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Type 2 Diabetes Mellitus (T2DM) is one of major life style disorder with multiple systemic complications. Lifestyle modification and management of chronic mental stress plays a major role in treating and preventing T2DM. Naturopathy uses lifestyle modification and natural therapies to cure the diseases. Effectiveness of Yoga practice in stress management is proven through various studies. In this study we evaluate the effect of Naturopathy and Yogic lifestyle intervention on the anthropometric, biochemical, electrophysiological parameters and development of cardiovascular risk among T2DM patients. Methods The study is a prospective randomized parallel group trial. The study is divided into two phases, intensive phase and continuation phase. 252 T2DM patients will be randomized into intervention group and control group after screening. The intervention group will receive intense NY CTRI/2018/12/016550

We evaluated possible mediators underlying lifestyle intervention effects on neonatal adiposity, assessed with sum of skinfolds and cord blood leptin. This is a secondary analysis of the DALI study, a randomised controlled trial in nine European countries. Pregnant women with a pre-pregnancy body mass index of ≥29 kg/m2 were randomly assigned to counselling for healthy eating (HE), physical activity (PA), HE&PA combined, or to usual care. We considered five maternal metabolic factors at 24–28 and 35–37 weeks of gestation, and four cord blood factors as possible mediators of the effect of combined HE&PA counselling on neonatal adiposity. From all potential mediators, the intervention only affected cord blood non-esterified fatty acids (NEFA), which was higher in the HE&PA group compared to UC (0.068 (mmol/L), 95% CI: 0.004 to 0.133). Cord blood NEFA did not mediate the HE&PA intervention effects on neonatal sum of skinfolds or cord blood leptin, based on an indirect effect on skinfolds of 0.018 (mm), 95% CI: −0.217 to 0.253 and an indirect effect on leptin of −0.143 (μg/l), 95% CI: −0.560 to 0.273. The Dali study observed reductions in neonatal adiposity in pregnant women with obesity, but we were not able to identify the underlying metabolic pathway.

Evidence-based lifestyle interventions tailored to young adults with serious mental illness are needed to reduce their cardiometabolic risk. This study evaluated the effectiveness of a group lifestyle intervention ("PeerFIT") enhanced with mobile health (mHealth) compared with one-on-one mHealth coaching (basic education supported by activity tracking [BEAT]) for young adults with serious mental illness who were overweight or obese.Participants were young adults ages 18-35 years with serious mental illness and a body mass index ≥25 kg/mParticipants were 150 young adults with a mean ± SD body mass index of 37.1±7.4. Intent-to-treat analyses revealed no significant between-group difference for weight-loss, CRF, or CVD outcomes at 6 and 12 months. Participants in both conditions achieved clinically significant CVD risk reduction, weight loss, and CRF from baseline to 6 and 12 months, and all these improvements were statistically significant (p0.01).The PeerFIT group lifestyle intervention was not superior to one-on-one mHealth coaching in achieving clinically significant changes in weight, CRF, and CVD risk reduction. Although both interventions improved outcomes, low-intensity mHealth coaching may be a more scalable approach for addressing modifiable cardiometabolic risk factors among young adults with serious mental illness.

The difference between brain age predicted from MRI and chronological age (the so-called BrainAGE) has been proposed as an ageing biomarker. We analyse its cross-species potential by testing it on rats undergoing an ageing modulation intervention. Our rat brain age prediction model combined Gaussian process regression with a classifier and achieved a mean absolute error (MAE) of 4.87 weeks using cross-validation on a longitudinal dataset of 31 normal ageing rats. It was then tested on two groups of 24 rats (MAE = 9.89 weeks, correlation coefficient = 0.86): controls vs. a group under long-term environmental enrichment and dietary restriction (EEDR). Using a linear mixed-effects model, BrainAGE was found to increase more slowly with chronological age in EEDR rats ( p = 0.015 for the interaction term). Cox regression showed that older BrainAGE at 5 months was associated with higher mortality risk ( p = 0.03 ). Our findings suggest that lifestyle-related prevention approaches may help to slow down brain ageing in rodents and the potential of BrainAGE as a predictor of age-related health outcomes.

Context Women with polycystic ovary syndrome (PCOS) have an increased risk of metabolic syndrome (MetS). Both PCOS and MetS are associated with excess weight. Objective To examine the effect of a three-component lifestyle intervention (LSI) with or without short message service (SMS+ or SMS−, respectively) on the prevalence and severity of MetS and metabolic parameters, compared to care as usual (CAU). Design Randomized controlled trial. Methods Women diagnosed with PCOS and a BMI >25 kg/m2 (n = 183) were either assigned to a 1-year three-component (cognitive behavioural therapy, diet, and exercise) LSI, with or without SMS support, or to CAU which provided weight-loss advice only. Main outcome measures included changes in the prevalence of MetS, the continuous MetS severity z-score (cMetS z-score), metabolic parameters, and the impact of weight loss. Results After 1 year, the decrease in the cMetS z-score was greater in the SMS+ group than the CAU group (−0.39, P = 0.015). The prevalence of MetS changed with −21.6% (P = 0.037), −16.5% (P = 0.190), and +7.0% (P = 0.509) in both LSI groups and CAU group, respectively. A post hoc analysis for both LSI groups combined vs CAU resulted in a MetS difference of −25.9% (P = 0.046). Moreover, weight loss per se resulted in significantly favourable effects on all metabolic parameters. Conclusions This three-component LSI was more successful in improving metabolic health compared to CAU. Therefore, we recommend this intervention to women with PCOS and excess weight, provided that a clinically relevant weight loss is being pursued.

We have developed two advanced cirrhosis regression experimental models with persistent relevant fibrosis and portal hypertension and an associated deteriorated metabolism that mimic what happens in patients. LI, despite improving metabolism, did not enhance the regression process in our cirrhotic models. CR did not further reduce PP, hepatic fibrosis, or HSC activation. MEE exhibited a profibrogenic effect in the liver blunting cirrhosis regression. One of the potential explanations of this worsening could be ammonia accumulation.

Background and rationale Obesity is associated with the development and progression of many diseases. Understanding and management of obesity have become increasingly important; however, a knowledge gap remains between how healthcare providers (HCPs) consider weight‐loss treatment and the importance of weight loss for improving obesity‐related diseases. Objective The objective of this study was to investigate how HCPs assess obesity, how they interpret the relationship between obesity and 12 recognized co‐morbidities of obesity (excluding diabetes), and their view about the value of various weight‐loss therapies. Methods This was a cross‐sectional, non‐interventional, descriptive study. Participants were medical doctors (HCPs) from eight European countries. Results Eighty‐nine percent of the 197 HCPs that completed the survey considered obesity a disease. For most of the 12 obesity‐related diseases under consideration, a majority of HCPs agreed that weight loss could reverse the disease or prevent progression. Among HCPs who have recommended weight loss, lifestyle interventions were by far the most common recommendation. However, more than three out of four HCPs stated that they would be likely to prescribe anti‐obesity medications if available and reimbursed. Conclusion Most HCPs in this survey consider obesity a disease that needs to be treated. However, the majority of HCPs appear to prefer recommending lifestyle changes, although it is well documented that weight loss obtained by lifestyle changes is difficult to maintain. These results underscore the need for improved education of HCPs involved in the treatment of obesity‐related diseases., Visual Abstract

Chronic heart failure is common, debilitating, and often the culmination of pervasive cardiovascular insults that systematically undermine the heart’s circulatory capacity and invoke counterproductive neuro-hormonal compensatory changes. Prevention of chronic heart failure therefore requires minimising the impact of traditional cardiovascular risk factors with incisive treatment of hypertension and type II Diabetes Mellitus (T2DM) and prompt lifestyle interventions for smoking, lack of exercise, obesity and hypercholesterolemia. This review is narrative, with selected emphasis on major studies, rather than structured on a specific clinical question, and should be read as such.

