8-electrode multifrequency bioelectrical impedance method of body fat estimation. At 6 months follow-up, significant improvement in several domains of knowledge was observed in intervention children (n=99; males=60; females=39) as compared with control school children (n=102; males=61; females=41). In the intervention group, significantly lower proportion of children consumed aerated drinks (15.1%; P<0.001) and energy-dense unhealthy foods (8.9%; P=0.03), whereas significantly higher proportion brought tiffin (packed lunch) to school (14.9%; P=0.004) and brought a fruit in their tiffin (30.7%; P<0.001) as compared with the control group. Significant decrease in mean waist circumference (P=0.02, 95% confidence interval (CI)=-2.43,-0.17), sagittal abdominal diameter (P<0.001, 95% CI=-0.82,-0.09), waist-to-hip ratio (P=0.02, 95% CI=-0.03,-0.004) and fasting blood glucose (P=0.05, 95% CI=-0.09, 5.00) was seen in intervention as compared with control school children. Multi-component model of nutrition and lifestyle education was successful in improving the nutrition-related knowledge, eating habits and lifestyle practices, and resulted in beneficial changes in anthropometric and biochemical profiles of the Asian Indian adolescents. This model should be applied on countrywide basis to prevent obesity and diabetes.

Management of Chronic Daily Headache and Psychiatric Co-Morbidities by Lifestyle Modification: Participatory Action Research Combining New Communication Media

PubMed Central

Faizi, Fakhrudin; Tavallaee, Abbas; Rahimi, Abolfazl; Saghafinia, Masoud

2017-01-01

Background Lifestyle modification has a significant role in chronic daily headache (CDH) management. Participatory action research (PAR) can play an important role in managing chronic medical conditions. However, it has been scarcely used in CDH management. Objectives This study aimed to empower patients with CDH to modify their lifestyle in order to reduce both their headache and related psychiatric co-morbidities in a multidisciplinary headache clinic at Baqiyatallah hospital, Tehran, IR Iran. Methods In the PAR plan, 37 patients (27 females) diagnosed with CDH were selected using purposeful sampling. Along with face-to-face group sessions, all available communication means such as phone calls, emails, short message system (SMS), and social media (Telegram) were used to facilitate the process. Questionnaires of health promotion lifestyle profile (HPLPІІ), visual analog scale (VAS), and depression-anxiety-stress scale (DASS21) were used to collect data. The data were analyzed using SPSS software. Results Mean age of the patients was 38.33 (± 9.7) years. Both “general pain” and “the worst imaginable pain” reduced (mean of reduction: 2.56 ± 2.7 and 2.3 ± 2.9, respectively, P < 0.001). > 50% of pain reduction occurred in “the worst imaginable pain" category (-1.45 ± 2.02, P < 0.001) and mean VAS score reduced to 5.20 (± 2.3) compared to the start of the study (7.50 ± 1.9, P < 0.001). Mean DASS-21 score also reduced significantly for depression (P < 0.016), anxiety (P < 0.026), and stress (P < 0.008). HPLPІІ score significantly improved (118.17 ± 14.8 vs. 160.83 ± 16.4, P < 0.001) and the highest increase was seen in the subscale of "stress management" (17.73 ± 2.8 vs. 25.53 ± 3.9, P < 0.001). Conclusions The empowering PAR plan combined with new communication tools helped the CDH patients better handle their lifestyle, reduce their headache, and lower their symptoms. Further studies with better use of currently available communication tools and social media are recommended for action research to be more applicable. PMID:28920050

Management of Chronic Daily Headache and Psychiatric Co-Morbidities by Lifestyle Modification: Participatory Action Research Combining New Communication Media.

PubMed

Faizi, Fakhrudin; Tavallaee, Abbas; Rahimi, Abolfazl; Saghafinia, Masoud

2017-04-01

Lifestyle modification has a significant role in chronic daily headache (CDH) management. Participatory action research (PAR) can play an important role in managing chronic medical conditions. However, it has been scarcely used in CDH management. This study aimed to empower patients with CDH to modify their lifestyle in order to reduce both their headache and related psychiatric co-morbidities in a multidisciplinary headache clinic at Baqiyatallah hospital, Tehran, IR Iran. In the PAR plan, 37 patients (27 females) diagnosed with CDH were selected using purposeful sampling. Along with face-to-face group sessions, all available communication means such as phone calls, emails, short message system (SMS), and social media (Telegram) were used to facilitate the process. Questionnaires of health promotion lifestyle profile (HPLPІІ), visual analog scale (VAS), and depression-anxiety-stress scale (DASS21) were used to collect data. The data were analyzed using SPSS software. Mean age of the patients was 38.33 (± 9.7) years. Both "general pain" and "the worst imaginable pain" reduced (mean of reduction: 2.56 ± 2.7 and 2.3 ± 2.9, respectively, P < 0.001). > 50% of pain reduction occurred in "the worst imaginable pain" category (-1.45 ± 2.02, P < 0.001) and mean VAS score reduced to 5.20 (± 2.3) compared to the start of the study (7.50 ± 1.9, P < 0.001). Mean DASS-21 score also reduced significantly for depression (P < 0.016), anxiety (P < 0.026), and stress (P < 0.008). HPLPІІ score significantly improved (118.17 ± 14.8 vs. 160.83 ± 16.4, P < 0.001) and the highest increase was seen in the subscale of "stress management" (17.73 ± 2.8 vs. 25.53 ± 3.9, P < 0.001). The empowering PAR plan combined with new communication tools helped the CDH patients better handle their lifestyle, reduce their headache, and lower their symptoms. Further studies with better use of currently available communication tools and social media are recommended for action research to be more applicable.

Longterm management of Polycystic Ovarian Syndrome (PCOS).

PubMed

Bates, Gordon W; Legro, Richard S

2013-07-05

Polycystic Ovarian Syndrome (PCOS) has been associated with numerous reproductive and metabolic abnormalities. Despite tremendous advances in the management of reproductive dysfunction, insight into the metabolic implications of PCOS is limited by the lack of uniform diagnostic criteria, the heterogeneity of the condition and the presence of confounders including obesity. Obesity clearly has a role in long term health and may best predict both reproductive and metabolic dysfunction as well as negatively affect the response to treatment in women with PCOS. Diabetes, cardiovascular disease and cancer are also at the forefront of any risk assessment or comprehensive treatment strategy for these women. Lifestyle modifications including dietary changes, increased exercise and weight loss are appropriate first line interventions for many women with PCOS. Pharmaceuticals including metformin, lipid lowering agents and oral contraceptives should be tailored to the individual's risk profile and treatment goals. Copyright © 2012. Published by Elsevier Ireland Ltd.

Prediabetes as a toxic environment for the initiation of microvascular and macrovascular complications.

PubMed

Brannick, Ben; Wynn, Anne; Dagogo-Jack, Samuel

2016-06-01

Prediabetes is a state characterized by impaired fasting glucose or impaired glucose tolerance. Evidence is increasingly demonstrating that prediabetes is a toxic state, in addition to being a harbinger of future development of diabetes mellitus. This minireview discusses the pathophysiology and clinical significance of prediabetes, and approach to its management, in the context of the worldwide diabetes epidemic. The pathophysiologic defects underlying prediabetes include insulin resistance, β cell dysfunction, increased lipolysis, inflammation, suboptimal incretin effect, and possibly hepatic glucose overproduction. Recent studies have revealed that the long-term complications of diabetes may manifest in some people with prediabetes; these complications include classical microvascular and macrovascular disorders, and our discussion explores the role of glycemia in their development. Finally, landmark intervention studies in prediabetes, including lifestyle modification and pharmacologic treatment, are reviewed. © 2016 by the Society for Experimental Biology and Medicine.

Premenstrual dysphoric disorder in medical students residing in hostel and its association with lifestyle factors

PubMed Central

Mishra, Amrita; Banwari, Girish; Yadav, Priyanka

2015-01-01

Context: There is scant research on premenstrual syndrome (PMS) and its more severe counterpart, premenstrual dysphoric disorder (PMDD) in Indian females. This study aimed to evaluate symptoms of PMS in medical students and to find the association of sociodemographic variables and lifestyle factors with PMDD. Subjects and Methods: A total of 179 medical students residing in the hostel of an Indian medical college and its affiliated teaching hospital were approached, of which 100 (55.8%) returned the completed questionnaires. Data related to lifestyle factors was collected. Self-screening quiz for Diagnostic and Statistical Manual of Mental Disorders-IV-Text Revision PMDD and Shortened Premenstrual Assessment Form were used for diagnosis of PMDD and detection of symptomatology, respectively. Results: PMDD was present in 37% of the respondents. It was found at a higher rate in older and postgraduate students. PMDD was significantly associated with lifestyle factors, namely, sleep, physical activity, total tea/coffee intake, and change in tea/coffee and food intake under stress. The most common physical and psychological symptoms were body ache/joint pain and feeling depressed/blue, respectively. Conclusions: PMDD is fairly common in Indian medical students residing in hostel although cultural factors may influence symptom expression. This study suggests that PMDD is associated with lifestyle factors in young, professional, urban women. Modification in lifestyle may thus be an important approach for management of PMS/PMDD. Prospective studies with larger representative samples are needed to validate these findings. PMID:27212819

Premenstrual dysphoric disorder in medical students residing in hostel and its association with lifestyle factors.

PubMed

Mishra, Amrita; Banwari, Girish; Yadav, Priyanka

2015-01-01

There is scant research on premenstrual syndrome (PMS) and its more severe counterpart, premenstrual dysphoric disorder (PMDD) in Indian females. This study aimed to evaluate symptoms of PMS in medical students and to find the association of sociodemographic variables and lifestyle factors with PMDD. A total of 179 medical students residing in the hostel of an Indian medical college and its affiliated teaching hospital were approached, of which 100 (55.8%) returned the completed questionnaires. Data related to lifestyle factors was collected. Self-screening quiz for Diagnostic and Statistical Manual of Mental Disorders-IV-Text Revision PMDD and Shortened Premenstrual Assessment Form were used for diagnosis of PMDD and detection of symptomatology, respectively. PMDD was present in 37% of the respondents. It was found at a higher rate in older and postgraduate students. PMDD was significantly associated with lifestyle factors, namely, sleep, physical activity, total tea/coffee intake, and change in tea/coffee and food intake under stress. The most common physical and psychological symptoms were body ache/joint pain and feeling depressed/blue, respectively. PMDD is fairly common in Indian medical students residing in hostel although cultural factors may influence symptom expression. This study suggests that PMDD is associated with lifestyle factors in young, professional, urban women. Modification in lifestyle may thus be an important approach for management of PMS/PMDD. Prospective studies with larger representative samples are needed to validate these findings.

Using Mobile & Personal Sensing Technologies to Support Health Behavior Change in Everyday Life: Lessons Learned

PubMed Central

Klasnja, Predrag; Consolvo, Sunny; McDonald, David W.; Landay, James A.; Pratt, Wanda

2009-01-01

Lifestyle modification is a key facet of the prevention and management of chronic diseases. Mobile devices that people already carry provide a promising platform for facilitating these lifestyle changes. This paper describes key lessons learned from the development and evaluation of two mobile systems for encouraging physical activity. We argue that by supporting persistent cognitive activation of health goals, encouraging an extensive range of relevant healthy behaviors, focusing on long-term patterns of activity, and facilitating social support as an optional but not primary motivator, systems can be developed that effectively motivate behavior change and provide support when and where people make decisions that affect their health. PMID:20351876

Non-alcoholic fatty liver disease and impaired proinsulin conversion as newly identified predictors of the long-term non-response to a lifestyle intervention for diabetes prevention: results from the TULIP study.

PubMed

Schmid, Vera; Wagner, Robert; Sailer, Corinna; Fritsche, Louise; Kantartzis, Konstantinos; Peter, Andreas; Heni, Martin; Häring, Hans-Ulrich; Stefan, Norbert; Fritsche, Andreas

2017-12-01

Lifestyle intervention is effective to prevent type 2 diabetes. However, a considerable long-term non-response occurs to a standard lifestyle intervention. We investigated which risk phenotypes at baseline and their changes during the lifestyle intervention predict long-term glycaemic non-response to the intervention. Of 300 participants at high risk for type 2 diabetes who participated in a 24 month lifestyle intervention with diet modification and increased physical activity, 190 participants could be re-examined after 8.7 ± 1.6 years. All individuals underwent a five-point 75 g OGTT and measurements of body fat compartments and liver fat content with MRI and spectroscopy at baseline, 9 and 24 months during the lifestyle intervention, and at long-term follow-up. Fasting proinsulin to insulin conversion (PI/I ratio) and insulin sensitivity and secretion were calculated from the OGTT. Non-response to lifestyle intervention was defined as no decrease in glycaemia, i.e. no decrease in AUC for glucose at 0-120 min during OGTT (AUCglucose 0-120 min ). Before the lifestyle intervention, 56% of participants had normal glucose regulation and 44% individuals had impaired fasting glucose and/or impaired glucose tolerance. At long-term follow-up, 11% had developed diabetes. Multivariable regression analysis with adjustment for age, sex, BMI and change in BMI during the lifestyle intervention revealed that baseline insulin secretion and insulin sensitivity, as well as change in insulin sensitivity during the lifestyle intervention, predicted long-term glycaemic control after 9 years. In addition, increased hepatic lipid content as well as impaired fasting proinsulin conversion at baseline were newly detected phenotypes that independently predicted long-term glycaemic control. Increased hepatic lipid content and impaired proinsulin conversion are new predictors, independent of change in body weight, for non-response to lifestyle intervention in addition to the confirmed factors, impaired insulin secretion and insulin sensitivity.

People with multiple unhealthy lifestyles are less likely to consult primary healthcare

PubMed Central

2014-01-01

Background Behavioural interventions are often implemented within primary healthcare settings to prevent type 2 diabetes and other lifestyle-related diseases. Although smoking, alcohol consumption, physical inactivity and poor diet are associated with poorer health that may lead a person to consult a general practitioner (GP), previous work has shown that unhealthy lifestyles cluster among low socioeconomic groups who are less likely to seek primary healthcare. Therefore, it is uncertain whether behavioural interventions in primary healthcare are reaching those in most need. This study investigated patterns of GP consultations in relation to the clustering of unhealthy lifestyles among a large sample of adults aged 45 years and older in New South Wales, Australia. Methods A total of 267,153 adults participated in the 45 and Up Study between 2006 and 2009, comprising 10% of the equivalent demographic in the state of New South Wales, Australia (response rate: 18%). All consultations with GPs within 6 months prior and post survey completion were identified (with many respondents attending multiple GPs) via linkage to Medicare Australia data. An index of unhealthy lifestyles was constructed from self-report data on adherence to published guidelines on smoking, alcohol consumption, diet and physical activity. Logistic and zero-truncated negative binomial regression models were used to analyse: (i) whether or not a person had at least one GP consultation within the study period; (ii) the count of GP consultations attended by each participant who visited a GP at least once. Analyses were adjusted for measures of health status, socioeconomic circumstances and other confounders. Results After adjustment, participants scoring 7 unhealthy lifestyles were 24% more likely than persons scoring 0 unhealthy lifestyles not to have attended any GP consultation in the 12-month time period. Among those who attended at least one consultation, those with 7 unhealthy lifestyles reported 7% fewer consultations than persons with 0 unhealthy lifestyles. No effect modification was observed. Conclusion To optimise the prevention of lifestyle-related diseases, interventions for positive behavioural change need to incorporate non-primary healthcare settings in order to reach people with multiple unhealthy lifestyles. PMID:24965672

People with multiple unhealthy lifestyles are less likely to consult primary healthcare.

PubMed

Feng, Xiaoqi; Girosi, Federico; McRae, Ian S

2014-06-26

Behavioural interventions are often implemented within primary healthcare settings to prevent type 2 diabetes and other lifestyle-related diseases. Although smoking, alcohol consumption, physical inactivity and poor diet are associated with poorer health that may lead a person to consult a general practitioner (GP), previous work has shown that unhealthy lifestyles cluster among low socioeconomic groups who are less likely to seek primary healthcare. Therefore, it is uncertain whether behavioural interventions in primary healthcare are reaching those in most need. This study investigated patterns of GP consultations in relation to the clustering of unhealthy lifestyles among a large sample of adults aged 45 years and older in New South Wales, Australia. A total of 267,153 adults participated in the 45 and Up Study between 2006 and 2009, comprising 10% of the equivalent demographic in the state of New South Wales, Australia (response rate: 18%). All consultations with GPs within 6 months prior and post survey completion were identified (with many respondents attending multiple GPs) via linkage to Medicare Australia data. An index of unhealthy lifestyles was constructed from self-report data on adherence to published guidelines on smoking, alcohol consumption, diet and physical activity. Logistic and zero-truncated negative binomial regression models were used to analyse: (i) whether or not a person had at least one GP consultation within the study period; (ii) the count of GP consultations attended by each participant who visited a GP at least once. Analyses were adjusted for measures of health status, socioeconomic circumstances and other confounders. After adjustment, participants scoring 7 unhealthy lifestyles were 24% more likely than persons scoring 0 unhealthy lifestyles not to have attended any GP consultation in the 12-month time period. Among those who attended at least one consultation, those with 7 unhealthy lifestyles reported 7% fewer consultations than persons with 0 unhealthy lifestyles. No effect modification was observed. To optimise the prevention of lifestyle-related diseases, interventions for positive behavioural change need to incorporate non-primary healthcare settings in order to reach people with multiple unhealthy lifestyles.

Alternatives to Testosterone Therapy: A Review.

PubMed

Lo, Eric M; Rodriguez, Katherine M; Pastuszak, Alexander W; Khera, Mohit

2018-01-01

Although testosterone therapy (TTh) is an effective treatment for hypogonadism, recent concerns regarding its safety have been raised. In 2015, the US Food and Drug Administration issued a warning about potential cardiovascular risks resulting from TTh. Fertility preservation is another reason to search for viable alternative therapies to conventional TTh, and in this review we evaluate the literature examining these alternatives. To review the role and limitations of non-testosterone treatments for hypogonadism. A literature search was conducted using PubMed to identify relevant studies examining medical and non-medical alternatives to TTh. Search terms included hypogonadism, testosterone replacement therapy, testosterone therapy, testosterone replacement alternatives, diet and exercise and testosterone, varicocele repair and testosterone, stress reduction and testosterone, and sleep apnea and testosterone. Review of peer-reviewed literature. Medical therapies examined include human chorionic gonadotropins, aromatase inhibitors, and selective estrogen receptor modulators. Non-drug therapies that are reviewed include lifestyle modifications including diet and exercise, improvements in sleep, decreasing stress, and varicocele repair. The high prevalence of obesity and metabolic syndrome in the United States suggests that disease modification could represent a viable treatment approach for affected men with hypogonadism. These alternatives to TTh can increase testosterone levels and should be considered before TTh. Lo EM, Rodriguez KM, Pastuszak AW, Khera M. Alternatives to Testosterone Therapy: A Review. Sex Med Rev 2018;6:106-113. Copyright © 2017. Published by Elsevier Inc.

Osteosarcopenic obesity in women: impact, prevalence, and management challenges

PubMed Central

JafariNasabian, Pegah; Inglis, Julia E; Kelly, Owen J; Ilich, Jasminka Z

2017-01-01

Osteosarcopenic obesity syndrome (OSO) has recently been identified as a condition encompassing osteopenia/osteoporosis, sarcopenia and obesity. OSO is especially deleterious in older adults (even if they are not obese by conventional measures), due to age-related redistribution of fat and its infiltration into bone and muscle. Osteoporosis and bone fractures in elderly increase the risk of sarcopenia, which, through decreased mobility, increases the risk of more falls and fractures, creating a vicious cycle. Obesity plays a dual role: to a certain extent, it promotes bone and muscle gains through mechanical loading; in contrast, increased adiposity is also a source of pro-inflammatory cytokines and other endocrine factors that impair bone and muscle. As the elderly population increases, changes in lifestyle to delay the onset of OSO, or prevent OSO, are warranted. Among these changes, dietary patterns and physical activity modifications are the first ones to be implemented. The typical Western diet (and lifestyle) promotes several chronic diseases including OSO, by facilitating a pro-inflammatory state, largely via the imbalance in omega-6/omega-3 fatty acid ratio and low-fiber and high-processed food consumption. Nutritional modifications to prevent and/or alleviate the OSO syndrome include adequate intake of protein, calcium, magnesium and vitamin D and increasing consumptions of foods containing omega-3 polyunsaturated fatty acids and fiber. Certain types of physical activity, often decreased in overweight/obese women and in elderly, might preserve bone and muscle, as well as help in reducing body fat accrual and fat infiltration. Habitual daily activities and some alternative modes of exercise may be more appropriate for older adults and play a crucial role in preventing bone and muscle loss and maintaining optimal weight. In conclusion, older adults who suffer from OSO syndrome may benefit from combined efforts to improve diet and physical activity, and such recommendations should be fostered as part of public health programs. PMID:28144165

Osteosarcopenic obesity in women: impact, prevalence, and management challenges.

PubMed

JafariNasabian, Pegah; Inglis, Julia E; Kelly, Owen J; Ilich, Jasminka Z

2017-01-01

Osteosarcopenic obesity syndrome (OSO) has recently been identified as a condition encompassing osteopenia/osteoporosis, sarcopenia and obesity. OSO is especially deleterious in older adults (even if they are not obese by conventional measures), due to age-related redistribution of fat and its infiltration into bone and muscle. Osteoporosis and bone fractures in elderly increase the risk of sarcopenia, which, through decreased mobility, increases the risk of more falls and fractures, creating a vicious cycle. Obesity plays a dual role: to a certain extent, it promotes bone and muscle gains through mechanical loading; in contrast, increased adiposity is also a source of pro-inflammatory cytokines and other endocrine factors that impair bone and muscle. As the elderly population increases, changes in lifestyle to delay the onset of OSO, or prevent OSO, are warranted. Among these changes, dietary patterns and physical activity modifications are the first ones to be implemented. The typical Western diet (and lifestyle) promotes several chronic diseases including OSO, by facilitating a pro-inflammatory state, largely via the imbalance in omega-6/omega-3 fatty acid ratio and low-fiber and high-processed food consumption. Nutritional modifications to prevent and/or alleviate the OSO syndrome include adequate intake of protein, calcium, magnesium and vitamin D and increasing consumptions of foods containing omega-3 polyunsaturated fatty acids and fiber. Certain types of physical activity, often decreased in overweight/obese women and in elderly, might preserve bone and muscle, as well as help in reducing body fat accrual and fat infiltration. Habitual daily activities and some alternative modes of exercise may be more appropriate for older adults and play a crucial role in preventing bone and muscle loss and maintaining optimal weight. In conclusion, older adults who suffer from OSO syndrome may benefit from combined efforts to improve diet and physical activity, and such recommendations should be fostered as part of public health programs.

Effects of health intervention program on cardiometabolic risk profiles from health evaluation center in Asian population: a longitudinal study and propensity analysis.

PubMed

Liu, Chuan-Chuan; Hung, Chung-Lieh; Shih, Shou-Chuan; Ko, Hung-Ju; Chang, Ray-E

2015-08-20

Health intervention program (HIP) based on diet and lifestyle modifications had been shown to improve cardiovascular risks. The effects of such program on a variety of cardiometabolic outcome measures conducted in a strict analysis remained relatively unexplored. A total of 2,660 participants (mean age: 43.3 ± 10 years, 63.6% male) underwent annual health survey from our health evaluation department. We implemented health intervention program (HIP) in which diet and lifestyle modifications including smoking cessation and advised physical activities were introduced. We further studied the effects of HIP on several cardiometabolic outcome measures including Framingham, metabolic scores and renal function in terms of Egfr with a mean follow-up period of 38.5 months. Propensity score (PS) matching (HIP vs non-HIP group) was used to avoid effects of case selection bias. Totally 1,004 (502 subjects for each group) left after PS matching protocol (both HIP and non-HIP group). The HIP group showed significant decline of waist circumference (-1.46 ± 0.61, p = 0.016), post-prandial glucose (-6.77 ± 2.06, p = 0.001), and total cholesterol level (-4.42 ± 2.15, p = 0.04), with borderline increase in eGFR (1.72 ± 0.94, p = 0.068) after an average of 1.91 ± 1.14 year follow up period. Exercise behavior significantly increased for those who received HIP when compared to the non-HIP group (44.6 vs 52.4 %, p = 0.014). PS matching and difference-in-difference (DID) analysis further confirmed the beneficial effects of ATP III reduction by HIP (-0.36 ± 0.06, p < 0.05). We demonstrated in our study that several cardiometabolic profiles can be substantially improved after health intervention introduction at the health evaluation center, supporting the beneficial evidence of such health intervention programs implementation based on primary prevention view points.

Effect of Web-based lifestyle modification on weight control: a meta-analysis.

PubMed

Kodama, S; Saito, K; Tanaka, S; Horikawa, C; Fujiwara, K; Hirasawa, R; Yachi, Y; Iida, K T; Shimano, H; Ohashi, Y; Yamada, N; Sone, H

2012-05-01

Web-based treatment programs are attractive in primary care because of their ability to reach numerous individuals at low cost. Our aim of this meta-analysis is to systematically review the weight loss or maintenance effect of the Internet component in obesity treatment programs. MEDLINE and EMBASE literature searches were conducted to identify studies investigating the effect of Web-based individualized advice on lifestyle modification on weight loss. Randomized controlled trials that consisted of a Web-user experimental and non-Web user control group were included. Weight changes in the experimental group in comparison with the control group were pooled with a random-effects model. A total of 23 studies comprising 8697 participants were included. Overall, using the Internet had a modest but significant additional weight-loss effect compared with non-Web user control groups (-0.68 kg, P=0.03). In comparison with the control group, stratified analysis indicated that using the Internet as an adjunct to obesity care was effective (-1.00 kg, P<0.001), but that using it as a substitute for face-to-face support was unfavorable (+1.27 kg, P=0.01). An additional effect on weight control was observed when the aim of using the Internet was initial weight loss (-1.01 kg; P=0.03), but was not observed when the aim was weight maintenance (+0.68 kg; P=0.26). The relative effect was diminished with longer educational periods (P-trend=0.04) and was insignificant (-0.20 kg; P=0.75) in studies with educational periods of 12 months or more. The current meta-analysis indicates that the Internet component in obesity treatment programs has a modest effect on weight control. However, the effect was inconsistent, largely depending on the type of usage of the Internet or the period of its use.

Emerging Drugs and Indications for Cardio-Metabolic Disorders in People with Severe Mental Illness.

PubMed

Kouidrat, Youssef; Amad, Ali; De Hert, Marc

2015-01-01

Patients with severe mental illnesses, such as schizophrenia and bipolar disorder, are at increased risk of developing metabolic disorders including obesity, diabetes, and dyslipidemia. All of these comorbidities increase the risk of cardiovascular disease and mortality. Different approaches, including diet and lifestyle modifications, behavioral therapy and switching antipsychotic agents, have been proposed to manage these metabolic abnormalities. However, these interventions may be insufficient, impractical or fail to counteract the metabolic dysregulation. Consequently, a variety of pharmacological agents such as antidiabetic drugs, have been studied in an attempt to reverse the weight gain and metabolic abnormalities evident in these patients. Despite a significant effect, many of these treatments are used off-label. This qualitative review focuses on pharmacological agents that could offer significant benefits in the management of cardio-metabolic disorders associated with serious mental illness.

Approach to hemorrhoids.

PubMed

Lohsiriwat, Varut

2013-07-01

Hemorrhoids are a very common anorectal disorder defined as the symptomatic enlargement and abnormally downward displacement of anal cushions. The current pathophysiologies of hemorrhoids include the degenerative change of supportive tissue within the anal cushions, vascular hyperplasia, and hyperperfusion of hemorrhoidal plexus. Low-grade hemorrhoids are easily and effectively treated with dietary and lifestyle modification, medical intervention, and some office-based procedures. An operation is usually indicated in symptomatic high-grade and/or complicated hemorrhoids. Whilst hemorrhoidectomy has been the mainstay of surgical treatment, more recently other approaches have been employed including Ligasure hemorrhoidectomy, stapled hemorrhoidopexy, and doppler-guided hemorrhoidal artery ligation. Post-procedural pain and disease recurrence remain the most challenging problems in the treatment of hemorrhoids. This article deals with modern approaches to hemorrhoids based on the latest evidence and reviews of the literature. The management of hemorrhoids in complicated situations is also discussed.

Polycystic ovarian syndrome.

PubMed

Khan, Khurshid A; Stas, Sameer; Kurukulasuriya, L Romayne

2006-01-01

Polycystic ovarian syndrome (PCOS) is the most common reproductive endocrinopathy of women during their childbearing years. A significant degree of controversy exists regarding the etiology of this syndrome, but there is a growing consensus that the key features include insulin resistance, androgen excess, and abnormal gonadotropin dynamics. Familial and genetic factors cause predisposition to PCOS. Insulin resistance and adiposity put women with PCOS at a higher risk for diabetes, hypertension, dyslipidemia, and cardiovascular disease. Even though the adverse health consequences associated with PCOS are substantial, most women are not aware of these risks. Early recognition and treatment of metabolic sequelae should be the main focus of clinicians. Lifestyle modifications, mainly a balanced diet, weight loss, and regular exercise, are of utmost importance. On the pharmacologic front, various therapies including metformin, thiazolidinediones, and others appear to be very promising in the management of cardiometabolic aspects of PCOS.

Adherence to lifestyle modifications after a cardiac rehabilitation program and endothelial progenitor cells. A six-month follow-up study.

PubMed

Cesari, F; Marcucci, R; Gori, A M; Burgisser, C; Francini, S; Roberts, A T; Sofi, F; Gensini, G F; Abbate, R; Fattirolli, F

2014-07-03

An increase of endothelial progenitor cells (EPCs) among acute myocardial infarction (AMI) patients participating in a cardiac rehabilitation (CR) program has been reported, but no data on the impact of adherence to lifestyle recommendations provided during a CR program on EPCs are available. It was our aim to investigate the effect of adherence to lifestyle recommendations on EPCs, inflammatory and functional parameters after six months of a CR program in AMI patients. In 110 AMI patients (90 male/20 female; mean age 57.9 ± 9.4 years) EPCs, high sensitivity C-reactive protein (hsCRP), N-terminal pro-brain natriuretic peptide (NT-ProBNP) levels, and cardiopulmonary testings were determined at the end of the CR (T1) and at a six-month follow-up (T2). At T2 we administered a questionnaire assessing dietary habits and physical activity. At T2, we observed a decrease of EPCs (p<0.05), of hsCRP (p=0.009) and of NT-ProBNP (p<0.0001). Patient population was divided into three categories by Healthy Lifestyle (HL) score (none/low, moderate and high adherence to lifestyle recommendations). We observed a significant association between adherence to lifestyle recommendations, increase in EPCs and exercise capacity between T1 and T2 (Δ EPCs p for trend <0.05; ΔWatt max p for trend=0.004). In a multivariate logistic regression analyses, being in the highest tertile of HL score affected the likelihood of an increase of EPC levels at T2 [OR (95% confidence interval): 3.36 (1.0-10.72) p=0.04]. In conclusion, adherence to lifestyle recommendations provided during a CR program positively influences EPC levels and exercise capacity.

Impact of Hormonal Contraception and Weight Loss on HDL-C efflux and Lipoprotein Particles in Women with Polycystic Ovary Syndrome

PubMed Central

Dokras, Anuja; Playford, Martin; Kris-Etherton, Penny M.; Kunselman, Allen R.; Stetter, Christy M.; Williams, Nancy I.; Gnatuk, Carol L.; Estes, Stephanie J.; Sarwer, David B; Allison, Kelly C; Coutifaris, Christos; Mehta, Nehal; Legro, Richard S

2017-01-01

Objective To study the effects of oral contraceptive pills (OCP), the first line treatment for PCOS, on HDL-C function (reverse cholesterol efflux capacity) and lipoprotein particles measured by NMR spectroscopy. Design Secondary analysis of a randomized controlled trial (OWL-PCOS) of OCP or Lifestyle (intensive lifestyle modification) or Combined (OCP+Lifestyle) treatment for 16 weeks. Patients 87 overweight/obese women with PCOS at two academic centers Measurements Change in HDL-C efflux capacity and lipoprotein particles. Results HDL-C efflux capacity increased significantly at 16 weeks in the OCP group (0.11; 95% CI 0.03, 0.18, p=0.008) but not in the Lifestyle (p=0.39) or Combined group (p=0.18). After adjusting for HDL-C and TG levels, there was significant mean change in efflux in the Combined group (0.09; 95% CI 0.01, 0.15; p=0.01). Change in HDL-C efflux correlated inversely with change in serum testosterone (rs = −0.21; p=0.05). In contrast, OCP use induced an atherogenic LDL-C profile with increase in small (p=0.006) and large LDL-particles (p=0.002). Change in small LDL-particles correlated with change in serum testosterone (rs = −0.31, p=0.009) and insulin sensitivity index (rs = −0.31, p=0.02). Both Lifestyle and Combined groups did not show significant changes in the atherogenic LDL-particles. Conclusions OCP use is associated with improved HDL-C function and a concomitant atherogenic LDL-C profile. Combination of a Lifestyle program with OCP use improved HDL-C function and mitigated adverse effects of OCP on lipoproteins. Our study provides evidence for use of OCP in overweight/obese women with PCOS when combined with Lifestyle changes. PMID:28199736

Evolutionary changes of Hox genes and relevant regulatory factors provide novel insights into mammalian morphological modifications.

PubMed

Li, Kui; Sun, Xiaohui; Chen, Meixiu; Sun, Yingying; Tian, Ran; Wang, Zhengfei; Xu, Shixia; Yang, Guang

2018-01-01

The diversity of body plans of mammals accelerates the innovation of lifestyles and the extensive adaptation to different habitats, including terrestrial, aerial and aquatic habitats. However, the genetic basis of those phenotypic modifications, which have occurred during mammalian evolution, remains poorly explored. In the present study, we synthetically surveyed the evolutionary pattern of Hox clusters that played a powerful role in the morphogenesis along the head-tail axis of animal embryos and the main regulatory factors (Mll, Bmi1 and E2f6) that control the expression of Hox genes. A deflected density of repetitive elements and lineage-specific radical mutations of Mll have been determined in marine mammals with morphological changes, suggesting that evolutionary changes may alter Hox gene expression in these lineages, leading to the morphological modification of these lineages. Although no positive selection was detected at certain ancestor nodes of lineages, the increased ω values of Hox genes implied the relaxation of functional constraints of these genes during the mammalian evolutionary process. More importantly, 49 positively-selected sites were identified in mammalian lineages with phenotypic modifications, indicating adaptive evolution acting on Hox genes and regulatory factors. In addition, 3 parallel amino acid substitutions in some Hox genes were examined in marine mammals, which might be responsible for their streamlined body. © 2017 The Authors. Integrative Zoology published by International Society of Zoological Sciences, Institute of Zoology/Chinese Academy of Sciences and John Wiley & Sons Australia, Ltd.

