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Variants in APOA5 and ADIPOQ Moderate Improvements in Metabolic Syndrome during a One-Year Lifestyle Intervention.
Lowry, DE, Fenwick, PH, Roke, K, Jeejeebhoy, K, Dhaliwal, R, Brauer, P, Royall, D, Tremblay, A, Klein, D, Mutch, DM
Lifestyle genomics. 2018;(2):80-89
Abstract
BACKGROUND Metabolic syndrome (MetS) comprises a cluster of risk factors including central obesity, hypertension, dyslipidemia, and impaired glucose homeostasis. Lifestyle interventions that promote improvements in diet quality and physical activity represent a first line of therapy for MetS. However, varying responses to lifestyle interventions are well documented and may be partially explained by underlying genetic differences. The aim of this study was to investigate if variants in genes previously associated with MetS influence the magnitude of change in MetS risk during a 1-year lifestyle intervention. METHODS The present study used data collected from the Canadian Health Advanced by Nutrition and Graded Exercise study cohort (n = 159 men and women) to investigate the effect of 17 candidate single nucleotide polymorphisms (SNPs) on response to a 1-year lifestyle intervention. Associations between SNPs and the continuous MetS (cMetS) score, as well as individual MetS components, were examined. RESULTS Reductions in cMetS score at both 3 months and 1 year were significantly associated with 2 variants: rs662799 (A/G) in apolipoprotein A5 (APOA5) and rs1501299 (G/T) in adiponectin (ADIPOQ). Individuals carrying a minor T allele in rs1501299 experienced a greater reduction in cMetS score at both 3 months and 1 year, whereas major allele AA homozygotes in rs662799 experienced greater reductions in cMetS score during the intervention. No associations were identified between the aforementioned SNPs and individual components of MetS. Both un-weighted and weighted genetic risk scores (GRS) using these 2 SNPs revealed that individuals carrying none of the risk alleles experienced significantly greater reductions in cMetS score after 1 year. CONCLUSIONS The findings from the current study suggest that individuals with certain genotypes may benefit more from a lifestyle intervention for MetS and that specific variants, either independently or as part of a GRS, could be used as a nutrigenomic tool to tailor the intervention to reduce the risk of MetS.
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A systematic review of physical activity-based behaviour change interventions reaching men with prostate cancer.
Finlay, A, Wittert, G, Short, CE
Journal of cancer survivorship : research and practice. 2018;(4):571-591
Abstract
PURPOSE Men who are survivors of prostate cancer report a variety of psychological and physical factors contributing to a lower quality of life, and physical activity can assist to mitigate these issues. This review aims to provide a summary of physical activity behaviour change trials targeting prostate cancer survivors, assess the feasibility of these interventions and, if possible, identify intervention and study characteristics associated with significant intervention effects. METHOD Four databases (PubMed, CINAHL, PsycINFO and EMBASE) were systematically searched for randomised controlled trials containing at least one behavioural outcome relating to physical activity published up until July 2016. Forward and backwards, hand, key author citation searching and known research were also considered. RESULTS From a total of 13, 828 titles, the search resulted in 12 studies (6 prostate cancer only and 6 mixed cancer interventions), eight of which found positive results most often related immediately to post-intervention aerobic activity. Factors relating to efficacy were not conclusive due to the heterogeneity of studies and lack of cancer-specific data in mixed cancer trials. Future research focusing on intervention reach, maintenance of intervention effects and resistance training outcomes is needed. CONCLUSION There is preliminary evidence to suggest that a variety of physical activity behaviour change interventions targeting men with a history of prostate cancer can be efficacious, at least in the short term. Experimental studies are required to identify key intervention features. IMPLICATIONS FOR CANCER SURVIVORS Physical activity interventions can assist prostate cancer survivors in relation to short-term lifestyle change, though more evidence is required to improve the clarity of factors related to efficacy.
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A Behavioral Weight Loss Program and Nonurinary Incontinence Lower Urinary Tract Symptoms in Overweight and Obese Women with Urinary Incontinence: A Secondary Data Analysis of PRIDE.