PURPOSE The aim of this study was (1) to assess AT through 13 different mathematical approaches and to compare their results; and (2) to understand if AT occurs after moderate WL. METHODS Ninety-four participants [mean (SD); BMI, 31.1 (4.3) kg/m2; age, 43.0 (9.4) years; 34% females] underwent a 1-year lifestyle intervention (clinicaltrials.gov ID: NCT03031951) and were randomized to intervention (IG, n = 49) or control groups (CG, n = 45), and all measurements were made at baseline and after 4 months. Fat mass (FM) and fat-free mass (FFM) were measured by dual-energy X-ray absorptiometry and REE by indirect calorimetry. AT was assessed through 13 different approaches, varying in how REE was predicted and/or how AT was assessed. RESULTS IG underwent a mean negative energy balance (EB) of 270 (289) kcal/day, p

Type 2 diabetes mellitus (T2DM) is a chronic progressive disorder and is associated with significant morbidity and mortality. The concept of T2DM remission and the reversal of diabetic parameters to normal levels has been gaining momentum over the past years. T2DM remission is increasingly being recognized by various global guidelines. Multiple models have been developed and validated for quantifying the extent of remission achieved. Based on favorable clinical evidence, T2DM remission can be considered as the therapeutic goal in diabetes management and, in select cases, as an alternative to expensive treatment options, which can be burdensome as T2DM progresses. This narrative review discusses the available strategies, such as lifestyle interventions, physical activity, bariatric surgery, medical nutrition therapy, and non-insulin glucose-lowering medications, for achieving T2DM remission. Although the concept of T2DM remission has emerged as a real-world option, effective implementation in routine clinical practice may not be feasible until long-term studies prove the efficacy of different approaches in this regard.

Background Recent studies have indicated that bariatric surgery is effective for the treatment of youth with severe obesity. The attitudes of pediatricians, parents, and adolescents regarding this topic remain unclear. Therefore, the aim of this study was to assess the current thoughts and beliefs of Dutch pediatricians, parents, and adolescents regarding bariatric surgery in youth. Methods An online survey containing twenty questions on bariatric surgery in youth was distributed to pediatricians of the Dutch Society of Pediatrics. Parents and adolescents who participated in an interdisciplinary care program for overweight, obesity, and severe obesity filled out an online survey of twelve questions. Results One hundred and twenty-one pediatricians, 49 parents, and 19 adolescents completed the surveys. Seventy-two pediatricians (59.5%) considered bariatric surgery to be an effective treatment for youth with severe obesity when conventional treatment fails, and intend to refer patients for bariatric surgery. The most frequently suggested conditions for bariatric surgery were a minimum age of 16 years (n = 59, 48.7%), a BMI threshold of 40 kg/m2 (n = 51, 42.2%), and a minimum Tanner stage of IV (n = 59, 48.8%). Thirty parents (61.2%) and fourteen adolescents (73.7%) responded that bariatric surgery should become available for youth with severe obesity. Conclusion Dutch pediatricians, parents, and adolescents increasingly accept bariatric surgery as a treatment modality in youth with severe obesity who do not respond successfully to lifestyle intervention. Whether pediatricians will actually refer youth for bariatric surgery remains to be seen when this treatment option will be implemented in the Netherlands. Graphical abstract

PURPOSE OF REVIEW Workplaces provide a unique opportunity to deliver health promotion interventions to their workers. This review summarizes evidence from the most recent studies (September 2019 to April 2021) of workplace healthy lifestyle interventions and identifies gaps in the literature and key aspects for successful future workplace lifestyle interventions. RECENT FINDINGS Recent intervention studies have focused on four health domains: (1) multicomponent wellness programs, (2) healthy diet interventions, (3) physical activity interventions, and (4) mental health/sleep interventions. Within each group of studies, there was significant heterogeneity in study length, intervention components, and worker populations. Nonetheless, most studies across all categories showed positive associations between healthy lifestyle interventions and improved worker health. SUMMARY Although recent literature has shown an overall positive trend between healthy lifestyle interventions implemented at the workplace and improvements in markers of health and wellbeing, further research should include longer follow-up periods, more objective measures of wellbeing, evaluation of worker performance, and analogous interventions between studies to identify the most effective interventions to improve worker health and wellness.

Hayat Mushcab, Fawaz Alsharif, Asghar Nazeer, Ali Mollah, Ashwaq Matroud, Saeed Qahtani, Mohammed Ghamdi Johns Hopkins Aramco Healthcare, Dhahran, Saudi ArabiaCorrespondence: Hayat MushcabJohns Hopkins Aramco Healthcare, Room 2, Building 1188, Dhahran, Saudi ArabiaTel +966 556373411Email hayat.mushcab@gmail.comBackground: Lifestyle modification interventions help prevent or postpone Type 2 Diabetes and its complications with diet modification and increasing physical activity. This is translational research of Tawazon-DPP in which we evaluate the efficacy of the intensive lifestyle modification program.Methods: Tawazon was piloted in 2 phases over 6 and 9 months at a Tertiary Hospital. Phase I was conducted in 2017 in one district facility with 47 participants while Phase II was conducted in 2018 in 4 district facilities with 247 participants. Data are collected retrospectively in a before-and-after study design. The program included adults with 25 kg/m2 BMI and HbA1c ranging between 5.7 and 6.4 mmol/L, while excluding participants with comorbidities, such as cardiovascular conditions, musculoskeletal injuries, and pregnancy.Results: We used descriptive analysis as well as Wilcoxon rank sign test and McNemar-Bowker for before and after data comparisons. Phase I exhibited a mean age of 43± 7 years and statistically significant improvement in HbA1c (0.3 mmol/L), weight (3.3 kg), BMI (1 kg/m2), triglyceride (30.4 mg/dL) and LDL (14.67 mg/dL). Phase II exhibited a mean age of 45± 9 years with 70% above 40 years old. Significant improvement was also found in HbA1c (0.2 mmol/L), weight (5.1 kg), and BMI (1.8 kg/m2); the lipid profile in the second phase showed better results with significant improvement in total cholesterol (7.4 mg/dL), triglyceride (20.9 mg/dL), LDL (8.8 mg/dL), and (0.9 mg/dL) increase in HDL.Conclusion: This pilot has taken lifestyle interventions to real-life and it led to the favored and desired outcome. It showed that long-term guided support can help patients make the needed changes in their diet, habits, and physical activity, thus, prevent or delay the onset of Type 2 diabetes.Keywords: diabetes, type 2, HbA1c, lifestyle, prevention

Adipositas und ihre Begleit- und Folgeerkrankungen stellen ein weltweit wachsendes Gesundheitsproblem dar. In Deutschland sind mindestens 15 Mio. Menschen von dieser Erkrankung betroffen. Die bisherigen Therapiekonzepte zur Lebensstilanderung zeigen bei den meisten Betroffenen nur begrenzte Wirksamkeit, was Ausmas und Nachhaltigkeit der Gewichtsabnahme betrifft. Die wirksameren chirurgischen Interventionen mussen dagegen Menschen mit extremer Adipositas (Body-Mass-Index ≥40 kg/m2) vorbehalten bleiben. Daher wird seit Langem nach pharmakologischen Optionen fur eine Unterstutzung der Lebensstilmasnahmen gesucht. Derzeit stehen mit Orlistat, Liraglutid und Amfepramon nur wenige Substanzen mit einer Reihe von Einschrankungen zur Verfugung. Neue Entwicklungen geben aber berechtigten Anlass zur Hoffnung, dass es in den kommenden Jahren zu einem Paradigmenwechsel in der Pharmakotherapie der Adipositas kommen konnte. Fur viele alternative „Schlankheitsmittel“, insbesondere in Form von Nahrungserganzungsmitteln, fehlt wissenschaftliche Evidenz bezuglich der Wirksamkeit bzw. sind die Effekte ohne klinische Relevanz.