Context and Cardiovascular Risk Modification in Two Regions of Ontario, Canada: A Photo Elicitation Study

PubMed Central

Angus, Jan E.; Rukholm, Ellen; Michel, Isabelle; Larocque, Sylvie; Seto, Lisa; Lapum, Jennifer; Timmermans, Katherine; Chevrier-Lamoureux, Renée; Nolan, Robert P.

2009-01-01

Cardiovascular diseases, which include coronary heart diseases (CHD), remain the leading cause of death in Canada and other industrialized countries. This qualitative study used photo-elicitation, focus groups and in-depth interviews to understand health behaviour change from the perspectives of 38 people who were aware of their high risk for CHD and had received information about cardiovascular risk modification while participating in a larger intervention study. Participants were drawn from two selected regions: Sudbury and District (northern Ontario) and the Greater Toronto Area (southern Ontario). Analysis drew on concepts of place and space to capture the complex interplay between geographic location, sociodemographic position, and people’s efforts to understand and modify their risk for CHD. Three major sites of difference and ambiguity emerged: 1) place and access to health resources; 2) time and food culture; and 3) itineraries or travels through multiple locations. All participants reported difficulties in learning and adhering to new lifestyle patterns, but access to supportive health resources was different in the two regions. Even within regions, subgroups experienced different patterns of constraint and advantage. In each region, “fast” food and traditional foods were entrenched within different temporal and social meanings. Finally, different and shifting strategies for risk modification were required at various points during daily and seasonal travels through neighbourhoods, to workplaces, or on vacation. Thus health education for CHD risk modification should be place-specific and tailored to the needs and resources of specific communities. PMID:19826558

School Based Multicomponent Intervention for Obese Children in Udupi District, South India - A Randomized Controlled Trial.

PubMed

Nayak, Baby S; Bhat, Vinod H

2016-12-01

Childhood obesity and overweight is a global epidemics and has been increasing in the developing countries. Childhood obesity is linked with increased mortality and morbidity independent of adult obesity. Declining physical activity, access to junk food and parenting style are the major determinants of overweight in children. Thus, there is a need for increasing the physical activity of children, educating the parents as well as the children on lifestyle modification. This can be achieved through implementation of multicomponent intervention. To evaluate the effectiveness of multicomponent intervention on improving the lifestyle practices, reducing the body fat and improving the self esteem of obese children from selected schools of Udupi District, South India. A sample of 120 obese children were enrolled for multicomponent intervention. The components of multicomponent intervention were: education provided to the obese children on lifestyle modification, education of the parents and increasing the physical education activity of these children in the form of aerobics under the supervision of physical education teacher. There was an attrition of 25% in the intervention group. Thus the final sample in the intervention group was 90. Total sample of 131 overweight/ obese children enrolled as controls. There was an attrition of 20.61% in the control group. Thus, the final sample in the control group was 104. Intervention group received the multicomponent intervention for six month. Mixed Method Repeated measures Ananlysis of Variance (ANOVA) was applied for analysis of data. Results indicated that the intervention was effective in reducing the Body Mass Index (BMI), triceps, biceps, subscapular skin fold thickness of obese children. The intervention was also effective in improving the lifestyle practices and self-esteem of obese children. Overweight/obese children need to control diet and perform vigorous exercise at least for 20 minutes a day to reduce the excess fat and maintain their body fat level.

Epidemiology of concurrent headache and sleep problems in Denmark.

PubMed

Lund, Nunu; Westergaard, Maria Lurenda; Barloese, Mads; Glümer, Charlotte; Jensen, Rigmor Højland

2014-09-01

There are no previous epidemiologic studies on concurrent headache and sleep problems (HSP). This cross-sectional study aimed to determine the prevalence of HSP in Denmark, broadly characterize those with HSP, and examine associations between HSP and socioeconomic/lifestyle factors. A total of 129,150 randomly selected individuals were invited to participate in the Danish National Health Survey 2010. Respondents were asked about headache, sleep problems, depression and anxiety in the last two weeks, health-related lifestyle and quality of life (SF-12). Socioeconomic data were retrieved from national registers. Prevalence proportions were adjusted for stratified sampling and non-response. Regression analyses examined associations between HSP and socioeconomic/lifestyle factors. Of 68,518 respondents, 16.3% reported only headache, 21.1% only sleep problems, and 18.1% HSP with 2.6% being severely affected. Prevalence was higher among women and the middle-aged. Severe HSP was associated with low socioeconomic position, non-Western ethnicity, unhealthy lifestyle, high stress and anxiety/depression. Those with HSP had substantially reduced quality of life; more so than those having only headache or only sleep problems. HSP is a highly prevalent condition. Lifestyle modification, stress reduction, and screening for concurrent depression and anxiety may play important roles in management. The high prevalence of HSP suggests a common pathophysiological mechanism. © International Headache Society 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

Genetic Predisposition to Weight Loss and Regain With Lifestyle Intervention: Analyses From the Diabetes Prevention Program and the Look AHEAD Randomized Controlled Trials

PubMed Central

Papandonatos, George D.; Pan, Qing; Pajewski, Nicholas M.; Delahanty, Linda M.; Peter, Inga; Erar, Bahar; Ahmad, Shafqat; Harden, Maegan; Chen, Ling; Fontanillas, Pierre; Wagenknecht, Lynne E.; Kahn, Steven E.; Wing, Rena R.; Jablonski, Kathleen A.; Huggins, Gordon S.; Knowler, William C.; Florez, Jose C.

2015-01-01

Clinically relevant weight loss is achievable through lifestyle modification, but unintentional weight regain is common. We investigated whether recently discovered genetic variants affect weight loss and/or weight regain during behavioral intervention. Participants at high-risk of type 2 diabetes (Diabetes Prevention Program [DPP]; N = 917/907 intervention/comparison) or with type 2 diabetes (Look AHEAD [Action for Health in Diabetes]; N = 2,014/1,892 intervention/comparison) were from two parallel arm (lifestyle vs. comparison) randomized controlled trials. The associations of 91 established obesity-predisposing loci with weight loss across 4 years and with weight regain across years 2–4 after a minimum of 3% weight loss were tested. Each copy of the minor G allele of MTIF3 rs1885988 was consistently associated with greater weight loss following lifestyle intervention over 4 years across the DPP and Look AHEAD. No such effect was observed across comparison arms, leading to a nominally significant single nucleotide polymorphism×treatment interaction (P = 4.3 × 10−3). However, this effect was not significant at a study-wise significance level (Bonferroni threshold P < 5.8 × 10−4). Most obesity-predisposing gene variants were not associated with weight loss or regain within the DPP and Look AHEAD trials, directly or via interactions with lifestyle. PMID:26253612

Lorcaserin plus lifestyle modification for weight loss maintenance: Rationale and design for a randomized controlled trial.

PubMed

Tronieri, Jena Shaw; Alfaris, Nasreen; Chao, Ariana M; Pearl, Rebecca L; Alamuddin, Naji; Bakizada, Zayna M; Berkowitz, Robert I; Wadden, Thomas A

2017-08-01

Few studies have examined the efficacy of recently approved medications for chronic weight management in facilitating the maintenance of lost weight. This paper provides an overview of the design and rationale for a trial investigating whether lorcaserin, when combined with behavioral weight loss maintenance sessions (WLM), will facilitate the maintenance of losses of ≥5% of initial weight. In this two-phase trial, participants with obesity will enroll in a 14-week run-in diet program consisting of weekly group lifestyle modification sessions and a 1000-1200kcal/d meal replacement diet. Participants who complete this weight induction phase and lose at least 5% of initial weight will then be randomized to 52weeks of WLM plus lorcaserin or WLM plus placebo. We hypothesize that at 52weeks post randomization, participants assigned to WLM plus lorcaserin will achieve significantly better maintenance of the prior 5% weight loss. We will recruit 182 adults with obesity to participate in the diet run-in, 136 of whom (75%) are expected to become eligible for the randomized controlled trial. Co-primary outcomes include the percentage of participants who maintain a loss of at least 5% of initial weight at week 52 and change in weight (kg) from randomization to week 52. This two-phase design will allow us to determine the potential efficacy of chronic weight management using lorcaserin for maintaining initial losses of at least 5% body weight, induced by the use of a structured meal-replacement diet. This combined approach holds promise of achieving larger long-term weight losses. NCT02388568 on ClinicalTrials.gov. Copyright © 2017 Elsevier Inc. All rights reserved.

Review of family-based approaches to improve postoperative outcomes among bariatric surgery patients.

PubMed

Vidot, Denise C; Prado, Guillermo; De La Cruz-Munoz, Nestor; Cuesta, Melissa; Spadola, Christine; Messiah, Sarah E

2015-01-01

Bariatric surgery must be partnered with postoperative lifestyle modifications for enduring weight loss and related health effects to be fully appreciated. Little is known about how these lifestyle modifications may be affected by the involvement of other family members living in the household; therefore, this review describes current family-based approaches to improving postoperative outcomes in bariatric surgery patients and their families. A MEDLINE search of publications from 1999 to 2014 was conducted in January 2014. Retrieved titles and abstracts were assessed by 2 authors to determine relevance to the topic surrounding family-based approaches to improve postbariatric surgery outcomes. All study designs except case studies were considered if they included some aspect of family as a predictor in relation to improved health outcomes after surgery. Initial searches yielded 650 publications (bariatric surgery+family, n = 193; bariatric surgery+child, n = 338; bariatric surgery+spouse, n = 4; bariatric surgery+social support, n = 115). Two studies met criteria for a family-based approach to improving metabolic outcomes in bariatric patients. Seven studies discussed the impact of bariatric surgery on families. All other studies were excluded for not discussing family-based approaches. Despite limited documentation of family-based approaches on improving health outcomes in patients who underwent bariatric surgery, evidence suggests that such an approach may be advantageous if planned a priori to occur before, during, and after bariatric surgery. Future studies could test the combination of bariatric surgery and a family-based approach for improved metabolic outcomes in both the patient and involved family member(s). Copyright © 2015 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

Profiling of cardio-metabolic risk factors and medication utilisation among Type II diabetes patients in Ghana: a prospective cohort study.

PubMed

Adua, Eric; Roberts, Peter; Sakyi, Samuel Asamoah; Yeboah, Francis Agyemang; Dompreh, Albert; Frimpong, Kwasi; Anto, Enoch Odame; Wang, Wei

2017-09-07

Type II diabetes mellitus (T2DM) is complicated by multiple cardio-metabolic risk factors. Controlling these factors requires lifestyle modifications alongside utilisation of anti-diabetic medications. Different glucose lowering [(biguanides (BIGs), sulfonylureas (SUAs), thiazolidinediones (TNZ)], lipid lowering (statins), and anti-hypertensive medicines [angiotensin converting enzyme inhibitors (ACEIs), calcium channel blockers (CCBs), angiotensin II receptor blockers (ARBs) and central acting drugs (CADs)] have been approved for controlling hyperglycaemia, dyslipidaemia and hypertension respectively. Here, we examined factors that characterise T2DM and explored the response to medication therapy among T2DM patients. This prospective cohort study recruited 241 T2DM patients reporting at a clinic in Ghana, from January through to August, 2016. Each patient's demographic, medications and anthropometric data was obtained while information on medication adherence was captured using Morisky adherence scale-8 (MMAS-8). Fasting blood samples were collected for biochemical analysis. The mean age of participants was 57.82 years for baseline and six-month follow-up. Physical activity differed at baseline and follow up (p < 0.05) but not body mass index (BMI). BIG alone, or in combination with SUA and TNZ did not improve glycaemic status at follow up (p > 0.05). Many participants using either ACEI or ARB were able to control their blood pressures. Among dyslipidaemia patients under statin treatment, there was an improved lipid profile at follow-up. Statin medications are effective for reducing dyslipidaemia in T2DM patients. However, control of modifiable risk factors, particularly blood glucose and to a lesser degree blood pressure is suboptimal. Addressing these will require concomitant interventions including education on medication adherence and correct dietary plans, lifestyle modifications and physical activity.

An evidence-based strategy for the conservative management of the male patient with incontinence.

PubMed

Newman, Diane K; Guzzo, Thomas; Lee, David; Jayadevappa, Ravishankar

2014-11-01

Incontinence is not an isolated symptom in men, but rather a component of a multifactorial problem that may include other lower urinary tract symptoms (LUTS). Male urinary incontinence is often seen following prostate surgery and procedures, particularly prostate cancer surgery. Men with enlarged prostates experience overactive bladder symptoms of urgency and frequency. Despite these bothersome lower urinary tract problems in men, conservative treatment remains poorly investigated. This review will provide the current evidence-based strategies for the use of conservative management in men with urinary incontinence and other LUTS. Conservative treatment for urinary incontinence is an effective intervention and has been recommended by the evidence-based guidelines as the first-line intervention for LUTS. Despite this prevalence, the only population of men who continue to receive systematic consideration with respect to conservative management are those with postprostatectomy urinary symptoms. Although continence status gradually improves in the ensuing weeks and months, evidence-based research has shown that preoperative and early postoperative pelvic floor muscle training can speed the recovery of continence in the short and long term. Recent research has also shown that behavioral therapy combined with medication can improve the male symptom of nocturia. Lifestyle changes of weight loss in obese men with diabetes and LUTS and dietary modification has also been shown to be effective. Although sparse, there are data to support conservative interventions as the first-line treatment in men with LUTS. There is a strong recommendation for implementing a pelvic floor muscle training (PFMT) program before and after prostatectomy. Positive lifestyle changes such as weight loss in obese men and dietary modification can lessen urgency, nocturia, and incontinence. Despite this growing evidence on effectiveness, urologists rarely recommend conservative treatment to patients.

Protective influence of healthful nutrition on mechanisms of environmental pollutant toxicity and disease risks.

PubMed

Hoffman, Jessie B; Hennig, Bernhard

2017-06-01

Human exposures to environmental contaminants around the world contribute to the global burden of disease and thus require urgent attention. Exploring preventive measures against environmental exposure and disease risk is essential. While a sedentary lifestyle and/or poor dietary habits can exacerbate the deleterious effects resulting from exposure to toxic chemicals, much emerging evidence suggests that positive lifestyle changes (e.g., healthful nutrition) can modulate and/or reduce the toxicity of environmental pollutants. Our work has shown that diets high in anti-inflammatory bioactive food components (e.g., phytochemicals or polyphenols) are possible strategies for modulating and reducing the disease risks associated with exposure to toxic pollutants in the environment. Thus, consuming healthy diets rich in plant-derived bioactive nutrients may reduce the vulnerability to diseases linked to environmental toxic insults. This nutritional paradigm in environmental toxicology requires further study in order to improve our understanding of the relationships between nutrition and other lifestyle modifications and toxicant-induced diseases. © 2017 New York Academy of Sciences.

Pharmacological Effects of Niacin on Acute Hyperlipemia.

PubMed

la Paz, Sergio Montserrat-de; Bermudez, Beatriz; Naranjo, M Carmen; Lopez, Sergio; Abia, Rocio; Muriana, Francisco J G

2016-01-01

The well-known changes in modern lifestyle habits including over nutrition and physical inactivity have led to striking adverse effects on public health (e.g., obesity, diabetes, and metabolic syndrome) over recent decades. One noticeable consequence is exaggerated and prolonged state of postprandial hyperlipemia due to the ingestion of multiple fat-enriched meals during the course of a day. Postprandial (non-fasting) hyperlipemia is characterized by increased blood levels of exogenous triglycerides (TG) in the form of apolipoprotein (apo) B48-containing TG-rich lipoproteins (TRL), which have a causal role in the pathogenesis and progression of cardiovascular disease (CVD). The cardiovascular benefits of lifestyle modification (healthy diet and exercise) and conventional lipid-lowering therapies (e.g., statins, fibrates, and niacin) could involve their favourable effects on postprandial metabolism. Pharmacologically, niacin has been used as an athero-protective drug for five decades. Studies have since shown that niacin may decrease fasting levels of plasma verylow- density lipoproteins (VLDL), low-density lipoprotein cholesterol (LDL-C), and lipoprotein [a] (Lp[a]), while may increase high-density lipoprotein cholesterol (HDL-C). Herein, the purpose of this review was to provide an update on effects and mechanisms related to the pharmacological actions of niacin on acute hyperlipemia.

A Paleolithic Diet with and without Combined Aerobic and Resistance Exercise Increases Functional Brain Responses and Hippocampal Volume in Subjects with Type 2 Diabetes

PubMed Central

Stomby, Andreas; Otten, Julia; Ryberg, Mats; Nyberg, Lars; Olsson, Tommy; Boraxbekk, Carl-Johan

2017-01-01

Type 2 diabetes is associated with impaired episodic memory functions and increased risk of different dementing disorders. Diet and exercise may potentially reverse these impairments. In this study, sedentary individuals with type 2 diabetes treated by lifestyle ± metformin were randomized to a Paleolithic diet (PD, n = 12) with and without high intensity exercise (PDEX, n = 12) for 12 weeks. Episodic memory function, associated functional brain responses and hippocampal gray matter volume was measured by magnetic resonance imaging. A matched, but not randomized, non-interventional group was included as a reference (n = 6). The PD included a high intake of unsaturated fatty acids and protein, and excluded the intake of dairy products, grains, refined sugar and salt. The exercise intervention consisted of 180 min of supervised aerobic and resistance exercise per week. Both interventions induced a significant weight loss, improved insulin sensitivity and increased peak oxygen uptake without any significant group differences. Furthermore, both interventions were associated with increased functional brain responses within the right anterior hippocampus, right inferior occipital gyrus and increased volume of the right posterior hippocampus. There were no changes in memory performance. We conclude that life-style modification may improve neuronal plasticity in brain areas linked to cognitive function in type 2 diabetes. Putative long-term effects on cognitive functions including decreased risk of dementing disorders await further studies. Clinical trials registration number: Clinicaltrials. gov NCT01513798. PMID:29255413

A Paleolithic Diet with and without Combined Aerobic and Resistance Exercise Increases Functional Brain Responses and Hippocampal Volume in Subjects with Type 2 Diabetes.

PubMed

Stomby, Andreas; Otten, Julia; Ryberg, Mats; Nyberg, Lars; Olsson, Tommy; Boraxbekk, Carl-Johan

2017-01-01

Type 2 diabetes is associated with impaired episodic memory functions and increased risk of different dementing disorders. Diet and exercise may potentially reverse these impairments. In this study, sedentary individuals with type 2 diabetes treated by lifestyle ± metformin were randomized to a Paleolithic diet (PD, n = 12) with and without high intensity exercise (PDEX, n = 12) for 12 weeks. Episodic memory function, associated functional brain responses and hippocampal gray matter volume was measured by magnetic resonance imaging. A matched, but not randomized, non-interventional group was included as a reference ( n = 6). The PD included a high intake of unsaturated fatty acids and protein, and excluded the intake of dairy products, grains, refined sugar and salt. The exercise intervention consisted of 180 min of supervised aerobic and resistance exercise per week. Both interventions induced a significant weight loss, improved insulin sensitivity and increased peak oxygen uptake without any significant group differences. Furthermore, both interventions were associated with increased functional brain responses within the right anterior hippocampus, right inferior occipital gyrus and increased volume of the right posterior hippocampus. There were no changes in memory performance. We conclude that life-style modification may improve neuronal plasticity in brain areas linked to cognitive function in type 2 diabetes. Putative long-term effects on cognitive functions including decreased risk of dementing disorders await further studies. Clinical trials registration number: Clinicaltrials. gov NCT01513798.

The perfect storm: obesity, adipocyte dysfunction, and metabolic consequences.

PubMed

de Ferranti, Sarah; Mozaffarian, Dariush

2008-06-01

As the prevalence of adiposity soars in both developed and developing nations, appreciation of the close links between obesity and disease increases. The strong relationships between excess adipose tissue and poor health outcomes, including cardiovascular disease, diabetes, and cancer, mandate elucidation of the complex cellular, hormonal, and molecular pathophysiology whereby adiposity initiates and maintains adverse health effects. In this report we review adipocyte metabolism and function in the context of energy imbalance and postprandial nutrient excess, including adipocyte hypertrophy and hyperplasia, adipocyte dysfunction, and other systemic consequences. We also discuss implications for laboratory evaluation and clinical care, including the role of lifestyle modifications. Chronic energy imbalance produces adipocyte hypertrophy and hyperplasia, endoplasmic reticulum stress, and mitochondrial dysfunction. These processes lead to increased intracellular and systemic release of adipokines, free fatty acids, and inflammatory mediators that cause adipocyte dysfunction and induce adverse effects in the liver, pancreatic beta-cells, and skeletal muscle as well as the heart and vascular beds. Several specialized laboratory tests can quantify these processes and predict clinical risk, but translation to the clinical setting is premature. Current and future pharmacologic interventions may target these pathways; modest changes in diet, physical activity, weight, and smoking are likely to have the greatest impact. Adipocyte endoplasmic reticulum and mitochondrial stress, and associated changes in circulating adipokines, free fatty acids, and inflammatory mediators, are central to adverse health effects of adiposity. Future investigation should focus on these pathways and on reversing the adverse lifestyle behaviors that are the fundamental causes of adiposity.

Endoscopic Devices for Obesity.

PubMed

Sampath, Kartik; Dinani, Amreen M; Rothstein, Richard I

2016-06-01

The obesity epidemic, recognized by the World Health Organization in 1997, refers to the rising incidence of obesity worldwide. Lifestyle modification and pharmacotherapy are often ineffective long-term solutions; bariatric surgery remains the gold standard for long-term obesity weight loss. Despite the reported benefits, it has been estimated that only 1% of obese patients will undergo surgery. Endoscopic treatment for obesity represents a potential cost-effective, accessible, minimally invasive procedure that can function as a bridge or alternative intervention to bariatric surgery. We review the current endoscopic bariatric devices including space occupying devices, endoscopic gastroplasty, aspiration technology, post-bariatric surgery endoscopic revision, and obesity-related NOTES procedures. Given the diverse devices already FDA approved and in development, we discuss the future directions of endoscopic therapies for obesity.

Update on the evaluation of repeated stone formers.

PubMed

Kadlec, Adam O; Turk, Thomas M

2013-12-01

Office management of stone disease is an important component of a urologist's practice. Evaluation should include analysis of stone composition, 24-hour urine studies, identification of modifiable risk factors, and targeted dietary, lifestyle, and/or medical therapy. A sizeable portion of investigated etiologies and risk factors for stone disease have centered on the complex interplay between obesity, diabetes, and other disease states that comprise the metabolic syndrome. Alternatives to traditional preventive therapy, such as probiotics and various fruit juices, are still being studied but may prove useful adjuncts to traditional preventive therapy, where the mainstays remain increased fluid intake, dietary modification, and pharmacologic therapy. Future studies on preventive therapy of urolithiasis are likely to focus on strategies to increase compliance, cost-effectiveness, and systems-based implementation.

Update on Prevention of Cardiovascular Disease in Adults With Type 2 Diabetes Mellitus in Light of Recent Evidence: A Scientific Statement From the American Heart Association and the American Diabetes Association.

PubMed

Fox, Caroline S; Golden, Sherita Hill; Anderson, Cheryl; Bray, George A; Burke, Lora E; de Boer, Ian H; Deedwania, Prakash; Eckel, Robert H; Ershow, Abby G; Fradkin, Judith; Inzucchi, Silvio E; Kosiborod, Mikhail; Nelson, Robert G; Patel, Mahesh J; Pignone, Michael; Quinn, Laurie; Schauer, Philip R; Selvin, Elizabeth; Vafiadis, Dorothea K

2015-09-01

Cardiovascular disease risk factor control as primary prevention in patients with type 2 diabetes mellitus has changed substantially in the past few years. The purpose of this scientific statement is to review the current literature and key clinical trials pertaining to blood pressure and blood glucose control, cholesterol management, aspirin therapy, and lifestyle modification. We present a synthesis of the recent literature, new guidelines, and clinical targets, including screening for kidney and subclinical cardiovascular disease for the contemporary management of patients with type 2 diabetes mellitus. © 2015 by the American Diabetes Association and the American Heart Association, Inc.

Pathogenesis and Prevention of Hepatic Steatosis

PubMed Central

Nassir, Fatiha; Rector, R. Scott; Hammoud, Ghassan M.

2015-01-01

Hepatic steatosis is defined as intrahepatic fat of at least 5% of liver weight. Simple accumulation of triacylglycerols in the liver could be hepatoprotective; however, prolonged hepatic lipid storage may lead to liver metabolic dysfunction, inflammation, and advanced forms of nonalcoholic fatty liver disease. Nonalcoholic hepatic steatosis is associated with obesity, type 2 diabetes, and dyslipidemia. Several mechanisms are involved in the accumulation of intrahepatic fat, including increased flux of fatty acids to the liver, increased de novo lipogenesis, and/or reduced clearance through β-oxidation or very-low-density lipoprotein secretion. This article summarizes the mechanisms involved in the accumulation of triacylglycerols in the liver, the clinical implications, and the prevention of hepatic steatosis, with a focus on the role of mitochondrial function and lifestyle modifications. PMID:27099587

Evidence-based cancer prevention recommendations for Japanese.

PubMed

Sasazuki, S; Inoue, M; Shimazu, T; Wakai, K; Naito, M; Nagata, C; Tanaka, K; Tsuji, I; Sugawara, Y; Mizoue, T; Matsuo, K; Ito, H; Tamakoshi, A; Sawada, N; Nakayama, T; Kitamura, Y; Sadakane, A; Tsugane, S

2018-06-01

A comprehensive evidence-based cancer prevention recommendation for Japanese was developed. We evaluated the magnitude of the associations of lifestyle factors and infection with cancer through a systematic review of the literature, meta-analysis of published data, and pooled analysis of cohort studies in Japan. Then, we judged the strength of evidence based on the consistency of the associations between exposure and cancer and biological plausibility. Important factors were extracted and summarized as an evidence-based, current cancer prevention recommendation: 'Cancer Prevention Recommendation for Japanese'. The recommendation addresses six important domains related to exposure and cancer, including smoking, alcohol drinking, diet, physical activity, body weight and infection. The next step should focus on the development of effective behavior modification programs and their implementation and dissemination.

The Metabolic Syndrome

PubMed Central

Cornier, Marc-Andre; Dabelea, Dana; Hernandez, Teri L.; Lindstrom, Rachel C.; Steig, Amy J.; Stob, Nicole R.; Van Pelt, Rachael E.; Wang, Hong; Eckel, Robert H.

2008-01-01

The “metabolic syndrome” (MetS) is a clustering of components that reflect overnutrition, sedentary lifestyles, and resultant excess adiposity. The MetS includes the clustering of abdominal obesity, insulin resistance, dyslipidemia, and elevated blood pressure and is associated with other comorbidities including the prothrombotic state, proinflammatory state, nonalcoholic fatty liver disease, and reproductive disorders. Because the MetS is a cluster of different conditions, and not a single disease, the development of multiple concurrent definitions has resulted. The prevalence of the MetS is increasing to epidemic proportions not only in the United States and the remainder of the urbanized world but also in developing nations. Most studies show that the MetS is associated with an approximate doubling of cardiovascular disease risk and a 5-fold increased risk for incident type 2 diabetes mellitus. Although it is unclear whether there is a unifying pathophysiological mechanism resulting in the MetS, abdominal adiposity and insulin resistance appear to be central to the MetS and its individual components. Lifestyle modification and weight loss should, therefore, be at the core of treating or preventing the MetS and its components. In addition, there is a general consensus that other cardiac risk factors should be aggressively managed in individuals with the MetS. Finally, in 2008 the MetS is an evolving concept that continues to be data driven and evidence based with revisions forthcoming. PMID:18971485

The multitude and diversity of environmental carcinogens.

PubMed

Belpomme, D; Irigaray, P; Hardell, L; Clapp, R; Montagnier, L; Epstein, S; Sasco, A J

2007-11-01

We have recently proposed that lifestyle-related factors, screening and aging cannot fully account for the present overall growing incidence of cancer. In order to propose the concept that in addition to lifestyle related factors, exogenous environmental factors may play a more important role in carcinogenesis than it is expected, and may therefore account for the growing incidence of cancer, we overview herein environmental factors, rated as certainly or potentially carcinogenic by the International Agency for Research on Cancer (IARC). We thus analyze the carcinogenic effect of microorganisms (including viruses), radiations (including radioactivity, UV and pulsed electromagnetic fields) and xenochemicals. Chemicals related to environmental pollution appear to be of critical importance, since they can induce occupational cancers as well as other cancers. Of major concerns are: outdoor air pollution by carbon particles associated with polycyclic aromatic hydrocarbons; indoor air pollution by environmental tobacco smoke, formaldehyde and volatile organic compounds such as benzene and 1,3 butadiene, which may particularly affect children, and food pollution by food additives and by carcinogenic contaminants such as nitrates, pesticides, dioxins and other organochlorines. In addition, carcinogenic metals and metalloids, pharmaceutical medicines and cosmetics may be involved. Although the risk fraction attributable to environmental factors is still unknown, this long list of carcinogenic and especially mutagenic factors supports our working hypothesis according to which numerous cancers may in fact be caused by the recent modification of our environment.

Baseline Predictors of Missed Visits in the Look AHEAD Study

PubMed Central

Fitzpatrick, Stephanie L.; Jeffery, Robert; Johnson, Karen C.; Roche, Cathy C.; Van Dorsten, Brent; Gee, Molly; Johnson, Ruby Ann; Charleston, Jeanne; Dotson, Kathy; Walkup, Michael P.; Hill-Briggs, Felicia; Brancati, Frederick L.

2013-01-01

Objective To identify baseline attributes associated with consecutively missed data collection visits during the first 48 months of Look AHEAD—a randomized, controlled trial in 5145 overweight/obese adults with type 2 diabetes designed to determine the long-term health benefits of weight loss achieved by lifestyle change. Design and Methods The analyzed sample consisted of 5016 participants who were alive at month 48 and enrolled at Look AHEAD sites. Demographic, baseline behavior, psychosocial factors, and treatment randomization were included as predictors of missed consecutive visits in proportional hazard models. Results In multivariate Cox proportional hazard models, baseline attributes of participants who missed consecutive visits (n=222) included: younger age ( Hazard Ratio [HR] 1.18 per 5 years younger; 95% Confidence Interval 1.05, 1.30), higher depression score (HR 1.04; 1.01, 1.06), non-married status (HR 1.37; 1.04, 1.82), never self-weighing prior to enrollment (HR 2.01; 1.25, 3.23), and randomization to minimal vs. intensive lifestyle intervention (HR 1.46; 1.11, 1.91). Conclusions Younger age, symptoms of depression, non-married status, never self-weighing, and randomization to minimal intervention were associated with a higher likelihood of missing consecutive data collection visits, even in a high-retention trial like Look AHEAD. Whether modifications to screening or retention efforts targeted to these attributes might enhance long-term retention in behavioral trials requires further investigation. PMID:23996977

The multitude and diversity of environmental carcinogens

DOE Office of Scientific and Technical Information (OSTI.GOV)

Belpomme, D.; Cancer Research Center, Association for Research and Treatments Against Cancer; Irigaray, P.

2007-11-15

We have recently proposed that lifestyle-related factors, screening and aging cannot fully account for the present overall growing incidence of cancer. In order to propose the concept that in addition to lifestyle related factors, exogenous environmental factors may play a more important role in carcinogenesis than it is expected, and may therefore account for the growing incidence of cancer, we overview herein environmental factors, rated as certainly or potentially carcinogenic by the International Agency for Research on Cancer (IARC). We thus analyze the carcinogenic effect of microorganisms (including viruses), radiations (including radioactivity, UV and pulsed electromagnetic fields) and xenochemicals. Chemicalsmore » related to environmental pollution appear to be of critical importance, since they can induce occupational cancers as well as other cancers. Of major concerns are: outdoor air pollution by carbon particles associated with polycyclic aromatic hydrocarbons; indoor air pollution by environmental tobacco smoke, formaldehyde and volatile organic compounds such as benzene and 1,3 butadiene, which may particularly affect children, and food pollution by food additives and by carcinogenic contaminants such as nitrates, pesticides, dioxins and other organochlorines. In addition, carcinogenic metals and metalloids, pharmaceutical medicines and cosmetics may be involved. Although the risk fraction attributable to environmental factors is still unknown, this long list of carcinogenic and especially mutagenic factors supports our working hypothesis according to which numerous cancers may in fact be caused by the recent modification of our environment.« less

High fat diet and exercise lead to a disrupted and pathogenic DNA methylome in mouse liver.

PubMed

Zhou, Dan; Hlady, Ryan A; Schafer, Marissa J; White, Thomas A; Liu, Chen; Choi, Jeong-Hyeon; Miller, Jordan D; Roberts, Lewis R; LeBrasseur, Nathan K; Robertson, Keith D

2017-01-02

High-fat diet consumption and sedentary lifestyle elevates risk for obesity, non-alcoholic fatty liver disease, and cancer. Exercise training conveys health benefits in populations with or without these chronic conditions. Diet and exercise regulate gene expression by mediating epigenetic mechanisms in many tissues; however, such effects are poorly documented in the liver, a central metabolic organ. To dissect the consequences of diet and exercise on the liver epigenome, we measured DNA methylation, using reduced representation bisulfite sequencing, and transcription, using RNA-seq, in mice maintained on a fast food diet with sedentary lifestyle or exercise, compared with control diet with and without exercise. Our analyses reveal that genome-wide differential DNA methylation and expression of gene clusters are induced by diet and/or exercise. A combination of fast food and exercise triggers extensive gene alterations, with enrichment of carbohydrate/lipid metabolic pathways and muscle developmental processes. Through evaluation of putative protective effects of exercise on diet-induced DNA methylation, we show that hypermethylation is effectively prevented, especially at promoters and enhancers, whereas hypomethylation is only partially attenuated. We assessed diet-induced DNA methylation changes associated with liver cancer-related epigenetic modifications and identified significant increases at liver-specific enhancers in fast food groups, suggesting partial loss of liver cell identity. Hypermethylation at a subset of gene promoters was associated with inhibition of tissue development and promotion of carcinogenic processes. Our study demonstrates extensive reprogramming of the epigenome by diet and exercise, emphasizing the functional relevance of epigenetic mechanisms as an interface between lifestyle modifications and phenotypic alterations.

Pharmacological management of obesity in pediatric patients.

PubMed

Boland, Cassie L; Harris, John Brock; Harris, Kira B

2015-02-01

To review current evidence of pharmacological options for managing pediatric obesity and provide potential areas for future research. A MEDLINE search (1966 to October 2014) was conducted using the following keywords: exenatide, liraglutide, lorcaserin, metformin, obesity, orlistat, pediatric, phentermine, pramlintide, topiramate, weight loss, and zonisamide. Identified articles were evaluated for inclusion, with priority given to randomized controlled trials with orlistat, metformin, glucagon-like peptide-1 agonists, topiramate, and zonisamide in human subjects and articles written in English. References were also reviewed for additional trials. Whereas lifestyle modification is considered first-line therapy for obese pediatric patients, severe obesity may benefit from pharmacotherapy. Orlistat is the only Food and Drug Administration (FDA)-approved medication for pediatric obesity and reduced body mass index (BMI) by 0.5 to 4 kg/m(2), but gastrointestinal (GI) adverse effects may limit use. Metformin has demonstrated BMI reductions of 0.17 to 1.8 kg/m(2), with mild GI adverse effects usually managed with dose titration. Exenatide reduced BMI by 1.1 to 1.7 kg/m(2) and was well-tolerated with mostly transient or mild GI adverse effects. Topiramate and zonisamide reduced weight when used in the treatment of epilepsy. Future studies should examine efficacy and safety of pharmacological agents in addition to lifestyle modifications for pediatric obesity. Lifestyle interventions remain the treatment of choice in pediatric obesity, but concomitant pharmacotherapy may be beneficial in some patients. Orlistat should be considered as second-line therapy for pediatric obesity. Evidence suggests that other diabetes and antiepileptic medications may also provide weight-loss benefits, but safety should be further evaluated. © The Author(s) 2014.