Breyer, BN, Creasman, JM, Richter, HE, Myers, D, Burgio, KL, Wing, RR, West, DS, Kusek, JW, Subak, LL, ,
The Journal of urology. 2018;(1):215-222
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PURPOSE We sought to determine whether a behavioral weight reduction intervention would improve nonurinary incontinence lower urinary tract storage symptoms at 6 months, including urinary frequency, nocturia and urgency, compared to a structured education program serving as the control group among overweight and obese women with urinary incontinence. MATERIALS AND METHODS PRIDE (Program to Reduce Incontinence by Diet and Exercise) was a randomized clinical trial performed in 338 overweight or obese women with urinary incontinence. Participants were randomized, including 226 to 6-month behavioral weight loss intervention and 112 to the control group. All participants received a self-help behavioral treatment booklet to improve bladder control. On this secondary data analysis we examined changes in nonurinary incontinence lower urinary tract storage symptoms from baseline to 6 months and the impact of treatment allocation (intervention vs control), weight loss and physical activity. RESULTS Nonurinary incontinence lower urinary tract storage symptoms were common at baseline, varying from 48% to 62%. In the 2 groups combined women experienced significant improvement in nocturia, urgency and International Prostate Symptom Score at 6 months (all p <0.001). However, lower urinary tract storage symptom outcomes at 6 months did not differ between the intervention and control groups. Similarly no difference was observed in the amount of weight lost (5% or greater vs less than 5%) or physical activity (1,500 kcal or greater expenditure per week compared to less than 1,500 kcal). CONCLUSIONS Lower urinary tract storage symptoms were common among overweight and obese women with urinary incontinence. The prevalence decreased significantly after 6 months independent of treatment group assignment, amount of weight lost or physical activity. These improvements may have been due to self-help behavioral educational materials, trial participation or repeat assessment of symptoms.
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Do elevated symptoms of depression predict adherence and outcomes in the UPBEAT randomised controlled trial of a lifestyle intervention for obese pregnant women?
Molyneaux, E, Begum, S, Briley, AL, Seed, PT, Howard, LM, Poston, L, ,
BMC pregnancy and childbirth. 2018;(1):378
Abstract
BACKGROUND Lifestyle interventions for obese pregnant women have been widely researched but little is known about predictors of low adherence or poor outcomes. This study evaluated the prospective associations between elevated symptoms of antenatal depression and gestational diabetes, adherence and gestational weight gain in a large RCT of a behavioural intervention for obese pregnant women. The effect of the intervention on symptoms of depression at follow-up was also examined. METHODS The UPBEAT RCT randomised 1555 obese pregnant women to receive a dietary and physical activity lifestyle intervention or standard care. Symptoms of antenatal depression were assessed with the Edinburgh Postnatal Depression Scale at baseline (15+ 0-18+ 6 weeks' gestation) and follow-up (27+ 0-28+ 6 weeks' gestation). Gestational diabetes was assessed with an oral glucose tolerance test at 27+ 0-28+ 6 weeks' gestation. Adherence was pre-defined as receiving at least 5 of 8 intervention sessions. Gestational weight gain was calculated as the difference between pre-pregnancy weight (estimated as measured baseline weight minus 1.25 kg) and last measured weight at 34+ 0-36+ 0 weeks' gestation. Due to substantial missing data in certain variables, multiple imputation was used to impute missing data. Women who were no longer pregnant at 27+ 0-28+ 6 weeks' gestation were excluded from the sample for these analyses. RESULTS One thousand five-hundered twenty-six women were included in these analyses following multiple imputation; 797 (52.2%) had complete data. 13.4% had elevated symptoms of antenatal depression at baseline. There was no evidence for associations between antenatal depression status and gestational diabetes (adjusted OR 0.80, 95%CI 0.52 to 1.22, p = 0.30), adherence (adjusted OR 1.16, 95%CI 0.63 to 2.15, p = 0.63) or gestational weight gain (adjusted regression coefficient 0.52, 95%CI -0.26 to 1.29, p = 0.19). The intervention was not associated with change in depressive symptoms at follow-up (regression coefficient 0.003, 95%CI -0.49 to 0.49, p = 0.99). Similar results were obtained in complete case analyses. CONCLUSIONS Elevated symptoms of antenatal depression did not predict gestational diabetes, adherence or gestational weight gain in this large RCT of a lifestyle intervention for obese pregnant women. The intervention also did not influence symptoms of depression at follow-up. Obese pregnant women with elevated symptoms of depression should not be excluded from lifestyle interventions. TRIAL REGISTRATION ISRCTN89971375 . Registered 28 November 2008.
