The Effects of a Preconception Lifestyle Intervention on Childhood Cardiometabolic Health—Follow-Up of a Randomized Controlled Trial

Maternal obesity is associated with adverse metabolic outcomes in her offspring, from the earliest stages of development leading to obesity and poorer cardiometabolic health in her offspring. We investigated whether an effective preconception lifestyle intervention in obese women affected cardiometabolic health of their offspring. We randomly allocated 577 infertile women with obesity to a 6-month lifestyle intervention, or to prompt infertility management. Of the 305 eligible children, despite intensive efforts, 17 in the intervention and 29 in the control group were available for follow-up at age 3–6 years. We compared the child’s Body Mass Index (BMI) Z score, waist and hip circumference, body-fat percentage, blood pressure Z scores, pulse wave velocity and serum lipids, glucose and insulin concentrations. Between the intervention and control groups, the mean (±SD) offspring BMI Z score (0.69 (±1.17) vs. 0.62 (±1.04)) and systolic and diastolic blood pressure Z scores (0.45 (±0.65) vs. 0.54 (±0.57); 0.91 (±0.66) vs. 0.96 (±0.57)) were similar, although elevated compared to the norm population. We also did not detect any differences between the groups in the other outcomes. In this study, we could not detect effects of a preconception lifestyle intervention in obese infertile women on the cardiometabolic health of their offspring. Low follow-up rates, perhaps due to the children’s age or the subject matter, combined with selection bias abating contrast in periconceptional weight between participating mothers, hampered the detection of potential effects. Future studies that account for these factors are needed to confirm whether a preconception lifestyle intervention may improve the cardiometabolic health of children of obese mothers.

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Effect of a lifestyle intervention in obese infertile women on cardiometabolic health and quality of life: A randomized controlled trial

PLoS ONE ◽

10.1371/journal.pone.0190662 ◽

2018 ◽

Vol 13 (1) ◽

pp. e0190662 ◽

Cited By ~ 19

Author(s):

Lotte van Dammen ◽

Vincent Wekker ◽

Anne M. van Oers ◽

Meike A. Q. Mutsaerts ◽

Rebecca C. Painter ◽

...

Keyword(s):

Quality Of Life ◽

Randomized Controlled Trial ◽

Lifestyle Intervention ◽

Controlled Trial ◽

Cardiometabolic Health ◽

Infertile Women ◽

Randomized Controlled

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A real-world evaluation of a tertiary care childhood obesity intervention to reduce metabolic risk in a hard-to-reach urban population

BMC Pediatrics ◽

10.1186/s12887-019-1763-5 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 2

Author(s):

Nagla S. Bayoumi ◽

Elizabeth Helzner ◽

Aimee Afable ◽

Michael A. Joseph ◽

Sarita Dhuper

Keyword(s):