Purpose Emerging evidence suggests that the progesterone-mediated receptor activator of nuclear factor κB (RANK)/soluble RANK ligand (sRANKL)/osteoprotegerin (OPG) pathway plays an important role in mammary carcinogenesis and is hyperactivated in germline (g)BRCA1/2 mutation carriers. We analyzed the effects of a 3-month intensive lifestyle intervention within the LIBRE-1 study on the serum levels of OPG and sRANKL and hypothesized that the intervention program provides a beneficial impact on the biomarkers by increasing OPG and reducing sRANKL serum concentrations. Methods Serum levels of OPG and sRANKL of 49 gBRCA1/2 mutation carriers were quantified using enzyme-linked immunosorbent assays. We used previously collected blood samples from participants of the prospective LIBRE-1 study, who were randomized into an intervention group (IG), increasing physical activity and adherence to the Mediterranean diet (MedD) through supervised sessions from study entry to the first study visit after 3 months and a usual-care control group (CG). Differences in biomarker levels before and after the 3-month intervention were tested within and between study groups. Results The lifestyle intervention resulted in a significant increase in OPG for participants in both the IG (q = 0.022) and CG (q = 0.002). sRANKL decreased significantly in the IG (q = 0.0464) and seemed to decrease in the CG (q = 0.5584). An increase in the intake of Omega-3 polyunsaturated fatty acids was significantly associated with an increase in OPG (r = 0.579, q = 0.045). Baseline serum levels of sRANKL were a strong predictor for the change of sRANKL in the course of the intervention (ß-estimate = − 0.70; q = 0.0018). Baseline physical fitness (assessed as VO2peak) might predict the change of OPG in the course of the intervention program (ß-estimate = 0.133 pg/ml/ml/min/kg; p = 0.0319; q = 0.2871). Conclusion Findings from this pilot study seem to confirm our hypothesis by showing an increase in OPG and decrease in sRANKL over a 3-month lifestyle intervention and suggest that increased physical activity and adherence to the MedD are potent modulators of the biomarkers OPG and potentially sRANKL.

Lifestyle intervention (LI) can prevent type 2 diabetes, but response to LI varies depending on risk subphenotypes. We tested whether individuals with prediabetes with low risk (LR) benefit from conventional LI and individuals with high risk (HR) benefit from an intensification of LI in a multicenter randomized controlled intervention over 12 months with 2 years’ follow-up. A total of 1,105 individuals with prediabetes based on American Diabetes Association glucose criteria were stratified into an HR or LR phenotype based on previously described thresholds of insulin secretion, insulin sensitivity, and liver fat content. LR individuals were randomly assigned to conventional LI according to the Diabetes Prevention Program (DPP) protocol or control (1:1) and HR individuals to conventional or intensified LI with doubling of required exercise (1:1). A total of 908 (82%) participants completed the study. In HR individuals, the difference between conventional and intensified LI in postchallenge glucose change was −0.29 mmol/L [95% CI −0.54; −0.04], P = 0.025. Liver fat (−1.34 percentage points [95% CI −2.17; −0.50], P = 0.002) and cardiovascular risk (−1.82 percentage points [95% CI −3.13; −0.50], P = 0.007) underwent larger reductions with intensified than with conventional LI. During a follow-up of 3 years, intensified compared with conventional LI had a higher probability of normalizing glucose tolerance (P = 0.008). In conclusion, it is possible in HR individuals with prediabetes to improve glycemic and cardiometabolic outcomes by intensification of LI. Individualized, risk phenotype–based LI may be beneficial for the prevention of diabetes.

Background: Cardiovascular diseases and Type 2 diabetes mellitus are two leading noncommunicable diseases globally. Mitigating their overlapping cardiometabolic risk factors have been identified as vital to the global effort to prevent and control these chronic diseases. Objective: The purpose of the study was to examine the efficacy of lifestyle education intervention on cardiometabolic risk factors. Subjects and Methods: A prospective, placebo-controlled, parallel-group, randomized trial was used to conduct a 12-week lifestyle educational intervention on 184 corporate workers. The collected data were analyzed with analysis of covariance at 0.05 alpha level. Results: The treatment significantly improved the mean difference (all P < 0.05) of the intervention groups' fruits and vegetable consumption (0.64, 95% confidence interval [CI]: 1.03–1.81), physical activity (0.38, 95% CI: 1.22–1.80), and attitude toward healthy living (22.3, 95% CI: 35.56–59.37). It also significantly reduced the mean difference of the participants' salt intake (0.39, 95% CI: 1.44–1.99), daily tobacco use (0.12, 95% CI: 1.70–1.96), alcohol consumption (0.31, 95% CI: 0.37–0.99), resting heart rate (−4.81 bpm, 95% CI: 77.89–84.65), systolic blood pressure (−5.52 mmHg, 95% CI: 117.9–127.61), diastolic blood pressure (−4.41 mmHg, 95% CI: 75.10–81.47), body mass index (−1.78, 95% CI: 24.58–27.65), waist circumference (−0.90 cm, 95% CI: 87.70–91.53), fasting blood glucose (−0.36 mmol/l, 95% CI: 4.84–5.48), total blood cholesterol (0.41 mmol/l, 95% CI: 4.41–5.19), and type 2 diabetes risk scores (−1.76, 95% CI: 5.25–8.86). Conclusion: Lifestyle education is an effective intervention program in reducing the prevalence of cardio-metabolic risk factors among corporate workers.

Introduction: To determine the effects of a novel lifestyle intervention combining lifestyle behavioral education with the complementary–integrative health modality of guided imagery (GI) on dietary and physical activity behaviors in adolescents. The primary aim of this study was to determine the incremental effects of the lifestyle education, stress reduction GI (SRGI), and lifestyle behavior GI (LBGI) components of the intervention on the primary outcome of physical activity lifestyle behaviors (sedentary behavior, light, moderate, and vigorous physical activity), as well as dietary intake behaviors, at the completion of the 12-week intervention. The authors hypothesized that the intervention would improve obesity-related lifestyle behaviors. Materials and Methods: Two hundred and thirty-two adolescent participants (aged 14–17 years, sophomore or junior year of high school) were cluster randomized by school into one of four intervention arms: nonintervention Control (C), Lifestyle education (LS), SRGI, and LBGI. After-school intervention sessions were held two (LS) or three (SRGI, LBGI) times weekly for 12 weeks. Physical activity (accelerometry) and dietary intake (multiple diet recalls) outcomes were assessed pre- and postintervention. Primary analysis: intention-to-treat (ITT) mixed-effects modeling with diagonal covariance matrices; secondary analysis: ad hoc subgroup sensitivity analysis using only those participants adherent to protocol. Results: ITT analysis showed that the Healthy Eating Index (HEI) increased in the LS group compared with C (p = 0.02), but there was no additional effect of GI. Among adherent participants, sedentary behavior was decreased stepwise relative to C in SRGI (d = −0.73, p = 0.004) > LBGI (d = −0.59, p = 0.04) > LS (d = −0.41, p = 0.07), and moderate + vigorous physical activity was increased in SRGI (d = 0.58, p = 0.001). Among adherent participants, the HEI was increased in LS and SRGI, and glycemic index reduced in LBGI. Conclusions: While ITT analysis was negative, among adherent participants, the Imagine HEALTH lifestyle intervention improved eating habits, reduced sedentary activity, and increased physical activity, suggesting that GI may amplify the role of lifestyle education alone for some key outcomes. Clinical Trials.gov ID: NCT02088294

