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Effectiveness of a Lifestyle Intervention on Metabolic Syndrome. A Randomized Controlled Trial

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Abstract

BACKGROUND

Intensive lifestyle intervention significantly reduces the progression to diabetes in high-risk individuals.

OBJECTIVE

It is not known whether a program of moderate intervention might effectively reduce metabolic abnormalities in the general population.

DESIGN

Two-arm randomized controlled 1-year trial.

PATIENTS

Three hundred and thirty-five patients participated from a dysmetabolic population-based cohort of 375 adults aged 45–64 years in northwestern Italy.

MEASUREMENTS

We compared the effectiveness of a general recommendation-based program of lifestyle intervention carried out by trained professionals versus standard unstructured information given by family physicians at reducing the prevalence of multiple metabolic and inflammatory abnormalities.

RESULTS

At baseline, clinical/anthropometric/laboratory and lifestyle characteristics of the intervention (n = 169) and control (n = 166) groups were not significantly different. The former significantly reduced total/saturated fat intake and increased polyunsaturated fat/fiber intake and exercise level compared to the controls. Weight, waist circumference, high-sensitivity C-reactive protein, and most of the metabolic syndrome components decreased in the intervention group and increased in the controls after 12 months. Lifestyle intervention significantly reduced metabolic syndrome (odds ratio [OR] = 0.28; 95% CI 0.18–0.44), with a 31% (21–41) absolute risk reduction, corresponding to 3.2 (2–5) patients needing to be treated to prevent 1 case after 12 months. The intervention significantly reduced the prevalence of central obesity (OR = 0.33; 0.20–0.56), and hypertriglyceridemia (OR = 0.48; 0.31–0.75) and the incidence of diabetes (OR = 0.23; 0.06–0.85).

CONCLUSION

A lifestyle intervention based on general recommendations was effective in reducing multiple metabolic/inflammatory abnormalities. The usual care by family physicians was ineffective at modifying progressive metabolic deterioration in high-risk individuals.

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References

  1. Pan XR, Li GW, Hu YH, et al. Effects of diet and exercise in preventing NIDDM in people with impaired glucose tolerance. The Da Qing IGT and Diabetes Study. Diabetes Care. 1997;20:537–44.

    Article  PubMed  CAS  Google Scholar 

  2. Tuomilehto J, Lindström J, Eriksson JG, et al. Prevention of type 2 diabetes by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med. 2001;344:1343–50.

    Article  PubMed  CAS  Google Scholar 

  3. The Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346:393–403.

    Article  Google Scholar 

  4. Herman WH, Herger TJ, Brandle M, et al. The cost-effectiveness of lifestyle modification on metformin in preventing type 2 diabetes in adults with impaired glucose tolerance. Ann Intern Med. 2005;142:323-32.

    PubMed  Google Scholar 

  5. Eddy DM, Schlessinger L, Kahn R. Clinical outcomes and cost-effectiveness of strategies for managing people at high risk for diabetes. Ann Intern Med. 2005;143:251–64.

    PubMed  Google Scholar 

  6. Isooma B, Almgren P, Tuomi T, et al. Cardiovascular morbidity and mortality associated with the metabolic syndrome. Diabetes Care. 2001;24:683–9.

    Article  Google Scholar 

  7. Lorenzo C, Okoloise M, Williams K, et al. The metabolic syndrome as predictor of type 2 diabetes. Diabetes Care. 2003;26:3153–9.

    Article  PubMed  Google Scholar 

  8. National Institute of Health. Executive summary of the third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA. 2001;285:2486–97.

    Article  Google Scholar 

  9. Ford ES. Risk for all-cause mortality, cardiovascular disease, and diabetes associated with the metabolic syndrome. A summary of the evidence. Diabetes Care. 2005;28:1769–78.

    Article  PubMed  Google Scholar 

  10. Kahn R, Buse J, Ferranini E, Stern M. The metabolic syndrome: time for a critical appraisal. Joint statement from the American Diabetes Association and the European Association for the Study of Diabetes. Diabetologia. 2005;48:1684–99.

    Article  PubMed  CAS  Google Scholar 

  11. Ridker PM, Buring JE, Cook NR, Rifai N. C-reactive protein, the metabolic syndrome, and risk of incident cardiovascular events. Circulation. 2003;107:391–7.

    Article  PubMed  Google Scholar 

  12. Orchard TJ, Temprosa M, Goldberg R, et al. The effect of metformin and intensive lifestyle intervention on the metabolic syndrome: the Diabetes Prevention Program Randomized Trial. Ann Intern Med. 2005;142:611–9.

    PubMed  CAS  Google Scholar 

  13. Kukkonen-Harjula KT, Borg PT, Nenonen AM, Fogelholm MG. Effects of a weight maintenance program with or without exercise on the metabolic syndrome: a randomized trial in obese men. Prev Med. 2005;41:784–90.

    Article  PubMed  Google Scholar 

  14. Esposito K, Marfella R, Ciotola M, et al. Effect of a Mediterranean-style diet on endothelial dysfunction and markers of vascular inflammation in the metabolic syndrome. JAMA. 2004;292:1440–6.

    Article  PubMed  CAS  Google Scholar 

  15. Azadbakht L, Mirmiran P, Esmaillzader A, et al. Beneficial effects of a Dietary Approaches to Stop Hypertension eating plan on features of the metabolic syndrome. Diabetes Care. 2005;28:2823–31.

    Article  PubMed  CAS  Google Scholar 

  16. Poppitt SD, Keogh GF, Prentice AM, et al. Long-term effects of ad libitum low-fat, high-carbohydrate diets on body weight and serum lipids in overweight subjects with metabolic syndrome. Am J Clin Nutr. 2002;75:11–20.