Blood Pressure ◽

Lifestyle Intervention ◽

Severe Obesity ◽

Low Density Lipoprotein ◽

Tertiary Care ◽

Density Lipoprotein ◽

Z Score ◽

Lipid Levels ◽

Diastolic Hypertension

Abstract Background Research on outcomes associated with lifestyle interventions serving pediatric populations in urban settings, where a majority have severe obesity, is scarce. This study assessed whether participation in a lifestyle intervention improved body mass index (BMI) percentile, BMI z-score, blood pressure, and lipid levels for children and adolescents. Methods The Live Light Live Right program is a lifestyle intervention that uses medical assessment, nutritional education, access to physical fitness classes, and behavioral modification to improve health outcomes. Data was analyzed for 144 subjects aged 2–19 who participated for a minimum of 12 consecutive months between 2002 and 2016. McNemar tests were used to determine differences in the proportion of participants who moved from abnormal values at baseline to normal at follow-up for a given clinical measure. Paired sample t-tests assessed differences in blood pressure and lipid levels. Multiple linear regression assessed the change in blood pressure or lipid levels associated with improvement in BMI%95 and BMI z-score. Results The majority were female (62.5%), mean age was 9.6, and 71% were Black. At baseline, 70.1% had severe obesity, systolic hypertension was present in 44, and 13.9% had diastolic hypertension. One-third had abnormally low high-density lipoprotein (HDL) at baseline, 35% had elevated low-density lipoprotein (LDL), and 47% had abnormal total cholesterol (TC). The average difference in percentage points of BMI%95 at follow-up compared was − 3.0 (95% CI: − 5.0, − 1.1; p < 0.003). The mean difference in BMI z-score units at follow-up was − 0.15 (95% CI: − 0.2, − 0.1; p < 0.0001). Participants with systolic or diastolic hypertension had an average improvement in blood pressure of − 15.3 mmHg (p < 0.0001) and − 9.6 mmHg (p < 0.0001), respectively. There was a mean improvement of 4.4 mg/dL for participants with abnormal HDL (p < 0.001) and − 7.8 mg/dL for those with abnormal LDL at baseline (p = 0.036). For those with abnormal baseline TC, a one-unit improvement in BMI%95 was associated with a 0.61 mg/dL improvement in TC while holding constant age, contact hours, and months since enrollment (p = 0.043). Conclusions Participation in the program resulted in significant improvements in BMI percentile, BMI z-score, blood pressure, and lipid levels.

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Lifestyle Intervention Enabled by Mobile Technology on Weight Loss in Patients With Nonalcoholic Fatty Liver Disease: Randomized Controlled Trial (Preprint)

10.2196/preprints.14802 ◽

2019 ◽

Author(s):

Su Lin Lim ◽

Jolyn Johal ◽

Kai Wen Ong ◽

Chad Yixian Han ◽

Yiong Huak Chan ◽

...

Keyword(s):

Blood Pressure ◽

Weight Loss ◽

Fatty Liver ◽

Lifestyle Intervention ◽

Controlled Trial ◽

Intervention Group ◽

Mobile App ◽

Control Group ◽

Nonalcoholic Fatty Liver ◽

Randomized Controlled

BACKGROUND The prevalence of nonalcoholic fatty liver disease (NAFLD) reaches up to 30% in the Asian adult population, with a higher prevalence in obese patients. Weight reduction is typically recommended for patients at high risk or diagnosed with NAFLD, but is a challenge to achieve. OBJECTIVE We aimed to evaluate the effect of a lifestyle intervention with a mobile app on weight loss in NAFLD patients. METHODS This prospective randomized controlled trial included 108 adults with NAFLD confirmed by steatosis on ultrasound and a body mass index ≥23 kg/m2 who were recruited from a fatty liver outpatient clinic. The patients were randomly allocated to either a control group (n=53) receiving standard care, consisting of dietary and lifestyle advice by a trained nurse, or an intervention group (n=55) utilizing the Nutritionist Buddy (nBuddy) mobile app in addition to receiving dietary and lifestyle advice by a dietitian. Body weight, alanine aminotransferase (ALT), aspartate aminotransferase (AST), waist circumference, and blood pressure were measured at baseline, and then at 3 and 6 months. Intention-to-treat and per-protocol analyses were used for statistical comparisons. RESULTS The intervention group had a 5-fold higher likelihood (relative risk 5.2, P=.003, 95% CI 1.8-15.4) of achieving ≥5% weight loss compared to the control group at 6 months. The intervention group also showed greater reductions in weight (mean 3.2, SD 4.1 kg vs mean 0.5, SD 2.9 kg; P<.001), waist circumference (mean 2.9, SD 5.0 cm vs mean –0.7, SD 4.4 cm; P<.001), systolic blood pressure (mean 12.4, SD 14.8 mmHg vs mean 2.4, SD 12.4 mmHg; P=.003), diastolic blood pressure (mean 6.8, SD 8.9 mmHg vs mean –0.9, SD 10.0 mmHg; P=.001), ALT (mean 33.5, SD 40.4 IU/L vs mean 11.5, SD 35.2 IU/L; P=.004), and AST (mean 17.4, SD 27.5 U/L vs mean 7.4, SD 17.6 IU/L, P=.03) at 6 months. CONCLUSIONS Lifestyle intervention enabled by a mobile app can be effective in improving anthropometric indices and liver enzymes in patients with NAFLD. This treatment modality has the potential to be extended to a larger population scale. CLINICALTRIAL Australian New Zealand Clinical Trials Registry ACTRN12617001001381; https://tinyurl.com/w9xnfmp