Background: This study was aiming to assess factors influencing the contribution of primary healthcare physicians concerning prevention of type 2 diabetes in the Jazan region, south of Saudi Arabia. Materials and Methods: A cross-sectional study was conducted to assess physicians' knowledge about evidence-based guidelines concerning diabetes prevention, their attitude towards lifestyle interventions and their practice concerning screening and provision of lifestyle interventions in their clinics. Interviews were conducted to complete a semi-structured questionnaire. Data analysis involved reviewing open-ended responses of physicians followed by quantitative analysis to assess level of knowledge, attitudes, and practice adherence. Results: A total of 234 physicians from 127 primary healthcare centres (PHCs) in the region were recruited. Knowledge of evidence-based clinical indicators for the prevention of diabetes was limited (mean level of knowledge 3.14/8 [SD: 1.2)]. Recruited physicians did have a positive overall attitude to the influence of lifestyle/behavioural therapy on the prevention of type 2 diabetes. The physicians narrated a variety of factors that might influence the effectiveness of this approach, which were related to the community, the patients and the physicians themselves. Only the association between gender of physicians and their levels of knowledge was statistically significant where odds of greater knowledge were higher among female physicians in comparison to males (odds ratio : 1.8, P value = 0.025). Conclusion: Most of the physicians in our sample were misinformed about the components of lifestyle/behavioural interventions for diabetes prevention, which mandates designing and implementing lifestyle medicine programmes for the PHC physicians in Jazan region.

Aims Nutritional and lifestyle interventions can contribute to prevent and treat obesity and its complications; however, genetic background may influence the success of a therapy. The aim of this pilot study is to evaluate the effects of the interaction between nutrigenetic variants and nutritional intervention, as well as the changes in clinical parameters and the adherence to Mediterranean diet (MedDiet) and to physical activity, of 18 overweight or obese subjects affected by T2D or dysglycemia included in a nutritional program. Methods The subjects’ clinical parameters as well as their PREDIMED score and physical activity levels were recorded and compared at baseline, at 6 months and at the end of the intervention. Rs9939609 in FTO, rs17782313 near MC4R, rs326 in LPL, rs16147 in NPY, rs2943641 near IRS-1 were genotyped. Results The subjects carrying the A allele in FTO lost less weight (p = 0.022) and had a lower BMI decrease from baseline to 12 months (p-interaction = 0.047) than TT carriers. In addition, there was a significant PREDIMED score modification over time, according to genotypes for FTO rs9939609 (p = 0.025) and NPY rs16147 (p = 0.039), respectively. Conclusions These preliminary findings show a significant interaction between genetic variants and the PREDIMED score, suggesting that individuals carrying the FTO variant may lose less weight than non-carriers through diet/lifestyle intervention.

Exercise and dietary (EX+D) interventions could represent an optimal treatment for attenuating or reversing adverse effects of androgen deprivation therapy (ADT) in prostate cancer (PCa) patients. The Individualized Diet and Exercise Adherence-Pilot (IDEA-P) trial compared the effects of an EX+D intervention relative to standard-of-care (SC) treatment among PCa patients undergoing ADT. The present study evaluated the effects of the EX+D intervention on body composition (BC) obtained via dual-energy X-ray absorptiometry (DXA) in a subsample of IDEA-P patients. A secondary objective was to explore the association of adiposity and lean mass with mobility performance and strength.Complete DXA data were acquired from a subsample of 22 PCa patients (EX+D:Intention-to-treat analysis revealed EX+D resulted in significant improvements in fat mass (Findings suggest the EX+D intervention resulted in superior preservation of lean tissue and improvement in adiposity relative to SC treatment. Results underscore the utility of implementing EX+D interventions for preserving muscle mass and reducing adiposity in PCa patients undergoing ADT.

Aims: Children with obesity are treated by a lifestyle intervention to obtain weight loss. Nevertheless, weight regain often occurs. This systematic review examines the effect of weight regain on cardiometabolic health and summarizes these results in the metabolic syndrome prevalence as integrated endpoint. Data synthesis: A literature search was performed in PubMed and Web of Science. Studies were selected if they included participants aged

We investigated the effect of a multidomain lifestyle intervention on the risk of dementia estimated using the validated CAIDE risk score (post-hoc analysis). The Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) is a 2-year randomized controlled trial among 1,260 at-risk older adults (60–77 years). Difference in the estimated mean change in CAIDE score at 2 years in the intervention compared to the control group was –0.16 (95 %CI –0.31 to 0.00) (p = 0.013), corresponding to a relative dementia risk reduction between 6.04–6.50%. This could be interpreted as a reflection of the prevention potential of the intervention.

Efforts to promote children’s preferences for healthy foods hold much potential for improving diet quality and preventing obesity. The purpose of this review was to summarize recent evidence for associations between maternal diet during pregnancy and lactation and child food preferences, dietary patterns, and weight outcomes. Recent research illustrates greater maternal vegetable intakes during pregnancy and lactation predict greater child preferences for and intakes of vegetables. Recent randomized clinical trials to improve maternal weight outcomes during the perinatal period via behavioral lifestyle interventions that included dietary components have yielded mixed findings for effects on child weight outcomes. There is strong evidence that maternal diet during pregnancy and lactation shapes flavor preferences during infancy; more research is needed to understand factors that facilitate versus hinder the translation of these preferences to later dietary patterns and weight outcomes.

Research question: What is the effect of weight loss through different interventions (three-component lifestyle intervention with short message service [SMS+] versus three-component lifestyle intervention without SMS [SMS–] versus care as usual [CAU]) on polycystic ovary syndrome (PCOS) characteristics (ovulatory dysfunction, hyperandrogenism, polycystic ovarian morphology [PCOM]) and phenotype distribution? Design: Analysis of secondary outcome measures of a randomized controlled trial. Women diagnosed with PCOS (n = 183), who wished to become pregnant, with a body mass index above 25 kg/m², were assigned to a 1-year three-component (cognitive behavioural therapy, diet, exercise) lifestyle intervention group, with or without SMS, or to CAU (advice to lose weight). Results: The prevalence of biochemical hyperandrogenism was 30.9% less in the SMS- group compared with CAU after 1 year (P = 0.027). Within-group analyses revealed significant improvements in ovulatory dysfunction (SMS+: –39.8%, P = 0.001; SMS–: –30.5%, P = 0.001; CAU: –32.1%, P < 0.001), biochemical hyperandrogenism (SMS–: –27.8%, P = 0.007) and PCOM (SMS–: –14.0%, P = 0.034). Weight loss had a significantly favourable effect on the chance of having ovulatory dysfunction (estimate 0.157 SE 0.030, P < 0.001) and hyperandrogenism (estimate 0.097 SE 0.027, P < 0.001). Conclusions: All groups demonstrated improvements in PCOS characteristics, although these were more profound within the lifestyle intervention groups. Weight loss per se led to an amelioration of diagnostic characteristics and in the phenotype of PCOS. A three-component lifestyle intervention aimed at a 5–10% weight loss should be recommended for all women with PCOS before they become pregnant.