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Incorporating Appetite Awareness Training Within Family-Based Behavioral Treatment of Pediatric Obesity: A Randomized Controlled Pilot Study.
Njardvik, U, Gunnarsdottir, T, Olafsdottir, AS, Craighead, LW, Boles, RE, Bjarnason, R
Journal of pediatric psychology. 2018;(9):1017-1027
Abstract
OBJECTIVE To assess additive effects of incorporating appetite awareness training (AAT), a strategy to encourage eating in response to hunger and satiety cues, within a family-based behavioral treatment (FBT) for childhood obesity. METHODS Total 84 families with a child with obesity in the age range of 8-12 years, Body Mass Index Standard Deviation Score (BMI-SDS) ≥ 2, and a participating parent were randomly allocated to two conditions; standard FBT was compared with FBT incorporating AAT strategies (FBT-AAT). Treatment consisted of group therapy sessions (held separately for children and parents) as well as single-family (parent-child dyad) sessions (24 sessions total) delivered over 18 weeks at a tertiary care outpatient clinic. One booster session was provided 1-year posttreatment and a final follow-up assessment was conducted at 2 years. The primary outcome was change in child standardized body mass index (BMI-SDS). RESULTS The two conditions did not differ significantly at posttest, but the FBT-AAT group was at a significantly lower weight compared with FBT at both the first-year, F(1, 82) = 4.150, p<.05, and the second-year follow-ups, F(1, 82) = 14.912, p <.001. It was notable that over the second-year of follow-up, the FBT-AAT group continued to show improvement, whereas the FBT group did not. CONCLUSIONS Incorporating specific self-regulatory training in attending to hunger and fullness signals during a standardized family-based treatment may have enhanced the long-term maintenance of treatment effects. Findings are promising and warrant further study.
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Family Physician-Led Group Visits for Lifestyle Modification in Women with Weight Problems: A Pilot Intervention and Follow-Up Study.
Tunay, M, Kurdak, H, Özcan, S, Özdemir, Ç, Özer, ZY
Obesity facts. 2018;(1):1-14
Abstract
OBJECTIVE Lifestyle modification requires extensive information sharing and counseling. However, one-on-one primary care consultations are lacking to cover all necessary components due to time constraints. This preliminary study aims to investigate the feasibility and effects of lifestyle-changing intervention by family physician-led group visits (GVs) on weight management in overweight and obese women. METHODS 60 volunteers fulfilling the inclusion criteria were enrolled. Baseline and 6th month assessments consisted of anthropometric measurements, SF-36 Health Survey, blood variables, exercise test, and resting metabolic rate. Weight maintenance was controlled at the 12th month. RESULTS Although weight loss among participants varied, the mean body weights were significantly decreased by 8.2% in full-attenders (n = 30). A significant increase in HDL-cholesterol and decreases in heart rate and blood pressure were found. SF-36 summary scales were significantly improved. Weight change was moderately correlated with exercise duration, compliance to diet, and baseline mental component score. It was determined that 62.5% of the participants either lost or maintained body weight at the 12th month. CONCLUSION Significant weight loss and quality of life improvement was achieved in this pilot study. GVs may be a promising alternative to primary care consultations for obesity management; however, the high dropout level and diverse outcomes need further assessment.
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Clinic and Home-Based Behavioral Intervention for Obesity in Preschoolers: A Randomized Trial.