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Associations of Lifestyle Intervention Effect with Blood Pressure and Physical Activity among Community-Dwelling Older Americans with Hypertension in Southern California

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17165673 ◽

2020 ◽

Vol 17 (16) ◽

pp. 5673

Author(s):

Mei-Lan Chen ◽

Jie Hu ◽

Thomas P. McCoy ◽

Susan Letvak ◽

Luba Ivanov

Keyword(s):

Physical Activity ◽

Blood Pressure ◽

Older Adults ◽

Lifestyle Intervention ◽

Controlled Trial ◽

Intervention Group ◽

Community Dwelling ◽

Future Research ◽

Control Group ◽

Intervention Effects

A healthy lifestyle and regular physical activity are highly recommended for older adults. However, there has been limited research into testing lifestyle intervention effects on physical activity in older adults with hypertension. The purpose of this study was to assess the association of lifestyle intervention effects with physical activity and blood pressure in older adults with hypertension, accounting for social support and perceived stress as control variables. This study performed a secondary analysis of a two-arm randomized controlled trial. A total of 196 participants were randomly assigned to a six-month lifestyle intervention group or a control group. Hierarchical multiple regression analyses demonstrated that lifestyle intervention effects were not significantly associated with improvements in physical activity and blood pressure, but the final regression models were statistically significant (all p < 0.001). The result revealed that only physical activity frequency at baseline was significantly related to improvement in physical activity. Systolic blood pressure (SBP) at baseline and monthly income were significantly associated with change in SBP, while age and diastolic blood pressure (DBP) at baseline were significantly related to change in DBP. The findings provide empirical evidence for developing and optimizing lifestyle interventions for future research and clinical practice in this population.

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Effectiveness of a 6-Month Lifestyle Intervention on Diet, Physical Activity, Quality of Life, and Markers of Cardiometabolic Health in Women with PCOS and Obesity and Non-PCOS Obese Controls: One Size Fits All?

Nutrients ◽

10.3390/nu13103425 ◽

2021 ◽

Vol 13 (10) ◽

pp. 3425

Author(s):

Zheng Wang ◽

Henk Groen ◽

Astrid E. P. Cantineau ◽

Tessa M. van Elten ◽

Matty D. A. Karsten ◽

...

Keyword(s):

Quality Of Life ◽

Physical Activity ◽

Lifestyle Intervention ◽

Intervention Program ◽

Controlled Trial ◽

Dropout Rate ◽

Cardiometabolic Health ◽

Infertile Women ◽

The Difference

Little is known about the difference in effectiveness of lifestyle intervention between women with PCOS and non-PCOS women. In a post hoc longitudinal analysis of a randomized, controlled trial, we aimed to investigate whether infertile women with PCOS and obesity (N = 87) responded differently to a 6-month lifestyle intervention program than infertile non-PCOS obese controls (N = 172). We evaluated several aspects of the intervention such as changes in diet, physical activity, and dropout rate, as well as the effect on weight, quality of life (QoL), and cardiometabolic outcomes. Multilevel analyses were used, and analyses were adjusted for baseline characteristics such as age, education, and smoking. Although BMI in both groups significantly decreased at 3 months and 6 months, there were no significant differences between the groups at 3 months (adjusted B: −0.3, 95% CI: −0.9 to 0.3, p = 0.35) and 6 months (adjusted B: 0.5, 95% CI: −0.4 to 1.4, p = 0.29). Women with PCOS and non-PCOS women had similar compliance with the lifestyle intervention in terms of actual change in diet and physical activity. Mental QoL scores were not different at either 3 or 6 months. Physical QoL scores were lower in women with PCOS compared with non-PCOS women at 3 months (adjusted B: −2.4, 95% CI: −4.8 to −0.06, p = 0.045) but not at 6 months. Cardiometabolic parameters did not differ between the groups. Our results showed that infertile women with PCOS and obesity and non-PCOS obese controls responded largely similarly to our lifestyle intervention and achieved the same level of improvement in markers of cardiometabolic health.