    PubMed  CAS  Google Scholar 

  17. Sacerdote C, Fiorini L, Rosato R, et al. Randomized controlled trial: effect of nutritional counseling in general practice. Int J Epidemiol. 2006;35:409–15.

    Article  PubMed  Google Scholar 

  18. Bo S, Gentile L, Ciccone G, et al. The metabolic syndrome and high C-reactive protein: prevalence and difference by sex in a southern-European population-based cohort. Diabetes Metab Res Rev. 2005;21:515–24.

    Article  PubMed  CAS  Google Scholar 

  19. The practical guide. Identification, evaluation, and treatment of overweight and obesity in adults. NIH Publication number 00-4084; October 2000

  20. Bo S, Menato G, Lezo A, et al. Dietary fat and gestational hyperglycemia. Diabetologia. 2001;44:972-8.

    Article  PubMed  CAS  Google Scholar 

  21. Taylor HL, Jacobs DR Jr, Schucker B, et al. Questionnaire for the assessment of leisure time physical activities. J Chronic Dis. 1978;31:741–55.

    Article  PubMed  CAS  Google Scholar 

  22. The Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Diabetes Care. 2003;26:S5–20.

    Article  Google Scholar 

  23. Matthews DR, Hosker JP, Rudenski AS, et al. Homeostasis model assessment: insulin resistance and β-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia. 1985;28:412–9.

    Article  PubMed  CAS  Google Scholar 

  24. Ross R, Dagnone D, Jones PJH, et al. Reduction in obesity and related comorbid conditions after diet-induced weight loss or exercise-induced weight loss in men. Ann Intern Med. 2000;133:92–103.

    PubMed  CAS  Google Scholar 

  25. Lindström J, Louheranta A, Mannelin M, et al. The Finnish Diabetes Prevention Study. Lifestyle intervention and 3-year results on diet and physical activity. Diabetes Care. 2003;26:3230–6.

    Article  PubMed  Google Scholar 

  26. Marshall JA, Bessesen DH, Hamman RF. High saturated fat and low starch and fiber are associated with hyperinsulinaemia in a non-diabetic population: the San Luis Valley Diabetes Study. Diabetologia. 1997;40:430–8.

    Article  PubMed  CAS  Google Scholar 

  27. McKeon NM, Meigs JB, Liu S, et al. Carbohydrate nutrition, insulin resistance, and the prevalence of the metabolic syndrome in the Framingham Offspring Cohort. Diabetes Care. 2004;27:538–46.

    Article  Google Scholar 

  28. Freire RD, Cardoso MA, Gimeno SGA, Ferreira SRG. Dietary fat is associated with metabolic syndrome in Japanese Brazilians. Diabetes Care. 2005;28:1779–85.

    Article  PubMed  CAS  Google Scholar 

  29. Klein-Platat C, Drai J, Oujaa M, et al. Plasma fatty acid composition is associated with the metabolic syndrome and low-grade inflammation in overweight adolescents. Am J Clin Nutr. 2005;82:1178–84.

    PubMed  CAS  Google Scholar 

  30. Basu A, Devaraj S, Jialal I. Dietary factors that promote or retard inflammation. Arterioscler Thromb Vasc Biol. 2006;26:995–1001.

    Article  PubMed  CAS  Google Scholar 

  31. Laaksonen DE, Lakka HM, Salonen JT, et al. Low levels of leisure-time physical activity and cardiorespiratory fitness predict development of the metabolic syndrome. Diabetes Care. 2002;25:1612–8.

    Article  PubMed  Google Scholar 

  32. Aronson D, Sella R, Sheikh-Ahmad M, et al. The association between cardiorespiratory fitness and C-reactive protein in subjects with the metabolic syndrome. J Am Coll Cardiol. 2004;44:2003–7.

    Article  PubMed  CAS  Google Scholar 

  33. Dallongeville J, Cottel D, Ferrières J, et al. Household income is associated with the risk of metabolic syndrome in a sex-specific manner. Diabetes Care. 2005;28:409–15.

    Article  PubMed  Google Scholar 

  34. The Diabetes Prevention Program Research Group. Impact of intensive lifestyle and metformin therapy on cardiovascular disease risk factors in the Diabetes Prevention Program. Diabetes Care. 2005;28:888–94.

    Article  Google Scholar 

  35. Hillier TA, Fagot-Campagna A, Eschwège E, et al. Weight change and changes in the metabolic syndrome as the French population moves towards overweight: the DESIR Cohort. Int J Epidemiol. 2006;35:190–6.

    Article  PubMed  CAS  Google Scholar 

  36. Thompson RL, Summerbell CD, Hooper L, et al. Relative efficacy of differential methods of dietary advice: a systematic review. Am J Clin Nutr. 2003;77:1052S–1057S.

    PubMed  CAS  Google Scholar 

  37. Timpson NJ, Lawlor DA, Harbord RM, et al. C-reactive protein and its role in metabolic syndrome: mendelian randomisation study. Lancet. 2005;366:1954–9.

    Article  PubMed  CAS  Google Scholar 

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Acknowledgments

We are indebted to Federica Ghione, Sabrina Guidi, Pia Mangiameli, Elisabetta Pisu, Elena Repetti, Marina Rivetti, Elisa Tiozzo, and Ileana Baldi for their precious assistance.

This study was supported by a grant from Regione Piemonte

Conflicts of Interest

None disclosed.

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Correspondence to Simona Bo MD.

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Bo, S., Ciccone, G., Baldi, C. et al. Effectiveness of a Lifestyle Intervention on Metabolic Syndrome. A Randomized Controlled Trial. J GEN INTERN MED 22, 1695–1703 (2007). https://doi.org/10.1007/s11606-007-0399-6

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  • DOI: https://doi.org/10.1007/s11606-007-0399-6

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