Telehealth delivery of pediatric weight management interventions may address time, travel, and cost barriers to in-person interventions, thus improving accessibility. This narrative review highlights findings from the past 5 years of pediatric lifestyle interventions for weight management that utilize telehealth for treatment delivery. We describe impressions and future directions. We identified and included 20 studies that described unique interventions from the past 5 years. The majority of reviewed studies indicated statistically significant reductions in BMI z-scores, high retention and attendance, and high satisfaction. However, mean decreases in BMI z-scores were marginal (approximately 0.10) in all but two studies. Studies did not often report effect sizes. Pediatric telehealth weight management interventions demonstrate good feasibility and acceptability. Improvement in reporting results and more rigorous research, including use of randomized designs, recruitment of larger samples, and incorporation of extended follow-up is needed to determine clinical impact and magnitude of effects.

Purpose of Review To provide updated evidence on the endoscopic procedures for weight loss and to bring personal insights on the future of endobariatrics. Recent Findings Intragastric balloons promote significant improvement in histologic and radiologic aspects of non-alcoholic steatohepatitis; the endoscopic sleeve gastroplasty is effective up to 5 years and seems particularly beneficial to patients with BMI≤40kg/m2; distal POSE is a promising technique but still lacks adequate clinical data; aspiration therapy triggers remarkable weight loss, but data on weight trends after removal of the device are still lacking; the satiety-inducing device, the sleeveballoon, the gastric mucosal devitalization, and the endoscopic magnetic partial jejunal diversion are promising procedures still under study and refinements. Summary Several therapeutic options are necessary during obesity’s natural history. Therefore, endobariatrics should act in harmony with lifestyle interventions, diet modification, psychological treatment, pharmacotherapy, and bariatric surgery seeking the best outcome in the long term.

Hypertension (HTN) is associated with increased cardiovascular risk and unhealthy lifestyles in adults. However, data on both physiological and lifestyle factors associated with abnormal blood pressure (BP) in adolescents, as well as the effectiveness of interventions in improving these factors among adolescents with abnormal BP, is scarce.Students enrolled in a middle-school-based wellness program, Project Healthy Schools (PHS), between 2005-2016 were eligible. Three systolic (SBP) and diastolic (DBP) BP measurements were taken pre-PHS and post-PHS; averages of the final two were analyzed. Students were grouped by baseline BP: abnormal BP (≥90th percentile for SBP and/or DBP, or ≥120/80 mmHg) or normal BP (90th percentile for SBP and/or DBP, or120/80 mmHg). Demographics, physiologic measures, and health behaviors were compared between groups pre- and post-PHS.Of 2,865 students, 812 (28.3%) had abnormal BP. Median SBP was 119 mmHg in abnormal BP students and 103 mmHg in normal BP students (p.001). Females were less likely to have abnormal BP than males (48.4% vs. 51.6%, p.01). Pre-PHS, abnormal BP students were more likely to be overweight (62.3% vs. 28.2%, p.001) or obese (38.9% vs. 11.3%, p.001) than normal BP students. Their total cholesterol, triglycerides, random glucose, resting, and recovery heart rates were also higher, and they had worse dietary and sedentary habits. Post-PHS, abnormal BP students demonstrated greater reduction in SBP (-4.0 vs. 2.8 mmHg, p.001) and DBP (-3.3 vs. .8 mmHg, p.001) than normal BP students.Abnormal BP was prevalent and associated with worse cardiometabolic health parameters and behaviors at baseline. Abnormal BP students demonstrated significant improvements in BP post-PHS, suggesting school-based programs may be effective as nonpharmacological lifestyle interventions in this population.

Background The intervention in the Lifestyle Medicine Clinic from La Carlota Hospital gives an opportunity to assess the clinical effect of a healthy lifestyle in an inpatient setting with emphasis in a plant-based diet, supervised daily exercise, sleep hygiene, psychological and optional spiritual therapies. This work evaluated the effect of short-term therapy on biometrics and blood profiles' risk factors for non-communicable diseases (NCDs). Methods Twenty-five patients were enrolled in the intervention, 12 for the 10-day intervention and 13 for the 21-day intervention. Results The intervention improved most of the NCDs risk factors for the 10-day intervention weight decreased by -4.3% (p < .001), BMI -4.1% (p < .001), SBP -16.3% (p = .002), DBP -11.8% (p = .004), fasting glucose -31.3% (p = .041), total cholesterol -12.8% (p < .001), LDL -13.9 (p = .017), triglycerides and HDL lack statistical significance, however, there was a reduction of -7.7% and -9% respectively. For the 21-day intervention weight decreased by -8.3% (p = .016), SBP -11.2% (p = .005), DBP -11.4% (p = .022), triglycerides -39.5% (p = .034), total cholesterol -23.6% (p < .000), HDL -14.7% (p = .038), LDL -27.3% p < .000), BMI and fasting glucose presented a -15.2% and -21.2% reduction respectively without statistical significance. Conclusion The present study confirms that short-term lifestyle interventions effectively reduce the risk factors associated with NCD's.

Background Health‐related quality of life (HRQOL), a multifaceted construct for understanding health and healthcare outcomes, is comprised of eight domains of well‐being and functioning over time and has become an essential factor in assessing outcomes for youth with obesity. Aims To evaluate the effect of a community based, lifestyle intervention, on obesity‐specific HRQOL using the Sizing Me Up (SMU) in this group of Latino and White youth. Materials and Methods For this 12‐week family and community‐based intervention (ACT; Actively Changing Together), HRQOL was measured before and after the intervention concluded using the obesity‐specific HRQOL tool, SMU. This study enrolled 68 youth (10.9 ± 2 years; 54% male; 50% non‐Hispanic white). Paired t‐tests were used to examine the Sizing Me Up sub‐scales: Emotion, Physical, Social Avoidance, Positive Attributes, Teasing, and the total score. A greater change score indicated a larger increase in quality of life sub‐scale. Results Significant improvements from baseline to follow‐up were found in the total SMU (mean change = 5.27, SD 10.76, p = 0.00) and for the sub‐scores of: emotion (mean change = 8.06, SD 16.85, p ≤ 0.00), teasing (mean change = 5.65, SD 16.79, p = 0.01), and social avoidance (mean change = 3.92, SD 11.21, p = 0.01). Conclusions Sizing Me Up provided a clinically meaningful tool for this research study to evaluate obesity‐specific HRQOL among Hispanic and non‐Hispanic White youth with obesity.