Effect of lifestyle improvement program on the biomarkers of adiposity, inflammation and gut hormones in overweight/obese Asian Indians with prediabetes.

PubMed

Gokulakrishnan, Kuppan; Ranjani, Harish; Weber, Mary Beth; Pandey, Gautam Kumar; Anjana, Ranjit Mohan; Balasubramanyam, Muthuswamy; Prabhakaran, Dorairaj; Tandon, Nikhil; Narayan, K M; Mohan, Viswanathan

2017-09-01

While lifestyle modification is known to offer several metabolic benefits, there is paucity of comprehensive data on changes in biomarkers of adiposity, inflammation as well as gut hormones. We investigated these biomarkers in overweight/obese individuals with prediabetes randomized to either 4 months of a lifestyle improvement program or standard care and followed them up for a year. Participants [standard care and intervention arm (n = 75 each)] were randomly selected from the Diabetes Community Lifestyle Improvement Program trial. Glycemic and lipid control and anthropometric measurements were assessed by standard protocols. Adipokines, inflammatory markers and gut hormones were measured using multiplex and standard ELISA kits. Along with modest benefits in primary outcomes (glycemic and lipid control and weight reduction), participants in the intervention group showed significant reductions (p < 0.001) in plasma levels of leptin (17.6%), TNF-α (35%), IL-6 (33.3%), MCP-1 (22.3%) and PYY (28.3%) and increased levels of adiponectin (33.1%) and ghrelin (23.6%) at the end of 4 months of lifestyle intervention. The changes were independent of weight and persisted even at 1 year of follow-up. In contrast, participants from the standard care arm did not show any statistically significant improvements on the above parameters. Participants who underwent an intensive lifestyle improvement program showed metabolic benefits as well as favorable beneficial changes in systemic levels of adipokines, cytokines and gut hormones, not only during the intervention period, but also during 12-month follow-up period.

Medical Treatment for Postthrombotic Syndrome

PubMed Central

Palacios, Federico Silva; Rathbun, Suman Wasan

2017-01-01

Deep vein thrombosis (DVT) is a prevalent disease. About 20 to 30% of patients with DVT will develop postthrombotic syndrome (PTS) within months after the initial diagnosis of DVT. There is no gold standard for diagnosis of PTS, but clinical signs include pitting edema, hyperpigmentation, phlebectatic crown, venous eczema, and varicose veins. Several scoring systems have been developed for diagnostic evaluation. Conservative treatment includes compression therapy, medications, lifestyle modification, and exercise. Compression therapy, the mainstay and most proven noninvasive therapy for patients with PTS, can be prescribed as compression stockings, bandaging, adjustable compression wrap devices, and intermittent pneumatic compression. Medications may be used to both prevent and treat PTS and include anticoagulation, anti-inflammatories, vasoactive drugs, antibiotics, and diuretics. Exercise, weight loss, smoking cessation, and leg elevation are also recommended. Areas of further research include the duration, compliance, and strength of compression stockings in the prevention of PTS after DVT; the use of intermittent compression devices; the optimal medical anticoagulant regimen after endovascular therapy; and the role of newer anticoagulants as anti-inflammatory agents. PMID:28265131

Effect of Intense Lifestyle Modification and Cardiac Rehabilitation on Psychosocial Cardiovascular Disease Risk Factors and Quality of Life

ERIC Educational Resources Information Center

Aldana, Steven G.; Whitmer, William R.; Greenlaw, Roger; Avins, Andrew L.; Thomas, Dean; Salberg, Audrey; Greenwell, Andrea; Lipsenthal, Lee; Fellingham, Gill W.

2006-01-01

This study examined the effect of the Ornish Program for Reversing Heart Disease and cardiac rehabilitation(CR) on psychosocial risk factors and quality of life in patients with confirmed coronary artery disease. Participants had previously undergone a revascularization procedure. The 84 patients self-selected to participate in the Ornish Program…

Combination phentermine and topiramate extended release in the management of obesity.

PubMed

Alfaris, Nasreen; Minnick, Alyssa M; Hopkins, Christina M; Berkowitz, Robert I; Wadden, Thomas A

2015-06-01

Losing ≥ 5% of initial weight improves quality of life and risk factors for cardiovascular disease (CVD) in obese individuals. Lifestyle modification, the cornerstone of weight reduction, may be complemented by pharmacotherapy. In 2012, the FDA approved the combination of phentermine and topiramate extended release (ER) for chronic weight management, as an adjunct to lifestyle modification. This review examines the safety and efficacy of phentermine-topiramate ER, as determined by randomized controlled trials (RCTs). A preliminary study confirmed the benefit of combining the two medications for improving weight loss and reducing adverse effects, as compared to using equivalent-dose monotherapy alone. Across RCTs, groups prescribed phentermine 15 mg/topiramate ER 92 mg lost an average of 10% of initial weight, ∼ 8% more than placebo and 2% more than phentermine 7.5 mg/topiramate 46 mg. Weight loss reduced the risk of developing type 2 diabetes and improved CVD risk factors. Phentermine-topiramate ER, however, was associated with increased heart rate, the clinical significance of which is being investigated in an FDA-required CVD outcomes study. The medication also must be used with caution in women of child-bearing age because of an increased risk to infants of oral cleft.

Personalized multistep cognitive behavioral therapy for obesity

PubMed Central

Dalle Grave, Riccardo; Sartirana, Massimiliano; El Ghoch, Marwan; Calugi, Simona

2017-01-01

Multistep cognitive behavioral therapy for obesity (CBT-OB) is a treatment that may be delivered at three levels of care (outpatient, day hospital, and residential). In a stepped-care approach, CBT-OB associates the traditional procedures of weight-loss lifestyle modification, ie, physical activity and dietary recommendations, with specific cognitive behavioral strategies that have been indicated by recent research to influence weight loss and maintenance by addressing specific cognitive processes. The treatment program as a whole is delivered in six modules. These are introduced according to the individual patient’s needs in a flexible and personalized fashion. A recent randomized controlled trial has found that 88 patients suffering from morbid obesity treated with multistep residential CBT-OB achieved a mean weight loss of 15% after 12 months, with no tendency to regain weight between months 6 and 12. The treatment has also shown promising long-term results in the management of obesity associated with binge-eating disorder. If these encouraging findings are confirmed by the two ongoing outpatient studies (one delivered individually and one in a group setting), this will provide evidence-based support for the potential of multistep CBT-OB to provide a more effective alternative to standard weight-loss lifestyle-modification programs. PMID:28615960

[Diet and lifestyle rules in chronic constipation in adults: From fantasy to reality…].

PubMed

Fathallah, Nadia; Bouchard, Dominique; de Parades, Vincent

2017-01-01

Chronic constipation is one of the most common chronic gastrointestinal complaints and a frequent reason for consultation. Lifestyle modification and dietary advice attract a lot of patients, often dissatisfied with a long-term drug intake. These behavioral modifications are recommended as a first-line approach in the treatment of chronic mild constipation in the majority of current guidelines despite a low level of evidence. Fiber supplementation is probably the most relevant measure because of a satisfactory level of proof. It improves stool frequency and consistency. It has a positive effect on excessive straining and colonic transit time. The recommended daily fiber intake is at least 20 to 25g. To avoid side effects like bloating and abdominal pain, it must be gradually adjusted after a several days period. The benefice of increasing water intake or daily physical exercise in the treatment of chronic constipation have a lack of evidence, except specific situations such as elderly, hospitalized, institutionalized, dehydrated people or people consuming fluids less than 500mL/day. Change in environmental defecation conditions or bowel habits are probably anecdotal recommendations. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

Future Perspectives in Sleep Medicine.

PubMed

Huon, Leh-Kiong Anne; Guilleminault, Christian

2017-01-01

"Sleep Medicine" is now a specialty in its own right. Currently, there is increasing recognition of the very negative impact sleep disorders have on learning, education, safety, and quality of life. Technological advances will help us to break down diagnoses (e.g., narcolepsy has now been subdivided into types 1 and 2, depending upon the hypocretin levels in the spinal fluid) and to discover relationships to other bodily systems (e.g., type 1 narcolepsy potentially being an autoimmune disorder). The modern lifestyle of many, as characterized by a shortening of sleep periods, shift work, jet lag, and the need to be constantly available, means that advances in sleep medicine may result in a major understanding of more balanced "work-rest lifestyle" modifications. © 2017 S. Karger AG, Basel.

Elite Dental Students: a Cross-Sectional Study on Different Aspects of Their Life-Style.

PubMed

Zafarmand, Abdolhamid; Asvar, Maryam

2017-12-01

Lifestyle has a key role in having a life with quality. This is much more critical in academic community. Elite students are the scientific capital of each community; therefore, improvement of their life-style is a very crucial issue and is a way of esteeming them. This study was aimed to scrutinize the life-style of elite dental students to provide a guideline for healthy life-style for their own and for other students, as well. This descriptive and cross-sectional study was carried out on 115 Elite dental students, from a list 175 students, based upon their interest. The HPLP-II questionnaire was used which focuses on 6 behavioral fields: Spiritual Growth, Interpersonal Relations, Nutrition, Physical Activity, Health Responsibility, and Stress Management. The results also compared genders and marital status within the study group. The elite dental students were categorized in 3 age groups as 19≥ yrs (Group I), 20-22 yrs (Group II), and 23≤ yrs. (Group III) for comparison. Data were analyzed using SPSS version 19, independent t-test, one-way ANOVA, and Tukey's test. The mean score of the HPLP-II questionnaire was 2.51±0.27 (out of score 4). Spiritual growth (2.85±0.42) and physical activity (2.16±0.58) were the highest and the lowest scores, respectively. Physical activity was the only subscale different between genders ( p = 0.000). Marital status had not effect on life-style of students. Between the age groups, the physical activity was significantly different between group I and II (0.002). Elite dental students' life-style is most prominent in spiritual growth and interpersonal relationships dimensions, but is the weakest in physical activity and health responsibility behavioral attitudes. To improve the talent of all students, interventional workshops/courses aiming at modification and promotion of students' lifestyle is recommendable in the curriculum.

Association between combined lifestyle factors and non-restorative sleep in Japan: a cross-sectional study based on a Japanese health database.

PubMed

Wakasugi, Minako; Kazama, Junichiro James; Narita, Ichiei; Iseki, Kunitoshi; Moriyama, Toshiki; Yamagata, Kunihiro; Fujimoto, Shouichi; Tsuruya, Kazuhiko; Asahi, Koichi; Konta, Tsuneo; Kimura, Kenjiro; Kondo, Masahide; Kurahashi, Issei; Ohashi, Yasuo; Watanabe, Tsuyoshi

2014-01-01

Although lifestyle factors such as cigarette smoking, excessive drinking, obesity, low or no exercise, and unhealthy dietary habits have each been associated with inadequate sleep, little is known about their combined effect. The aim of this study was to quantify the overall impact of lifestyle-related factors on non-restorative sleep in the general Japanese population. A cross-sectional study of 243,767 participants (men, 39.8%) was performed using the Specific Health Check and Guidance System in Japan. A healthy lifestyle score was calculated by adding up the number of low-risk lifestyle factors for each participant. Low risk was defined as (1) not smoking, (2) body mass index<25 kg/m², (3) moderate or less alcohol consumption, (4) regular exercise, and (5) better eating patterns. Logistic regression analysis was used to examine the relationship between the score and the prevalence of non-restorative sleep, which was determined from questionnaire responses. Among 97,062 men (mean age, 63.9 years) and 146,705 women (mean age, 63.7 years), 18,678 (19.2%) and 38,539 (26.3%) reported non-restorative sleep, respectively. The prevalence of non-restorative sleep decreased with age for both sexes. Compared to participants with a healthy lifestyle score of 5 (most healthy), those with a score of 0 (least healthy) had a higher prevalence of non-restorative sleep (odds ratio, 1.59 [95% confidence interval, 1.29-1.97] for men and 2.88 [1.74-4.76] for women), independently of hypertension, hypercholesterolemia, diabetes, and chronic kidney disease. The main limitation of the study was the cross-sectional design, which limited causal inferences for the identified associations. A combination of several unhealthy lifestyle factors was associated with non-restorative sleep among the general Japanese population. Further studies are needed to establish whether general lifestyle modification improves restorative sleep.

Elite Dental Students: a Cross-Sectional Study on Different Aspects of Their Life-Style

PubMed Central

Zafarmand, Abdolhamid; Asvar, Maryam

2017-01-01

Statement of the Problem: Lifestyle has a key role in having a life with quality. This is much more critical in academic community. Elite students are the scientific capital of each community; therefore, improvement of their life-style is a very crucial issue and is a way of esteeming them. Purpose: This study was aimed to scrutinize the life-style of elite dental students to provide a guideline for healthy life-style for their own and for other students, as well. Materials and Method: This descriptive and cross-sectional study was carried out on 115 Elite dental students, from a list 175 students, based upon their interest. The HPLP-II questionnaire was used which focuses on 6 behavioral fields: Spiritual Growth, Interpersonal Relations, Nutrition, Physical Activity, Health Responsibility, and Stress Management. The results also compared genders and marital status within the study group. The elite dental students were categorized in 3 age groups as 19≥ yrs (Group I), 20-22 yrs (Group II), and 23≤ yrs. (Group III) for comparison. Data were analyzed using SPSS version 19, independent t-test, one-way ANOVA, and Tukey’s test. Results: The mean score of the HPLP-II questionnaire was 2.51±0.27 (out of score 4). Spiritual growth (2.85±0.42) and physical activity (2.16±0.58) were the highest and the lowest scores, respectively. Physical activity was the only subscale different between genders (p= 0.000). Marital status had not effect on life-style of students. Between the age groups, the physical activity was significantly different between group I and II (0.002). Conclusion: Elite dental students’ life-style is most prominent in spiritual growth and interpersonal relationships dimensions, but is the weakest in physical activity and health responsibility behavioral attitudes. To improve the talent of all students, interventional workshops/courses aiming at modification and promotion of students' lifestyle is recommendable in the curriculum. PMID:29201967

Cluster randomised controlled trial of a peer-led lifestyle intervention program: study protocol for the Kerala diabetes prevention program.

PubMed

Sathish, Thirunavukkarasu; Williams, Emily D; Pasricha, Naanki; Absetz, Pilvikki; Lorgelly, Paula; Wolfe, Rory; Mathews, Elezebeth; Aziz, Zahra; Thankappan, Kavumpurathu Raman; Zimmet, Paul; Fisher, Edwin; Tapp, Robyn; Hollingsworth, Bruce; Mahal, Ajay; Shaw, Jonathan; Jolley, Damien; Daivadanam, Meena; Oldenburg, Brian

2013-11-04

India currently has more than 60 million people with Type 2 Diabetes Mellitus (T2DM) and this is predicted to increase by nearly two-thirds by 2030. While management of those with T2DM is important, preventing or delaying the onset of the disease, especially in those individuals at 'high risk' of developing T2DM, is urgently needed, particularly in resource-constrained settings. This paper describes the protocol for a cluster randomised controlled trial of a peer-led lifestyle intervention program to prevent diabetes in Kerala, India. A total of 60 polling booths are randomised to the intervention arm or control arm in rural Kerala, India. Data collection is conducted in two steps. Step 1 (Home screening): Participants aged 30-60 years are administered a screening questionnaire. Those having no history of T2DM and other chronic illnesses with an Indian Diabetes Risk Score value of ≥60 are invited to attend a mobile clinic (Step 2). At the mobile clinic, participants complete questionnaires, undergo physical measurements, and provide blood samples for biochemical analysis. Participants identified with T2DM at Step 2 are excluded from further study participation. Participants in the control arm are provided with a health education booklet containing information on symptoms, complications, and risk factors of T2DM with the recommended levels for primary prevention. Participants in the intervention arm receive: (1) eleven peer-led small group sessions to motivate, guide and support in planning, initiation and maintenance of lifestyle changes; (2) two diabetes prevention education sessions led by experts to raise awareness on T2DM risk factors, prevention and management; (3) a participant handbook containing information primarily on peer support and its role in assisting with lifestyle modification; (4) a participant workbook to guide self-monitoring of lifestyle behaviours, goal setting and goal review; (5) the health education booklet that is given to the control arm. Follow-up assessments are conducted at 12 and 24 months. The primary outcome is incidence of T2DM. Secondary outcomes include behavioural, psychosocial, clinical, and biochemical measures. An economic evaluation is planned. Results from this trial will contribute to improved policy and practice regarding lifestyle intervention programs to prevent diabetes in India and other resource-constrained settings. Australia and New Zealand Clinical Trials Registry: ACTRN12611000262909.

Lifestyle intervention and one-year prognosis of patients following open heart surgery: a randomised clinical trial.

PubMed

Kadda, Olga; Kotanidou, Anastasia; Manginas, Athanasios; Stavridis, George; Nanas, Serafim; Panagiotakos, Demosthenes B

2015-06-01

To evaluate the one-year prognosis of a lifestyle counselling intervention (diet, smoking cessation and exercise) among patients who had open heart surgery. Cardiovascular disease is the leading cause of morbidity worldwide in both developing and developed countries. Lifestyle modification plays an important role for patients who are at a high risk of developing cardiovascular disease and for those with an established cardiovascular disease. Randomised, nonblind and lifestyle counselling intervention study with a one-year follow-up. A randomised, nonblind intervention study was performed on 500 patients who had open heart surgery. After hospital discharge, 250 patients (intervention group) were randomly allocated lifestyle counselling according to the recent guidelines provided by the European Society of Cardiology (European Journal Preventive Cardiology, 19, 2012, 585). The remaining 250 patients (control group) received the regular instructions. Primary end-point was the development of a cardiovascular disease (nonfatal event) during the first year; secondary end-points included fatal events, smoking abstinence, dietary habits and a physical activity evaluation. According to the primary end-point, the odds of having a nonfatal cardiovascular disease event are 0·56-times (95%CI 0·28, 0·96, p = 0·03) lower for the intervention group compared to the control group. One-year after surgery, it was found that participants in the intervention group were 1·96-times (95%CI 1·31, 2·93, p < 0·001) more likely to achieve dietary recommendations, 3·32-times (95%CI 2·24, 4·91, p < 0·001) more likely to achieve physical activity recommendations and 1·34-times (95%CI 1·15, 1·56, p < 0·001) more likely to return to work. Lifestyle counselling intervention following open heart surgery can improve health outcomes and reduce the risk of a new cardiac event. Health care services must recommend and organise well-structured cardiac rehabilitation programmes adjusted to the patient's needs. A well-structured cardiac rehabilitation programme adjusted to the patient's profile is a safe and cost-effective way to improve patients' outcome. © 2015 John Wiley & Sons Ltd.

Effects of lifestyle intervention in BRCA1/2 mutation carriers on nutrition, BMI, and physical fitness (LIBRE study): study protocol for a randomized controlled trial.

PubMed

Kiechle, Marion; Engel, Christoph; Berling, Anika; Hebestreit, Katrin; Bischoff, Stephan C; Dukatz, Ricarda; Siniatchkin, Michael; Pfeifer, Katharina; Grill, Sabine; Yahiaoui-Doktor, Maryam; Kirsch, Ellen; Niederberger, Uwe; Enders, Ute; Löffler, Markus; Meindl, Alfons; Rhiem, Kerstin; Schmutzler, Rita; Erickson, Nicole; Halle, Martin

2016-07-29

Women with highly penetrant BRCA mutations have a 55-60 % lifetime risk for breast cancer and a 16-59 % lifetime risk of developing ovarian cancer. However, penetrance differs interindividually, indicating that environmental and behavioral factors may modify this risk. It is well documented that the risk for sporadic breast cancer disease can be modified by changing lifestyle factors that primarily include physical activity, dietary habits, and body weight. It can thus be hypothesized that the modification of these lifestyle factors may also influence the incidence and progression of cancer in BRCA mutation carriers. This multicenter, interdisciplinary, prospective, two-armed, randomized (1:1) controlled trial aims to enroll a minimum of 600 BRCA1 and BRCA2 mutation carriers to partake in either a lifestyle intervention or usual care. The study primarily aims to demonstrate an improvement of nutritional behavior (adherence to the Mediterranean diet), body mass index, and physical fitness. Furthermore, the effects on quality of life, stress coping capacity, breast cancer incidence, and mortality will be investigated. The intervention group (IG) will receive a structured lifestyle intervention over 12 months, whereas the control group (CG) will only receive information regarding a healthy lifestyle. During the first 3 months, women in the IG will receive structured, individualized, and mainly supervised endurance training with a minimum of 18 MET-h physical activity per week and nutrition education based on the Mediterranean diet. Over the following 9 months, IG monthly group training sessions and regular telephone contacts will motivate study participants. The CG will receive one general training session about healthy nutrition in accordance with the recommendations of the German Society of Nutrition (standard of care in Germany) and the benefits of regular physical activity on health status. At randomization and subsequent time points (3 and 12 months), cardiopulmonary fitness will be assessed by spiroergometry, and nutritional and psychological status will be assessed by validated questionnaires, interviews, and clinical examinations. As data on the role of lifestyle intervention in women with a hereditary risk for breast and ovarian cancer are currently lacking, this study will be of major importance from a scientific, as well as a practical advice viewpoint. It will investigate the optimal strategy to improve physical fitness, nutritional status, and psychological factors such as quality of life, perceived stress, optimism, as well as incidence and outcome of cancer in this selected group of women at high risk. If the study indicates a positive long-term outcome, a structured lifestyle intervention program could be added to health care prevention strategies for BRCA1 and BRCA2 mutation carriers. ClinicalTrials.gov: NCT02516540 . Registered on 22 July 2015.

Treating cardiovascular disease in women.

PubMed

Taggu, Wasing; Lloyd, Guy

2007-12-01

Cardiovascular disease (CVD) is the most common cause of death in women but some of the challenges of management differ from those in men. This article addresses the gender-specific issues of cardiovascular management, with emphasis on ischaemic heart disease and modification of coronary risk factors. Women with ischaemic heart disease present later than men, and are therefore older and more likely to suffer from co-morbidities such as diabetes and hypertension. Proven CVD risk factors in women can be divided into those that are modifiable and those that are non-modifiable. The former include diabetes, dyslipidaemia, hypertension, smoking, obesity, sedentary lifestyle and poor nutrition; the latter include family history of heart disease and older age at presentation. It is this difference in age and general health that explains much of the variability in response to treatment. Pharmacotherapy, percutaneous intervention, surgical revascularization, and cardiac rehabilitation and disease prevention are discussed.

Anti-Obesity Pharmacotherapy: New Drugs and Emerging Targets

PubMed Central

Kim, Gilbert W.; Lin, Jieru E.; Blomain, Erik S.; Waldman, Scott A.

2014-01-01

Obesity is a growing pandemic and related health and economic costs are staggering. Pharmacotherapy partnered with lifestyle modifications form the core of current strategies to reduce the burden of this disease and its sequelae. However, therapies targeting weight loss have a significant history of safety risks, including cardiovascular and psychiatric events. Here, evolving strategies for developing anti-obesity therapies, including targets, mechanisms, and developmental status are highlighted. Progress in this field is underscored by Belviq® (lorcaserin) and Qsymia® (phentermine/topiramate), the first agents in more than 10 years to achieve regulatory approval for chronic management weight in obese patients. On the horizon, novel insights in metabolism and energy homeostasis reveal cGMP signaling circuits as emerging targets for anti-obesity pharmacotherapy. These innovations in molecular discovery may elegantly align with practical off-the-shelf approaches leveraging existing approved drugs that modulate cGMP levels for the management of obesity. PMID:24105257

Diagnosed a Patient with Central Serous Chorioretinopathy? Now What?: Management of Central Serous Chorioretinopathy.

PubMed

Goldhagen, Brian E; Goldhardt, Raquel

2017-06-01

The goal of this paper is to provide a comprehensive review of the management options for central serous chorioretinopathy (CSCR). The majority of cases of acute CSCR may be managed with observation and cessation of corticosteroids, if possible, as well as life-style modifications including stress reduction and control of hypertension. The management of chronic disease is more challenging and may include either medication or laser-based treatment. Management of CSCR necessitates an individualized and selective treatment approach. There is overall poor evidence for the use of systemic and intravitreal medications. From this class of treatments, mineralocorticoid receptor antagonists appear to have the greatest potential. Although conventional thermal photocoagulation may be used in select cases, the most promising treatment options at this time for chronic CSCR are photodynamic therapy, either half-dose or half-fluence, and non-damaging (subthreshold) retinal laser therapy.

Managing hypertension in type 2 diabetes mellitus.

PubMed

Horr, Samuel; Nissen, Steven

2016-06-01

Hypertension is a common problem in the diabetic population with estimates suggesting a prevalence exceeding 60%. Comorbid hypertension and diabetes mellitus are associated with high rates of macrovascular and microvascular complications. These two pathologies share overlapping risk factors, importantly central obesity. Treatment of hypertension is unequivocally beneficial and improves all-cause mortality, cardiovascular mortality, major cardiovascular events, and microvascular outcomes including nephropathy and retinopathy. Although controversial, current guidelines recommend a target blood pressure in the diabetic population of <140/90 mmHg, which is a similar target to that proposed for individuals without diabetes. Management of blood pressure in patients with diabetes includes both lifestyle modifications and pharmacological therapies. This article reviews the evidence for management of hypertension in patients with type 2 diabetes mellitus, and provides a recommended treatment strategy based on the available data. Copyright © 2016 Elsevier Ltd. All rights reserved.

Influence of ALA54THR polymorphism of fatty acid binding protein 2 on lifestyle modification response in obese subjects.

PubMed

de Luis, D A; Aller, R; Izaola, O; Sagrado, M Gonzalez; Conde, R

2006-01-01

It has been found that the expression of fatty acid binding protein 2 (FABP2) mRNA is under dietary control. A G-to-A transition at codon 54 of FABP2 results in an amino acid substitution (from Ala 54 to Thr 54). This polymorphism was associated with high insulin resistance and high fasting insulin concentrations. The aim of our study was to investigate the influence of Thr54 polymorphism in the FABP2 protein on the response to a lifestyle modification (Mediterranean hypocaloric diet and exercise) in obese patients. A population of 69 obese (body mass index > 30) nondiabetic outpatients was analyzed in a prospective way. Before and after 3 months of the lifestyle modification program, indirect calorimetry, tetrapolar electrical bioimpedance measurement, blood pressure recording, serial assessment of the nutritional intake (3 days of written food records), and biochemical analysis were performed. The lifestyle modification program consisted of a hypocaloric diet (1,520 kcal; 52% carbohydrates, 25% lipids, and 23% proteins). The exercise program consisted of aerobic exercise for at least three times/week (60 min each). Statistical analysis was performed for combined Ala54/Thr54 and Thr54/Thr54 as a mutant group and wild-type Ala54/Ala54 as second group. The mean age was 45.5 +/- 16.7 years, the mean body mass index was 34.1 +/- 5.1, and there were 14 males (20.3%) and 55 females (79.7%) with a weight loss of 3.17 +/- 3.5 kg (3.5%). Thirty-seven patients (53.6%) had the genotype Ala54/Ala54 (wild-type group) and 32 (46.4%) patients either the genotype Ala54/Thr54 (26 patients, 30.2%) or the genotype Thr54/Thr54 (6 patients, 16.2%). The percentage of responders (weight loss) was similar in both groups (89.2 vs. 90.6%). In the wild-type group, body mass index, weight, fat mass, low-density lipoprotein cholesterol level, and waist circumference decreased, whereas the VO2 (oxygen consumption) increased. In the mutant group, glucose, body mass index, weight, waist circumference, and systolic blood pressure decreased, and VO2 increased. No differences were detected between basal values in both groups. Only the leptin levels showed a significant decrease in the wild-type group (23.85%; p < 0.05), with no statistically significant difference in the mutant group (2.59%; NS). Resistin, tumor necrosis factor alpha, interleukin 6, insulin, and C-reactive protein remained without changes in both groups. Weight loss is associated with different changes, depending on the FABP2 genotype. Carriers of the Thr54 allele have a different response than wild-type obese subjects, with a significant decrease of systolic blood pressure and glucose levels in Thr54 carriers and a significant decrease in fat mass, low-density lipoprotein cholesterol, and leptin in wild-type patients. Copyright 2006 S. Karger AG, Basel.

The Genome Sequence of the Leaf-Cutter Ant Atta cephalotes Reveals Insights into Its Obligate Symbiotic Lifestyle

PubMed Central

Suen, Garret; Holt, Carson; Abouheif, Ehab; Bornberg-Bauer, Erich; Bouffard, Pascal; Caldera, Eric J.; Cash, Elizabeth; Cavanaugh, Amy; Denas, Olgert; Elhaik, Eran; Favé, Marie-Julie; Gadau, Jürgen; Gibson, Joshua D.; Graur, Dan; Grubbs, Kirk J.; Hagen, Darren E.; Harkins, Timothy T.; Helmkampf, Martin; Hu, Hao; Johnson, Brian R.; Kim, Jay; Marsh, Sarah E.; Moeller, Joseph A.; Muñoz-Torres, Mónica C.; Murphy, Marguerite C.; Naughton, Meredith C.; Nigam, Surabhi; Overson, Rick; Rajakumar, Rajendhran; Reese, Justin T.; Scott, Jarrod J.; Smith, Chris R.; Tao, Shu; Tsutsui, Neil D.; Viljakainen, Lumi; Wissler, Lothar; Yandell, Mark D.; Zimmer, Fabian; Taylor, James; Slater, Steven C.; Clifton, Sandra W.; Warren, Wesley C.; Elsik, Christine G.; Smith, Christopher D.; Weinstock, George M.; Gerardo, Nicole M.; Currie, Cameron R.

2011-01-01

Leaf-cutter ants are one of the most important herbivorous insects in the Neotropics, harvesting vast quantities of fresh leaf material. The ants use leaves to cultivate a fungus that serves as the colony's primary food source. This obligate ant-fungus mutualism is one of the few occurrences of farming by non-humans and likely facilitated the formation of their massive colonies. Mature leaf-cutter ant colonies contain millions of workers ranging in size from small garden tenders to large soldiers, resulting in one of the most complex polymorphic caste systems within ants. To begin uncovering the genomic underpinnings of this system, we sequenced the genome of Atta cephalotes using 454 pyrosequencing. One prediction from this ant's lifestyle is that it has undergone genetic modifications that reflect its obligate dependence on the fungus for nutrients. Analysis of this genome sequence is consistent with this hypothesis, as we find evidence for reductions in genes related to nutrient acquisition. These include extensive reductions in serine proteases (which are likely unnecessary because proteolysis is not a primary mechanism used to process nutrients obtained from the fungus), a loss of genes involved in arginine biosynthesis (suggesting that this amino acid is obtained from the fungus), and the absence of a hexamerin (which sequesters amino acids during larval development in other insects). Following recent reports of genome sequences from other insects that engage in symbioses with beneficial microbes, the A. cephalotes genome provides new insights into the symbiotic lifestyle of this ant and advances our understanding of host–microbe symbioses. PMID:21347285

The critical role of community-based micro-grants for disability aids and equipment: results from a needs analysis.

PubMed

Muenchberger, Heidi; Ehrlich, Carolyn; Parekh, Sanjoti; Crozier, Michelle

2016-01-01

To investigate the role of philanthropic micro-grants (maximum of $10,000) in the provision of aids and equipment for adults (aged 18-65 years of age) with complex disabilities and examine key trends in aids and equipment requests. This study examined, through quantitative and qualitative analysis, aids and equipment requests (n = 371 individual applications as represented by 136 service organisations in three Australian states) received by a not-for-profit (NFP) organisation across five consecutive years of an innovative micro-grants scheme. Findings highlight that living situation (living with family or living independently) significantly influences the nature of requests for respite, aids, equipment and home modifications. Specifically, people with complex disabilities living with their families require greater combined service provision (higher equipment need, respite support, home modifications) than those living independently (equipment need only). Type of disability did not influence request type. Qualitative data further indicated the "last resort" nature of respite requests, particularly for younger applicants (under 45 years of age) indicating critical unmet needs in the community. Results demonstrate the vital role of NFP organisations and philanthropic funds in supporting daily lifestyle aids and equipment (including respite) that might otherwise not be funded for people with complex disabilities. Although preliminary in its scope and prior to implementation of a National Disability Insurance Scheme (NDIS) in Australia, findings suggest both opportunity and risk to the uptake of community-based micro-grant funding: opportunity for users through the provision of essential aids and lifestyle supports, and risk through over-subscription and devolving of responsibility for critical support resources from public sector. The aids and equipment needs of adults under the age of 65 appear to have been underestimated, poorly defined and under-serviced. Service users need more assistance for their carers (i.e. equipment to facilitate safe lifting, urgent breaks from care routines) as well as aids, equipment and modifications to help them to live a more normal life (e.g. going to the beach). Living situation (i.e. independently or with family) significantly influences the nature and extent of aids and equipment requested. Supporting adults up to the age of 65 to live more independently would positively influence carers and family, while at the same time providing opportunities for more targeted personal care supports. Philanthropic and not-for-profit schemes are helping to address these needs through micro-grant schemes for purchases under $10 000, but sustainability is questioned. The introduction of Australia's National Disability Insurance Scheme (NDIS) presents an opportunity to consider the lifestyle needs of service users and carers, and determine who is best placed to address them.

Supportive care after curative treatment for breast cancer (survivorship care): resource allocations in low- and middle-income countries. A Breast Health Global Initiative 2013 consensus statement.

PubMed

Ganz, Patricia A; Yip, Cheng Har; Gralow, Julie R; Distelhorst, Sandra R; Albain, Kathy S; Andersen, Barbara L; Bevilacqua, Jose Luiz B; de Azambuja, Evandro; El Saghir, Nagi S; Kaur, Ranjit; McTiernan, Anne; Partridge, Ann H; Rowland, Julia H; Singh-Carlson, Savitri; Vargo, Mary M; Thompson, Beti; Anderson, Benjamin O

2013-10-01

Breast cancer survivors may experience long-term treatment complications, must live with the risk of cancer recurrence, and often experience psychosocial complications that require supportive care services. In low- and middle-income settings, supportive care services are frequently limited, and program development for survivorship care and long-term follow-up has not been well addressed. As part of the 5th Breast Health Global Initiative (BHGI) Global Summit, an expert panel identified nine key resources recommended for appropriate survivorship care, and developed resource-stratified recommendations to illustrate how health systems can provide supportive care services for breast cancer survivors after curative treatment, using available resources. Key recommendations include health professional education that focuses on the management of physical and psychosocial long-term treatment complications. Patient education can help survivors transition from a provider-intense cancer treatment program to a post-treatment provider partnership and self-management program, and should include: education on recognizing disease recurrence or metastases; management of treatment-related sequelae, and psychosocial complications; and the importance of maintaining a healthy lifestyle. Increasing community awareness of survivorship issues was also identified as an important part of supportive care programs. Other recommendations include screening and management of psychosocial distress; management of long-term treatment-related complications including lymphedema, fatigue, insomnia, pain, and women's health issues; and monitoring survivors for recurrences or development of second primary malignancies. Where possible, breast cancer survivors should implement healthy lifestyle modifications, including physical activity, and maintain a healthy weight. Health professionals should provide well-documented patient care records that can follow a patient as they transition from active treatment to follow-up care. Copyright © 2013 The Authors. Published by Elsevier Ltd.. All rights reserved.