Stark, LJ, Spear Filigno, S, Bolling, C, Ratcliff, MB, Kichler, JC, Robson, SM, Simon, SL, McCullough, MB, Clifford, LM, Odar Stough, C, et al
The Journal of pediatrics. 2018;:115-121.e1
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OBJECTIVE To test the hypotheses that an innovative skills-based behavioral family clinic and home-based intervention (LAUNCH) would reduce body mass index z score (BMIz) compared with motivational interviewing and to standard care in preschool-aged children with obesity. STUDY DESIGN Randomized controlled trial with children between the ages of 2 and 5 years above the 95th percentile for body mass index for age and sex recruited from 27 pediatrician offices across 10 recruitment cycles between March 12, 2012 and June 8, 2015. Children were randomized to LAUNCH (an 18-session clinic and home-based behavioral intervention), motivational interviewing (delivered at the same frequency as LAUNCH), or standard care (no formal intervention). Weight and height were measured by assessors blinded to participant assignment. The primary outcome, BMIz at month 6 after adjusting for baseline BMIz, was tested separately comparing LAUNCH with motivational interviewing and LAUNCH with standard care using regression-based analysis of covariance models. RESULTS A total of 151 of the 167 children randomized met intent-to-treat criteria and 92% completed the study. Children were 76% White and 57% female, with an average age of 55 months and BMI percentile of 98.57, with no demographic differences between the groups. LAUNCH participants demonstrated a significantly greater decrease in BMIz (mean = -0.32, SD = ±0.33) compared with motivational interviewing (mean = -0.05, SD = ±0.27), P < .001, ω2 = 0.74 and compared with standard care (mean = -0.13, SD = ±0.31), P < .004, ω2 = 0.75. CONCLUSIONS In preschool-age children, an intensive 6-month behavioral skills-based intervention is necessary to reduce obesity. TRIAL REGISTRATION Clinicaltrials.gov NCT01546727.
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Family-based intervention using face-to-face sessions and social media to improve Malay primary school children's adiposity: a randomized controlled field trial of the Malaysian REDUCE programme.
Ahmad, N, Shariff, ZM, Mukhtar, F, Lye, MS
Nutrition journal. 2018;(1):74
Abstract
BACKGROUND Social media may be an effective medium by which parents could be trained to promote healthy eating behaviour and physical activity for their children. This trial evaluates the effectiveness of a family-based intervention using social media in combination with face-to-face sessions - the REDUCE (REorganise Diet, Unnecessary sCreen time and Exercise) programme - on adiposity of Malay children. METHODS Five primary schools in an urban area in Selangor, Malaysia participated in this two-arm randomized controlled field trial. Participants were parents (n = 134) and their primary school-going children 8-11 years of age who were either overweight or obese. These parent-child dyads were randomly allocated to intervention and wait-list control groups and were blinded to group assignment. The intervention was a four-week training programme using two face-to-face sessions and two Facebook sessions followed by weekly booster sessions over a three-month period using WhatsApp. The primary outcome was body mass index (BMI) z-score. Height, body weight, waist circumference and percentage of body fat were measured by blinded assessors. Data were collected at baseline (T1), immediately post-training (T2) and at three- (T3) and six-month post training (T4) and were analysed using generalized linear mixed modelling adjusted for covariates to estimate the intervention effects. Subgroup analysis was conducted for overweight and obese children. RESULTS Ninety-one percent of parents completed the study, 64 in intervention group and 58 in wait-list group. At the sixth month post-training, BMI z-scores were significantly reduced in the intervention group compared to the wait-list group, for the all children (overweight and obese children) and within the obese subgroup ((F(6, 517) = 2.817, p = 0.010) and (F(6, 297) = 6.072, p < 0.001) respectively. For waist circumference percentile and body fat percentage, the intervention group experienced a significant reduction compared to the wait-list group, within the obese subgroup ((F(6, 297) = 3.998, p = 0.001) and within the overweight subgroup (F(6, 201) = 2.526, p = 0.022). CONCLUSIONS The four-month REDUCE intervention programme was effective in reducing childhood adiposity. Further research using this approach needs to be conducted including cost-effectiveness studies before implementing it in a child obesity prevention programme. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry: ACTRN12617000844347 (7 June 2017 retrospectively registered). National Medical Research Register, Ministry of Health Malaysia: NMRR-14-685-21,874 (July 2014).
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Physical Activity in a Randomized Culturally Adapted Lifestyle Intervention.