Background. It is hypothesized that normal weight individuals develop diabetes through different pathophysiological mechanisms and that methods of prevention may differ in the absence of overweight/obesity. In this study, we compared the effect of lifestyle health coaching (LHC) on fasting plasma glucose (FPG) in normal weight, overweight, and obese US adults with prediabetes. Methods. Subjects were 1358 individuals who completed baseline and follow-up evaluations as part of an LHC program (follow-up = ~6 months). Participants were stratified, based on baseline body mass index (BMI), into normal weight (n = 129), overweight (n = 345), and obese (n = 884) cohorts. LHC included counseling, predominantly via telehealth, on exercise and nutrition. Results. BMI decreased ( P < .001) in the overweight and obese participants but was unchanged in the normal weight participants. FPG decreased ( P < .001) in all 3 cohorts, and the magnitude of decrease did not differ significantly among cohorts. FPG decreased to

Introduction Obesity is a chronic illness that requires a multifaceted personalized treatment approach. Methods & Findings Using current guidelines and recent studies in weight management, this article reviews the multiple components of weight management: lifestyle intervention (dietary intervention, physical activity, and behavioral interventions), pharmacotherapy, endoscopic procedures, and surgical procedures. This review briefly discusses specific diets and dietary strategies, compensatory mechanisms acting against weight loss, recent changes to Food and Drug Administration approved antiobesity medications, and technological advances in weight management delivery. Conclusion Current literature is lacking large studies on the safety and efficacy of combination therapies involving pharmacotherapy plus 1 or more procedures.

Objectives The authors sought to study the impact of diet and lifestyle intervention on changes in atherosclerotic plaque volume and composition. Background Lifestyle and diet modification are the leading strategies to manage coronary artery disease; however, their direct impact on atherosclerosis remains unknown. Coronary plaque composition is related to the risk of future cardiovascular events independent of stenosis severity and can be conveniently evaluated with computed tomography angiography (CTA). Methods We enrolled 92 patients (41% women; mean age 60 ± 7.7 years) with nonobstructive ( 351 HU), fibrous plaque (151 to 350 HU), and fibrofatty plaque combined with necrotic core (-30 to 150 HU), referred to as noncalcified plaque. Results Percent atheroma volume increased in the control arm (Δ = +1.1 ± 3.4%; p = 0.033) versus no significant change in the experimental arm (Δ = +1.0% ± 4.2%; p = 0.127; intergroup p = 0.851). There was a reduction in noncalcified plaque in both the experimental arm (Δ = −51.3 ± 79.5 mm3 [−1.7 ± 2.7%]; p Conclusions Controlled diet and lifestyle intervention together with OMT may slow the progression of atherosclerosis and reduce noncalcified plaque volume compared to OMT alone. (Dietary Intervention to Stop Coronary Atherosclerosis in Computed Tomography [DISCO-CT]; NCT02571803 )

An estimated 35 million individuals in the United States have diabetes. The American Diabetes Association recommends metformin as first-line pharmacologic treatment. The primary objective of this study was to evaluate the metformin initiation rate in veterans with recently identified type 2 diabetes.Veterans with new onset type 2 diabetes were identified using National Veterans Health Administration Data. Retrospective information was obtained from those with a first A1C ≥ 6.5% (48 mmol/mol) between 2013 and 2018. Veterans with at least one additional A1C6.5% (48 mmol/mol) documented in the three years prior to the A1C diagnostic for diabetes were included in the analysis.A total of 144,180 veterans were included. Of those, 45,776 (31.7%) were started on metformin within one year of diabetes diagnosis. The median time to metformin initiation was 12 days and median time to initiation of any anti-hyperglycemic was 11 days. Approximately 16,000 veterans were referred for lifestyle interventions within 90 days.Metformin initiation occurred in fewer patients than expected given metformin is a generic, well-tolerated medication recommended as first-line pharmacologic treatment option regardless of A1C. Further studies are needed to assess the barriers of initiating metformin at time of diabetes diagnosis.

Diet has been shown to influence disease activity in hidradenitis suppurativa (HS). Modification of dietary intake is the most commonly used lifestyle intervention in HS, and patients frequently report HS improvement after implementing dietary changes. Providing nutrition education may be perceived as not feasible within the time constraints of an outpatient office visit, and many physicians may also not feel equipped to do this. In addition, most insurances have limited coverage for nutrition visits. However, dietary changes may be employed as a low-cost adjunctive treatment option that can be combined with conventional medical treatment to mitigate HS symptoms. Though dietary modification has been increasingly recognized as a commonly used and influential factor in HS management, there is no comprehensive HS nutritional guide. Herein, we provide tools for both physicians and patients to facilitate evidence-based nutrition education in HS through collaboration with dermatologists specializing in HS, a registered dietitian, and a culinary specialist.

Purpose: This study tested self-efficacy and social support for activity and dietary changes as mediators of changes in type 2 diabetes related outcomes following a lifestyle intervention among Latino youth. Setting and Intervention: Latino adolescents (14-16 years) with obesity (BMI% = 98.1 ± 1.4) were randomized to a 3-month intervention (n = 67) that fostered self-efficacy and social support through weekly, family-centered sessions or a comparison condition (n = 69). Measures: Primary outcomes included insulin sensitivity and weight specific quality of life. Mediators included self-efficacy, friend, and family social support for health behaviors. Data was collected at baseline, 3-months, 6-months, and 12-months. Analysis: Sequential path analysis was used to examine mediators as mechanisms by which the intervention influenced primary outcomes. Results: The intervention had a direct effect on family (β = 0.33, P < .01) and friend social support (β = 0.22, P < .001) immediately following the intervention (3-months). Increased family social support mediated the intervention’s effect on self-efficacy at 6-months (β = 0.09, P < .01). However, social support and self-efficacy did not mediate long-term changes in primary outcomes ( P > .05) at 12-months. Conclusions: Family social support may improve self-efficacy for health behaviors in high-risk Latino youth, highlighting the important role of family diabetes prevention. Fostering family social support is a critical intervention target and more research is needed to understand family-level factors that have the potential to lead to long-term metabolic and psychosocial outcome in vulnerable youth.

Objectives Most electronically delivered lifestyle interventions are labor intensive, requiring logging onto websites and manually recording activity and diet. Cumbersome technology and lack of a human coach may have contributed to the limitations of prior interventions. In response, the current program of research created a comprehensive electronically delivered lifestyle intervention using a user‐friendly, interactive, smartphone app‐based model, and evaluated it in a randomized controlled trial. Methods Twenty‐eight adults, body mass index 25–42 kg/m2, with smartphones and sedentary jobs, were randomized to the intervention, along with conventional outpatient weight‐management visits every 3 months, or to a wait‐listed control group that received only weight‐management visits. The intervention included wearable activity trackers, smartscales, food photography logs, physician‐driven app‐based behavioral coaching, and peer support via the app. The prespecified primary outcome was a comparison of change in weight in kilograms, in the intervention versus control group at 6 months. Results At 6 months, the intervention group experienced a statistically significant weight change of −7.16 ± 1.78 kg (mean ± SE, 95% CI −11.05 to −3.26, p

OBJECTIVE: This study tested the effectiveness of the Peer-led Group Lifestyle Balance (PGLB) intervention in a predominantly racial/ethnic minority sample with serious mental illness who was overweight/obese and living in supportive housing. METHODS: The trial was conducted in three supportive housing agencies enrolling 314 participants randomly assigned to PGLB or usual care. PGLB is a 12-month manualized healthy lifestyle intervention delivered by peer-specialists. Assessments were conducted at baseline, 6, 12, and 18 months. Study outcomes examined for the total sample and by study site were clinically significant changes from baseline on: weight loss (≥5% weight loss), cardiorespiratory fitness (CRF, ≥50-meter increase in the 6-minute walking test [6MWT]) and cardiovascular (CVD) risk reduction (clinically significant weight loss or CRF improvement). RESULTS: Participants were predominantly racial/ethnic minorities (81.7%) with a mean baseline weight of 218.8±54.0 pounds and mean Body Mass Index=33.7±7.2. Although a larger proportion of participants in PGLB than in usual care achieved clinically significant changes in study outcomes at 12 and 18 months, none were statistically significant. Outcomes differed by study site: two sites reported no significant differences between PGLB and usual care and one site reported that PGLB significantly outperformed usual care on clinically significant weight loss at 18 months and on CVD risk reductions at 6 and 12 months. CONCLUSIONS: PGLB was not superior to usual care in achieving clinically significant changes in weight loss, CRF, and CVD risk reductions at 12 and 18 months. Questions remain regarding how PGLB works, for whom, and in which settings.