The role of epigenetics in cardiovascular health and ageing: A focus on physical activity and nutrition.

PubMed

Wallace, Robert G; Twomey, Laura C; Custaud, Marc-Antoine; Turner, Jonathan D; Moyna, Niall; Cummins, Philip M; Murphy, Ronan P

2017-11-16

The cardiovascular system is responsible for transport of blood and nutrients to tissues, and is pivotal to the physiological health and longevity. Epigenetic modification is a natural, age-associated process resulting in highly contextualised gene expression with clear implications for cell differentiation and disease onset. Biological/epigenetic age is independent of chronological age, constituting a highly reflective snapshot of an individual's overall health. Accelerated vascular ageing is of major concern, effectively lowering disease threshold. Age-related chronic illness involves a complex interplay between many biological processes and is modulated by non-modifiable and modifiable risk factors. These alter the static genome by a number of epigenetic mechanisms, which change gene expression in an age and lifestyle dependent manner. This 'epigenetic drift' impacts health and contributes to the etiology of chronic illness. Lifestyle factors may cause acceleration of this epigenetic "clock", pre-disposing individuals to cardiovascular disease. Nutrition and physical activity are modifiable lifestyle choices, synergistically contributing to cardiovascular health. They represent a powerful potential epigenetic intervention point for effective cardiovascular protective and management strategies. Thus, together with traditional risk factors, monitoring the epigenetic signature of ageing may prove beneficial for tailoring lifestyle to fit biology - supporting the increasingly popular concept of "ageing well". Copyright © 2017 Elsevier B.V. All rights reserved.

Therapeutic interventions to reduce the risk of progression from prediabetes to type 2 diabetes mellitus

PubMed Central

Portero McLellan, Katia Cristina; Wyne, Kathleen; Villagomez, Evangelina Trejo; Hsueh, Willa A

2014-01-01

Clinical trials have demonstrated that it is possible to prevent diabetes through lifestyle modification, pharmacological intervention, and surgery. This review aims to summarize the effectiveness of these various therapeutic interventions in reducing the risk of progression of prediabetes to diabetes, and address the challenges to implement a diabetes prevention program at a community level. Strategies focusing on intensive lifestyle changes are not only efficient but cost-effective and/or cost-saving. Indeed, lifestyle intervention in people at high risk for type 2 diabetes mellitus (T2DM) has been successful in achieving sustained behavioral changes and a reduction in diabetes incidence even after the counseling is stopped. Although prediabetes is associated with health and economic burdens, it has not been adequately addressed by interventions or regulatory agencies in terms of prevention or disease management. Lifestyle intervention strategies to prevent T2DM should be distinct for different populations around the globe and should emphasize sex, age, ethnicity, and cultural and geographical considerations to be feasible and to promote better compliance. The translation of diabetes prevention research at a population level, especially finding the most effective methods of preventing T2DM in various societies and cultural settings remains challenging, but must be accomplished to stop this worldwide epidemic. PMID:24672242

The Association of Prehypertension With Meals Eaten Away From Home in Young Adults in Singapore.

PubMed

Seow, Dominique Y B; Haaland, Benjamin; Jafar, Tazeen H

2015-10-01

Elevated blood pressure (BP) during early life years is associated with future risk of hypertension and cardiovascular morbidity and mortality. This study aimed to determine the prevalence and lifestyle factors associated with prehypertension (systolic BP (SBP) 120-139 mm Hg and/or diastolic BP (DBP) 80-89 mm Hg) or hypertension (SBP ≥ 140 mm Hg and/or DBP ≥ 90 mm Hg or on antihypertensive medications) among young adults at a Singapore university. A cross-sectional survey of 501 university-going young adults aged 18-40 years in Singapore was conducted using convenience sampling. Data on BP, body mass index (BMI), and lifestyle factors (meals eaten away from home/week, physical activity) was collected, and their association with prehypertension or hypertension was determined. Prehypertension was found in 27.4% (95% confidence interval (95% CI) = 24-32) of the population: 49% (44-58) in men and 9% (6-13) in women (P < 0.001). 2.2% (1.2-3.9) had hypertension. In a multivariable model, those with prehypertension or hypertension tended to eat more meals away from home per week (per meal/week odds ratio (OR) = 1.05, 95% CI = 1.01-1.09), have higher BMI (per kg/m2 OR = 1.15, 95% CI = 1.02-1.30), and low physical activity (low vs. moderate/high activity OR = 2.14, 95% CI = 1.20-3.82). Other associates were male gender (OR = 7.01, 95% CI = 3.97-12.4) and older age (per year OR = 1.06, 95% CI = 1.01-1.11). Prehypertension may be common among university-going young adults in Singapore and is associated with potentially preventable lifestyle factors. Our findings call for large-scale population-based studies, including lifestyle modification trials for prevention of hypertension among young adults in Singapore. © American Journal of Hypertension, Ltd 2015. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

A systematic review of lifestyle counseling for diverse patients in primary care.

PubMed

Melvin, Cathy L; Jefferson, Melanie S; Rice, LaShanta J; Nemeth, Lynne S; Wessell, Andrea M; Nietert, Paul J; Hughes-Halbert, Chanita

2017-07-01

Prior research and systematic reviews have examined strategies related to weight management, less is known about lifestyle and behavioral counseling interventions optimally suited for implementation in primary care practices generally, and among racial and ethnic patient populations. Primary care practitioners may find it difficult to access and use available research findings on effective behavioral and lifestyle counseling strategies and to assess their effects on health behaviors among their patients. This systematic review compiled existing evidence from randomized trials to inform primary care providers about which lifestyle and behavioral change interventions are shown to be effective for changing patients' diet, physical activity and weight outcomes. Searches identified 444 abstracts from all sources (01/01/2004-05/15/2014). Duplicate abstracts were removed, selection criteria applied and dual abstractions conducted for 106 full text articles. As of June 12, 2015, 29 articles were retained for inclusion in the body of evidence. Randomized trials tested heterogeneous multi-component behavioral interventions for an equally wide array of outcomes in three population groups: diverse patient populations (23 studies), African American patients only (4 studies), and Hispanic/Mexican American/Latino patients only (2 studies). Significant and consistent findings among diverse populations showed that weight and physical activity related outcomes were more amenable to change via lifestyle and behavioral counseling interventions than those associated with diet modification. Evidence to support specific interventions for racial and ethnic minorities was promising, but insufficient based on the small number of studies. Copyright © 2017. Published by Elsevier Inc.

Treatment of Obesity in Primary Care.

PubMed

Tsai, Adam G; Remmert, Jocelyn E; Butryn, Meghan L; Wadden, Thomas A

2018-01-01

This article outlines some of the behavioral, pharmacologic, and surgical interventions available to primary care physicians (PCPs) to help their patients with weight management. Studies on lifestyle modification, commercial weight loss programs, and medical and surgical options are reviewed. Several clinical suggestions on obesity management that PCPs can take back and use immediately in office practice are offered. Copyright © 2017 Elsevier Inc. All rights reserved.

Prevention of diabetes in family medicine.

PubMed

Alibasic, Esad; Ramic, Enisa; Alic, Alma

2013-01-01

none declared. The incidence of diabetes type 2 (diabetes mellitus type 2 - DM 2) is rapidly increasing worldwide. Physical inactivity and obesity are the major determinants of the disease. Primary prevention of DM 2 entails health monitoring of people at risk category. People with impaired glycemic control are at high risk for development of DM 2 and enter the intensive supervision program for primary and secondary prevention. To evaluate the impact of metformin and lifestyle modification on glycemia and obesity in patients with prediabetes. The study was conducted on three groups of 20 patients each (total of 60 patients) aged from 45 to 80, with an abnormal glycoregulation and prediabetes. The study did not include patients who already met the diagnostic criteria for the diagnosis of diabetes. During the study period of 6 months, one group was extensively educated on changing lifestyle (healthy nutrition and increased physical activity), the second group was treated with 500 mg metformin twice a day, while the control group was advised about diet and physical activities but different from the first two groups. At beginning of the study, all patients were measured initial levels of blood glucose, HbA1C, BMI (Body Mass Index), body weight and height and waist size. Also the same measurements were taken at the end of the conducted research, 6 months later. For the assessment of diabetes control was conducted fasting plasma glucose (FPG) test and 2 hours after a glucose load, and HbA1C. At the beginning of the study the average HbA1C (%) values in three different groups according to the type of intervention (lifestyle changes, metformin, control group) were as follows: (6.4 ± 0.5 mmol / l), (6.5 ± 1.2 mmol / l), (6.7 ± 0.5 mmol / l). At the end of the research, the average HbA1C values were: 6.2 ± 0.3 mmol / l, 6.33 ± 0.5 mmol / l and 6.7 ± 1.4 mmol / l. In the group of patients who received intensive training on changing lifestyle or group that was treated with metformin, the average reduction in blood glucose and HbA1C remained within the reference range and there were no criteria for the diagnosis of diabetes. Unlike the control group, a group that was well educated on changing habits decreased average body weight by 4.25 kg, BMI by 1.3 and waist size by 2.5 cm. Metformin therapy led to a reduction in the average weight of 3.83 kg, BMI of 1.33 and 3.27 for waist size. Changing lifestyle (healthy diet and increased physical activity) has led to a reduction in total body weight in 60% of patients, BMI in 65% of patients, whereas metformin therapy led to a reduction of the total body weight in 50%, BMI in 45% of patients. In the control group, the overall reduction in body weight was observed in 25%, and BMI in 15% of patients. Modification of lifestyle, such as diet and increased physical activity or use of metformin may improve glycemic regulation, reduce obesity and prevent or delay the onset of developing DM 2.

Lifestyle change diminishes a hypertensive response to exercise in type 2 diabetes.

PubMed

Schultz, Martin G; Hordern, Matthew D; Leano, Rodel; Coombes, Jeffrey S; Marwick, Thomas H; Sharman, James E

2011-05-01

A hypertensive response to exercise (HRE) is common in patients with type 2 diabetes and is associated with increased left ventricular (LV) mass and mortality. This study aimed to determine whether lifestyle modification would improve exercise blood pressure (BP) and reduce LV mass in patients with type 2 diabetes. One hundred and eighty-five patients with type 2 diabetes were randomized to 1 yr of lifestyle intervention (n=97, mean ± SD age=54.7 ± 11.3 yr, 51% men) or usual care (control; n=88, age=53.8 ± 8.1 yr, 61% men). Brachial BP was measured at rest and during a graded maximal exercise test at baseline and 1 yr. Patients also underwent two-dimensional echocardiography to determine LV dimensions. A subgroup of 61 patients had resting and exercise central BP estimated from radial tonometry. An HRE was defined as a maximal exercise systolic BP of ≥210 mm Hg for men and ≥190 mm Hg for women. At study entry, there were 101 patients (55%) with an HRE (n=51 controls). Compared with controls, lifestyle intervention significantly reduced the propensity to develop an HRE in those participants who did not have HRE at baseline (29.8% vs 59.5%, P=0.006). However, absolute values of exercise and resting (brachial and central) BP and LV mass were not significantly changed (all P values >0.05). There were significant (all P values <0.05) improvements in V˙O2max, body mass index, plasma glucose, insulin resistance, and HDL cholesterol after lifestyle intervention compared with control. Lifestyle intervention significantly attenuates the development of an HRE but does not reduce cardiac size after 1 yr in patients with type 2 diabetes. © 2011 by the American College of Sports Medicine

Fasting serum insulin and the homeostasis model of insulin resistance (HOMA-IR) in the monitoring of lifestyle interventions in obese persons.

PubMed

Vogeser, Michael; König, Daniel; Frey, Ingrid; Predel, Hans-Georg; Parhofer, Klaus Georg; Berg, Aloys

2007-09-01

Lifestyle changes with increased physical activity and balanced energy intake are recognized as the principal interventions in obesity and insulin resistance. Only few prospective studies, however, have so far addressed the potential role of routine biochemical markers of insulin sensitivity in the monitoring of respective interventions. Fasting insulin and glucose was measured in 33 obese individuals undergoing a lifestyle modification program (MOBILIS) at baseline and after 1 year. The HOMA-IR index (homeostasis model of insulin resistance) was calculated as [fasting serum glucose*fasting serum insulin/22.5], with lower values indicating a higher degree of insulin sensitivity. While the median body mass index (BMI) and waist circumference decreased by 10% and 11%, respectively, the HOMA-IR index decreased in an over-proportional manner by 45% within 1 year (BMI baseline, median 35.7, interquartile range (IQR) 33.7-37.7; after 1 year, median 32.2, IQR 29.6-35.1. HOMA-IR baseline, median 2.9, IQR 1.5-4.6; after 1 year 1.6, IQR 0.9-2.7). In contrast to HOMA-IR and fasting serum insulin, no significant changes in fasting serum glucose were observed. Baseline and post-intervention HOMA-IR showed a high degree of inter-individual variation with eight individuals maintaining high HOMA-IR values despite weight loss after 1 year of intervention. Individual changes in the carbohydrate metabolism achieved by a lifestyle intervention program were displayed by fasting serum insulin concentrations and the HOMA-IR but not by fasting glucose measurement alone. Therefore, assessment of the HOMA-IR may help to individualize lifestyle interventions in obesity and to objectify improvements in insulin sensitivity after therapeutic lifestyle changes.

Common questions about the diagnosis and management of benign prostatic hyperplasia.

PubMed

Pearson, Ryan; Williams, Pamela M

2014-12-01

Benign prostatic hyperplasia (BPH) is a common condition that increases in prevalence with age. A history should include onset, duration, and severity of lower urinary tract symptoms and medication use to rule out other causes of symptoms. Physical examination includes a digital rectal examination and assessment for bladder distention or neurologic impairment. Recommended tests include serum prostate-specific antigen measurement and urinalysis to help identify infection, genitourinary cancer, or calculi as an alternative cause of lower urinary tract symptoms. BPH severity is assessed using validated, self-administered symptom questionnaires such as the American Urological Association Symptom Index or International Prostate Symptom Score. Mild or nonbothersome symptoms do not require treatment. Bothersome symptoms are managed with lifestyle modifications, medications, and surgery. Alpha blockers are first-line medications for BPH. Surgical referral is indicated if BPH-related complications develop, medical therapy fails, or the patient chooses it. Dietary supplements, such as saw palmetto, pygeum, cernilton, and beta sitosterols, and acupuncture are not recommended for the management of BPH.

Short-term Intervention to Revert Premalignant Lesions as Strategy to Prevent Gastrointestinal Cancers.

PubMed

Han, Young-Min; Park, Jong-Min; Lee, Ho-Jae; Kim, Eun-Hee; Hahm, Ki Baik

2013-12-01

"Prevention might be better than treatment in cancer treatment" is brief conclusion drawn from war on cancer through National Cancer Act of 1971 by U.S. President Richard Nixon. However, the clinical practice of chemoprevention is still in its infancy in spite of a wealth of data showing its effectiveness in experimental animals as well as in vitro mechanism research. Recent advances in either high throughput analysis including cancer genomes and tailored medicine or molecular targeted therapeutics, preventive strategies also should be changes as previous preventive strategies including phytoceuticals, life-style modification, and some empirical agents. Furthermore, molecular targeted therapeutics achieved high goal of effectiveness under the concept of therapeutic or preventive "synthetic lethality", of which extended application can be included within the scope of chemoprevention. Here, we will summarize several recent advances in chemopreventive strategy objected to justify optimism that chemoprevention will be an effective approach for the control of human cancer. siTRP (short-term intervention to revert premalignancy) strategy will be introduced for cancers in gastroenterology.

Health-Related Lifestyle Factors and Sexual Dysfunction: A Meta-Analysis of Population-Based Research.

PubMed

Allen, Mark S; Walter, Emma E

2018-04-01

Sexual dysfunction is a common problem among men and women and is associated with negative individual functioning, relationship difficulties, and lower quality of life. To determine the magnitude of associations between 6 health-related lifestyle factors (cigarette smoking, alcohol intake, physical activity, diet, caffeine, and cannabis use) and 3 common sexual dysfunctions (erectile dysfunction, premature ejaculation, and female sexual dysfunction). A comprehensive literature search of 10 electronic databases identified 89 studies that met the inclusion criteria (452 effect sizes; N = 348,865). Pooled mean effects (for univariate, age-adjusted, and multivariable-adjusted estimates) were computed using inverse-variance weighted random-effects meta-analysis and moderation by study and population characteristics were tested using random-effects meta-regression. Mean effect sizes from 92 separate meta-analyses provided evidence that health-related lifestyle factors are important for sexual dysfunction. Cigarette smoking (past and current), alcohol intake, and physical activity had dose-dependent associations with erectile dysfunction. Risk of erectile dysfunction increased with greater cigarette smoking and decreased with greater physical activity. Alcohol had a curvilinear association such that moderate intake was associated with a lower risk of erectile dysfunction. Participation in physical activity was associated with a lower risk of female sexual dysfunction. There was some evidence that a healthy diet was related to a lower risk of erectile dysfunction and female sexual dysfunction, and caffeine intake was unrelated to erectile dysfunction. Publication bias appeared minimal and findings were similar for clinical and non-clinical samples. Modification of lifestyle factors would appear to be a useful low-risk approach to decreasing the risk of erectile dysfunction and female sexual dysfunction. Strengths include the testing of age-adjusted and multivariable-adjusted models and tests of potential moderators using meta-regression. Limitations include low statistical power in models testing diet, caffeine, and cannabis use as risk factors. Results provide compelling evidence that cigarette smoking, alcohol, and physical activity are important for sexual dysfunction. Insufficient research was available to draw conclusions regarding risk factors for premature ejaculation or for cannabis use as a risk factor. These findings should be of interest to clinicians treating men and women with complaints relating to symptoms of sexual dysfunction. Allen MS, Walter EE. Health-Related Lifestyle Factors and Sexual Dysfunction: A Meta-Analysis of Population-Based Research. J Sex Med 2018;15:458-475. Copyright © 2018 International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.

Mudskippers and Their Genetic Adaptations to an Amphibious Lifestyle.

PubMed

You, Xinxin; Sun, Min; Li, Jia; Bian, Chao; Chen, Jieming; Yi, Yunhai; Yu, Hui; Shi, Qiong

2018-02-07

Mudskippers are the largest group of amphibious teleost fish that are uniquely adapted to live on mudflats. During their successful transition from aqueous life to terrestrial living, these fish have evolved morphological and physiological modifications of aerial vision and olfaction, higher ammonia tolerance, aerial respiration, improved immunological defense against terrestrial pathogens, and terrestrial locomotion using protruded pectoral fins. Comparative genomic and transcriptomic data have been accumulated and analyzed for understanding molecular mechanisms of the terrestrial adaptations. Our current review provides a general introduction to mudskippers and recent research advances of their genetic adaptations to the amphibious lifestyle, which will be helpful for understanding the evolutionary transition of vertebrates from water to land. Our insights into the genomes and transcriptomes will also support molecular breeding, functional identification, and natural compound screening.

Older Adults' Opinions on Fall Prevention in Relation to Physical Activity Level.

PubMed

Tuvemo Johnson, Susanna; Martin, Cathrin; Anens, Elisabeth; Johansson, Ann-Christin; Hellström, Karin

2018-01-01

The purpose of this study was to explore and describe older adults' opinions regarding actions to prevent falls and to analyze differences in the opinions of highly versus less physically active older adults. An open-ended question was answered by 262 individuals aged 75 to 98 years living in the community. The answers were analyzed using qualitative content analysis, and differences in the categories were compared between highly and less physically active persons. Physical activity was measured according to a five-level scale. The content analysis resulted in eight categories: assistive devices, avoiding hazards, behavioral adaptive strategies, being physically active, healthy lifestyle, indoor modifications, outdoor modifications, and seeking assistance. Behavioral adaptive strategies were mentioned to a greater extent by highly active people, and indoor modifications were more often mentioned by less active older adults. Support for active self-directed behavioral strategies might be important for fall prevention among less physically active older adults.

Effect of mHealth on modifying behavioural risk-factors of non-communicable diseases in an adult, rural population in Delhi, India.

PubMed

Sharma, Malvika; Banerjee, Bratati; Ingle, G K; Garg, Suneela

2017-01-01

The rising trend of non-communicable diseases (NCDs) has led to a "dual burden" in low and middle-income (LAMI) countries like India which are still battling with high prevalence of communicable diseases. The incorporation of a target specially dedicated to NCDs within the goal 3 of the newly adopted Sustainable Development Goals indicates the importance the world now accords to prevention and control of these diseases. Mobile phone technology is increasingly viewed as a promising communication channel that can be utilized for primary prevention of NCDs by promoting behaviour change and risk factor modification. A "Before and After" Intervention study was conducted on 400 subjects, over a period of one year, in Barwala village, Delhi, India. An mHealth intervention package consisting of weekly text messages and monthly telephone calls addressing lifestyle modification for risk factors of NCDs was given to the intervention group, compared to no intervention package in control group. After Intervention Phase, significant reduction was seen in behavioural risk factors (unhealthy diet and insufficient physical activity) in the intervention group compared to control group. Body mass index (BMI), systolic blood pressure and fasting blood sugar level also showed significant difference in the intervention group as compared to controls. Our study has demonstrated the usefulness of mHealth for health promotion and lifestyle modification at community level in a LAMI country. With the growing burden of NCDs in the community, such cost effective and innovative measures will be needed that can easily reach the masses.

Family support and cardiac rehabilitation: a comparative study of the experiences of South Asian and White-European patients and their carer's living in the United Kingdom.

PubMed

Astin, Felicity; Atkin, Karl; Darr, Aliya

2008-03-01

Effective lifestyle modification facilitated by cardiac rehabilitation is known to reduce the occurrence of adverse coronary events and mortality. South Asians have poorer outcomes after a myocardial infarction than the general UK population, but little is known about their experiences of family support, cardiac rehabilitation and lifestyle change. To explore the nature of family support available to a sample of South Asian and White-European cardiac patients and to highlight similarities and differences between these groups with regard to cardiac rehabilitation and lifestyle modification. Using a qualitative approach, semi-structured interviews (in 1 of 6 languages) were conducted by researchers with; 45 South Asian patients and 37 carers and 20 White-European patients and 17 carers. Interviews were conducted in a home setting, up to eighteen months after discharge from hospital following myocardial infarction, coronary artery bypass surgery or unstable angina. The main themes that emerged related to the provision of advice and information, family support and burden, dietary change and exercise regimes. Several cultural and ethnic differences were identified between patients and their families alongside similarities, irrespective of ethnicity. These may represent generic characteristics of recovery after a cardiac event. Health professionals should develop a cultural repertoire to engage with diversity and difference. Not every difficulty a person encounters as they try to access appropriate service delivery can be attributed to ethnic background. By improving services generally, support for South Asian populations can be improved. The challenge is to know when ethnicity makes a difference and mediates a person's relationship with service support and when it does not.

Effect of life-style modification on postmenopausal overweight and obese Indian women: A randomized controlled 24 weeks preliminary study.

PubMed

Tandon, Vishal R; Sharma, Sudhaa; Mahajan, Annil; Mahajan, Shagun

2014-01-01

The aim of the following study is to evaluate the effect of life-style modification on postmenopausal (PM) overweight and obese Indian women in a randomized controlled 24 week study. Two groups were formed Group I (n = 30) was designated as intervention (dietary and exercise group) and Group II (n = 24) served as control. Comparison of weight, waist circumference (WC) and body mass index (BMI) were made and compared among two groups at 4, 8, 16 and 24 weeks. Mean age at menopause was 48.35 years versus 49.65 years; mean number of menopausal symptoms were 5.70 ± 1.76 versus 5.10 ± 1.56 and mean duration since menopause was 2.70 versus 2.90 years in Groups I and II respectively. When the effect of Group I and control on weight was compared at 4, 8, 16 and 24 weeks, there was no significant difference between them up to 8 week. At 8 weeks Group I caused a significant decrease in weight (P ≤ 0.05) when compared with control arm and which continued throughout the study period (P < 0.05) at both 16 and 24 weeks. Group I produced a significant reduction in WC from 8 weeks onwards up to 24 weeks (P ≤ 0.05). BMI was statistically significant in Group I and the effect started at 4(th) week (P ≤ 0.05) and the differences in BMI reduction were highly significant at 16(th) and 24(th) weeks (P ≤ 0.001). The results of the present study strongly recommend the life-style management to be incorporated in daily style of postmenopausal women under controlled supervision.

PREDIRCAM eHealth platform for individualized telemedical assistance for lifestyle modification in the treatment of obesity, diabetes, and cardiometabolic risk prevention: a pilot study (PREDIRCAM 1).

PubMed

González, Cintia; Herrero, Pau; Cubero, José M; Iniesta, José M; Hernando, M Elena; García-Sáez, Gema; Serrano, Alvaro J; Martinez-Sarriegui, Iñaki; Perez-Gandia, Carmen; Gómez, Enrique J; Rubinat, Esther; Alcantara, Valeria; Brugués, Eulalia; Chico, Ana; Mato, Eugenia; Bell, Olga; Corcoy, Rosa; de Leiva, Alberto

2013-07-01

Healthy diet and regular physical activity are powerful tools in reducing diabetes and cardiometabolic risk. Various international scientific and health organizations have advocated the use of new technologies to solve these problems. The PREDIRCAM project explores the contribution that a technological system could offer for the continuous monitoring of lifestyle habits and individualized treatment of obesity as well as cardiometabolic risk prevention. PREDIRCAM is a technological platform for patients and professionals designed to improve the effectiveness of lifestyle behavior modifications through the intensive use of the latest information and communication technologies. The platform consists of a web-based application providing communication interface with monitoring devices of physiological variables, application for monitoring dietary intake, ad hoc electronic medical records, different communication channels, and an intelligent notification system. A 2-week feasibility study was conducted in 15 volunteers to assess the viability of the platform. The website received 244 visits (average time/session: 17 min 45 s). A total of 435 dietary intakes were recorded (average time for each intake registration, 4 min 42 s ± 2 min 30 s), 59 exercises were recorded in 20 heart rate monitor downloads, 43 topics were discussed through a forum, and 11 of the 15 volunteers expressed a favorable opinion toward the platform. Food intake recording was reported as the most laborious task. Ten of the volunteers considered long-term use of the platform to be feasible. The PREDIRCAM platform is technically ready for clinical evaluation. Training is required to use the platform and, in particular, for registration of dietary food intake. © 2013 Diabetes Technology Society.

An unusual archosaurian from the marine Triassic of China

NASA Astrophysics Data System (ADS)

Li, Chun; Wu, Xiao-Chun; Cheng, Yen-Nien; Sato, Tamaki; Wang, Liting

2006-04-01

A new Triassic archosaurian from China shows a number of aquatic specializations, of which the most striking is the extreme lateral compression of the long tail. Others that may also reflect aquatic adaptations include platelike scapula and coracoid, elongate neck with extremely long and slender ribs, and reduction of osteoderms. In contrast, its pelvic girdle and hind limb have no aquatic modifications. Anatomic features, taphonomy, and local geological data suggest that it may have lived in a coastal-island environment. This lifestyle, convergent with some Jurassic marine crocodyliforms that lived at least 40 million years later and the saltwater species of extant Crocodylus, contradicts with the prevailing view that Triassic archosaurians were restricted to nonmarine ecosystems. Its mosaic anatomy represents a previously unknown ecomorph within primitive archosaurians.

The diagnosis and management of cerebrovascular disease in diabetes.

PubMed

Phipps, Michael S; Jastreboff, Ania M; Furie, Karen; Kernan, Walter N

2012-06-01

Cerebrovascular disease is a leading cause of morbidity and mortality in diabetes. Compared with nondiabetic patients, diabetic patients have at least twice the risk for stroke, earlier onset of symptoms, and worse functional outcomes. Approximately 20 % of diabetic patients will die from stroke, making it one of the leading causes of death in this population. Effective strategies for primary and secondary prevention of stroke have been developed in research cohorts that included both diabetic and nondiabetic patients. Nevertheless, prevention in diabetes has some specific considerations. In this paper, we summarize evidence to guide the diagnosis and management of stroke in diabetic patients. We propose that diabetic stroke patients should have a robust risk assessment to target interventions, like other patients with cerebrovascular disease, but with special attention to glycemic control and lifestyle modification.

Transtheoretical model stages of change for dietary and physical exercise modification in weight loss management for overweight and obese adults.

PubMed

Mastellos, Nikolaos; Gunn, Laura H; Felix, Lambert M; Car, Josip; Majeed, Azeem

2014-02-05

Obesity is a global public health threat. The transtheoretical stages of change (TTM SOC) model has long been considered a useful interventional approach in lifestyle modification programmes, but its effectiveness in producing sustainable weight loss in overweight and obese individuals has been found to vary considerably.  To assess the effectiveness of dietary intervention or physical activity interventions, or both, and other interventions based on the transtheoretical model (TTM) stages of change (SOC) to produce sustainable (one year and longer) weight loss in overweight and obese adults. Studies were obtained from searches of multiple electronic bibliographic databases. We searched The Cochrane Library, MEDLINE, EMBASE and PsycINFO. The date of the last search, for all databases, was 17 December 2013. Trials were included if they fulfilled the criteria of randomised controlled clinical trials (RCTs) using the TTM SOC as a model, that is a theoretical framework or guideline in designing lifestyle modification strategies, mainly dietary and physical activity interventions, versus a comparison intervention of usual care; one of the outcome measures of the study was weight loss, measured as change in weight or body mass index (BMI); participants were overweight or obese adults only; and the intervention was delivered by healthcare professionals or trained lay people at the hospital and community level, including at home. Two review authors independently extracted the data, assessed studies for risk of bias and evaluated overall study quality according to GRADE (Grading of Recommendations Assessment, Development and Evaluation). We resolved disagreements by discussion or consultation with a third party. A narrative, descriptive analysis was conducted for the systematic review. A total of three studies met the inclusion criteria, allocating 2971 participants to the intervention and control groups. The total number of participants randomised to the intervention groups was 1467, whilst 1504 were randomised to the control groups. The length of intervention was 9, 12 and 24 months in the different trials. The use of TTM SOC in combination with diet or physical activity, or both, and other interventions in the included studies produced inconclusive evidence that TTM SOC interventions led to sustained weight loss (the mean difference between intervention and control groups varied from 2.1 kg to 0.2 kg at 24 months; 2971 participants; 3 trials; low quality evidence). Following application of TTM SOC there were improvements in physical activity and dietary habits, such as increased exercise duration and frequency, reduced dietary fat intake and increased fruit and vegetable consumption (very low quality evidence). Weight gain was reported as an adverse event in one of the included trials. None of the trials reported health-related quality of life, morbidity, or economic costs as outcomes. The small number of studies and their variable methodological quality limit the applicability of the findings to clinical practice. The main limitations include inadequate reporting of outcomes and the methods for allocation, randomisation and blinding; extensive use of self-reported measures to estimate the effects of interventions on a number of outcomes, including weight loss, dietary consumption and physical activity levels; and insufficient assessment of sustainability due to lack of post-intervention assessments. The evidence to support the use of TTM SOC in weight loss interventions is limited by risk of bias and imprecision, not allowing firm conclusions to be drawn. When combined with diet or physical activity, or both, and other interventions we found very low quality evidence that it might lead to better dietary and physical activity habits. This systematic review highlights the need for well-designed RCTs that apply the principles of the TTM SOC appropriately to produce conclusive evidence about the effect of TTM SOC lifestyle interventions on weight loss and other health outcomes.

Management of OAB in those over age 65.

PubMed

Natalin, Ricardo; Lorenzetti, Fabio; Dambros, Miriam

2013-10-01

The International Continence Society (ICS) defines overactive bladder (OAB) as an association of symptoms including "urgency, with or without urge incontinence, usually with increased frequency and nocturia". This conditon has been associated with a decrease in quality of life and a higher related risk of overall health condition decrease, and is rising since its prevalence increases with age and the forecast for the world population estimates an increase of those over 65 years old. Aging alone can be considered a major risk factor for developing OAB symptoms that are considered multifactorial and due to body tissue and anatomic changes, lifestyle-associated factors, comorbidities and personal characteristics. The high prevalence of this condition and multiple etiology factors makes of its treatment a challenge-especially in the older population. A major concern over OAB treatment of elderly patients is the risk of cognitive side effects due to the pharmacologic treatment with anticholinergic drugs. First-line treatment for OAB symptoms are the use of pharmacologic therapy with antimuscarinic drugs, which has been proved to be effective in controlling urgency, urge incontinence episodes, incontinence episodes, and nocturia. The impact caused by this condition is significant regarding the economic and human costs associated bringing into attention the need of studying and reviewing this specific population. Conservative Management and Lifestyle Modifications: Behavioral therapy's aims are to reduce urinary frequency and urgency to an accepted level and to increase bladder outlet volume. It consists of actions to teach patients to improve and learn bladder control. Lifestyle modifications are a conjunct of daily activities that can be managed to have the lowest interference on the functioning of the urinary tract. Pharmacologic Therapy: There are various medications with antimuscarinic properties available for the treatment of OAB symptoms. The most commonly used are oxybutinin, tolterodine, solifenacin, darifenacin, fesosterodine and trospium. Second-line Therapy: OAB treatment accounts for some refractory to conventional treatment patients who will require alternative therapies to achieve improvement of symptoms as the use of intradetrusor injection of botulinum A toxin by binding to receptors on the membrane of cholinergic nerves causing temporary chemodenervation and consequent muscle relaxation. Neuromodulation is also an effective therapy that aims to achieve inhibition of detrusor activity by continuous neural stimulation through peripheral nerves as the use of the tibial nerve or central as it is performed by direct spine stimulation on sacral roots through the implantation of an automated generator. In conclusion, evidence from the literature has shown that antimuscarinic treatment of OAB in the elderly population is safe and effective in improving symptoms and patient's quality of life. Managing OAB symptoms in this population is a great challenge. An optimal therapeutic approach to treat should involve medical treatment with drug and behavioral therapy in addition to lifestyle advice.

Do genetic modifiers of high-density lipoprotein cholesterol and triglyceride levels also modify their response to a lifestyle intervention in the setting of obesity and type-2 diabetes mellitus?: The Action for Health in Diabetes (Look AHEAD) study.