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Abstract MP44: Nitrite Generating Capacity Assessed Through the Oral Microbial Metagenome is Associated With Cardiometabolic Risk

Circulation ◽

10.1161/circ.141.suppl_1.mp44 ◽

2020 ◽

Vol 141 (Suppl_1) ◽

Author(s):

Bruno Bohn ◽

Charlene Goh ◽

Lisa Marotz ◽

Rebecca L Molinsky ◽

Sumith Roy ◽

...

Keyword(s):

Blood Pressure ◽

Diastolic Blood Pressure ◽

Cardiometabolic Risk ◽

Oral Bacteria ◽

Cardiometabolic Health ◽

Oral Microbiota ◽

Z Score ◽

Generating Capacity ◽

Z Scores ◽

Microbial Genes

Introduction: Nitric oxide (NO) is important for cardiometabolic health. The enterosalivary nitrate-nitrite-NO pathway generates NO following oral microbiota-mediated production of salivary nitrite. We investigated the association between the abundance of genes in this pathway and cardiometabolic biomarkers. Hypothesis: Microbial genes favoring increased oral nitrite generation are associated with better cardiometabolic profile. Methods: We enrolled 784 diabetes-free adults in the Oral Infections, Glucose Intolerance and Insulin Resistance Study (ORIGINS). Subgingival plaques were collected from 6-8 teeth/participant. 16S rRNA microbial genes (Illumina, MiSeq) were sequenced; PICRUSt2 estimated abundance of microbial genes in the nitrate-nitrite pathway associated with either nitrite generation or depletion. Gene abundance was summed within each group, and a ratio between nitrite generation to depletion (GDR) was calculated; higher levels suggest increased nitrite generating capacity. Systolic and diastolic blood pressure were measured and HbA1C, insulin, and glucose levels were determined in fasting blood. Z-scores were calculated for cardiometabolic biomarkers and averaged to form a cardiometabolic z-score (CMZ-score). Adjusted multivariable linear models were used to regress the CMZ-score and individual Z-scores on GDR. Results: Participants were 69% female and aged 19-58 years (mean=32±9). Mean CMZ-score was 0.00±0.7. Mean (range) GDR was 1.88 (0.22-7.84). Mean CMZ-scores (SE) across GDR quartiles were 0.17 (0.06), 0.01 (0.05), -0.04 (0.05), and -0.14 (0.05), p-value for trend=0.02. Linear regression coefficients summarizing associations between GDR and individual Z-scores (Table) show lower Z-score for systolic and diastolic blood pressure, HbA1C, and insulin levels in those with higher GDR. Conclusions: Increased capacity for nitrite production by oral bacteria, assessed through a metagenome estimation approach, is associated with lower levels of cardiometabolic risk.

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The effect of eggs on early child growth in rural Malawi: the Mazira Project randomized controlled trial

American Journal of Clinical Nutrition ◽

10.1093/ajcn/nqz163 ◽

2019 ◽

Vol 110 (4) ◽

pp. 1026-1033 ◽

Cited By ~ 10

Author(s):

Christine P Stewart ◽

Bess Caswell ◽

Lora Iannotti ◽

Chessa Lutter ◽

Charles D Arnold ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Head Circumference ◽