Summary Background & aims Trials investigating the efficacy of different interventions for overweight children are limited and controversial. Therefore, the aim of this study is to perform a network meta-analysis on the efficacy of various interventions for children with obesity (an average age of 6–12 years old). Methods We obtained the data of trials reporting pre-post obesity relevant outcomes (e.g. BMI, BMI z-score, percent body fat, or percent overweight) from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (Ovid), PubMed, and Web of Science databases (completed before February 25, 2019) and included at least one pair of direct comparison groups. The mean difference of outcomes and their associated 95% CI were used to determine the efficacy. The P-score was calculated to illustrate the rank probability of various treatments for different outcomes using a network meta-analysis. Our meta-analysis included 24 studies that evaluated the interventions for childhood obesity. Results All 24 trials had no high risk of bias. Interventions such as exercise without parents (E w/o P); diet with parents (D w/P); and diet, exercise, and lifestyle with parents (D+E+L w/P) were significantly effective for children with obesity when compared with no intervention. Conclusions E w/o P exhibited the highest P-score, with the D w/P and D+E+L w/P ranks having P-scores of 0.7486 and 0.5464, respectively. Moreover, the results indicate that E w/o P, D w/P, and D+E+L w/P were significantly effective treatments for children with obesity when compared with no intervention.

Purpose The aim of this study was to evaluate the efficacy of a 17-week, 3-component lifestyle intervention for enhancing health behaviors during the coronavirus disease-2019 (COVID-19) pandemic. Methods A parallel-group (intervention and control) study was conducted amongst 79 airline pilots over a 17-week period during the COVID-19 pandemic. The intervention group (n = 38) received a personalized sleep, dietary, and physical activity (PA) program. The control group (n = 41) received no intervention. Outcome measures for sleep, fruit and vegetable intake, PA, and subjective health were measured though an online survey before and after the 17-week period. The changes in outcome measures were used to determine the efficacy of the intervention. Results Significant main effects for Time × Group were found for International Physical Activity Questionnaire-Walk (p = 0.02) and for all other outcome measures (p < 0.01). The intervention group significantly improved in sleep duration (p < 0.01; d = 1.02), Pittsburgh Sleep Quality Index score (p < 0.01; d = –1.01), moderate-to-vigorous PA (p < 0.01; d = 1.32), fruit and vegetable intake (p < 0.01; d = 3.11), Short-Form-12v2 physical score (p < 0.01; d = 1.84), and Short-Form-12v2 mental score (p < 0.01; d = 2.69). The control group showed significant negative change for sleep duration (p < 0.01; d = –0.47), Pittsburgh Sleep Quality Index score (p < 0.01; d = 0.28), and Short-Form-12v2 mental score (p < 0.01; d = –0.64). Conclusion Results provide preliminary evidence that a 3-component healthy sleep, eating and PA intervention elicit improvements in health behaviors and perceived subjective health in pilots and may improve quality of life during an unprecedented global pandemic., Graphical abstract Image, graphical abstract

Hidradenitis suppurativa (HS) is a chronic, inflammatory skin condition that substantially reduces patient quality of life. Many HS patients ask their dermatologist about potential lifestyle modifications, such as following particular diets or avoiding specific products, in an attempt to alleviate their symptoms. However, insufficient research has been conducted to support well-informed lifestyle modification counseling, and patients frequently defer to anecdotal endorsements of various interventions found on social media support groups. Therefore, we sought to clarify what lifestyle modifications were capable of improving HS symptoms. We conducted a survey-based study to examine modifiable risk factors and their association with the severity of HS. Five hundred and ninety-one patients with HS participated in an online survey detailing the severity of their HS symptoms before and after various lifestyle interventions. Average improvements in both subjective and objective ratings of symptom severity were calculated and statistical differences between the levels of improvement seen among various categories of lifestyle interventions were determined. Numerous lifestyle interventions including substantial weight loss, smoking cessation, use of gentle skin and depilatory products, and menstrual regulation were associated with both subjective and objective improvements in symptom severity. Our results suggest that patients affected by HS may experience clinically significant improvement from a variety of lifestyle modifications.

Objectives The intima-media thickness of the common carotid artery (ccIMT) is an established risk marker for cardiovascular disease (CVD). However, it is unclear whether lifestyle interventions can easily demonstrate an improvement in ccIMT. The objective was to test if our intervention would beneficially affect ccIMT (among other CVD markers). Design Non-randomized controlled trial Setting Rural northwest Germany Participants Middle-aged and elderly participants from the general population (intervention: n = 114; control: n = 87) Intervention A community-based, 6-month controlled lifestyle intervention focusing on four areas of lifestyle change: a plant-based diet, physical activity, stress management, and an improved social life. A strong emphasis was on dietary change. Measurements We tested whether ccIMT change from baseline to 6 months was different between groups. Results With all participants included, no significant difference in mean ccIMT change between groups was observed (p = 0.708). However, in a subgroup analysis with participants with high baseline mean ccIMT (≥0.800 mm) a significant difference in mean ccIMT change between intervention (−0.023 [95% CI −0.052, 0.007] mm; n = 22; baseline mean ccIMT: 0.884 ± 0.015 mm) and control (0.041 [95% CI 0.009, 0.073] mm; n = 13; baseline mean ccIMT: 0.881 ± 0.022 mm) was observed (p = 0.004). Adjusting for potential confounders did not substantially alter the results. Conclusion The results indicate that healthy lifestyle changes can beneficially affect ccIMT within 6 months and that such a beneficial effect may be more easily demonstrated if participants with high baseline ccIMT are recruited. The observed effect is of relevance for the prevention of CVD events, including myocardial infarction and stroke.

Background and Objectives The high prevalence of overweight or obesity in older adults is a public health concern because obesity affects health, including the risk of mobility disability. Research Design and Methods The Mobility and Vitality Lifestyle Program, delivered by community health workers (CHWs), enrolled 303 community-dwelling adults to assess the impact of a 32-session behavioral weight management intervention. Participants completed the program at 26 sites led by 22 CHWs. Participation was limited to people aged 60–75 who had a body mass index (BMI) of 27–45 kg/m2. The primary outcome was the performance on the Short Physical Performance Battery (SPPB) over 12 months. Results Participants were aged 67.7 (SD 4.1) and mostly female (87%); 22.7% were racial minorities. The mean (SD) BMI at baseline was 34.7 (4.7). Participants attended a median of 24 of 32 sessions; 240 (80.3%) completed the 9- or 13-month outcome assessment. Median weight loss in the sample was 5% of baseline body weight. SPPB total scores improved by +0.31 units (p < .006), gait speed by +0.04 m/s (p < .0001), and time to complete chair stands by −0.95 s (p < .0001). Weight loss of at least 5% was associated with a gain of +0.73 in SPPB scores. Increases in activity (by self-report or device) were not independently associated with SPPB outcomes but did reduce the effect of weight loss. Discussion and Implications Promoting weight management in a community group setting may be an effective strategy for reducing the risk of disability in older adults.