PubMed

Huggins, Gordon S; Papandonatos, George D; Erar, Bahar; Belalcazar, L Maria; Brautbar, Ariel; Ballantyne, Christie; Kitabchi, Abbas E; Wagenknecht, Lynne E; Knowler, William C; Pownall, Henry J; Wing, Rena R; Peter, Inga; McCaffery, Jeanne M

2013-08-01

High-density lipoprotein cholesterol (HDL-C) and triglycerides are cardiovascular risk factors susceptible to lifestyle behavior modification and genetics. We hypothesized that genetic variants identified by genome-wide association studies as associated with HDL-C or triglyceride levels modify 1-year treatment response to an intensive lifestyle intervention, relative to a usual care of diabetes mellitus support and education. We evaluated 82 single-nucleotide polymorphisms, which represent 31 loci demonstrated by genome-wide association studies to be associated with HDL-C and triglycerides, in 3561 participants who consented for genetic studies and met eligibility criteria. Variants associated with higher baseline HDL-C levels, cholesterol ester transfer protein (CETP) rs3764261 and hepatic lipase (LIPC) rs8034802, were found to be associated with HDL-C increases with intensive lifestyle intervention (P=0.0038 and 0.013, respectively) and had nominally significant treatment interactions (P=0.047 and 0.046, respectively). The fatty acid desaturase-2 rs1535 variant, associated with low baseline HDL-C (P=0.017), was associated with HDL-C increases with intensive lifestyle intervention (0.0037) and had a nominal treatment interaction (P=0.035). Apolipoprotein B (rs693) and LIPC (rs8034802) single-nucleotide polymorphisms showed nominally significant associations with HDL-C and triglyceride changes with intensive lifestyle intervention and a treatment interaction (P<0.05). Phosphatidylglycerophosphate synthase-1 single-nucleotide polymorphisms (rs4082919) showed the most significant triglyceride treatment interaction in the full cohort (P=0.0009). This is the first study to identify genetic variants modifying lipid responses to a randomized lifestyle behavior intervention in overweight or obese individuals with diabetes mellitus. The effects of genetic factors on lipid changes may differ from the effects on baseline lipids and are modifiable by behavioral intervention.

Prevention of ischemic stroke in clinical practice: a role of internists and general practitioners.

PubMed

Niewada, Maciej; Członkowska, Anna

2014-01-01

Stroke constitutes a substantial clinical and socio-economic burden. It is currently the third cause of death worldwide and results in mortality or disability in every third patient at the end of the first year following an acute cerebrovascular event. Although in-hospital mortality rates in stroke patients have decreased, prevention and cardiovascular risk control remain critical for improving the prognosis and reducing stroke burden worldwide. The definitions of stroke and transient ischemic attack (TIA) have been recently modified following the findings from neuroimaging and thrombolysis research. Both stroke and TIA are recurrent and preventable disorders. Both patients with stroke and those with TIA require prompt clinical workup, risk assessment, and appropriate management because the risk of recurrence, stroke, and coronary events is significant. The 5 most common cardiovascular risk factors (high blood pressure, smoking, abdominal obesity, diet, and lack of physical activity) are responsible for 80% of the cases. Stroke prevention involves lifestyle modification and specific treatment. Secondary prevention of ischemic stroke involves early treatment (antiplatelets and carotid interventions) and long-term management including lifestyle changes, antihypertensive therapy, antiplatelets, antithrombotic drugs in patients with atrial fibrillation, and the use of statins and other lipid-lowering drugs. Stroke patients are at risk of depression, dementia, epilepsy, and other complications that also require targeted treatment.

Identifying similar and different factors effecting long-term cardiac exercise rehabilitation behavior modification between New Zealand and the United Kingdom.

PubMed

Dunn, Stephanie; Lark, Sally; Fallows, Stephen

2014-07-01

Cardiac Rehabilitation (CR) programs are the most cost-effective measure for reducing morbidity associated with Coronary Vascular Disease (CVD). To be more effective there is a need to understand what influences the maintenance of healthy behaviors. This study identifies similar and different influences in CR of the United Kingdom (UK) and New Zealand (NZ). A retrospective study. Participants had previously been discharged from CR for 6 to 12+ months within the UK (n = 22) and NZ (n = 21). Participant's attended a focus group. Discussions were digitally recorded, transcribed then thematically analyzed. The CR programs were observed over 2 months to enable comment on findings relating to 'theory in practice.' Similar positive patient experiences influencing behavior between groups and countries were; support, education, positive attitude, and motivation. Companionship and exercising alongside people with similar health problems was the major determinant for positive exercise behavior. Barriers to maintaining exercise included; physical disabilities, time constraints, and weather conditions. NZ participants were more affected by external factors (eg, opportunity, access, and time). Both CR programs were successful in facilitating the maintenance of healthy lifestyles. Exercising with other cardiac patients for support in a structured environment was the strongest influence in maintaining healthy lifestyles beyond CR programs.

Integrating physical activity into mental health services for persons with serious mental illness.

PubMed

Richardson, Caroline R; Faulkner, Guy; McDevitt, Judith; Skrinar, Gary S; Hutchinson, Dori S; Piette, John D

2005-03-01

This article reviews evidence supporting the need for interventions to promote physical activity among persons with serious mental illness. Principles of designing effective physical activity interventions are discussed along with ways to adapt such interventions for this population. Individuals with serious mental illness are at high risk of chronic diseases associated with sedentary behavior, including diabetes and cardiovascular disease. The effects of lifestyle modification on chronic disease outcomes are large and consistent across multiple studies. Evidence for the psychological benefits for clinical populations comes from two meta-analyses of outcomes of depressed patients that showed that effects of exercise were similar to those of psychotherapeutic interventions. Exercise can also alleviate secondary symptoms such as low self-esteem and social withdrawal. Although structured group programs can be effective for persons with serious mental illness, especially walking programs, lifestyle changes that focus on accumulation of moderate-intensity activity throughout the day may be most appropriate. Research suggests that exercise is well accepted by people with serious mental illness and is often considered one of the most valued components of treatment. Adherence to physical activity interventions appears comparable to that in the general population. Mental health service providers can provide effective, evidence-based physical activity interventions for individuals with serious mental illness.

E-counseling as an emerging preventive strategy for hypertension.

PubMed

Nolan, Robert P; Liu, Sam; Payne, Ada Y M

2014-07-01

Lifestyle counseling that includes exercise training, diet modification, and medication adherence is critical to hypertension management. This article summarizes the efficacy of lifestyle counseling interventions in face-to-face, telehealth, and e-counseling settings. It also discusses the therapeutic potential of e-counseling as a preventive strategy for hypertension. The recent proliferation of telehealth and e-counseling programs increases the reach of preventive counseling for patients with cardiovascular disorders. Blood pressure reduction following these interventions is comparable to face-to-face interventions. However, the effectiveness of e-counseling varies depending on the design features of the core protocol. An evidence-based guideline needs to be established that identifies e-counseling components which are independently associated with blood pressure reduction. As the Internet becomes more sophisticated, e-counseling is demonstrating a therapeutic advantage in comparison with other telehealth interventions. Current evidence supports further development of preventive e-counseling programs for hypertension. A pressing challenge for investigators is to specify key evidence-based components of e-counseling that are essential to the core protocol. In order to achieve this goal, it will be necessary to ensure that e-counseling programs are also clinically organized, in order to guide patients through the process of initiating and sustaining therapeutic behavior change.

Effect of additional brief counselling after periodic health examination on motivation for health behavior change [corrected].

PubMed

Son, Ki Young; Lee, Cheol Min; Cho, BeLong; Lym, Youl Lee; Oh, Seung Won; Chung, Wonjoo; Lee, Jin-Seok; Park, DuShin; Kim, Han Suk

2012-11-01

This study was to evaluate the effect of additional brief counseling by a primary care physician on lifestyle modification of examinees after a periodic health examination. 1,000 participants of the 2007 Korean national health screening program were asked to note any variation in their health behavior after participating in the screening program. The degree of comprehensive motivation for lifestyle modification was assessed in terms of stages of health behavior change. We calculated odds ratio of positive change (enhanced stage of change) with multiple logistic regression analysis and age-adjusted proportion of positive changers. Of 989 respondents, 486 and 503 received the basic and additional programs, respectively. Additional group were more likely to be positive changer than basic group (adjusted OR 1.78; 95% CI 1.19-2.65), and this was more prominent in older age group (adjusted OR 2.38, 95% CI 1.23-4.58). The age-adjusted proportions of positive changers were 22.7% (95% CI, 17.9-28.3) and 36.2% (95% CI, 30.4-42.4) in the basic and additional groups, respectively (P < 0.001). The additional consultation led to improvements in the stage of health behavior change after the health examination. Thus, such a consultation should be considered when designing a health-screening program.

Primary analysis of the Mandarin-speaking sub-study within the Sydney diabetes prevention program.

PubMed

Taing, Cecilia Y; Gibson, Alice A; Colagiuri, Stephen; Vita, Philip; Cardona-Morrell, Magnolia; Bauman, Adrian; Moore, Michael; Williams, Mandy; Milat, Andrew; Hony, Jacky; Lin, Sophia; Gwizd, Melissa; Fiatarone Singh, Maria A

2017-10-01

There is strong and consistent evidence from large scale randomised controlled trials that type 2 diabetes can be prevented or delayed through lifestyle modification which improves diet quality, increases physical activity and achieves weight loss in people at risk. Worldwide, the prevalence of type 2 diabetes is increasing in individuals of Chinese descent. Culturally tailored programs are required to address the risk in the Chinese population. This paper analyses effectiveness of a culturally tailored community-based lifestyle modification program (Sydney Diabetes Prevention Program (SDPP)) targeting Mandarin speakers. The SDPP was a 12 month translational study aiming to promote increased physical activity and dietary changes. Effectiveness was assessed through the improvement of anthropometric, metabolic, physical activity and dietary outcomes and number of goals met. Seventy-eight Mandarin-speaking participants at a high risk (Australian Diabetes Risk, AUSDRISK≥15) of developing diabetes were recruited for this study. In this cohort, waist circumference, total cholesterol and fat intake significantly improved at the 12-month review. In comparison to the English-speaking stream, the Mandarin-speaking stream achieved fewer improvements in outcomes and goals. The SDPP was not effective in reducing the risk factors associated with developing type 2 diabetes in this cohort of high risk Mandarin-speaking individuals living in Sydney. Copyright © 2017 Elsevier B.V. All rights reserved.

Effect of Aditional Brief Counselling after Periodic Health Examination on Motivation for Health Behavior Change

PubMed Central

Son, Ki Young; Lee, Cheol Min; Lym, Youl Lee; Oh, Seung Won; Chung, Wonjoo; Lee, Jin-Seok; Park, DuShin; Kim, Han Suk

2012-01-01

This study was to evaluate the effect of additional brief counseling by a primary care physician on lifestyle modification of examinees after a periodic health examination. 1,000 participants of the 2007 Korean national health screening program were asked to note any variation in their health behavior after participating in the screening program. The degree of comprehensive motivation for lifestyle modification was assessed in terms of stages of health behavior change. We calculated odds ratio of positive change (enhanced stage of change) with multiple logistic regression analysis and age-adjusted proportion of positive changers. Of 989 respondents, 486 and 503 received the basic and additional programs, respectively. Additional group were more likely to be positive changer than basic group (adjusted OR 1.78; 95% CI 1.19-2.65), and this was more prominent in older age group (adjusted OR 2.38, 95% CI 1.23-4.58). The age-adjusted proportions of positive changers were 22.7% (95% CI, 17.9-28.3) and 36.2% (95% CI, 30.4-42.4) in the basic and additional groups, respectively (P < 0.001). The additional consultation led to improvements in the stage of health behavior change after the health examination. Thus, such a consultation should be considered when designing a health-screening program. PMID:23166407

Orthotics Compared to Conventional Therapy and Other Non-Surgical Treatments for Plantar Fasciitis

PubMed Central

Lewis, Rebecca D.; Wright, Paul; McCarthy, Laine H.

2016-01-01

Clinical Question In adults with acute plantar fasciitis whose symptoms have not been relieved with the conventional regimen of NSAIDS, stretching and lifestyle modification, do the addition of orthotics (prefabricated or custom fitted) reduce pain and improve function compared with other non-surgical treatments (manipulative chiropractic, physical therapy and/or heel steroid injections)? Answer Yes. Studies have shown that orthotics, both prefabricated and custom fitted, reduce pain and improve function in adults with acute plantar fasciitis with few risks or side effects. Used alone or in addition to conventional therapy (NSAIDs, stretching, lifestyle modification), orthotics are effective and well tolerated by patients for short-term pain relief and improved function. Prefabricated orthotics are less costly and provide similar relief to more expensive custom orthotics. Level of Evidence of the Answer A Search Terms Plantar fasciitis, heel pain, treatment, orthotics, Limits Adult, human, English, Review, Randomized-Control Trials, Systematic Reviews, adults age 18 or more, publication dates 2004 to present. Date Search was Conducted January 16, 2014; updated January 20, 2015 Inclusion Criteria Recent published systematic reviews, randomized controlled, meta-analyses; adults with confirmed acute or recent diagnosis of plantar fasciitis. Exclusion Criteria Studies older than 10 years, children, adolescents less than 18 years of age, chronic or recalcitrant plantar fasciitis. PMID:26855444

Orthotics Compared to Conventional Therapy and Other Non-Surgical Treatments for Plantar Fasciitis.

PubMed

Lewis, Rebecca D; Wright, Paul; McCarthy, Laine H

2015-12-01

In adults with acute plantar fasciitis whose symptoms have not been relieved with the conventional regimen of NSAIDS, stretching and lifestyle modification, do the addition of orthotics (prefabricated or custom fitted) reduce pain and improve function compared with other non-surgical treatments (manipulative chiropractic, physical therapy and/or heel steroid injections)? Yes. Studies have shown that orthotics, both prefabricated and custom fitted, reduce pain and improve function in adults with acute plantar fasciitis with few risks or side effects. Used alone or in addition to conventional therapy (NSAIDs, stretching, lifestyle modification), orthotics are effective and well tolerated by patients for short-term pain relief and improved function. Prefabricated orthotics are less costly and provide similar relief to more expensive custom orthotics. Level of Evidence of the Answer: A Search Terms: Plantar fasciitis, heel pain, treatment, orthotics, Limits: Adult, human, English, Review, Randomized-Control Trials, Systematic Reviews, adults age 18 or more, publication dates 2004 to present. Date Search was Conducted: January 16, 2014; updated January 20, 2015 INCLUSION CRITERIA: Recent published systematic reviews, randomized controlled, meta-analyses; adults with confirmed acute or recent diagnosis of plantar fasciitis. Studies older than 10 years, children, adolescents less than 18 years of age, chronic or recalcitrant plantar fasciitis.

Evaluation of lorcaserin for the treatment of obesity.

PubMed

Berlie, Helen D; Hurren, Kathryn M

2013-08-01

Obesity is an epidemic associated with significant morbidity. Lorcaserin , a novel serotonin 2C receptor antagonist, was recently approved as an adjunct to lifestyle modification for long-term weight loss and maintenance. Clinical studies in patients without diabetes demonstrated 5.8% mean weight loss from baseline with lorcaserin compared to 2.5% with placebo and over twice as many patients achieved ≥ 5% weight loss. Patients with diabetes achieved mean weight loss of 4.5% with lorcaserin compared to 1.5% with placebo as well as modest improvements in glycemic outcomes. The authors review the pharmacology and clinical efficacy as well as the safety and tolerability of lorcaserin. This was achieved through a PubMed search (1960 - present) on lorcaserin to generate the key literature in the area. The lorcaserin package insert and Food and Drug Administration briefing documents were also used to identify relevant information. To assess long-term clinical efficacy and safety, the authors used studies with a minimum duration of one year. Lorcaserin induces moderate but significant weight loss compared to placebo as an adjunct to lifestyle modification. Although head-to-head comparison trials are not available, lorcaserin is likely less effective but better tolerated than its recently approved competitor, phentermine/topiramate. Cardiovascular outcome data will be invaluable in determining lorcaserin's eventual utilization and place in therapy.

Behavioral Intervention in the Overweight and Obese Employee: The Challenge of Promoting Weight Loss and Physical Activity

PubMed Central

Maniwa, Rumi; Iwamoto, Mamiko; Nogi, Akiko; Yamasaki, Masayuki; Yang, Jian-jun; Hanaoka, Hideaki; Shiwaku, Kuninori

2012-01-01

Effects of gender and employment situation on weight loss and lifestyle modification were assessed in a 3-month intervention study done for overweight and obesity. A total of 384 individuals in Izumo City Japan, participated from 2000 to 2006. Lifestyle modifications were quantitatively evaluated by calculating calories of energy intake and expenditure. Eleven men and 15 women failed to complete the intervention; they were significantly younger in both genders, and the women had a higher rate of employment than the completing group (91 men and 267 women). Intervention induced a weight loss of 1.9 kg for men and 1.6 kg for women, with no significant differences by gender. Significant differences were found in changes in energy intake and expenditure in both genders, but these disappeared after adjusting for weight. There were significant decreases in weight (1.6 kg in unemployed, 2.5 kg in employed) in men. Increases in walking and exercise for the employed were smaller than those for the unemployed. The relationship between changes in weight and energy balance by employment status was independently significant using multiple regression analysis. Employment is associated with difficulty in losing weight due to limited exercise time in behavioral intervention. PMID:25648082

Diet, microbiota, and colorectal cancer.

PubMed

Akin, Hakan; Tözün, Nurdan

2014-01-01

Colorectal cancer (CRC) is the third most common cancer in the world causing nearly 500,000 deaths every year. In addition to genetic background, environmental factors including diet and lifestyle are accepted as major contributors to adenoma and CRC development. Lifestyle factors include high BMI, obesity, and reduced physical activity. Growing interest and accumulating data on human microbiota implicate that host-microbe interplay has an important role in the development of metabolic, neoplastic, and inflammatory diseases. Findings from recent studies suggest that colon cancer risk is determined by the interaction between diet and gut microbiota. Dietary changes affect gut microbiota and conversely microbiota mediates the generation of dietary factors triggering colon cancer. Identification of the microbial communities associated with carcinogenesis is of crucial importance. Nowadays, with the evolvement of culture-independent molecular techniques, it has become possible to identify main bacterial species in healthy individuals, inflammatory conditions, and CRC. Some recent studies have shown the differences in intestinal microbiota between colon cancer patients and healthy individuals. Animal studies have provided a better understanding of interaction between pathobionts and symbionts in the development of colon cancer. There is no single causative organism identified in CRC; however, there is strong evidence that reduction of protective bacteria, increase in some bacteria (ie, fusobacterium members; Bacteroides/Prevotella), and age-related changes in microbiota have an impact on adenoma or cancer development. Future studies will enable us to understand procarcinogenic and anticarcinogenic mechanisms and give insights to rational manipulation of the microbiota with prebiotics, probiotics, or dietary modifications.

RNomics and Modomics in the halophilic archaea Haloferax volcanii: identification of RNA modification genes

PubMed Central

Grosjean, Henri; Gaspin, Christine; Marck, Christian; Decatur, Wayne A; de Crécy-Lagard, Valérie

2008-01-01

Background Naturally occurring RNAs contain numerous enzymatically altered nucleosides. Differences in RNA populations (RNomics) and pattern of RNA modifications (Modomics) depends on the organism analyzed and are two of the criteria that distinguish the three kingdoms of life. If the genomic sequences of the RNA molecules can be derived from whole genome sequence information, the modification profile cannot and requires or direct sequencing of the RNAs or predictive methods base on the presence or absence of the modifications genes. Results By employing a comparative genomics approach, we predicted almost all of the genes coding for the t+rRNA modification enzymes in the mesophilic moderate halophile Haloferax volcanii. These encode both guide RNAs and enzymes. Some are orthologous to previously identified genes in Archaea, Bacteria or in Saccharomyces cerevisiae, but several are original predictions. Conclusion The number of modifications in t+rRNAs in the halophilic archaeon is surprisingly low when compared with other Archaea or Bacteria, particularly the hyperthermophilic organisms. This may result from the specific lifestyle of halophiles that require high intracellular salt concentration for survival. This salt content could allow RNA to maintain its functional structural integrity with fewer modifications. We predict that the few modifications present must be particularly important for decoding, accuracy of translation or are modifications that cannot be functionally replaced by the electrostatic interactions provided by the surrounding salt-ions. This analysis also guides future experimental validation work aiming to complete the understanding of the function of RNA modifications in Archaeal translation. PMID:18844986

Obesity Prevention and Treatment in Primary Care.

PubMed

Brown, Callie L; Perrin, Eliana M

2018-05-28

Despite many public health and clinical interventions, obesity rates remain high and evidence-based preventive strategies are elusive. Many consensus guidelines suggest providers should screen all children after age 2 for obesity by measuring height and weight, calculating body mass index (BMI), and sensitively communicating weight status in the context of health to the family at each visit. However, preventive counseling should begin in infancy and focus on healthy feeding, activity, and family lifestyle behaviors. For children with overweight or obesity, the American Academy of Pediatrics outlined four stages of treatment. 1) Primary care providers should offer "Prevention Plus," the use of motivational interviewing to achieve healthy lifestyle modifications in family behaviors or environments. 2) Children requiring the next level of obesity treatment, "structured weight management," require additional support beyond the primary care provider (such as a dietitian, physical therapist, or mental health counselor) and more structured goal setting with the team including providers adept at weight management counseling. 3) Children with severe obesity and motivated families may benefit from a referral to a "comprehensive multidisciplinary intervention," such as an obesity treatment clinic. 4) "Tertiary care interventions" occur in a multidisciplinary pediatric obesity treatment clinic with standard clinical protocols for evaluation of interventions, including medications and surgery. While it is certainly a challenge for providers to fit all the desired prevention and treatment counseling during preventive health visits, by beginning to provide anticipatory guidance at birth, providers can respond to parental questions, add to parents' knowledge base, and partner with parents and children and adolescents to help them grow up healthy. This is especially important in an increasingly toxic food environment with many incentives and messages to eat unhealthfully, barriers to appropriate physical activity, and concomitant stigma about obesity. Focusing on key nutrition and physical activity habits, and establishing these healthy behaviors at an early age, will allow children to develop a healthy growth trajectory. Much more work is required, however, to determine the best evidence-based practices for providers to counsel families on improving target behaviors, environmental modifications, and parenting skills and to decrease abundant disparities in obesity prevalence and treatment. Copyright © 2018 Elsevier Ltd. All rights reserved.

Genetic Predisposition to Weight Loss and Regain With Lifestyle Intervention: Analyses From the Diabetes Prevention Program and the Look AHEAD Randomized Controlled Trials.

PubMed

Papandonatos, George D; Pan, Qing; Pajewski, Nicholas M; Delahanty, Linda M; Peter, Inga; Erar, Bahar; Ahmad, Shafqat; Harden, Maegan; Chen, Ling; Fontanillas, Pierre; Wagenknecht, Lynne E; Kahn, Steven E; Wing, Rena R; Jablonski, Kathleen A; Huggins, Gordon S; Knowler, William C; Florez, Jose C; McCaffery, Jeanne M; Franks, Paul W

2015-12-01

Clinically relevant weight loss is achievable through lifestyle modification, but unintentional weight regain is common. We investigated whether recently discovered genetic variants affect weight loss and/or weight regain during behavioral intervention. Participants at high-risk of type 2 diabetes (Diabetes Prevention Program [DPP]; N = 917/907 intervention/comparison) or with type 2 diabetes (Look AHEAD [Action for Health in Diabetes]; N = 2,014/1,892 intervention/comparison) were from two parallel arm (lifestyle vs. comparison) randomized controlled trials. The associations of 91 established obesity-predisposing loci with weight loss across 4 years and with weight regain across years 2-4 after a minimum of 3% weight loss were tested. Each copy of the minor G allele of MTIF3 rs1885988 was consistently associated with greater weight loss following lifestyle intervention over 4 years across the DPP and Look AHEAD. No such effect was observed across comparison arms, leading to a nominally significant single nucleotide polymorphism×treatment interaction (P = 4.3 × 10(-3)). However, this effect was not significant at a study-wise significance level (Bonferroni threshold P < 5.8 × 10(-4)). Most obesity-predisposing gene variants were not associated with weight loss or regain within the DPP and Look AHEAD trials, directly or via interactions with lifestyle. © 2015 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered.

Effectiveness of a worksite mindfulness-based multi-component intervention on lifestyle behaviors

PubMed Central

2014-01-01

Introduction Overweight and obesity are associated with an increased risk of morbidity. Mindfulness training could be an effective strategy to optimize lifestyle behaviors related to body weight gain. The aim of this study was to evaluate the effectiveness of a worksite mindfulness-based multi-component intervention on vigorous physical activity in leisure time, sedentary behavior at work, fruit intake and determinants of these behaviors. The control group received information on existing lifestyle behavior- related facilities that were already available at the worksite. Methods In a randomized controlled trial design (n = 257), 129 workers received a mindfulness training, followed by e-coaching, lunch walking routes and fruit. Outcome measures were assessed at baseline and after 6 and 12 months using questionnaires. Physical activity was also measured using accelerometers. Effects were analyzed using linear mixed effect models according to the intention-to-treat principle. Linear regression models (complete case analyses) were used as sensitivity analyses. Results There were no significant differences in lifestyle behaviors and determinants of these behaviors between the intervention and control group after 6 or 12 months. The sensitivity analyses showed effect modification for gender in sedentary behavior at work at 6-month follow-up, although the main analyses did not. Conclusions This study did not show an effect of a worksite mindfulness-based multi-component intervention on lifestyle behaviors and behavioral determinants after 6 and 12 months. The effectiveness of a worksite mindfulness-based multi-component intervention as a health promotion intervention for all workers could not be established. PMID:24467802

Role of illness perception and self-efficacy in lifestyle modification among non-alcoholic fatty liver disease patients.

PubMed

Zelber-Sagi, Shira; Bord, Shiran; Dror-Lavi, Gali; Smith, Matthew Lee; Towne, Samuel D; Buch, Assaf; Webb, Muriel; Yeshua, Hanny; Nimer, Assy; Shibolet, Oren

2017-03-14

To describe the relationships between non-alcoholic fatty-liver disease (NAFLD) patient's disease consequences and treatment perceptions, self-efficacy, and healthy lifestyle maintenance. A cross-sectional study among 146 ultrasound diagnosed NAFLD patients who visited the fatty liver clinic at the Tel-Aviv Medical Center. Eighty-seven of these individuals, participated in a clinical trial of physical activity and underwent fasting blood tests, analyzed at the same lab. Exclusion criteria included positivity for serum HBsAg or anti-HCV antibodies; fatty liver suspected to be secondary to hepatotoxic drugs; excessive alcohol consumption (≥ 30 g/d in men or ≥ 20 g/d in women) and positive markers of genetic or immune-mediated liver diseases. Patients were asked to complete a self-report structured questionnaire, assembled by the Israeli Center for Disease Control. Nutrition habits were measured using six yes/no questions (0 = no, 1 = yes) adopted from the national survey questionnaire. Participants in the clinical trial completed a detailed semi-quantitative food frequency questionnaire (FFQ) reporting their habitual nutritional intake during the past year. Self-efficacy was assessed by the Self-Efficacy Scale questionnaire, emotional representation, degree of illness understanding, timeline perception, treatment perception and symptoms were measured by the Brief Illness Perception questionnaire. Illness consequences were measured by the Personal Models of Diabetes Interview questionnaire. A path analysis was performed to describe the interrelationships between the patients' illness perceptions, and assess the extent to which the data fit a prediction of nutritional habits. The study sample included 54.1% men, with a mean age of 47.76 ± 11.68 years (range: 20-60) and mean body mass index of 31.56 ± 4.6. The average perceived nutrition habits score was 4.73 ± 1.45 on a scale between 0-6, where 6 represents the healthiest eating habits. Most of the study participants (57.2%) did not feel they fully understood what NAFLD is. Better nutritional habits were positively predicted by the degree of illness understanding (β = 0.26; P = 0.002) and self-efficacy (β = 0.25; P = 0.003). Perceptions of more severe illness consequences were related with higher emotional representation (β = 0.55; P < 0.001), which was related with lower self-efficacy (β = -0.17; P = 0.034). The perception of treatment effectiveness was positively related with self-efficacy (β = 0.32; P < 0.001). In accordance with the correlation between self-efficacy and the perceived nutrition habits score, self-efficacy was also correlated with nutrient intake evaluated by the FFQ; negatively with saturated fat (percent of saturated fat calories from total calories) (r = -0.28, P = 0.010) and positively with fiber (r = 0.22, P = 0.047) and vitamin C intake (r = 0.34, P = 0.002). In a sub analysis of the clinical trial participants, objectively measured compliance to physical activity regimen was positively correlated with the self-efficacy level (r = 0.34, P = 0.046). Self-efficacy and illness understanding are major determinants of lifestyle-modification among NAFLD patients. This information can assist clinicians in improving compliance with lifestyle changes among these patients.

Cluster randomised controlled trial of a peer-led lifestyle intervention program: study protocol for the Kerala diabetes prevention program

PubMed Central

2013-01-01

Background India currently has more than 60 million people with Type 2 Diabetes Mellitus (T2DM) and this is predicted to increase by nearly two-thirds by 2030. While management of those with T2DM is important, preventing or delaying the onset of the disease, especially in those individuals at ‘high risk’ of developing T2DM, is urgently needed, particularly in resource-constrained settings. This paper describes the protocol for a cluster randomised controlled trial of a peer-led lifestyle intervention program to prevent diabetes in Kerala, India. Methods/design A total of 60 polling booths are randomised to the intervention arm or control arm in rural Kerala, India. Data collection is conducted in two steps. Step 1 (Home screening): Participants aged 30–60 years are administered a screening questionnaire. Those having no history of T2DM and other chronic illnesses with an Indian Diabetes Risk Score value of ≥60 are invited to attend a mobile clinic (Step 2). At the mobile clinic, participants complete questionnaires, undergo physical measurements, and provide blood samples for biochemical analysis. Participants identified with T2DM at Step 2 are excluded from further study participation. Participants in the control arm are provided with a health education booklet containing information on symptoms, complications, and risk factors of T2DM with the recommended levels for primary prevention. Participants in the intervention arm receive: (1) eleven peer-led small group sessions to motivate, guide and support in planning, initiation and maintenance of lifestyle changes; (2) two diabetes prevention education sessions led by experts to raise awareness on T2DM risk factors, prevention and management; (3) a participant handbook containing information primarily on peer support and its role in assisting with lifestyle modification; (4) a participant workbook to guide self-monitoring of lifestyle behaviours, goal setting and goal review; (5) the health education booklet that is given to the control arm. Follow-up assessments are conducted at 12 and 24 months. The primary outcome is incidence of T2DM. Secondary outcomes include behavioural, psychosocial, clinical, and biochemical measures. An economic evaluation is planned. Discussion Results from this trial will contribute to improved policy and practice regarding lifestyle intervention programs to prevent diabetes in India and other resource-constrained settings. Trial registration Australia and New Zealand Clinical Trials Registry: ACTRN12611000262909. PMID:24180316

Community-based randomized controlled trial of diabetes prevention study for high-risk individuals of type 2 diabetes: lifestyle intervention using web-based system.

PubMed

Cha, Seon-Ah; Lim, Sun-Young; Kim, Kook-Rye; Lee, Eun-Young; Kang, Borami; Choi, Yoon-Hee; Yoon, Kun-Ho; Ahn, Yu-Bae; Lee, Jin-Hee; Ko, Seung-Hyun

2017-05-05

The trend of increasing numbers of patients with type 2 diabetes emphasizes the need for active screening of high-risk individuals and intensive lifestyle modification (LSM). The community-based Korean Diabetes Prevention Study (C-KDPS) is a randomized controlled clinical trial to prevent type 2 diabetes by intensive LSM using a web-based program. The two public healthcare centers in Korea are involved, and 420 subjects are being recruited for 6 months and will be followed up for 22 months. The participants are allocated randomly to intensive LSM (18 individual sessions for 24 weeks) and usual care (control group). The major goals of the C-KDPS lifestyle intervention program are: 1) a minimum of 5-7% loss of initial body weight in 6 months and maintenance of this weight loss, 2) increased physical activity (≥ 150 min/week of moderate intensity activity), 3) balanced healthy eating, and 4) quitting smoking and alcohol with stress management. The web-based program includes education contents, video files, visit schedules, and inter-communicable keeping track sites. Primary outcomes are the diagnoses of newly developed diabetes. A 75-g oral glucose tolerance test with hemoglobin A1c level determination and cardiovascular risk factor assessment is scheduled at 6, 12, 18, and 22 months. Active screening of high-risk individuals and an effective LSM program are an essential prerequisite for successful diabetes prevention. We hope that our C-KDPS program can reduce the incidence of newly developed type 2 diabetes and be implemented throughout the country, merging community-based public healthcare resources and a web-based system. Clinical Research Information Service (CRIS), Republic of Korea (No. KCT0001981 ). Date of registration; July 28, 2016.

Effects of a Multicomponent Life-Style Intervention on Weight, Glycemic Control, Depressive Symptoms, and Renal Function in Low-Income, Minority Patients With Type 2 Diabetes: Results of the Community Approach to Lifestyle Modification for Diabetes Randomized Controlled Trial.

PubMed

Moncrieft, Ashley E; Llabre, Maria M; McCalla, Judith Rey; Gutt, Miriam; Mendez, Armando J; Gellman, Marc D; Goldberg, Ronald B; Schneiderman, Neil

2016-09-01

Few interventions have combined life-style and psychosocial approaches in the context of Type 2 diabetes management. The purpose of this study was to determine the effect of a multicomponent behavioral intervention on weight, glycemic control, renal function, and depressive symptoms in a sample of overweight/obese adults with Type 2 diabetes and marked depressive symptoms. A sample of 111 adults with Type 2 diabetes were randomly assigned to a 1-year intervention (n = 57) or usual care (n = 54) in a parallel groups design. Primary outcomes included weight, glycosylated hemoglobin, and Beck Depression Inventory II score. Estimated glomerular filtration rate served as a secondary outcome. All measures were assessed at baseline and 6 and 12 months after randomization by assessors blind to randomization. Latent growth modeling was used to examine intervention effects on each outcome. The intervention resulted in decreased weight (mean [M] = 0.322 kg, standard error [SE] = 0.124 kg, p = .010) and glycosylated hemoglobin (M = 0.066%, SE = 0.028%, p = .017), and Beck Depression Inventory II scores (M = 1.009, SE = 0.226, p < .001), and improved estimated glomerular filtration rate (M = 0.742 ml·min·1.73 m, SE = 0.318 ml·min·1.73 m, p = .020) each month during the first 6 months relative to usual care. Multicomponent behavioral interventions targeting weight loss and depressive symptoms as well as diet and physical activity are efficacious in the management of Type 2 diabetes. This study is registered at Clinicaltrials.gov ID: NCT01739205.

Relationship between socioeconomic and lifestyle factors and cataracts in Koreans: the Korea National Health and Nutrition Examination Survey 2008-2011.