Controlled Trial ◽

Intervention Group ◽

Child Growth ◽

Control Group ◽

Z Score ◽

Randomized Controlled ◽

The Impact

ABSTRACT Background Stunted growth is a significant public health problem in many low-income countries. Objective The aim of this study was to evaluate the impact of 1 egg per day on child growth in rural Malawi. Design We conducted an individually randomized controlled trial in which 660 children aged 6–9 mo were equally allocated into an intervention (1 egg/d) or control group. Eggs were provided during twice-weekly home visits for 6 mo. Control households were visited at the same frequency. Assessors blinded to intervention group measured length, weight, head circumference, and midupper arm circumference at baseline and the 6-mo follow-up visit. To assess adherence, multipass 24-h dietary recalls were administered at baseline, 3-mo, and 6-mo visits. Results Between February and July 2018, 660 children were randomly assigned into the intervention (n = 331) and control (n = 329) groups. Losses to follow-up totaled 10%. In the intervention group, egg consumption increased from 3.9% at baseline to 84.5% and 70.3% at the 3-mo and 6-mo visits, whereas in the control group, it remained below 8% at all study visits. The baseline prevalence of stunting was 14%, underweight was 8%, and wasting was 1% and did not differ by group. There was no intervention effect on length-for-age, weight-for-age, or weight-for-length z scores. There was a significantly higher head circumference for age z score of 0.18 (95% CI: 0.01, 0.34) in the egg group compared with the control group. There was a significant interaction with maternal education (P = 0.024), with an effect on length-for-age z score only among children whose mothers had higher education. Conclusions The provision of 1 egg per day to children in rural Malawi had no overall effect on linear growth. A background diet rich in animal source foods and low prevalence of stunting at baseline may have limited the potential impact. This trial was registered at clinicaltrials.gov as NCT03385252.

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Growth from birth to 6 months of infants with and without intrauterine preeclampsia exposure

Journal of Developmental Origins of Health and Disease ◽

10.1017/s2040174421000167 ◽

2021 ◽

pp. 1-5

Author(s):

Megan L. Gow ◽

Lynne Roberts ◽

Amanda Henry ◽

Gregory Davis ◽

George Mangos ◽

...

Keyword(s):

Cohort Study ◽

Weight Gain ◽

Post Partum ◽

Cardiometabolic Disease ◽

Cardiometabolic Health ◽

Z Score ◽

Rapid Weight Gain ◽

Z Scores ◽

Normotensive Pregnancy

Abstract Intrauterine preeclampsia exposure affects the lifelong cardiometabolic health of the child. Our study aimed to compare the growth (from birth to 6 months) of infants exposed to either a normotensive pregnancy or preeclampsia and explore the influence of being born small for gestational age (SGA). Participants were children of women participating in the Post-partum, Physiology, Psychology and Paediatric follow-up cohort study. Birth and 6-month weight and length z-scores were calculated for term and preterm (<37 weeks) babies, and change in weight z-score, rapid weight gain (≥0.67 increase in weight z-score) and conditional weight gain z-score were calculated. Compared with normotensive exposed infants (n = 298), preeclampsia exposed infants (n = 84) were more likely to be born SGA (7% versus 23%; P < 0.001), but weight gain from birth to 6 months, by any measure, did not differ between groups. Infants born SGA, irrespective of pregnancy exposure, were more likely to have rapid weight gain and had greater increases in weight z-score compared with those not born SGA. Preeclampsia exposed infants born SGA may benefit from interventions designed to prevent future cardiometabolic disease.

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Sports camp with six months of support from a local sports club as a treatment for childhood obesity

Scandinavian Journal of Public Health ◽

10.1177/1403494809344444 ◽

2009 ◽

Vol 37 (8) ◽

pp. 793-800 ◽

Cited By ~ 11

Author(s):

Paulina Nowicka ◽

Jan Lanke ◽

Angelo Pietrobelli ◽

Erwin Apitzsch ◽

Carl-Erik Flodmark

Keyword(s):