Siddiqui, F, Koivula, RW, Kurbasic, A, Lindblad, U, Nilsson, PM, Bennet, L
American journal of preventive medicine. 2018;(2):187-196
Abstract
INTRODUCTION Middle Eastern immigrants exhibit high levels of physical inactivity and are at an increased risk for Type 2 diabetes. The primary aim of this study was to examine the changes in objectively assessed physical activity levels following a culturally adapted lifestyle intervention program. The secondary aim was to examine the association between objectively assessed physical activity and insulin sensitivity. STUDY DESIGN RCT conducted over 4 months in 2015. PARTICIPANTS Iraqi immigrants residing in Malmö, Sweden, exhibiting one or more risk factors for Type 2 diabetes. INTERVENTION The intervention group (n=50) was offered a culturally adapted lifestyle intervention comprising seven group sessions including a cooking class. The control group (n=46) received usual care. MAIN OUTCOME MEASURES Raw accelerometry data were processed by validated procedures and daily mean physical activity intensity, vector magnitude high-pass filtered (VM-HPF), was inferred. Further inferences into the number of hours/day spent in sedentary (VM-HPF <48 milli-Gs [mGs] where G=9.8 m/sec2) and light- (48- <163 mGs); moderate- (163- <420 mGs); and vigorous-intensity (≥420 mGs) activities were also calculated (year of analysis was 2016-2017). RESULTS No difference was observed between the two groups in terms of change over time in VM-HPF. There was a significant increase in the number of hours/day spent in light intensity physical activity in the intervention group compared with the control group (β=0.023, 95% CI=0.001, 0.045, p=0.037). The intervention group also increased the time spent in sedentary activities, with the highest VM-HPF (36- <48 mGs) within the sedentary behavior (B=0.022, 95% CI=0.002, 0.042, p=0.03). Higher VM-HPF was significantly associated with a higher insulin sensitivity index (β=0.014, 95% CI=0.0004, 0.025, p=0.007). CONCLUSIONS The findings favor the culturally adapted intervention approach for addressing low physical activity levels among Middle Eastern immigrants. Replacing sedentary time with light-intensity activities could be an achievable goal and will have potential beneficial effects for diabetes prevention among this sedentary group of immigrants. TRIAL REGISTRATION This study was registered at www.clinicaltrials.gov NCT01420198.
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Online platform for healthy weight loss in adults with overweight and obesity - the "POEmaS" project: a randomized controlled trial.
Beleigoli, AM, Queiroz de Andrade, A, Haueisen Diniz, MF, Alvares, RS, Ribeiro, AL
BMC public health. 2018;(1):945
Abstract
BACKGROUND Obesity is a major health problem in Brazil affecting 19% of Brazilian adults with a rising incidence over the last 10 years. Moreover, low fruit/vegetables consumption and high sweetened beverage intake are major issues. Facing the challenge of universal healthcare access, internet-based programs have the potential to reach a large number of inhabitants, be widely accessible and cost effective. Our aim is to to assess the efficacy of a web-based platform to promote weight loss and diet and physical activity habits change in a Brazilian adult population. METHODS We designed a three-arm parallel randomized controlled trial including 18-60 years university students or employees with 25 kg/m2 minimum body mass index (BMI). Pregnancy, conditions with specific dietary requirements and participation in other weight loss programs are exclusion criteria. Participants are allocated to one of three groups: (1) waitlist with minimal intervention, (2) web-based platform, (3) web-based platform plus online dietician assistance. Assessors are blinded. Weight and BMI loss are the primary outcomes. Diet and physical activity behaviours, health perception and online activity features are secondary outcomes. The intervention comprises recommendations of diet and physical activity habits tailored to the Brazilian population and principles of behaviour change. The web-based platform has online social network and gamification features. Analysis will be on an intention-to-treat basis at 12 and 24 weeks after baseline. Differences in weight loss between groups will be performed by analysis of covariate. Linear regression will be used to assess whether treatment group allocation is an independent predictor of weight loss. The study was approved by the Federal University of Minas Gerais (UFMG) Ethics Research Committee. All participants signed an informed consent form prior to recruitment. DISCUSSION We present the study protocol of a three arm parallel randomized controlled trial which aims to test the efficacy of an online platform to promote weight loss for adults with overweight and obesity. We anticipate that the adoption of healthy lifestyle habits and weight loss will be more important in participants randomized to the online platform group. TRIAL REGISTRATION NCT03435445 on February 16th, 2018.