PubMed

Nam, G E; Han, K; Ha, S G; Han, B-D; Kim, D H; Kim, Y-H; Cho, K H; Park, Y G; Ko, B-J

2015-07-01

Cataracts are the leading cause of visual impairment and blindness, and therefore early identification and modification of the risk factors for cataracts are meaningful. This study aimed to investigate the relationship between socioeconomic status (SES) and lifestyle factors, and age-related cataracts in South Korea. This cross-sectional study was based on data collected in the 2008-2011 Korea National Health and Nutrition Examination Survey. A total of 15 866 subjects, aged ≥40 years, were included. SES was defined using household income and education level. Sociodemographic, lifestyle, and other associated factors were assessed by health interviews and examinations. Cataracts were diagnosed via slit-lamp examination using the Lens Opacities Classification System III. The prevalence of any cataract was 38.9% in men and 42.3% in women (P<0.001). In women, the risk of cataracts increased with decreases in household income (P-value for trend=0.016 and 0.041 in any, and cortical cataract, respectively) and education level (P-value for trend=0.009, 0.027, and 0.016 in any, nuclear, and cortical cataract, respectively) after adjusting for confounding factors. Current smoking was correlated with nuclear cataracts in men (OR 1.21; 95% CI: 1.00, 1.46 in age-adjusted analysis) and cataract surgery in women (OR 2.25; 95% CI: 1.00, 5.04 in multivariate-adjusted analysis). Socioeconomic disparities in cataract prevalence were observed in women; current smoking increased the risk of nuclear cataracts in men and surgery in women. Public health interventions focusing on gender differences are warranted to prevent and treat cataracts.

Psychosocial risk factors in relation to other cardiovascular risk factors in coronary heart disease: Results from the EUROASPIRE IV survey. A registry from the European Society of Cardiology.

PubMed

Pogosova, Nana; Kotseva, Kornelia; De Bacquer, Dirk; von Känel, Roland; De Smedt, Delphine; Bruthans, Jan; Dolzhenko, Maryna

2017-09-01

Background Depression and anxiety are established psychosocial risk factors for coronary heart disease. Contemporary data on their prevalence and associations with other risk factors were evaluated as part of the EUROASPIRE IV survey. Design The design of this study was cross-sectional. Methods The study group consisted of 7589 patients from 24 European countries examined at a median of 1.4 years after hospitalisation due to coronary heart disease events. Depression and anxiety were assessed using the Hospital Anxiety and Depression Scale. Results Symptoms of anxiety (Hospital Anxiety and Depression Scale-Anxiety score ≥8) were seen in 26.3% of participants and were more prevalent in women (39.4%) vs men (22.1%). Of the patients, 22.4% (30.6% of women and 19.8% of men) had symptoms of depression (Hospital Anxiety and Depression Scale-Depression score ≥8). Nevertheless, antidepressants and anti-anxiety medications were prescribed to only 2.4% of patients at hospital discharge, and 2.7% and 5.0% of patients, respectively, continued to take them at interview. Both anxiety and depression were associated with female gender, lower educational level and more sedentary lifestyle. Anxiety was more prevalent in younger age groups and depression rates increased with advancing age. Depression was positively associated with current smoking, central obesity and self-reported diabetes. A number of positive lifestyle changes reduced the odds of anxiety and depression. Conclusions A substantial proportion of patients have anxiety and depression symptoms after coronary heart disease events but these conditions are undertreated. These disorders, especially depression, are associated with other risk factors, including educational level, sedentary lifestyle, smoking, unhealthy diet and reduced compliance with risk factor modification.

Beating Diabetes Together: A Mixed-Methods Analysis of a Feasibility Study of Intensive Lifestyle Intervention for Youth with Type 2 Diabetes.

PubMed

Huynh, Elizabeth; Rand, Danielle; McNeill, Caitlin; Brown, Sarah; Senechal, Martin; Wicklow, Brandy; Dart, Allison; Sellers, Elizabeth; Dean, Heather; Blydt-Hansen, Tom; McGavock, Jonathan

2015-12-01

The purpose of this study was to assess the feasibility and lived experiences of an intensive group-based lifestyle intervention for youth with type 2 diabetes (Beating Diabetes Together) (BDT). The study included 12 Indigenous youth with type 2 diabetes (mean age, 14 years; n=9 girls); they participated in a 16-week pilot study of an intensive, group-based lifestyle intervention. We conducted a mixed-methods investigation of the cardiometabolic responses and lived experiences in the intervention. Of the 12 youth with cardiometabolic risk data, 5 youth and 2 mothers participated in semistructured interviews. Interview participants were purposely selected based on the frequency of attendance and availability. The intervention was well attended (>75% retention), and youth perceived significant benefits from participation. Thematic analysis of the interviews revealed 3 major themes. First, youth and parents described living with type 2 diabetes as being emotionally challenging. They described this experience as being isolating and connected to feelings of guilt and defeat. Second, youth and parents discussed benefits of participating in BDT. They shared the significance of positive relationships and experiences and how those have helped to manage their illness. Third, youth described the aspects that they most enjoyed at BDT. Peer support was an important determinant of physical activity, but they considered dietary changes to be individual behaviours. Glycemic control, blood pressure and anthropometric measures were not different following the intervention. Our findings support the importance of maintaining an inclusive environment and relationship building when designing strategies to promote behaviour modification for Indigenous youth living with type 2 diabetes. Copyright © 2015 Canadian Diabetes Association. Published by Elsevier Inc. All rights reserved.

Successful mental health aging: results from a longitudinal study of older Australian men.

PubMed

Almeida, Osvaldo P; Norman, Paul; Hankey, Graeme; Jamrozik, Konrad; Flicker, Leon

2006-01-01

The authors investigated the associations of medical and lifestyle factors with the mental health of men in their 80s. This was a prospective study of a community-representative cohort of older men. Successful mental health aging was defined as reaching age 80 years with Mini-Mental State Examination score (MMSE) of 24 or more and Geriatric Depression Scale-15 items (GDS-15) score of 5 or less. Of 601 men followed for 4.8 years, 76.0% enjoyed successful mental health aging. Successful mental health aging was inversely associated with age (hazard ratio [HR] = 0.87; 95% confidence interval [CI]: 0.81-0.94), non-English-speaking background (HR = 0.42; 95% CI: 0.21-0.85), and the consumption of full-cream milk (HR = 0.63; 95% CI: 0.45-0.89), and directly associated with high school or university education (HR = 1.92; 95% CI: 1.34-2.75) and vigorous (HR = 1.89; 95% CI: 1.17-3.05) and nonvigorous physical activity (HR = 1.50; 95% CI: 1.05-2.14). Marital status, smoking and alcohol use, weekly consumption of meat or fish, and a medical history of hypercholesterolemia, hypertension, diabetes, myocardial infarction, and stroke were not associated with mental health outcomes in men aged 80 years or over. Three in four men who reach age 80 years undergo successful mental health aging. Factors associated with successful mental health aging include education and lifestyle behaviors such as physical activity. Lifestyle modification by means of increasing physical activity and reducing saturated fat intake may prove to be a safe, inexpensive, and readily available strategy to help maximize the successful mental health aging of the population.

Dapagliflozin (Forxiga) for type 2 diabetes?

PubMed

2013-09-01

In the UK, diabetes mellitus affects around 3 million people, of whom over 90% have type 2 diabetes. Aims of treatment include minimising long-term complications (e.g. cardiovascular disease, blindness, chronic kidney disease, premature mortality) and avoiding unwanted effects of treatment (e.g. severe hypoglycaemia, weight gain). Management of diabetes includes patient support and education; addressing symptoms; lifestyle modification; targeting associated risk factors for cardiovascular disease; and surveillance for, and management of, complications including treatment-related hypoglycaemia. Dapagliflozin (Forxiga) belongs to a new class of oral glucose-lowering drugs that inhibit renal glucose reabsorption and promote glycosuria. It is licensed in the UK in adults with type 2 diabetes as monotherapy when diet and exercise alone do not provide adequate glycaemic control and who are unable to tolerate metformin; or, as add-on therapy, with other glucose-lowering agents including insulin, when these, with diet and exercise, do not provide adequate glycaemic control. The company's advertising materials claim that dapagliflozin provides a "novel method of controlling excess glucose" with "secondary benefit of weight loss". Here, we review the evidence for the use of dapagliflozin in the management of type 2 diabetes mellitus.

Household Air Pollution Exposure and Influence of Lifestyle on Respiratory Health and Lung Function in Belizean Adults and Children: A Field Study.

PubMed

Kurti, Stephanie P; Kurti, Allison N; Emerson, Sam R; Rosenkranz, Richard R; Smith, Joshua R; Harms, Craig A; Rosenkranz, Sara K

2016-06-28

Household air pollution (HAP) contributes to the global burden of disease. Our primary purpose was to determine whether HAP exposure was associated with reduced lung function and respiratory and non-respiratory symptoms in Belizean adults and children. Our secondary purpose was to investigate whether lifestyle (physical activity (PA) and fruit and vegetable consumption (FV)) is associated with reported symptoms. Belizean adults (n = 67, 19 Male) and children (n = 23, 6 Male) from San Ignacio Belize and surrounding areas participated in this cross-sectional study. Data collection took place at free walk-in clinics. Investigators performed initial screenings and administered questionnaires on (1) sources of HAP exposure; (2) reported respiratory and non-respiratory symptoms and (3) validated lifestyle questionnaires. Participants then performed pulmonary function tests (PFTs) and exhaled breath carbon monoxide (CO). There were no significant associations between HAP exposure and pulmonary function in adults. Increased exhaled CO was associated with a significantly lower forced expiratory volume in 1-s divided by forced vital capacity (FEV₁/FVC) in children. Exposed adults experienced headaches, burning eyes, wheezing and phlegm production more frequently than unexposed adults. Adults who met PA guidelines were less likely to experience tightness and pressure in the chest compared to those not meeting guidelines. In conclusion, adults exposed to HAP experienced greater respiratory and non-respiratory symptoms, which may be attenuated by lifestyle modifications.

Anti-inflammatory properties of blended edible oil with synergistic antioxidants.

PubMed

Upadya, Haridas; Devaraju, C J; Joshi, Shashank R

2015-01-01

Blending of oil combines the potency of two edible oils and offers a balance of fatty acids. Various cooking preparations existing across different ethnicities and regions subject oil to different cooking temperatures thereby causing deterioration of the oil due to oxidative stress. In order to prevent the oxidative damage of unsaturated fatty acid, a blend of rice bran oil (RBO) and safflower oil (SO) (70:30) with an antioxidant technology was designed. A controlled trial was carried out to assess the efficacy of the blend on different biomarkers including lipid parameters and some important inflammatory markers that have the potency to lead to various lifestyle diseases. A prospective, double-blind, randomized, parallel group study (on 80 adult hyperlipidemic patients) was conducted for 3 months. During the study, all the subjects were recommended lifestyle modifications, which included, exercise regime and diet counseling; oil quantity consumed was 1 L/person/month for both the groups. The subjects were divided into two groups; one group, continued with their regularly consumed oil whereas, the other was given the test oil. Biomarkers assessed were lipid profile and seven other inflammatory markers were assessed. Low-density lipoprotein cholesterol (LDL-C) the primary marker for cardiovascular diseases showed a decrease of 56.07 ± 04.31 mg/dL and 31.98 ± 03.81 mg/dL (P < 0.001 by analysis of variance [ANOVA]) from baseline in test and control group, respectively, during 3 months. Similar reduction trends were observed for total cholesterol where -52.31 ± 13.04 mg/dL and 31.98 ± 04.12 mg/dL (P < 0.001 by ANOVA, between the groups) were seen in test and control group, respectively. Oxidized LDL and high sensitivity C-reactive protein showed a reduction of 2.23 ± 1.3 units/dL and 0.87 ± 2.85 mg/L in test group whereas; an increase of 1.04 ± 1.73 units/dL and 0.44 ± 2.37 mg/L was seen in the control group, respectively (P < 0.05 by Student's t-test, between the groups). The study showed that the blend of RBO and SO with antioxidant technology along with other lifestyle changes helps lowering of blood lipids and stated inflammatory biomarkers and thus, in turn may help prevent lifestyle diseases.

Anti-inflammatory properties of blended edible oil with synergistic antioxidants

PubMed Central

Upadya, Haridas; Devaraju, C. J.; Joshi, Shashank R.

2015-01-01

Background: Blending of oil combines the potency of two edible oils and offers a balance of fatty acids. Various cooking preparations existing across different ethnicities and regions subject oil to different cooking temperatures thereby causing deterioration of the oil due to oxidative stress. In order to prevent the oxidative damage of unsaturated fatty acid, a blend of rice bran oil (RBO) and safflower oil (SO) (70:30) with an antioxidant technology was designed. A controlled trial was carried out to assess the efficacy of the blend on different biomarkers including lipid parameters and some important inflammatory markers that have the potency to lead to various lifestyle diseases. Study Design: A prospective, double-blind, randomized, parallel group study (on 80 adult hyperlipidemic patients) was conducted for 3 months. During the study, all the subjects were recommended lifestyle modifications, which included, exercise regime and diet counseling; oil quantity consumed was 1 L/person/month for both the groups. The subjects were divided into two groups; one group, continued with their regularly consumed oil whereas, the other was given the test oil. Biomarkers assessed were lipid profile and seven other inflammatory markers were assessed. Results: Low-density lipoprotein cholesterol (LDL-C) the primary marker for cardiovascular diseases showed a decrease of 56.07 ± 04.31 mg/dL and 31.98 ± 03.81 mg/dL (P < 0.001 by analysis of variance [ANOVA]) from baseline in test and control group, respectively, during 3 months. Similar reduction trends were observed for total cholesterol where −52.31 ± 13.04 mg/dL and 31.98 ± 04.12 mg/dL (P < 0.001 by ANOVA, between the groups) were seen in test and control group, respectively. Oxidized LDL and high sensitivity C-reactive protein showed a reduction of 2.23 ± 1.3 units/dL and 0.87 ± 2.85 mg/L in test group whereas; an increase of 1.04 ± 1.73 units/dL and 0.44 ± 2.37 mg/L was seen in the control group, respectively (P < 0.05 by Student's t-test, between the groups). Conclusion: The study showed that the blend of RBO and SO with antioxidant technology along with other lifestyle changes helps lowering of blood lipids and stated inflammatory biomarkers and thus, in turn may help prevent lifestyle diseases. PMID:26180768

Dietary habits and obesity indices in patients with gastro-esophageal reflux disease: a comparative cross-sectional study.

PubMed

Eslami, Omid; Shahraki, Mansour; Bahari, Ali; Shahraki, Touran

2017-11-28

Gastro-esophageal reflux disease (GERD) is suggested to be associated with some socio-demographic and lifestyle factors. Although the roles of some factors such as obesity are well documented, evidence on the impact of other factors such as dietary habits are still inconclusive. The aim of this study was to determine the relationship between socio-demographic and lifestyle factors with GERD in participants referred to a teaching hospital in Zahedan, South-East of Iran. This comparative cross-sectional study was conducted during 2014-2015. All patients completed a structured questionnaire regarding information on socio-demographic status, lifestyle factors and dietary habits. Anthropometric indices including body mass index (BMI) and waist circumference (WC) were used to determine general and central obesity, respectively. Data were analyzed using SPSS software version 22. Value of p < 0.05 was considered as statistically significant. Five hundred and five participants, including 285 GERD and 220 Non-GERD participants participated in the study. In univariate analysis, being married (OR = 1.57, 95%CI = 1.04, 2.36), general obesity (OR = 1.77, 95%CI = 1.11, 2.81), central obesity (OR = 2.09, 95%CI = 1.46,3.01) and consumption of citrus fruits between meals (OR = 1.69, 95%CI = 1.04, 2.73) were associated with higher odds of GERD, while higher educational level (OR = 0.53, 95%CI = 0.36,0.77) and regular physical activity ≥2 h/week (OR = 0.53, 95%CI = 0.30, 0.94) were associated with lower odds of GERD. In the adjusted model, central obesity (OR = 1.88, 95%CI = 1.18, 3.01) and consumption of citrus fruits between meals (OR = 2.22, 95%CI = 1.30, 3.81) were positively associated with odds of GERD, while higher educational level (OR = 0.55, 95%CI = 0.33, 0.91) was associated with decreased odds of GERD. According to the results of the current study, central obesity as determined by WC and citrus fruit intake were independent factors associated with GERD. Therefore, lifestyle modification might have a positive effect in the treatment of GERD in an urban population of Iran.

Outcome of coronary plaque burden: a 10-year follow-up of aggressive medical management.

PubMed

Goh, Victor K; Lau, Chu-Pak; Mohlenkamp, Stefan; Rumberger, John A; Achenbach, Stephan; Budoff, Matthew J

2010-03-12

The effect of aggressive medical therapy on quantitative coronary plaque burden is not generally known, especially in ethnic Chinese. We reasoned that Cardiac CT could conveniently quantify early coronary atherosclerosis in our patient population, and hypothesized that serial observation could differentiate the efficacy of aggressive medical therapy regarding progression and regression of the atherosclerotic process, as well as evaluating the additional impact of life-style modification and the relative effects of the application of statin therapy. We employed a standardized Cardiac CT protocol to serially scan 113 westernized Hong Kong Chinese individuals (64 men and 49 women) with Chest Pain and positive coronary risk factors. In all cases included for this serial investigation, subsequent evaluation showed no significantly-obstructive coronary disease by functional studies and angiography. After stringent risk factor modification, including aggressive statin therapy to achieve LDL-cholesterol lowering conforming to N.C.E.P. ATP III guidelines, serial CT scans were performed 1-12 years apart for changes in coronary artery calcification (CAC), using the Agatston Score (AS) for quantification. At baseline, the mean AS was 1413.6 for males (mean age 54.4 years) and 2293.3 for females (mean age 62.4 years). The average increase of AS in the entire study population was 24% per year, contrasting with 16.4% per year on strict risk factor modification plus statin therapy, as opposed to 33.2% per year for historical control patients (p < 0.001). Additionally, 20.4% of the 113 patients demonstrated decreasing calcium scores. Medical therapy also yielded a remarkably low adverse event rate during the follow-up period --- 2 deaths, 2 strokes and only 1 case requiring PCI. This study revealed that aggressive medical therapy can positively influence coronary plaque aiding in serial regression of calcium scores.

[Dietary modification in hypertensives].

PubMed

Berg, A; Kloock, B; König, D

2006-11-23

Successful treatment of hypertension requires a holistic approach. In this connection, focusing on a healthy lifestyle, eating, drinking and consumption behavior and, finally, the quality of foodstuffs and the exercise habits of the patient represents an essential supplement to the classical forms of pharmaceutical treatment. The major dietary-physiological factors have been shown to be weight reduction, the monitoring of salt consumption, appropriate intake of fiber, a preference for vegetables, and a reduction of immoderate alcohol consumption.

The Influence of Smoking on Disability Following Hospitalization for Musculoskeletal Disorders

DTIC Science & Technology

1998-01-01

Physical Medicine and Rehabilitation . 1998 ;79:366-374. Winslow E, Bohannon N, Brunton SA, Mayhew HE. Lifestyle modification: weight control, exercise ...penetrates only its peripheral 10-25%. Thus, smoking’s effect of reducing blood flow may further limit the supply of nutrients to the damaged tissue. This...eliminated during cardiac, stroke, and other types of rehabilitation , it is not yet considered as a risk factor for unsuccessful rehabilitation

PREVIEW Behavior Modification Intervention Toolbox (PREMIT): A Study Protocol for a Psychological Element of a Multicenter Project.

PubMed

Kahlert, Daniela; Unyi-Reicherz, Annelie; Stratton, Gareth; Meinert Larsen, Thomas; Fogelholm, Mikael; Raben, Anne; Schlicht, Wolfgang

2016-01-01

Losing excess body weight and preventing weight regain by changing lifestyle is a challenging but promising task to prevent the incidence of type-2 diabetes. To be successful, it is necessary to use evidence-based and theory-driven interventions, which also contribute to the science of behavior modification by providing a deeper understanding of successful intervention components. To develop a physical activity and dietary behavior modification intervention toolbox (PREMIT) that fulfills current requirements of being theory-driven and evidence-based, comprehensively described and feasible to evaluate. PREMIT is part of an intervention trial, which aims to prevent the onset of type-2 diabetes in pre-diabetics in eight clinical centers across the world by guiding them in changing their physical activity and dietary behavior through a group counseling approach. The program development took five progressive steps, in line with the Public Health Action Cycle: (1) Summing-up the intervention goal(s), target group and the setting, (2) uncovering the generative psychological mechanisms, (3) identifying behavior change techniques and tools, (4) preparing for evaluation and (5) implementing the intervention and assuring quality. PREMIT is based on a trans-theoretical approach referring to valid behavior modification theories, models and approaches. A major "product" of PREMIT is a matrix, constructed for use by onsite-instructors. The matrix includes objectives, tasks and activities ordered by periods. PREMIT is constructed to help instructors guide participants' behavior change. To ensure high fidelity and adherence of program-implementation across the eight intervention centers standardized operational procedures were defined and "train-the-trainer" workshops were held. In summary PREMIT is a theory-driven, evidence-based program carefully developed to change physical activity and dietary behaviors in pre-diabetic people.

PREVIEW Behavior Modification Intervention Toolbox (PREMIT): A Study Protocol for a Psychological Element of a Multicenter Project

PubMed Central

Kahlert, Daniela; Unyi-Reicherz, Annelie; Stratton, Gareth; Meinert Larsen, Thomas; Fogelholm, Mikael; Raben, Anne; Schlicht, Wolfgang

2016-01-01

Background: Losing excess body weight and preventing weight regain by changing lifestyle is a challenging but promising task to prevent the incidence of type-2 diabetes. To be successful, it is necessary to use evidence-based and theory-driven interventions, which also contribute to the science of behavior modification by providing a deeper understanding of successful intervention components. Objective: To develop a physical activity and dietary behavior modification intervention toolbox (PREMIT) that fulfills current requirements of being theory-driven and evidence-based, comprehensively described and feasible to evaluate. PREMIT is part of an intervention trial, which aims to prevent the onset of type-2 diabetes in pre-diabetics in eight clinical centers across the world by guiding them in changing their physical activity and dietary behavior through a group counseling approach. Methods: The program development took five progressive steps, in line with the Public Health Action Cycle: (1) Summing-up the intervention goal(s), target group and the setting, (2) uncovering the generative psychological mechanisms, (3) identifying behavior change techniques and tools, (4) preparing for evaluation and (5) implementing the intervention and assuring quality. Results: PREMIT is based on a trans-theoretical approach referring to valid behavior modification theories, models and approaches. A major “product” of PREMIT is a matrix, constructed for use by onsite-instructors. The matrix includes objectives, tasks and activities ordered by periods. PREMIT is constructed to help instructors guide participants' behavior change. To ensure high fidelity and adherence of program-implementation across the eight intervention centers standardized operational procedures were defined and “train-the-trainer” workshops were held. In summary PREMIT is a theory-driven, evidence-based program carefully developed to change physical activity and dietary behaviors in pre-diabetic people. PMID:27559319

Critical linkages between land-use transition and human health in the Himalayan region.

PubMed

Xu, Jianchu; Sharma, Rita; Fang, Jing; Xu, Yufen

2008-02-01

This article reviews critical linkages between land-use transition and human health in the Himalayan region by applying ecosystem approaches to human health (or EcoHealth). Land-use transition in the Himalayan and similar regions includes sedentarization, agricultural intensification, habitat modification, migration, change of livelihoods and lifestyles, biodiversity loss, and increasing flash floods. These transitions, which can have impacts on human health, are driven by state policies, a market economy, and climate change. Human health is dependent on access to ecosystem services for food, nutrition, medicine, fiber and shelter, fresh water, and clear air. Ecosystem management has been a key means of controlling disease vectors and creating suitable habitats for human well-being. The paper identifies the web of environmental factors that influence human health. Institutional and policy issues for land-use and health transitions are also discussed.

[Public health conceptual models and paradigms].

PubMed

Hernández-Girón, Carlos; Orozco-Núñez, Emanuel; Arredondo-López, Armando

2012-01-01

The epidemiological transition model proposed by Omhran at the beginning of the 1970s (decreased fecundity rate and increased life expectancy), together with modifications in lifestyles and diet, showed increased mortality due to chronically degenerative causes. This essay thus discusses and makes a comparative analysis of some currents of thought, taking as its common thread an analysis of epidemiological change identified in different eras or stages and relationships with some public health models or conceptual frameworks. Discussing public health paradigms leads to a historical recapitulation of conceptual models ranging from magical-religious conceptions to ecological and socio-medical models. M. Susser proposed 3 eras in this discipline's evolution in his speech on the future of the epidemiology. The epidemiological changes analysed through different approaches constitute elements of analysis that all models discussed in this essay include to delimit the contributions and variables so determining them.

The effectiveness of a life style modification and peer support home blood pressure monitoring in control of hypertension: protocol for a cluster randomized controlled trial.

PubMed

Su, Tin Tin; Majid, Hazreen Abdul; Nahar, Azmi Mohamed; Azizan, Nurul Ain; Hairi, Farizah Mohd; Thangiah, Nithiah; Dahlui, Maznah; Bulgiba, Awang; Murray, Liam J

2014-01-01

Death rates due to hypertension in low and middle income countries are higher compared to high income countries. The present study is designed to combine life style modification and home blood pressure monitoring for control of hypertension in the context of low and middle income countries. The study is a two armed, parallel group, un-blinded, cluster randomized controlled trial undertaken within lower income areas in Kuala Lumpur. Two housing complexes will be assigned to the intervention group and the other two housing complexes will be allocated in the control group. Based on power analysis, 320 participants will be recruited. The participants in the intervention group (n = 160) will undergo three main components in the intervention which are the peer support for home blood pressure monitoring, face to face health coaching on healthy diet and demonstration and training for indoor home based exercise activities while the control group will receive a pamphlet containing information on hypertension. The primary outcomes are systolic and diastolic blood pressure. Secondary outcome measures include practice of self-blood pressure monitoring, dietary intake, level of physical activity and physical fitness. The present study will evaluate the effect of lifestyle modification and peer support home blood pressure monitoring on blood pressure control, during a 6 month intervention period. Moreover, the study aims to assess whether these effects can be sustainable more than six months after the intervention has ended.

"Sedentary" Homeless Children in S. Paulo, Brazil: Their Houses, Their Families, Their Lifestyles.

ERIC Educational Resources Information Center

Rabinovich, Elaine Pedreira

This study examined the lifestyle of children from a sedentary grouping of 20 homeless families living under a viaduct in Sao Paulo, Brazil. The study particularly focused on issues related to this lifestyle, including dimensions of housing and cultural variations in housing related to child development and child rearing. The lifestyle of the…

Do advertisements for antihypertensive drugs in Australia promote quality prescribing? A cross-sectional study.

PubMed

Montgomery, Brett D; Mansfield, Peter R; Spurling, Geoffrey K; Ward, Alison M

2008-05-20

Antihypertensive medications are widely prescribed by doctors and heavily promoted by the pharmaceutical industry. Despite strong evidence of the effectiveness and cost-effectiveness of thiazide diuretics, trends in both promotion and prescription of antihypertensive drugs favour newer, less cost-effective agents. Observational evidence shows correlations between exposure to pharmaceutical promotion and less ideal prescribing. Our study therefore aimed to determine whether print advertisements for antihypertensive medications promote quality prescribing in hypertension. We performed a cross-sectional study of 113 advertisements for antihypertensive drugs from 4 general practice-oriented Australian medical publications in 2004. Advertisements were evaluated using a quality checklist based on a review of hypertension management guidelines. Main outcome measures included: frequency with which antihypertensive classes were advertised, promotion of thiazide class drugs as first line agents, use of statistical claims in advertisements, mention of harms and prices in the advertisements, promotion of assessment and treatment of cardiovascular risk, promotion of lifestyle modification, and targeting of particular patient subgroups. Thiazides were the most frequently advertised drug class (48.7% of advertisements), but were largely promoted in combination preparations. The only thiazide advertised as a single agent was the most expensive, indapamide. No advertisement specifically promoted any thiazide as a better first-line drug. Statistics in the advertisements tended to be expressed in relative rather than absolute terms. Drug costs were often reported, but without cost comparisons between drugs. Adverse effects were usually reported but largely confined to the advertisements' small print. Other than mentioning drug interactions with alcohol and salt, no advertisements promoted lifestyle modification. Few advertisements (2.7%) promoted the assessment of cardiovascular risk. Print advertisements for antihypertensive medications in Australia provide some, but not all, of the key messages required for guideline-concordant care. These results have implications for the regulation of drug advertising and the continuing education of doctors.

Patient Navigators Connecting Patients to Community Resources to Improve Diabetes Outcomes.

PubMed

Loskutova, Natalia Y; Tsai, Adam G; Fisher, Edwin B; LaCruz, Debby M; Cherrington, Andrea L; Harrington, T Michael; Turner, Tamela J; Pace, Wilson D

2016-01-01

Despite the recognized importance of lifestyle modification in reducing risk of developing type 2 diabetes and in diabetes management, the use of available community resources by both patients and their primary care providers (PCPs) remains low. The patient navigator model, widely used in cancer care, may have the potential to link PCPs and community resources for reduction of risk and control of type 2 diabetes. In this study we tested the feasibility and acceptability of telephone-based nonprofessional patient navigation to promote linkages between the PCP office and community programs for patients with or at risk for diabetes. This was a mixed-methods interventional prospective cohort study conducted between November 2012 and August 2013. We included adult patients with and at risk for type 2 diabetes from six primary care practices. Patient-level measures of glycemic control, diabetes care, and self-efficacy from medical records, and qualitative interview data on acceptability and feasibility, were used. A total of 179 patients participated in the study. Two patient navigators provided services over the phone, using motivational interviewing techniques. Patient navigators provided regular feedback to PCPs and followed up with the patients through phone calls. The patient navigators made 1028 calls, with an average of 6 calls per patient. At follow-up, reduction in HbA1c (7.8 ± 1.9% vs 7.2 ± 1.3%; P = .001) and improvement in patient self-efficacy (3.1 ± 0.8 vs 3.6 ± 0.7; P < .001) were observed. Qualitative analysis revealed uniformly positive feedback from providers and patients. The patient navigator model is a promising and acceptable strategy to link patient, PCP, and community resources for promoting lifestyle modification in people living with or at risk for type 2 diabetes. © Copyright 2016 by the American Board of Family Medicine.

Benchmarking Curriculum Content in Entry-Level Health Professional Education with Special Reference to Health Promotion Practice in Physical Therapy: A Multi-Institutional International Study

ERIC Educational Resources Information Center

Bodner, Michael E.; Rhodes, Ryan E.; Miller, William C.; Dean, Elizabeth

2013-01-01

Health promotion (HP) warrants being a clinical competency for health professionals given the global burden of lifestyle-related conditions; these are largely preventable with lifestyle behavior change. Physical therapists have a practice pattern conducive to HP, including lifestyle behavior change. The extent to which HP content is included in…

Prevention of type 2 diabetes mellitus in polycystic ovary syndrome: A review.

PubMed

Anwar, Safa; Shikalgar, Nigar

2017-12-01

Polycystic ovary syndrome (PCOS) is recognized as one of the most common endocrinopathies in women of reproductive age, associated with metabolic sequelae which includes increased risk factors for impaired glucose tolerance (IGT), type 2 diabetes mellitus (DM2) and cardiovascular disease (CVD). The adverse effects of DM2 affects a woman throughout her lifespan. Health care expenditure of DM2 highlights the need for prevention through appropriate screening, diagnosis and intervention. Lifestyle modification (LSM) programs that include diet and/or physical activity are suggested for patients characterized as prediabetic to delay the onset of adult DM2. Diet (i.e. low carbohydrate), combination of aerobic and resistance exercise with high intensity interval training (HIT) 150 to 175min/week with resistance exercise 2 to 3days/week and weight loss may be valuable supporters in the fight against IR, IGT and DM2 associated with PCOS. Copyright © 2017 Diabetes India. Published by Elsevier Ltd. All rights reserved.

Novel therapeutic strategies for the homozygous familial hypercholesterolemia.

PubMed

Mombelli, Giuliana; Pavanello, Chiara

2013-08-01

HoFH is an autosomal co-dominant disease with a prevalence of one in 1,000,000. Mutations of LDL-R gene are responsible for this disease. HoFH needs to be distinguished from autosomal recessive hypercholesterolemia protein (ARH) that causes a similar clinical phenotype. HoFH induces aggressive cardiovascular disease that can develop from birth. These patients possess high LDL-C levels, cutaneous and tendon xanthomas, and accelerated atherosclerosis shown in the first 2 decades of life. Current treatment modalities include life-style modifications, lipid-lowering therapy and LDL-apheresis. However, the treatment goal cannot be achieved only by statin therapy. New therapeutic strategies to lower LDL-C have been developed over recent years. These include monoclonal antibodies binding to PCSK9, inhibition of ApoB production and MTP-inhibitors. This review is focused on new treatments for HoFH and their patents. It is known to be an important contribution in this rare disease, which is difficult to manage.

Dietary Composition Independent of Weight Loss in the Management of Non-Alcoholic Fatty Liver Disease

PubMed Central

Eslamparast, Tannaz; Tandon, Puneeta; Raman, Maitreyi

2017-01-01

Poor dietary composition is an important factor in the progression of non-alcoholic fatty liver disease (NAFLD). The majority of NAFLD patients follow diets with overconsumption of simple carbohydrates, total and saturated fat, with reduced intake of dietary fiber and omega-3 rich foods. Although lifestyle modifications including weight loss and exercise remain the keystone of NAFLD management, modifying dietary composition with or without a calorie-restricted diet may also be a feasible and sustainable strategy for NAFLD treatment. In the present review article, we highlight the potential therapeutic role of a “high quality healthy diet” to improve hepatic steatosis and metabolic dysfunction in patients with NAFLD, independent of caloric restriction and weight loss. We provide a literature review evaluating the evidence behind dietary components including fiber-, meat- and omega-3-rich diets and, pending further evidence, we concur with the EASL-EASD-EASO Clinical Guidelines recommendation of the Mediterranean diet as the diet of choice in these patients. PMID:28933748

An Evidence-Based Approach to the Treatment of Gastroesophageal Reflux Disease.

PubMed

Patti, Marco G

2016-01-01

Gastroesophageal reflux disease (GERD) is prevalent worldwide, particularly in developed countries. It is estimated that the prevalence of GERD in the United States is approximately 20% and that it is increasing because of the epidemic of obesity. To review the pathophysiology, clinical presentation, diagnostic evaluation, and treatment of GERD. A search of PubMed was conducted for the years spanning 1985 to 2015 and included the following terms: heartburn, regurgitation, dysphagia, gastroesophageal reflux disease, cough, aspiration, laryngitis, GERD, GORD, endoscopy, manometry, pH monitoring, proton pump inhibitors, open fundoplication, and laparoscopic fundoplication. Only articles in English were included. Lifestyle modifications, proton pump inhibitors, and laparoscopic fundoplication are proven treatment modalities for GERD. Endoscopic procedures have not been proven as effective. A Roux-en-Y gastric bypass is the procedure of choice when GERD and morbid obesity coexist. Gastroesophageal reflux disease is a highly prevalent disease. Once the diagnosis has been established, the best results are obtained by a multidisciplinary team with the goal of individualizing treatment for patients.