Physical Activity ◽

Childhood Obesity ◽

Controlled Trial ◽

Intervention Group ◽

Treatment Strategies ◽

Control Group ◽

Z Score ◽

Sports Club ◽

Baseline Bmi

Aims: Although childhood obesity is becoming increasingly prevalent, treatment options are limited and the continued development of effective treatment strategies is necessary. It is equally important to explore involvement of other resources in society, such as sports associations. This study was designed to investigate the possibility of reducing the degree of obesity in obese children by focusing on physical activity as an intervention. Methods: Seventy-six children (40 boys) aged 8—12 years (mean age 10.5 years, mean body mass index (BMI) 28.9, standard deviation (SD) 3.0; mean BMI z-score 3.24, SD 0.49) were invited to participate in a one-week sports camp and six-month support system. After the camp a sports coach from a local sports club supported the child during participation in a chosen sport for six months. Weight, height, body composition (using dual energy x-ray absorptiometry and magnetic resonance imaging), and lifestyle (using a questionnaire) were measured at baseline and after 12 months. Data were pooled from two camps, one with a self-selected control group and one randomized controlled trial. Results: Twelve months after the camp the intervention group had a significant decrease in BMI z-score (baseline BMI z-score 3.22; follow up 3.10, p = 0.023). The control group also reduced their BMI z-score (baseline BMI z-score 3.27; follow up 3.18, p = 0.022). No differences were found in baseline values, follow-up values, or changes in BMI z-score between groups, nor between boys and girls. Conclusions: The focus on physical activity as an intervention had no effect on degree of obesity when compared with a waiting list control group.

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Effects of a lifestyle intervention programme after 1 year of follow-up among South Asians at high risk of type 2 diabetes: a cluster randomised controlled trial

BMJ Global Health ◽

10.1136/bmjgh-2021-006479 ◽

2021 ◽

Vol 6 (11) ◽

pp. e006479

Author(s):

Mirthe Muilwijk ◽

Marie Loh ◽

Samreen Siddiqui ◽

Sara Mahmood ◽

Saranya Palaniswamy ◽

...

Keyword(s):

Blood Pressure ◽

Waist Circumference ◽

Lifestyle Intervention ◽

South Asians ◽

Controlled Trial ◽

Intervention Group ◽

Cluster Randomised Controlled Trial ◽

Control Group ◽

Family Based ◽

Randomised Controlled

IntroductionSouth Asians are at high risk of type 2 diabetes (T2D). We assessed whether intensive family-based lifestyle intervention leads to significant weight loss, improved glycaemia and blood pressure in adults at elevated risk for T2D.MethodsThis cluster randomised controlled trial (iHealth-T2D) was conducted at 120 locations across India, Pakistan, Sri Lanka and the UK. We included 3684 South Asian men and women, aged 40–70 years, without T2D but with raised haemoglobin A1c (HbA1c) and/or waist circumference. Participants were randomly allocated either to the family-based lifestyle intervention or control group by location clusters. Participants in the intervention received 9 visits and 13 telephone contacts by community health workers over 1-year period, and the control group received usual care. Reductions in weight (aim >7% reduction), waist circumference (aim ≥5 cm reduction), blood pressure and HbA1C at 12 months of follow-up were assessed. Our linear mixed-effects regression analysis was based on intention-to-treat principle and adjusted for age, sex and baseline values.ResultsThere were 1846 participants in the control and 1838 in the intervention group. Between baseline and 12 months, mean weight of participants in the intervention group reduced by 1.8 kg compared with 0.4 kg in the control group (adjusted mean difference −1.10 kg (95% CI −1.70 to −1.06), p<0.001). The adjusted mean difference for waist circumference was −1.9 cm (95% CI −2.5; to 1.3), p<0.001). No overall difference was observed for blood pressure or HbA1c. People who attended multiple intervention sessions had a dose-dependent effect on waist circumference, blood pressure and HbA1c, but not on weight.ConclusionAn intensive family-based lifestyle intervention adopting low-resource strategies led to effective reduction in weight and waist circumference at 12 months, which has potential long-term benefits for preventing T2D. A higher number of attended sessions increased the effect on waist circumference, blood pressure and HbA1c.Trial registration numberEudraCT: 2016-001350-18; ClinicalTrials.gov: NCT02949739.

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