Objectives Prediabetes is prevalent in people living with HIV (PLWH). Insufficient and irregular sleep are linked to abnormal glucose metabolism. This study aimed to investigate the differences in sleep characteristics between PLWH with and without prediabetes, determine the acceptability/feasibility and effects of a pilot six-month intensive lifestyle intervention (ILI) program on glucose metabolism in those with prediabetes, and determine how sleep modulates these effects. Results Thirty-nine PLWH (20 normoglycemia and 19 prediabetes) participated. There were no differences in sleep characteristics between individuals with normoglycemia and prediabetes. Next, thirteen individuals with prediabetes completed a six-month ILI program. The ILI program resulted in significant body weight reduction at 6 months (63.5 ± 13.9 to 61.9 ± 14.0 kg, p = 0.012), which was maintained at 12 months (p p = 0.014). An increase in sleep variability was significantly associated with an increase in 2-h plasma glucose, independent of changes in BMI (b = 0.603), and physical activity (b = 0.774). This pilot study suggested that ILI in PLWH with prediabetes is feasible and effective in improving metabolic control, with its effects possibly modulated by sleep variability. These findings should be confirmed in a larger study to reduce diabetes risk in this population. Trail registration: ClinicalTrial.gov, NCT03545217 (date of registration: May 22, 2018)

Background: Behavioral lifestyle interventions are the foundation of adolescent obesity treatment. Tailoring an intervention using adolescent stakeholder engagement during the development process could improve intervention effectiveness. Methods: Adolescents with overweight/obesity ages 14–19 (n = 41) participated in 11 sex-specific focus groups (girls = 6, boys = 5) and were asked their preferences regarding who should lead the intervention and be involved, what the messaging of the program should be, how to make the program engaging and maintain participation, and how to best measure nutrition intake and activity. Transcripts were coded and analyzed for emergent themes. Results: Mean age was 16.0 ± 1.8 years and participants were racially/ethnically diverse. Adolescents preferred interventions that avoid a focus on “weight loss,” and instead emphasize “healthy lifestyle,” which represents a more comprehensive goal of targeting physical and mental well-being. Most participants indicated preferences for a relatable instructor with prior weight loss experience. Both sexes preferred optional parental involvement, as some parents were described as helpful, while others were perceived as a hindrance to success. Boys and girls identified incentives, engaging activities, and electronic communication as core components for engagement and retention, with girls emphasizing socialization and building relationships. Sex differences in preferences were observed. Girls had more concerns about intervention participation and preferred interventions to be sex stratified. Conclusions: Behavioral interventions to treat adolescent obesity should focus messaging/content on healthy lifestyles, rather than weight loss, and be sex stratified. Development and implementation of future behavioral interventions for adolescent obesity should consider tailoring to adolescent preferences when possible to improve feasibility, acceptability, and effectiveness.

Background Gestational diabetes mellitus (GDM) is associated with several maternal complications in pregnancy, including preeclampsia, preterm labor, need for induction of labor, and cesarean delivery as well as increased long-term risks of type 2 diabetes, metabolic syndrome, and cardiovascular disease. Intrauterine exposure to GDM raises the risk for complications in offspring as well, including stillbirth, macrosomia, and birth trauma, and long-term risk of metabolic disease. One of the strongest risk factors for GDM is the occurrence of GDM in a prior pregnancy. Preliminary data from epidemiologic and bariatric surgery studies suggest that reducing body weight before pregnancy can prevent the development of GDM, but no adequately powered trial has tested the effects of a maternal lifestyle intervention before pregnancy to reduce body weight and prevent GDM recurrence. Methods The principal aim of the Gestational Diabetes Prevention/Prevención de la Diabetes Gestacional is to determine whether a lifestyle intervention to reduce body weight before pregnancy can reduce GDM recurrence. This two-site trial targets recruitment of 252 women with overweight and obesity who have previous histories of GDM and who plan to have another pregnancy in the next 1–3 years. Women are randomized within site to a comprehensive pre-pregnancy lifestyle intervention to promote weight loss with ongoing treatment until conception or an educational control group. Participants are assessed preconceptionally (at study entry, after 4 months, and at brief quarterly visits until conception), during pregnancy (at 26 weeks’ gestation), and at 6 weeks postpartum. The primary outcome is GDM recurrence, and secondary outcomes include fasting glucose, biomarkers of cardiometabolic disease, prenatal and perinatal complications, and changes over time in weight, diet, physical activity, and psychosocial measures. Discussion The Gestational Diabetes Prevention /Prevención de la Diabetes Gestacional is the first randomized controlled trial to evaluate the effects of a lifestyle intervention delivered before pregnancy to prevent GDM recurrence. If found effective, the proposed lifestyle intervention could lay the groundwork for shifting current treatment practices towards the interconception period and provide evidence-based preconception counseling to optimize reproductive outcomes and prevent GDM and associated health risks. Trial registration ClinicalTrials.gov NCT02763150. Registered on May 5, 2016

Since its outbreak in late 2019, Coronavirus Disease 2019 (COVID-19) has been ravaging the health system of most countries of the world. Although many preventive and treatment strategies have been proposed and implemented to combat the disease, these efforts seem to be insufficient, and in some cases ineffective. This is evident by the daily rising global incidence and case fatality of the COVID-19 pandemic. A situation if not mitigated early will likely crumble the global economy and tilt the world to an unprecedented global recession. This challenge demands that researchers and clinicians ask more in-depth questions about the novel coronavirus disease. Aside from age that has been confirmed to be linearly associated, what are the other possible socio-demographic and lifestyle-related risk factors that may be associated with COVID-19? What are the possible factors or comorbid conditions that may worsen clinical progression and determine the clinical outcome in confirmed COVID-19 cases? Does the pre-, peri-, or post-morbid lifestyle choices of people have an impact on COVID-19 preventive and treatment efforts? And how can we use the knowledge of the associated risk factors, comorbid conditions, and lifestyle choices of people to improve preventive efforts and clinical management of COVID-19? Answer to these questions may likely serve as an important guide for policymakers and clinicians in their design and implementation of COVID-19 targeted preventive and treatment policies and programs, especially in Low- and Middle-Income Countries (LMICs). The purpose of this article is to critically review available literature and provide evidence-based recommendations.

Although the term “lifestyle medicine” was first used as the title of a symposium in 1989 and of an article in 1990, its concept is not new. The towering figures in medicine: Huang Ti (2698-2598 BCE), Hippocrates (460-377 BCE) and Ibn Sina (980-1037CE) had the credit to link the natural effects of diet, lifestyle, emotion and environment with the preservation of health. Unhealthy lifestyle behaviors, a well proven primary source of the global burden of chronic diseases, are among the leading risk factors for increased disability-adjusted life years around the world. While, Gastroesophageal Reflux Disease and Chronic Obstructive Pulmonary Disease augument each other, COPD and Obstructive Sleep Apnea have a common pathophysiology and are known to coexist leading Flenley to coin the term “Overlap Syndrome” ,in 1985. Behavioral therapy on each modifiable item, including diet and weight management, physical activity, smoking, sleeping pattern, stress and mood states have all been evaluated in the present study.