'Children are exposed to temptation all the time'- parents' lifestyle-related discussions in focus groups.

PubMed

Stenhammar, C; Wells, M; Ahman, A; Wettergren, B; Edlund, B; Sarkadi, A

2012-02-01

To explore parents' perspectives on providing their preschool child with a healthy lifestyle, including obstacles and resources. Five semi-structured focus group interviews were conducted, with 30 parents of 4-year-olds in Sweden. Interviews were transcribed verbatim and analysed using Systematic Text Condensation. Four themes emerged from the qualitative analysis: Lifestyle -'The way you live is parents' responsibility', Challenges to promote children's healthy lifestyle, Support from professionals, and peers might facilitate, and Request for an overall responsibility from society. Parents felt that they were role models for their child's lifestyle, a concept including many factors. Attractive and tempting sedentary activities and unhealthy foods were perceived as obstacles, and parents were frustrated by the media's contradictory lifestyle messages. Child health services were expected to more actively invite parents to discuss their child's lifestyle issues. Parents desired some collective responsibility for children's lifestyles through agencies, services and media messages that support and promote healthy choices. Parents struggled to give their children a healthy lifestyle and the 'temptations' of daily unhealthy choices causing hassles and conflicts. Parents desired professional support from preschool, Child Health Care and a collective responsibility from society with uniform guidelines. Parents groups were mentioned as peer support. © 2011 The Author(s)/Acta Paediatrica © 2011 Foundation Acta Paediatrica.

Using formative research to develop a worksite health promotion program for African American women.

PubMed

Zunker, Christie; Cox, Tiffany L; Wingo, Brooks C; Knight, Bern'Nadette; Jefferson, Wendy K; Ard, Jamy D

2008-01-01

To describe the development of a culturally appropriate worksite health promotion program (WHPP) designed to promote increased physical activity and improved nutrition in a high risk group of African American women. The program was based on EatRight, which is a lifestyle-oriented weight control program that focuses on food volume, rather than calories. Formative research included four nominal group technique (NGT) sessions conducted with 14 African American women from the selected worksite to gather input on job factors that affected their weight and daily life factors that affected their amount of physical activity. Their responses were used to adapt existing EatRight materials to target areas of special need for this unique group. Themes emerged from the NGT sessions that indicated stress at work and an environment of unhealthy eating, in addition to social eating and lack of social support for healthy eating added to unhealthy eating patterns at work. In response to physical activity, the primary themes included lack of time to exercise, stress of multiple family roles and responsibilities, and perceived physical barriers to physical activity. Based on the NGT themes, EatRight materials were adapted and additional topics (e.g., increasing social support, overcoming limitations, and time management) were included to develop a WHPP that addressed issues that the participants identified as relevant for their work and home lives. Conducting the NGT sessions and EatRight classes in the work environment, we were able to provide a convenient, familiar environment which fostered social support among participants. We believe that a culturally appropriate modification of EatRight holds great promise in addressing health disparities seen among African American women by offering education on lifestyle changes that will decrease weight through nutrition and physical activity.

Etiology and Prevention of Esophageal Cancer

PubMed Central

Yang, Chung S.; Chen, Xiaoxin; Tu, Shuiping

2016-01-01

Background Esophageal cancer (EC) occurs commonly, especially in Asia, and is the sixth leading cause of cancer deaths worldwide. Recently, great progress has been made in research on the etiology and prevention of EC. Summary The major risk factors for esophageal squamous cell carcinoma (ESCC) are tobacco smoking and alcohol drinking, which act synergistically. Dietary parameters, including dietary carcinogens and insufficiency of micronutrients, could also be important risk factors in certain areas. A common etiological factor for both EC and some other cancers are low levels of intake of fruits and vegetables. With improvements in diet and drinking water in developing countries, the incidence of ESCC decreased. However, in economically well-developed countries, the incidence of esophageal adenocarcinoma (EAC) has markedly increased in the past 40 years. The major etiological factor for EAC is gastroesophageal reflux, which is also an etiological factor for gastric cardia adenocarcinoma (GCA). In certain areas of China, the occurrence of GCA is closely related to ESCC. Susceptibility genes for EC are starting to be discovered, and this may help to identify high-risk groups that have more need for preventive measures. Mitigation of the risk factors, early detection and treatment of precancerous lesions are effective approaches for prevention. Smoking cessation, avoidance of excessive alcohol, meat and caloric consumption, increasing physical activity and frequent consumption of vegetables and fruits are prudent lifestyle modifications for the prevention of EC as well as other diseases. Key Message The etiology of EC includes tobacco smoking, alcohol drinking, low levels of intake of fruits and vegetables as well as gastroesophageal reflux and susceptibility genes. Practical Implications A healthy lifestyle including smoking cessation, increasing physical activity, consumption of vegetables as well as reduction of alcohol intake and caloric consumption are major approaches to the prevention of EC. PMID:27722152

Participants' Voices From Within a Healthy Lifestyle Group.

PubMed

Park, Tanya; Foster, Kim; Usher, Kim

2017-02-01

Weight gain is a serious health concern. People with mental illnesses are at increased risk of weight gain. The primary treatment is lifestyle changes such as increasing physical activity and dietary changes. This qualitative study explored the experience of people with schizophrenia who participated in a healthy lifestyle program. Four themes were identified. The findings indicate that benefits of the program were more than physical health improvements and included regular access to a health professional, gaining social relationships, and a sense of belonging. Future recommendations include retaining a group structure in lifestyle interventions to facilitate these additional benefits.

The feasibility and acceptability of nurse-led chronic disease management interventions in primary care: An integrative review.

PubMed

Stephen, Catherine; McInnes, Susan; Halcomb, Elizabeth

2018-02-01

To explore the feasibility and acceptability of nurse-led chronic disease management and lifestyle risk factor reduction interventions in primary care (general practice/family practice). Growing international evidence suggests that interventions delivered by primary care nurses can assist in modifying lifestyle risk factors and managing chronic disease. To date, there has been limited exploration of the feasibility and acceptability of such interventions. Integrative review guided by the work of Whittemore and Knafl (). Database search of CINAHL, Medline and Web of Science was conducted to identify relevant literature published between 2000-2015. Papers were assessed for methodological quality and data abstracted before thematic analysis was undertaken. Eleven papers met the inclusion criteria. Analysis uncovered four themes: (1) facilitators of interventions; (2) barriers to interventions; (3) consumer satisfaction; and (4) primary care nurse role. Literature supports the feasibility and acceptability of nurse-led interventions in primary care for lifestyle risk factor modification. The ongoing sustainability of these interventions rests largely on organizational factors such as funding, educational pathways and professional support of the primary care nursing role. Further robust research around primary care nurse interventions is required to strengthen the evidence base. © 2017 John Wiley & Sons Ltd.

Epidemiological predictors of metabolic syndrome in urban West Bengal, India.

PubMed

Chakraborty, Sasthi Narayan; Roy, Sunetra Kaviraj; Rahaman, Md Abdur

2015-01-01

Metabolic syndrome is one of the emerging health problems of the world. Its prevalence is high in urban areas. Though pathogenesis is complex, but the interaction of obesity, sedentary lifestyle, dietary, and genetic factors are known as contributing factors. Community-based studies were very few to find out the prevalence or predictors of the syndrome. To ascertain the prevalence and epidemiological predictors of metabolic syndrome. A total of 690 study subjects were chosen by 30 clusters random sampling method from 43 wards of Durgapur city. Data were analyzed in SPSS version 20 software and binary logistic regression was done to find out statistical significance of the predictors. Among 32.75% of the study population was diagnosed as metabolic syndrome according to National Cholesterol Education Program Adult Treatment Panel III definition with a modification for Asia Pacific cut-off of waist circumference. Odds were more among females (2.43), upper social class (14.89), sedentary lifestyle (17.00), and positive family history. The overall prevalence of metabolic syndrome was high in urban areas of Durgapur. Increased age, female gender, higher social status, sedentary lifestyle, positive family history, and higher education were the statistically significant predictors of metabolic syndrome.

Effects of lifestyle change interventions for people with intellectual disabilities: Systematic review and meta-analysis of randomized controlled trials.

PubMed

Willems, Mariël; Waninge, Aly; Hilgenkamp, Thessa I M; van Empelen, Pepijn; Krijnen, Wim P; van der Schans, Cees P; Melville, Craig A

2018-05-08

Promotion of a healthy lifestyle for people with intellectual disabilities is important; however, the effectiveness of lifestyle change interventions is unclear. This research will examine the effectiveness of lifestyle change interventions for people with intellectual disabilities. Randomized controlled trials (RCTs) of lifestyle change interventions for people with intellectual disabilities were included in a systematic review and meta-analysis. Data on study and intervention characteristics were extracted, as well as data on outcome measures and results. Internal validity of the selected papers was assessed using the Cochrane Collaboration's risk bias tool. Eight RCTs were included. Multiple outcome measures were used, whereby outcome measures targeting environmental factors and participation were lacking and personal outcome measures were mostly used by a single study. Risks of bias were found for all studies. Meta-analysis showed some effectiveness for lifestyle change interventions, and a statistically significant decrease was found for waist circumference. Some effectiveness was found for lifestyle change interventions for people with intellectual disabilities. However, the effects were only statistically significant for waist circumference, so current lifestyle change interventions may not be optimally tailored to meet the needs of people with intellectual disabilities. © 2018 John Wiley & Sons Ltd.

Efficacy of a virtual assistance-based lifestyle intervention in reducing risk factors for Type 2 diabetes in young employees in the information technology industry in India: LIMIT, a randomized controlled trial.

PubMed

Limaye, T; Kumaran, K; Joglekar, C; Bhat, D; Kulkarni, R; Nanivadekar, A; Yajnik, C

2017-04-01

To investigate a virtual assistance-based lifestyle intervention to reduce risk factors for Type 2 diabetes in young employees in the information technology industry in India. LIMIT (Lifestyle Modification in Information Technology) was a parallel-group, partially blinded, randomized controlled trial. Employees in the information technology industry with ≥3 risk factors (family history of cardiometabolic disease, overweight/obesity, high blood pressure, impaired fasting glucose, hypertriglyceridaemia, high LDL cholesterol and low HDL cholesterol) from two industries were randomized to a control or an intervention (1:1) group. After initial lifestyle advice, the intervention group additionally received reinforcement through mobile phone messages (three per week) and e-mails (two per week) for 1 year. The primary outcome was change in prevalence of overweight/obesity, analysed by intention to treat. Of 437 employees screened (mean age 36.2 ± 9.3 years; 74.8% men), 265 (61.0%) were eligible and randomized into control (n=132) or intervention (n=133) group. After 1 year, the prevalence of overweight/obesity reduced by 6.0% in the intervention group and increased by 6.8% in the control group (risk difference 11.2%; 95% CI 1.2-21.1; P=0.042). There were also significant improvements in lifestyle measurements, waist circumference, and total and LDL cholesterol in the intervention group. The number-needed-to-treat to prevent one case of overweight/obesity in 1 year was 9 (95% CI 5-82), with an incremental cost of INR10665 (£112.30) per case treated/prevented. A total of 98% of participants found the intervention acceptable. A virtual assistance-based lifestyle intervention was effective, cost-effective and acceptable in reducing risk factors for diabetes in young employees in the information technology industry, and is potentially scalable. © 2016 Diabetes UK.

Associations of lifestyle factors (smoking, alcohol consumption, diet and physical activity) with type 2 diabetes among American adults from National Health and Nutrition Examination Survey (NHANES) 2005-2014.

PubMed

Liu, Ying; Wang, Kesheng; Maisonet, Mildred; Wang, Liang; Zheng, Shimin

2017-09-01

Over the long term, unhealthy lifestyles can lead to many health problems, especially type 2 diabetes (T2D). The aim of the present study was to determine associations between lifestyle factors (smoking, alcohol consumption, physical activity, and diet) and T2D in American adults (aged ≥20 years) in a nationally representative sample. Data for 12 987 American adults participating in the National Health and Nutrition Examination Survey 2005-2014 were evaluated. Weighted multiple logistic regression models were used to examine associations between the four lifestyle factors and T2D after adjusting for demographics and socioeconomic status (SES). Prevalence trends for T2D were examined using Cochran-Armitage tests. There was a significant increasing prevalence trend for T2D among American adults. Smokers and individuals consuming >12 alcoholic drinks in the past year were less likely to report having T2D than non-smokers (odds ratio [OR] 0.41; 95% confidence interval [CI] 0.35-0.48) and those consuming <12 alcoholic drinks (OR 0.46; 95% CI 0.39-0.55). Participants with light physical activity have a greater likelihood of having T2D than those engaging in vigorous physical activity (OR 5.72; 95% CI 4.30-7.60). Individuals consuming a poor diet were more likely to report having T2D than those eating an excellent diet (OR 1.18; 95% CI 1.02-1.41). All these relationships remained significant after adjustment for demographics and SES. All four lifestyle factors were significantly associated with T2D among American adults. The findings of the present study provide useful information for healthcare providers that may help them promote specific lifestyle modifications. © 2016 Ruijin Hospital, Shanghai Jiaotong University School of Medicine and John Wiley & Sons Australia, Ltd.

Obesity and unhealthy lifestyle associated with poor executive function among Malaysian adolescents.

PubMed

Tee, Joyce Ying Hui; Gan, Wan Ying; Tan, Kit-Aun; Chin, Yit Siew

2018-01-01

The understanding on the roles of obesity and lifestyle behaviors in predicting executive function of adolescents has been limited. Low executive function proficiency may have adverse effects on adolescents' school academic performance. This cross-sectional study aimed to examine the relationship between BMI-for-age and multiple lifestyle behaviors (operationalized as meal consumption, physical activity, and sleep quality) with executive function (operationalized as inhibition, working memory, and cognitive flexibility) on a sample of Malaysian adolescents aged between 12 and 16 years (N = 513). Participants were recruited from two randomly selected schools in the state of Selangor in Malaysia. Using a self-administered questionnaire, parent participants provided information concerning their sociodemographic data, whereas adolescent participants provided information regarding their meal consumptions, physical activity, and sleep quality. The modified Harvard step test was used to assess adolescents' aerobic fitness, while Stroop color-word, digit span, and trail-making tests were used to assess adolescents' inhibition, working memory, and cognitive flexibility, respectively. Three separate hierarchical regression analyses were conducted for each outcome namely, inhibition, working memory, and cognitive flexibility. After adjusted for sociodemographic factors and BMI-for-age, differential predictors of inhibition and working memory were found. Habitual sleep efficiency significantly and positively predicted inhibition. Regular dinner intakes, physical activity levels, and sleep quality significantly and positively predicted working memory. Household income emerged as a consistent predictor for all executive function domains. In conclusion, an increased trend of obesity and unhealthy lifestyles among adolescents were found to be associated with poorer executive function. Regular dinner intakes, higher physical activity levels and better sleep quality predicted better executive function despite the inverse relationship between obesity and executive function. Future studies may explore how lifestyle modifications can optimize the development of executive function in adolescents as well as relieve the burden of obesity.

Do unfavourable alcohol, smoking, nutrition and physical activity predict sustained leisure time sedentary behaviour? A population-based cohort study.

PubMed

Nooijen, Carla F J; Möller, Jette; Forsell, Yvonne; Ekblom, Maria; Galanti, Maria R; Engström, Karin

2017-08-01

Comparing lifestyle of people remaining sedentary during longer periods of their life with those favourably changing their behaviour can provide cues to optimize interventions targeting sedentary behaviour. The objective of this study was to determine lifestyle predictors of sustained leisure time sedentary behaviour and assess whether these predictors were dependent on gender, age, socioeconomic position and occupational sedentary behaviour. Data from a large longitudinal population-based cohort of adults (aged 18-97years) in Stockholm responding to public health surveys in 2010 and 2014 were analysed (n=49,133). Leisure time sedentary behaviour was defined as >3h per day of leisure sitting time e.g. watching TV, reading or using tablet. Individuals classified as sedentary at baseline (n=9562) were subsequently categorized as remaining sedentary (n=6357) or reduced sedentary behaviour (n=3205) at follow-up. Lifestyle predictors were unfavourable alcohol consumption, smoking, nutrition, and physical activity. Odds ratios (OR) and corresponding 95% Confidence Intervals (CI) were calculated, adjusting for potential confounders. Unfavourable alcohol consumption (OR=1.22, CI:1.11-1.34), unfavourable candy- or cake consumption (OR=1.15, CI:1.05-1.25), and unfavourable physical activity in different contexts were found to predict sustained sedentary behaviour, with negligible differences according to gender, age, socioeconomic position and occupational sedentary behaviour. People with unfavourable lifestyle profiles regarding alcohol, sweets, or physical activity are more likely to remain sedentary compared to sedentary persons with healthier lifestyle. The impact of combining interventions to reduce leisure time sedentary behaviour with reducing alcohol drinking, sweet consumption and increasing physical activity should be tested as a promising strategy for behavioural modification. Copyright © 2017 Elsevier Inc. All rights reserved.

Genetic predisposition to obesity and lifestyle factors--the combined analyses of twenty-six known BMI- and fourteen known waist:hip ratio (WHR)-associated variants in the Finnish Diabetes Prevention Study.

PubMed

Jääskeläinen, Tiina; Paananen, Jussi; Lindström, Jaana; Eriksson, Johan G; Tuomilehto, Jaakko; Uusitupa, Matti

2013-11-01

Recent genome-wide association studies have identified multiple loci associated with BMI or the waist:hip ratio (WHR). However, evidence on gene-lifestyle interactions is still scarce, and investigation of the effects of well-documented dietary and other lifestyle data is warranted to assess whether genetic risk can be modified by lifestyle. We assessed whether previously established BMI and WHR genetic variants associate with obesity and weight change in the Finnish Diabetes Prevention Study, and whether the associations are modified by dietary factors or physical activity. Individuals (n 459) completed a 3 d food record and were genotyped for twenty-six BMI- and fourteen WHR-related variants. The effects of the variants individually and in combination were investigated in relation to obesity and to 1- and 3-year weight change by calculating genetic risk scores (GRS). The GRS were separately calculated for BMI and the WHR by summing the increasing alleles weighted by their published effect sizes. At baseline, the GRS were not associated with total intakes of energy, macronutrients or fibre. The mean 1- and 3-year weight changes were not affected by the BMI or WHR GRS. During the 3-year follow-up, a trend for higher BMI by the GRS was detected especially in those who reported a diet low in fibre (P for interaction=0·065). Based on the present findings, it appears unlikely that obesity-predisposing variants substantially modify the effect of lifestyle modification on the success of weight reduction in the long term. In addition, these findings suggest that the association between the BMI-related genetic variants and obesity could be modulated by the diet.

Effect of yoga based lifestyle intervention on state and trait anxiety.

PubMed

Gupta, Nidhi; Khera, Shveta; Vempati, R P; Sharma, Ratna; Bijlani, R L

2006-01-01

Considerable evidence exists for the place of mind body medicine in the treatment of anxiety disorders. Excessive anxiety is maladaptive. It is often considered to be the major component of unhealthy lifestyle that contributes significantly to the pathogenesis of not only psychiatric but also many other systemic disorders. Among the approaches to reduce the level of anxiety has been the search for healthy lifestyles. The aim of the study was to study the short-term impact of a comprehensive but brief lifestyle intervention, based on yoga, on anxiety levels in normal and diseased subjects. The study was the result of operational research carried out in the Integral Health Clinic (IHC) at the Department of Physiology of All India Institute of Medical Sciences. The subjects had history of hypertension, coronary artery disease, diabetes mellitus, obesity, psychiatric disorders (depression, anxiety, 'stress'), gastrointestinal problems (non ulcer dyspepsia, duodenal ulcers, irritable bowel disease, Crohn's disease, chronic constipation) and thyroid disorders (hyperthyroidism and hypothyroidism). The intervention consisted of asanas, pranayama, relaxation techniques, group support, individualized advice, and lectures and films on philosophy of yoga, the place of yoga in daily life, meditation, stress management, nutrition, and knowledge about the illness. The outcome measures were anxiety scores, taken on the first and last day of the course. Anxiety scores, both state and trait anxiety were significantly reduced. Among the diseased subjects significant improvement was seen in the anxiety levels of patients of hypertension, coronary artery disease, obesity, cervical spondylitis and those with psychiatric disorders. The observations suggest that a short educational programme for lifestyle modification and stress management leads to remarkable reduction in the anxiety scores within a period of 10 days.

Managing the pain of knee osteoarthritis.

PubMed

Hrnack, Scott A; Barber, F Alan

2014-09-01

Pain from knee osteoarthritis creates a significant burden for symptomatic patients, who are often forced to change their lifestyle because of their symptoms. Activity modification, therapy, weight loss, nonsteroidal anti-inflammatory drugs, shoe orthotics, bracing, and injections are the nonoperative options available. New technologies are also emerging in the treatment of knee osteoarthritis. Ultimately, these therapeutic modalities should reduce pain and increase the overall functioning of patients. These nonoperative modalities give the clinician several effective options before surgical management is considered.

Healthy eating and active living for diabetes in primary care networks (HEALD-PCN): rationale, design, and evaluation of a pragmatic controlled trial for adults with type 2 diabetes

PubMed Central

2012-01-01

Background While strong and consistent evidence supports the role of lifestyle modification in the prevention and management of type 2 diabetes (T2DM), the best strategies for program implementation to support lifestyle modification within primary care remain to be determined. The objective of the study is to evaluate the implementation of an evidence-based self- management program for patients with T2DM within a newly established primary care network (PCN) environment. Method Using a non-randomized design, participants (total N = 110 per group) will be consecutively allocated in bi-monthly blocks to either a 6-month self-management program lead by an Exercise Specialist or to usual care. Our primary outcome is self-reported physical activity and pedometer steps. Discussion The present study will assess whether a diabetes self-management program lead by an Exercise Specialist provided within a newly emerging model of primary care and linked to available community-based resources, can lead to positive changes in self-management behaviours for adults with T2DM. Ultimately, our work will serve as a platform upon which an emerging model of primary care can incorporate effective and efficient chronic disease management practices that are sustainable through partnerships with local community partners. Clinical Trials Registration ClinicalTrials.gov identifier: NCT00991380 PMID:22712881

Prediabetes Diagnosis and Treatment in Primary Care.

PubMed

Mainous, Arch G; Tanner, Rebecca J; Baker, Richard

2016-01-01

The increasing prevalence of diabetes is a major health problem. The detection and treatment of prediabetes can delay the onset of diabetes and presents an important diabetes prevention strategy. Using data from the 2012 National Ambulatory Medical Care Survey, we studied visits by adults aged ≥45 years without diagnosed diabetes who had an HbA1c test within 90 days of the visit (n = 518 unweighted visits; n = 11,167,004 weighted visits). HbA1c results were categorized into normal, prediabetes, and diabetes, and we examined patient characteristics (age, sex, race, payer type, body mass index) and treatment of prediabetes. Among visiting adults, 54.6% had a normal HbA1c value, 33.6% had prediabetes, and 11.9% had diabetes. Of those patient visits with HbA1c consistent with prediabetes, the number of patients diagnosed with prediabetes was too low for a reliable population estimate. Indication of treatment in the medical record (lifestyle modification counseling and/or metformin) was present in 23.0% of those with diagnosed or undiagnosed prediabetes. The most common treatment was lifestyle modification counseling. Our findings show that there are missed opportunities for diabetes prevention in primary care. Providers need to change their approach to prediabetes and play a more effective role in preventing diabetes. © Copyright 2016 by the American Board of Family Medicine.

Knowledge and Lifestyle-Associated Prevalence of Obesity among Newly Diagnosed Type II Diabetes Mellitus Patients Attending Diabetic Clinic at Komfo Anokye Teaching Hospital, Kumasi, Ghana: A Hospital-Based Cross-Sectional Study

PubMed Central

Obirikorang, Yaa; Obirikorang, Christian; Odame Anto, Enoch; Acheampong, Emmanuel; Dzah, Nyalako; Akosah, Caroline Nkrumah; Nsenbah, Emmanuella Batu

2016-01-01

This study aimed to determine the knowledge and prevalence of obesity among Ghanaian newly diagnosed type 2 diabetics. This cross-sectional study was conducted among diagnosed type 2 diabetics. Structured questionnaire was used to obtain data. Anthropometric measurements and fasting blood sugar levels were also assessed. Participants had adequate knowledge about the general concept of obesity (72.0%) and method of weight measurement (98.6%) but were less knowledgeable of ideal body weight (4.2%). The commonly known cause, complication, and management of obesity were poor diet (76.9%), hypertension (81.8%), and diet modification (86.7%), respectively. The anthropometric measures were higher among females compared to males. Prevalence of obesity was 61.3% according to WHR classification, 40.8% according to WHtR classification, 26.1% according to WC, and 14.8% according to BMI classification. Being female was significantly associated with high prevalence of obesity irrespective of the anthropometric measure used (p < 0.05). Taking of snacks in meals, eating meals late at night, physical inactivity, excessive fast food intake, and alcoholic beverage intake were associated with increased prevalence of obesity (p < 0.05). Prevalence of obesity is high among diabetic patient and thus increasing effort towards developing and making education programs by focusing on adjusting to lifestyle modifications is required. PMID:26881262

Knowledge and Lifestyle-Associated Prevalence of Obesity among Newly Diagnosed Type II Diabetes Mellitus Patients Attending Diabetic Clinic at Komfo Anokye Teaching Hospital, Kumasi, Ghana: A Hospital-Based Cross-Sectional Study.

PubMed

Obirikorang, Yaa; Obirikorang, Christian; Odame Anto, Enoch; Acheampong, Emmanuel; Dzah, Nyalako; Akosah, Caroline Nkrumah; Nsenbah, Emmanuella Batu

2016-01-01

This study aimed to determine the knowledge and prevalence of obesity among Ghanaian newly diagnosed type 2 diabetics. This cross-sectional study was conducted among diagnosed type 2 diabetics. Structured questionnaire was used to obtain data. Anthropometric measurements and fasting blood sugar levels were also assessed. Participants had adequate knowledge about the general concept of obesity (72.0%) and method of weight measurement (98.6%) but were less knowledgeable of ideal body weight (4.2%). The commonly known cause, complication, and management of obesity were poor diet (76.9%), hypertension (81.8%), and diet modification (86.7%), respectively. The anthropometric measures were higher among females compared to males. Prevalence of obesity was 61.3% according to WHR classification, 40.8% according to WHtR classification, 26.1% according to WC, and 14.8% according to BMI classification. Being female was significantly associated with high prevalence of obesity irrespective of the anthropometric measure used (p < 0.05). Taking of snacks in meals, eating meals late at night, physical inactivity, excessive fast food intake, and alcoholic beverage intake were associated with increased prevalence of obesity (p < 0.05). Prevalence of obesity is high among diabetic patient and thus increasing effort towards developing and making education programs by focusing on adjusting to lifestyle modifications is required.

Electronic game: A key effective technology to promote behavioral change in cancer patients.

PubMed

Safdari, Reza; Ghazisaeidi, Marjan; Goodini, Azadeh; Mirzaee, Mahboobeh; Farzi, Jebraeil

2016-01-01

Cancer diagnosis is a very unpleasant and unbelievable experience. Appropriate management and treatment of these diseases require a high degree of patient engagement. Interactive health electronic games are engaging, fun, challenging, and experiential and have the potential to change the attitude and behavior, which can improve the player's health. The use of these digital tools, as one of the most attractive and entertaining modern technologies, canem power patients, provide suitable palliative care, promote health behavior change strategies, increase patient engagement, enhance healthy lifestyle habits, improve self.management, and finally improve the quality of life of the patients. Finally, the aim of this article was to describe electronic games and their effects on the promotion of behavior change in cancer patients. In addition, this article describes categories, characteristic features, and benefits of this digital media in the lifestyle modification of cancer patients.

Major factors for facilitating change in behavioral strategies to reduce obesity

PubMed Central

Dalle Grave, Riccardo; Centis, Elena; Marzocchi, Rebecca; El Ghoch, Marwan; Marchesini, Giulio

2013-01-01

It is very unlikely that our obesity-promoting environment will change in the near future. It is therefore mandatory to improve our knowledge of the main factors associated with successful adoption of obesity-reducing behaviors. This may help design more powerful procedures and strategies to facilitate the adoption of healthy lifestyles in a “toxic” environment favoring the development of a positive energy balance. The aim of this review is to describe the main factors associated with successful adoption of obesity-reducing behaviors and to describe the most recent development, limits, and outcomes of lifestyle modification programs. The evidence regarding predictors of weight loss and weight loss maintenance remains largely incomplete. It is necessary to develop strategies matching treatments to patients’ needs to improve successful weight loss and its maintenance. How to detect and how to address these needs is a continuous, challenging, research problem. PMID:24124398

Introduction: Obesity and reproduction.

PubMed

Meldrum, David R

2017-04-01

Women bear the predominant burden of our obesogenic environment, with a higher incidence of obesity than men, more impact on their fertility and success with treatment, and significant maternal and perinatal morbidity and mortality. In this series, the causes, consequences, and solutions regarding the obesity pandemic, the mechanisms of the effect of obesity on the female and male, the epigenetic consequences of male obesity, the marked effects on perinatal outcomes, and the effects of weight loss before conception and during pregnancy are explored. Lifestyle modifications, in particular a healthy diet and exercise during the 3-6 months before conception and during treatment, should result in better outcomes than requiring weight loss before fertility treatments. Such fundamental changes toward a healthier lifestyle will achieve steady and sustainable weight loss and long-term benefits for general health. The role of bariatric surgery before pregnancy requires careful consideration. Copyright © 2017 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

Expectations Regarding Aging, Physical Activity, and Physical Function in Older Adults

PubMed Central

Breda, Aili I.; Watts, Amber S.

2017-01-01

Objective: The present study examined how expectations regarding aging (ERA) influence physical activity participation and physical function. Method: We surveyed 148 older adults about their ERA (ERA-38), health-promoting lifestyles (HPLP-II), and self-rated health (RAND-36). We tested the mediating effect of physical activity on the relationships between ERA and physical function. Results: Positive expectations were associated with more engagement in physical activity (B = 0.016, p < .05) and better physical function (B = 0.521, p < .01). Physical activity mediated the relationship between ERA and physical function (B = 5.890, p < .01, indirect effect 0.092, CI = [0.015, 0.239]). Discussion: ERA play an important role in adoption of physically active lifestyles in older adults and may influence health outcomes, such as physical function. Future research should evaluate whether attempts to increase physical activity are more successful when modifications to ERA are also targeted. PMID:28491915

Impact of hormonal contraception and weight loss on high-density lipoprotein cholesterol efflux and lipoprotein particles in women with polycystic ovary syndrome.

PubMed

Dokras, Anuja; Playford, Martin; Kris-Etherton, Penny M; Kunselman, Allen R; Stetter, Christy M; Williams, Nancy I; Gnatuk, Carol L; Estes, Stephanie J; Sarwer, David B; Allison, Kelly C; Coutifaris, Christos; Mehta, Nehal; Legro, Richard S

2017-05-01

To study the effects of oral contraceptive pills (OCP), the first-line treatment for PCOS, on high-density lipoprotein cholesterol (HDL-C) function (reverse cholesterol efflux capacity) and lipoprotein particles measured using nuclear magnetic resonance spectroscopy in obese women. Secondary analysis of a randomized controlled trial (OWL-PCOS) of OCP or Lifestyle (intensive Lifestyle modification) or Combined (OCP + Lifestyle) treatment groups for 16 weeks. Eighty-seven overweight/obese women with PCOS at two academic centres. Change in HDL-C efflux capacity and lipoprotein particles. High-density lipoprotein cholesterol efflux capacity increased significantly at 16 weeks in the OCP group [0·11; 95% confidence interval (CI) 0·03, 0·18, P = 0·008] but not in the Lifestyle (P = 0·39) or Combined group (P = 0·18). After adjusting for HDL-C and TG levels, there was significant mean change in efflux in the Combined group (0·09; 95% CI 0·01, 0·15; P = 0·01). Change in HDL-C efflux correlated inversely with change in serum testosterone (r s = -0·21; P = 0·05). In contrast, OCP use induced an atherogenic low-density lipoprotein cholesterol (LDL-C) profile with increase in small (P = 0·006) and large LDL-particles (P = 0·002). Change in small LDL-particles correlated with change in serum testosterone (r s = -0·31, P = 0·009) and insulin sensitivity index (ISI; r s = -0·31, P = 0·02). Both Lifestyle and Combined groups did not show significant changes in the atherogenic LDL particles. Oral contraceptive pills use is associated with improved HDL-C function and a concomitant atherogenic LDL-C profile. Combination of a Lifestyle program with OCP use improved HDL-C function and mitigated adverse effects of OCP on lipoproteins. Our study provides evidence for use of OCP in overweight/obese women with PCOS when combined with Lifestyle changes. © 2017 John Wiley & Sons Ltd.

Anorectal and Pelvic Pain

PubMed Central

Bharucha, Adil E.; Lee, Tae Hee

2016-01-01

Although pelvic pain is a symptom of several structural anorectal and pelvic disorders (eg, anal fissure, endometriosis, and pelvic inflammatory disease), this comprehensive review will focus on the three most common nonstructural, or functional, disorders associated with pelvic pain: functional anorectal pain (ie, levator ani syndrome, unspecified anorectal pain, and proctalgia fugax), interstitial cystitis/bladder pain syndrome, and chronic prostatitis/chronic pelvic pain syndrome. The first two conditions occur in both sexes, while the latter occurs only in men. They are defined by symptoms, supplemented with levator tenderness (levator ani syndrome) and bladder mucosal inflammation (interstitial cystitis). Although distinct, these conditions share several similarities, including associations with dysfunctional voiding or defecation, comorbid conditions (eg, fibromyalgia, depression), impaired quality of life, and increased health care utilization. Several factors, including pelvic floor muscle tension, peripheral inflammation, peripheral and central sensitization, and psychosocial factors, have been implicated in the pathogenesis. The management is tailored to symptoms, is partly supported by clinical trials, and includes multidisciplinary approaches such as lifestyle modifications and pharmacologic, behavioral, and physical therapy. Opioids should not be avoided, and surgery has a limited role, primarily in refractory interstitial cystitis. PMID:27712641

Diabetes Care in the Philippines.

PubMed

Tan, Gerry H

2015-01-01

Diabetes is increasing at an alarming rate in Asian countries including the Philippines. Both the prevalence and incidence of type 2 diabetes (T2D) continue to increase with a commensurate upward trend in the prevalence of prediabetes. The aim of this study was to review the prevalence of diabetes in the Philippines and to describe extensively the characteristics of diabetes care in the Philippines from availability of diagnostics tests to the procurement of medications. A literature search was performed using the search words diabetes care and Philippines. Articles that were retrieved were reviewed for relevance and then synthesized to highlight key features. The prevalence of diabetes in the Philippines is increasing. Rapid urbanization with increasing dependence on electronic gadgets and sedentary lifestyle contribute significantly to this epidemic. Diabetes care in the Philippines is disadvantaged and challenged with respect to resources, government support, and economics. The national insurance system does not cover comprehensive diabetes care in a preventive model and private insurance companies only offer limited diabetes coverage. Thus, most patients rely on "out-of-pocket" expenses, namely, laboratory procedures and daily medications. Consequently, poor pharmacotherapy adherence impairs prevention of complications. Moreover, behavioral modifications are difficult due to cultural preferences for a traditional diet of refined sugar, including white rice and bread. Translating clinical data into practice in the Philippines will require fundamental and transformative changes that increase diabetes awareness, emphasize lifestyle change while respecting cultural preferences, and promote public policy especially regarding the health insurance system to improve overall diabetes care and outcomes. Copyright © 2015 The Author. Published by Elsevier Inc. All rights reserved.

The 12-month effects of structured lifestyle advice and pelvic floor muscle training for pelvic organ prolapse.

PubMed

Due, Ulla; Brostrøm, Søren; Lose, Gunnar

2016-07-01

We evaluated the 12-month effects of adding pelvic floor muscle training to a lifestyle advice program in women with symptomatic pelvic organ prolapse stage II-III and the number of women who had sought further treatment. This study was a 12-month follow up of a randomized controlled trial comparing a structured lifestyle advice program alone (lifestyle group) or in combination with pelvic floor muscle training (training and lifestyle group). Both programs consisted of six separate group sessions within 12 weeks. Data were available from 83 (76%) of the 109 originally included women. At the 12-month follow up, 34/83 (41%) had not sought further treatment, 13/43 (30%) in the lifestyle group and 21/40 (52%) in the training and lifestyle group, and these could be included for analysis. The lifestyle group had significantly improved bladder symptoms compared with baseline on single-item analysis (p = 0.01). The training and lifestyle group had significantly improved pelvic organ prolapse symptoms on single-item analysis (p = 0.02) and of bowel-related quality of life (p = 0.04). No significant between-group differences were found in the symptom and quality of life scores. All together 49 women (59%) had sought further treatment, 70% in the lifestyle group, and 48% in the training and lifestyle group (p = 0.05). Twenty-six in the lifestyle group, and 15 in the training and lifestyle group had sought conservative treatment. Four women in each group had received surgery. More severe anterior prolapse and more bladder symptoms at the 3-month follow up were significantly associated with having sought further treatment in both groups. At 12-month follow up, the effects of adding pelvic floor muscle training to a structured lifestyle advice program were limited. © 2016 Nordic Federation of Societies of Obstetrics and Gynecology.

The coaching on lifestyle (CooL) intervention for obesity, a study protocol for an action-oriented mixed-methods study.

PubMed

van Rinsum, Celeste E; Gerards, Sanne M P L; Rutten, Geert M; van de Goor, Ien A M; Kremers, Stef P J

2018-01-08

Combined lifestyle interventions (CLIs) have proved to be effective in changing and maintaining behavioural lifestyle changes and reducing overweight and obesity, in clinical and real-world settings. In this CLI, lifestyle coaches are expected to promote lifestyle changes of participants regarding physical activity and diet. In the Coaching on Lifestyle (CooL) intervention, which takes a period of 8 to 10 months, lifestyle coaches counsel adults and children aged 4 years and older (and their parents) who are obese or are overweight with an increased risk of developing cardiovascular diseases or type II diabetes. In group and individual sessions, themes such as physical activity, dietary behaviours, sleep and stress are addressed. The aim of the present study is to monitor the implementation process of the CooL intervention and to examine how the lifestyle coaches contribute to a healthier lifestyle of the participants. This action-oriented study involves monitoring the implementation process of the CooL intervention and examining the lifestyle changes achieved by participants over time, in a one-group pre-post design using mixed methods. Methods include semi-structured interviews, observations, document analysis, biomedical parameters and questionnaires. The added value of the CooL study lies in its action-oriented approach and the use of mixed methods, including both qualitative and quantitative research methods. The long-term coaching used in the CooL intervention is expected to have beneficial effects on sustained lifestyle changes. NTR6208 ; date registered: 13-01-2017.

An exploration of lifestyle beliefs and lifestyle behaviour following stroke: findings from a focus group study of patients and family members.

PubMed

Lawrence, Maggie; Kerr, Susan; Watson, Hazel; Paton, Gillian; Ellis, Graham

2010-12-08

Stroke is a major cause of disability and family disruption and carries a high risk of recurrence. Lifestyle factors that increase the risk of recurrence include smoking, unhealthy diet, excessive alcohol consumption and physical inactivity. Guidelines recommend that secondary prevention interventions, which include the active provision of lifestyle information, should be initiated in hospital, and continued by community-based healthcare professionals (HCPs) following discharge. However, stroke patients report receiving little/no lifestyle information.There is a limited evidence-base to guide the development and delivery of effective secondary prevention lifestyle interventions in the stroke field. This study, which was underpinned by the Theory of Planned Behaviour, sought to explore the beliefs and perceptions of patients and family members regarding the provision of lifestyle information following stroke. We also explored the influence of beliefs and attitudes on behaviour. We believe that an understanding of these issues is required to inform the content and delivery of effective secondary prevention lifestyle interventions. We used purposive sampling to recruit participants through voluntary sector organizations (29 patients, including 7 with aphasia; 20 family members). Using focus group methods, data were collected in four regions of Scotland (8 group discussions) and were analysed thematically. Although many participants initially reported receiving no lifestyle information, further exploration revealed that most had received written information. However, it was often provided when people were not receptive, there was no verbal reinforcement, and family members were rarely involved, even when the patient had aphasia. Participants believed that information and advice regarding healthy lifestyle behaviour was often confusing and contradictory and that this influenced their behavioural intentions. Family members and peers exerted both positive and negative influences on behavioural patterns. The influence of HCPs was rarely mentioned. Participants' sense of control over lifestyle issues was influenced by the effects of stroke (e.g. depression, reduced mobility) and access to appropriate resources. For secondary prevention interventions to be effective, HCPs must understand psychological processes and influences, and use appropriate behaviour change theories to inform their content and delivery. Primary care professionals have a key role to play in the delivery of lifestyle interventions.

Cardiovascular assessment in liver transplant for non-alcoholic steatohepatitis patients: What we do, what we should do

PubMed Central

Sanchez-Torrijos, Yolanda; Ampuero, Javier; Romero-Gómez, Manuel

2017-01-01

Non-alcoholic fatty liver disease (NAFLD) is increasing considerably due to the current lifestyle, which means that it is becoming one of the main indications for liver transplantation. On the other hand, there is a strong association between NAFLD and cardiovascular disease. This has been evidenced in many studies revealing a higher presence of carotid plaques or carotid intima-media thickness, leading to cardiovascular events and, ultimately, mortality. According to the liver transplant guidelines, screening for heart disease in transplant candidates should be performed by electrocardiogram and transthoracic echocardiography while a stress echocardiogram should be reserved for those with more than two cardiovascular risk factors or greater than 50 years old. However, there are no specific recommendations in NAFLD patients requiring a liver transplantation, despite its well-known cardiovascular risk association. Many studies have shown that these patients probably require a more exhaustive assessment and a global approach including other specialists such as cardiologists or nutritionists. Also, the incidence of cardiovascular disease is also increased in NAFLD patients in the post-transplantation period in comparison with other etiologies, because of the pre-existent risk factors together with the immunosuppressive therapy. Therefore, an early intervention on the lifestyle and the individualized selection of the immunosuppressive regimen could lead to a modification of the cardiovascular risk factors in NAFLD patients requiring a liver transplantation. PMID:28596817

Large body size and sedentary lifestyle during childhood and early adulthood and esophageal squamous cell carcinoma in a high-risk population.

PubMed

Etemadi, A; Golozar, A; Kamangar, F; Freedman, N D; Shakeri, R; Matthews, C; Islami, F; Boffetta, P; Brennan, P; Abnet, C C; Malekzadeh, R; Dawsey, S M

2012-06-01

Little is known about the association of obesity and physical activity at young ages with subsequent risk of esophageal squamous cell carcinoma (ESCC). Between 2003 and 2007, we conducted a case-control study in a high-risk population in northeastern Iran. Three hundred ESCC cases and 571 matched controls were recruited. Each individual was shown a standard pictogram, to report body size at ages 15 and 30. Demographic and health-related information, including physical activity at these ages was also collected. In the fully adjusted models, very obese body size (last two pictograms) at age 15 [odds ratio (OR) 3.2, 95% confidence interval (CI) 1.3-7.7] and age 30 (OR 3.1; 95% CI 1.1-8.5) were associated with ESCC in women, but not in men. Sedentary work at age 15 (OR 3.3, 95% CI 1.3-8.3) and 30 (OR 18.2, 95% CI 3.9-86.2) were also associated with ESCC risk in women only. The increased risk in women at age 15 remained high after later reduction in body size, while women who became very obese only at age 30 did not show a significantly increased risk. These results highlight the importance of early lifestyle modifications in the context of cancer prevention, particularly in women.

The Seoul Metropolitan Lifestyle Intervention Program and Metabolic Syndrome Risk: A Retrospective Database Study

PubMed Central

Choo, Jina; Yoon, Seok-Jun; Ryu, Hosihn; Park, Mi-Suk; Lee, Hyang Sook; Park, Yoo Mi; Lim, Do-Sun

2016-01-01

Since 2011, the Seoul Metabolic Syndrome Management (SMESY) program has been employed as a community-wide, lifestyle modification intervention in Seoul, Korea. We aimed to determine if the SMESY intervention would be significantly associated with improvements in metabolic syndrome (MetS) risk factors. This retrospective database study included data from 25,449 participants aged 30–64 years between 1 January 2013 and 30 June 2013. In the SMESY program, 3 risk-stratified groups by the number of MetS factors were followed for 12 months with different intensity and timeframe of intervention. Among the high-(n = 7116) and moderate-risk groups (n = 14,762), all MetS factors (except triglycerides among the moderate-risk group) as well as MetS z-scores significantly improved over 12 months (all p < 0.05). Among the low-risk group (n = 3571), all factors aggravated significantly over 12 months (all p < 0.05). We observed temporal associations between the implementation of the SMESY program and improvements in MetS risk factors. However, such improvements differed by risk-stratified group, being most robust for the high-risk group, modest for the moderate-risk group, and aggravated for the low-risk group. Thus, more intensive interventions targeting different risk-stratified groups are needed, given a better understanding of the increase in risk factors observed in the low-risk group. PMID:27384576

Effect of Behavior Modification on Outcome in Early- to Moderate-Stage Chronic Kidney Disease: A Cluster-Randomized Trial.

PubMed

Yamagata, Kunihiro; Makino, Hirofumi; Iseki, Kunitoshi; Ito, Sadayoshi; Kimura, Kenjiro; Kusano, Eiji; Shibata, Takanori; Tomita, Kimio; Narita, Ichiei; Nishino, Tomoya; Fujigaki, Yoshihide; Mitarai, Tetsuya; Watanabe, Tsuyoshi; Wada, Takashi; Nakamura, Teiji; Matsuo, Seiichi

2016-01-01

Owing to recent changes in our understanding of the underlying cause of chronic kidney disease (CKD), the importance of lifestyle modification for preventing the progression of kidney dysfunction and complications has become obvious. In addition, effective cooperation between general physicians (GPs) and nephrologists is essential to ensure a better care system for CKD treatment. In this cluster-randomized study, we studied the effect of behavior modification on the outcome of early- to moderate-stage CKD. Stratified open cluster-randomized trial. A total of 489 GPs belonging to 49 local medical associations (clusters) in Japan. A total of 2,379 patients (1,195 in group A (standard intervention) and 1,184 in group B (advanced intervention)) aged between 40 and 74 years, who had CKD and were under consultation with GPs. All patients were managed in accordance with the current CKD guidelines. The group B clusters received three additional interventions: patients received both educational intervention for lifestyle modification and a CKD status letter, attempting to prevent their withdrawal from treatment, and the group B GPs received data sheets to facilitate reducing the gap between target and practice. The primary outcome measures were 1) the non-adherence rate of accepting continuous medical follow-up of the patients, 2) the collaboration rate between GPs and nephrologists, and 3) the progression of CKD. The rate of discontinuous clinical visits was significantly lower in group B (16.2% in group A vs. 11.5% in group B, p = 0.01). Significantly higher referral and co-treatment rates were observed in group B (p<0.01). The average eGFR deterioration rate tended to be lower in group B (group A: 2.6±5.8 ml/min/1.73 m2/year, group B: 2.4±5.1 ml/min/1.73 m2/year, p = 0.07). A significant difference in eGFR deterioration rate was observed in subjects with Stage 3 CKD (group A: 2.4±5.9 ml/min/1.73 m2/year, group B: 1.9±4.4 ml/min/1.73 m2/year, p = 0.03). Our care system achieved behavior modification of CKD patients, namely, significantly lower discontinuous clinical visits, and behavior modification of both GPs and nephrologists, namely significantly higher referral and co-treatment rates, resulting in the retardation of CKD progression, especially in patients with proteinuric Stage 3 CKD. The University Hospital Medical Information Network clinical trials registry UMIN000001159.

Household Air Pollution Exposure and Influence of Lifestyle on Respiratory Health and Lung Function in Belizean Adults and Children: A Field Study

PubMed Central

Kurti, Stephanie P.; Kurti, Allison N.; Emerson, Sam R.; Rosenkranz, Richard R.; Smith, Joshua R.; Harms, Craig A.; Rosenkranz, Sara K.

2016-01-01

Household air pollution (HAP) contributes to the global burden of disease. Our primary purpose was to determine whether HAP exposure was associated with reduced lung function and respiratory and non-respiratory symptoms in Belizean adults and children. Our secondary purpose was to investigate whether lifestyle (physical activity (PA) and fruit and vegetable consumption (FV)) is associated with reported symptoms. Belizean adults (n = 67, 19 Male) and children (n = 23, 6 Male) from San Ignacio Belize and surrounding areas participated in this cross-sectional study. Data collection took place at free walk-in clinics. Investigators performed initial screenings and administered questionnaires on (1) sources of HAP exposure; (2) reported respiratory and non-respiratory symptoms and (3) validated lifestyle questionnaires. Participants then performed pulmonary function tests (PFTs) and exhaled breath carbon monoxide (CO). There were no significant associations between HAP exposure and pulmonary function in adults. Increased exhaled CO was associated with a significantly lower forced expiratory volume in 1-s divided by forced vital capacity (FEV1/FVC) in children. Exposed adults experienced headaches, burning eyes, wheezing and phlegm production more frequently than unexposed adults. Adults who met PA guidelines were less likely to experience tightness and pressure in the chest compared to those not meeting guidelines. In conclusion, adults exposed to HAP experienced greater respiratory and non-respiratory symptoms, which may be attenuated by lifestyle modifications. PMID:27367712

The influence of lifestyle habits on quality of life in patients with established rheumatoid arthritis-A constant balancing between ideality and reality.

PubMed

Malm, Karina; Bremander, Ann; Arvidsson, Barbro; Andersson, Maria L E; Bergman, Stefan; Larsson, Ingrid

2016-01-01

Rheumatoid arthritis (RA) is a chronic, inflammatory, and systemic disease with symptoms that limit activities and affect quality of life. RA is associated with an increased risk of developing comorbidities, some of which are also known to be associated with lifestyle habits such as physical activity, diet, smoking, and alcohol. There has been an augmented focus on the implementation and maintenance of healthy lifestyle habits even for patients with RA in the past decade, but little is known about the link between patients' experiences of lifestyle habits and quality of life. The aim of the study was thus to describe and explore how patients with established RA experience the influence of lifestyle habits on quality of life. The study had a descriptive and explorative design, based on qualitative content analysis. Strategic sampling was used in order to achieve variations in experiences. Twenty-two patients with RA (14 women and 8 men) from 30 to 84 years old, with a disease duration ranging from 8 to 23 years, were interviewed. The analysis of the influence of lifestyle habits on quality of life resulted in the theme balancing between ideality and reality. Three categories emerged about how lifestyle habits influenced quality of life by limitations (including insufficiency and adaptation), self-regulation (including guilt and motivation), and companionship (including belonging and pleasure). Quality of life for patients with established RA was influenced by the balance between ideality and reality in the lifestyle habits: physical activity, diet, smoking, and alcohol. This is important new knowledge for health professionals when discussing lifestyle habits with RA patients.

The influence of lifestyle habits on quality of life in patients with established rheumatoid arthritis—A constant balancing between ideality and reality

PubMed Central

Malm, Karina; Bremander, Ann; Arvidsson, Barbro; Andersson, Maria L. E.; Bergman, Stefan; Larsson, Ingrid

2016-01-01

Introduction Rheumatoid arthritis (RA) is a chronic, inflammatory, and systemic disease with symptoms that limit activities and affect quality of life. RA is associated with an increased risk of developing comorbidities, some of which are also known to be associated with lifestyle habits such as physical activity, diet, smoking, and alcohol. There has been an augmented focus on the implementation and maintenance of healthy lifestyle habits even for patients with RA in the past decade, but little is known about the link between patients’ experiences of lifestyle habits and quality of life. The aim of the study was thus to describe and explore how patients with established RA experience the influence of lifestyle habits on quality of life. Methods The study had a descriptive and explorative design, based on qualitative content analysis. Strategic sampling was used in order to achieve variations in experiences. Twenty-two patients with RA (14 women and 8 men) from 30 to 84 years old, with a disease duration ranging from 8 to 23 years, were interviewed. Results The analysis of the influence of lifestyle habits on quality of life resulted in the theme balancing between ideality and reality. Three categories emerged about how lifestyle habits influenced quality of life by limitations (including insufficiency and adaptation), self-regulation (including guilt and motivation), and companionship (including belonging and pleasure). Conclusions Quality of life for patients with established RA was influenced by the balance between ideality and reality in the lifestyle habits: physical activity, diet, smoking, and alcohol. This is important new knowledge for health professionals when discussing lifestyle habits with RA patients. PMID:27172513

Relationships Among Perceived Wellness Culture, Healthy Lifestyle Beliefs, and Healthy Behaviors in University Faculty and Staff: Implications for Practice and Future Research.

PubMed

Melnyk, Bernadette Mazurek; Amaya, Megan; Szalacha, Laura A; Hoying, Jacqueline

2016-03-01

Identifying key factors influencing healthy lifestyle behaviors in university faculty and staff is critical in designing interventions to improve health outcomes and reduce health care costs. A descriptive study was conducted with 3,959 faculty and staff at a Midwestern, U.S. University. Key measures included perceived worksite culture, healthy lifestyle beliefs, and healthy lifestyle behaviors. Healthy lifestyle beliefs were strongly positively associated with healthy lifestyle behaviors. Regression analyses demonstrated positive healthy lifestyle behaviors based upon sex (female, Std. β = .068, p < .001) and role (faculty, Std. β = .059, p < .001) and a negative effect of race (African Americans, Std. β = -.059, p < .001). The positive effect of perceived wellness culture on healthy lifestyle behaviors was completely mediated by healthy lifestyle beliefs. Interventions to enhance perceived wellness culture and healthy lifestyle beliefs should result in healthier behaviors and improved health outcomes. © The Author(s) 2015.

The paternal hidden agenda: Epigenetic inheritance through sperm chromatin.

PubMed

Puri, Deepika; Dhawan, Jyotsna; Mishra, Rakesh K

2010-07-01

Epigenetic modifications play a crucial role in developmental gene regulation. These modifications, being reversible, provide a layer of information over and above the DNA sequence, that has plasticity and leads to the generation of cell type-specific epigenomes during cellular differentiation. In almost all higher eukaryotes, the oocyte provides not only its cytoplasm, mitochondria, maternally deposited RNA and proteins but also an epigenetic component in the form of DNA and histone-modifications. During spermeiogenesis however, most of the histones are replaced by protamines, leading to a loss of the epigenetic component. The sperm is, therefore, viewed as a passive carrier of the paternal genome with a disproportionate, lower epigenetic contribution except for DNA methylation, to the next generation. A recent study overturns this view by demonstrating a locus-specific retention of histones, with specific modifications in the sperm chromatin at the promoters of developmentally important genes. This programmed retention of epigenetic marks with a role in embryonic development is suggested to offset, in some measure, the dominant maternal effect. This new finding helps in addressing the question of epigenetic transmission of environmental and 'lifestyle' experiences across generations and raises the question of 'parental conflict' at the loci that may be differentially marked.

Effect of metformin combined with lifestyle modification versus lifestyle modification alone on proinflammatory-oxidative status in drug-naïve pre-diabetic and diabetic patients: A randomized controlled study.

PubMed

Bulatova, Nailya; Kasabri, Violet; Qotineh, Amenah; Al-Athami, Taiba; Yousef, Al-Motassem; AbuRuz, Salah; Momani, Munther; Zayed, Aymen

2018-05-01

Targeting biomarkers of oxidative-proinflammatory stress may result in improvement of modifiable metabolic syndrome, pre-diabetes and diabetes risk factors and subsequent risk reduction. 64 newly diagnosed antihyperglycemic treatment-naïve prediabetic and type 2 diabetes mellitus (T2DM) patients were randomly assigned using block design to either metformin combined with therapeutic lifestyle changes (TLC) or TLC alone. Body mass index (BMI), waist circumference, blood pressure, fasting plasma glucose (FPG), glycated hemoglobin (HbA1c), fasting lipid profile, plasma oxidative status and tumor necrosis factor (TNF)-α were measured at baseline, after 3 months and after 6 months from baseline. Except for HbA1c, baseline values did not differ significantly between the two groups. The post 3-months relative reductions in BMI (P=0.014) and HbA1c (P=0.037) in metformin combined with TLC intervention were significantly greater than those in TLC alone group. TNFα plasma levels were decreased significantly vs. baseline by metformin combined with TLC intervention (-22.90±46.76%, P=0.01). Conversely, TLC alone basically worsened proinflammatory status (42.40±40.82 %), P<0.001. Metformin with TLC treatment effected a therapeutic decrement of the oxidative stress (-15.44±35.32%, P=0.029 vs. baseline) unlike TLC alone (61.49±122.66%, P=0.01 vs. baseline). Both interventions' effects were sustained in the 6-month follow up periods. In both intervention groups, the relative changes in plasma TNFα were significantly correlated (P<0.01) with systolic blood pressure and the relative changes in oxidative stress were markedly correlated (P<0.05) with total cholesterol. Copyright © 2017 Diabetes India. Published by Elsevier Ltd. All rights reserved.

Inflammatory cytokine levels and breast cancer risk factors: racial differences of healthy Caucasian and African American women.

PubMed

Park, Na-Jin; Kang, Duck-Hee

2013-09-01

To examine racial differences in inflammatory cytokine levels (interleukin [IL]-6 and interferon-gamma [IFN-γ]) and breast cancer (BC) risk factors between healthy Caucasian and African American women; to examine differences in relationships of inflammatory cytokine levels with BC risk factors between these groups of women; and to determine the independent contribution of race to IL-6 and IFN-γ after controlling for relevant covariates. Cross-sectional and correlational descriptive design. Community surrounding a state university health system in the southeastern United States. 113 healthy women (65 Caucasians and 48 African Americans) aged 20 years or older and not pregnant. Secondary analysis of data collected from self-report questionnaires and blood samples. Inflammatory cytokine levels, BC risk factors (age, age at menarche, age at first live birth, family history of BC, breast biopsy, breastfeeding history and duration, body mass index, and physical activity), and race. Significant racial differences were noted in IL-6 and IFN-γ levels, reproductive or hormonal and lifestyle BC risk factors, and relationships between African American and Caucasian women. Controlling for all other effects, race appeared to be a significant predictor for IL-6 and IFN-γ. Racial differences in inflammatory cytokines and BC risk factors may provide partial evidence for existing racial disparities in BC for African American and Caucasian women. Additional studies are needed to confirm that potential. Additional biobehavioral research in racial disparities in BC may help to inform nurses to target race-specific modifications of lifestyle and behavioral factors to reduce BC health disparity between African American and Caucasian women. Being an African American woman predicted a higher level of inflammatory cytokine production after controlling for selected BC risk factors. Great potential exists for inflammatory responses as one of the underlying biologic mechanisms for existing BC disparity and for culturally tailored lifestyle or behavioral modification interventions for reducing BC risk and racial disparity.

Effects of genetic variants previously associated with fasting glucose and insulin in the Diabetes Prevention Program.

PubMed

Florez, Jose C; Jablonski, Kathleen A; McAteer, Jarred B; Franks, Paul W; Mason, Clinton C; Mather, Kieren; Horton, Edward; Goldberg, Ronald; Dabelea, Dana; Kahn, Steven E; Arakaki, Richard F; Shuldiner, Alan R; Knowler, William C

2012-01-01

Common genetic variants have been recently associated with fasting glucose and insulin levels in white populations. Whether these associations replicate in pre-diabetes is not known. We extended these findings to the Diabetes Prevention Program, a clinical trial in which participants at high risk for diabetes were randomized to placebo, lifestyle modification or metformin for diabetes prevention. We genotyped previously reported polymorphisms (or their proxies) in/near G6PC2, MTNR1B, GCK, DGKB, GCKR, ADCY5, MADD, CRY2, ADRA2A, FADS1, PROX1, SLC2A2, GLIS3, C2CD4B, IGF1, and IRS1 in 3,548 Diabetes Prevention Program participants. We analyzed variants for association with baseline glycemic traits, incident diabetes and their interaction with response to metformin or lifestyle intervention. We replicated associations with fasting glucose at MTNR1B (P<0.001), G6PC2 (P = 0.002) and GCKR (P = 0.001). We noted impaired β-cell function in carriers of glucose-raising alleles at MTNR1B (P<0.001), and an increase in the insulinogenic index for the glucose-raising allele at G6PC2 (P<0.001). The association of MTNR1B with fasting glucose and impaired β-cell function persisted at 1 year despite adjustment for the baseline trait, indicating a sustained deleterious effect at this locus. We also replicated the association of MADD with fasting proinsulin levels (P<0.001). We detected no significant impact of these variants on diabetes incidence or interaction with preventive interventions. The association of several polymorphisms with quantitative glycemic traits is replicated in a cohort of high-risk persons. These variants do not have a detectable impact on diabetes incidence or response to metformin or lifestyle modification in the Diabetes Prevention Program.

Anthroposophic lifestyle influences the concentration of metals in placenta and cord blood

DOE Office of Scientific and Technical Information (OSTI.GOV)

Fagerstedt, Sara; Kippler, Maria; Scheynius, Annika

Allergic diseases develop in genetically susceptible individuals in a complex interplay with the environment, usually early in life. We have previously shown that the anthroposophic lifestyle is associated with reduced risk of allergic disease in children, but details on the influencing environmental factors are largely unknown. This study aims to elucidate if anthroposophic lifestyle influences fetal exposure to selected toxic and essential elements. Randomly selected non-smoking mothers with (n=40) and without (n=40) anthroposophic lifestyle from the prospective birth cohort ALADDIN were included. Concentrations of 12 toxic and essential elements were analyzed in full term placentas and in the erythrocyte fractionsmore » of maternal peripheral blood and of umbilical cord blood, using inductively coupled plasma mass spectrometry. Cadmium concentrations in maternal blood and placenta were significantly higher in mothers with an anthroposophic lifestyle (p<0.001), while concentrations in cord blood were generally low, irrespective of lifestyle. Cobalt concentrations were higher in both maternal blood, placenta and cord blood in the anthroposophic group. Lead concentrations were higher in maternal blood and cord blood, but not placenta, of mothers with anthroposophic lifestyle. Analysis of covariance, including lifestyle, parity, maternal age, gestational age, vegetarian diet, use of herbal medicine and occupation in the model, showed that mainly the anthroposophic lifestyle was significantly associated with cadmium concentrations. In conclusion, women with an anthroposophic lifestyle had higher concentrations of cadmium, cobalt and lead concentrations. Cadmium concentrations might have been influenced by a diet rich in vegetables and/or low iron status of the mothers. - Highlights: • Toxic elements in mother–newborn pairs in relation to anthroposophic lifestyle. • Anthroposophic lifestyle was associated with higher levels of cadmium, cobalt and lead. • A diet rich in vegetables and/or low iron status may explain observed findings. • Nine other elements showed no differences by lifestyle.« less

Basic infertility including polycystic ovary syndrome.

PubMed

Brassard, Maryse; AinMelk, Youssef; Baillargeon, Jean-Patrice

2008-09-01

Infertility in women has many possible causes and must be approached systematically. The most common cause of medically treatable infertility is the polycystic ovary syndrome (PCOS). This syndrome is common in young women and is the cause of anovulatory infertility in 70% of cases. It is therefore an important condition to screen and manage in primary care medical settings. In the past 10 years, insulin sensitization with weight loss or metformin has been shown to be a safe and effective treatment for PCOS infertility that eliminates the risk of multiple pregnancy and may reduce the risk of early pregnancy loss as compared with ovulation-inductor drugs. The authors believe metformin should be considered as first-line therapy because it has the advantage to allow for normal single ovulation, for reduced early pregnancy loss, and, most importantly, lifestyle modifications and weight loss before pregnancy. Losing weight not only improves fertility but also reduces adverse pregnancy outcomes associated with obesity.

Neurogenic orthostatic hypotension - management update and role of droxidopa.

PubMed

Vijayan, Joy; Sharma, Vijay K

2015-01-01

Orthostatic hypotension (OH) is defined as a significant decrease in blood pressure (BP) during the first 3 minutes of standing or a head up on a tilt table. Symptoms of OH are highly variable, ranging from mild light-headedness to recurrent syncope. OH occurs due to dysfunction of one or more components of various complex mechanisms that interplay closely to maintain BP in a normal range during various physiological and associated disease states. Various biochemical and electrophysiological studies are often undertaken to assess the severity and etiology of OH. In addition to the lifestyle modifications, various medications that stimulate the adrenergic receptors or increase central blood volume are used in patients with OH. Droxidopa is a newer agent that increases the levels of norepinephrine in postganglionic sympathetic neurons. Management strategies for OH are presented, including the mechanism of action of droxidopa and various studies performed to assess its efficacy.

Population health-based approaches to utilizing digital technology: a strategy for equity.

PubMed

Graham, Garth N; Ostrowski, MaryLynn; Sabina, Alyse B

2016-11-01

Health care disparities and high chronic disease rates burden many communities and disproportionally impact racial/ethnic populations in the United States. These disparities vary geographically, increase health care expenses, and result in shortened lifespans. Digital technologies may be one tool for addressing health disparities and improving population health by increasing individuals' access to health information-especially as most low-income U.S. residents gain access to smartphones. The Aetna Foundation partners with organizations to use digital technologies, including mobile applications, data collection, and related platforms, for learning and sharing. Projects range from the broad-childhood education, lifestyle modification, health IT training, and nutrition education, to the specific-local healthy foods, stroke rehabilitation, and collection of city-level data. We describe our approaches to grantmaking and discuss lessons learned and their implications. When combined with sound policy strategies, emerging, scalable, digital technologies will likely become powerful allies for improving health and reducing health disparities.

Social Disorder in Adults with Type 2 Diabetes: Building on Race, Place, and Poverty

PubMed Central

Steve, Shantell L.; Tung, Elizabeth L.; Schlichtman, John J.; Peek, Monica E.

2016-01-01

The recent resurgence of social and civic disquiet in the USA has contributed to increasing recognition that social conditions are meaningfully connected to disease and death. As a “lifestyle disease,” control of diabetes requires modifications to daily activities, including healthy dietary practices, regular physical activity, and adherence to treatment regimens. One’s ability to develop the healthy practices necessary to prevent or control type 2 diabetes may be influenced by a context of social disorder, the disruptive social and economic conditions that influence daily activity and, consequently, health status. In this paper, we report on our narrative review of the literature that explores the associations between social disorder and diabetes-related health outcomes within vulnerable communities. We also propose a multilevel ecosocial model for conceptualizing social disorder, specifically focusing on its role in racial disparities and its pathways to mediating diabetes outcomes. PMID:27319322

Nutritional aspects to prevent heart diseases in traditional Persian medicine.

PubMed

Kordafshari, Gholamreza; Kenari, Hoorieh Mohammadi; Esfahani, Mohammad Mehdi; Ardakani, Mohammad Reza Shams; Keshavarz, Mansoor; Nazem, Esmaeil; Moghimi, Maryam; Zargaran, Arman

2015-01-01

Cardiovascular diseases are major health complications currently in various societies. Management of heart diseases as a prevention step or as treatment with low-cost procedures like lifestyle modifications including nutrition are important current trends. Although the term nutrition dates back to 2 past centuries, Persian physicians contributed to this term at least from 1000 years ago. Rhazes (865-925 AD) was one of the pioneers in this field. He preferred using foods in treating illnesses. "Foods and drinks" were 1 subject from 6 principles (Setteh Zarorieh) that Persian physicians believed can affect human health. In this review, we described some medieval Persian views on the role of nutrition in heart diseases and compare their prescriptions with current findings. Interestingly, current investigations mostly support Persian medicine principles. Historically, this work shows that the concept of nutrition in heart diseases has had a successful background at least from 1000 years ago in Persia. © The Author(s) 2014.

Molecular Mechanisms of Chromium in Alleviating Insulin Resistance

PubMed Central

Hua, Yinan; Clark, Suzanne; Ren, Jun; Sreejayan, Nair

2011-01-01

Type 2 diabetes is often associated with obesity, dyslipidemia, and cardiovascular anomalies and is a major health problem approaching global epidemic proportions. Insulin resistance, a prediabetic condition, precedes the onset of frank type 2 diabetes and offers potential avenues for early intervention to treat the disease. Although lifestyle modifications and exercise can reduce the incidence of diabetes, compliance has proved to be difficult, warranting pharmacological interventions. However, most of the currently available drugs that improve insulin sensitivity have adverse effects. Therefore, attractive strategies to alleviate insulin resistance include dietary supplements. One such supplement is chromium, which has been shown reduce insulin resistance in some, but not all, studies. Furthermore, the molecular mechanisms of chromium in alleviating insulin resistance remain elusive. This review examines emerging reports on the effect of chromium, as well as molecular and cellular mechanisms by which chromium may provide beneficial effects in alleviating insulin resistance. PMID:22423897

Sport therapy for hypertension: why, how, and how much?

PubMed

Manfredini, Fabio; Malagoni, Anna M; Mandini, Simona; Boari, Benedetta; Felisatti, Michele; Zamboni, Paolo; Manfredini, Roberto

2009-01-01

Exercise may prevent or reduce the effects of metabolic and cardiovascular diseases, including arterial hypertension. Both acute and chronic exercise, alone or combined with lifestyle modifications, decrease blood pressure and avoid or reduce the need for pharmacologic therapy in patients with hypertension. The hypotensive effect of exercise is observed in a large percentage of subjects, with differences due to age, sex, race, health conditions, parental history, and genetic factors. Exercise regulates autonomic nervous system activity, increases shear stress, improves nitric oxide production in endothelial cells and its bioavailability for vascular smooth muscle, up-regulates antioxidant enzymes. Endurance training is primarily effective, and resistance training can be combined with it. Low-to-moderate intensity training in sedentary patients with hypertension is necessary, and tailored programs make exercise safe and effective also in special populations. Supervised or home-based exercise programs allow a nonpharmacological reduction of hypertension and reduce risk factors, with possible beneficial effects on cardiovascular morbidity.