scholarly journals Effectiveness of Lifestyle Interventions for Prevention of Harmful Weight Gain among Adolescents from Ethnic Minorities: A Systematic Review

2020 ◽  
Vol 17 (17) ◽  
pp. 6059
Author(s):  
Nematullah Hayba ◽  
Samiha Elkheir ◽  
Jessica Hu ◽  
Margaret Allman-Farinelli
Keyword(s):  
Ethnic Minorities ◽  
Transition To Adulthood ◽  
Vegetable Intake ◽  
Overweight And Obesity ◽  
Racial Group ◽  
Lifestyle Interventions ◽  
Z Score ◽  
Randomized Controlled ◽  
Secondary Outcomes ◽  
Adolescent Period

The escalating obesity among adolescents is of major concern, especially among those from an ethnic minority background. The adolescent period offers a key opportunity for the implementation of positive lifestyle behaviours as children transition to adulthood. The objective of this review was to examine the effectiveness of lifestyle interventions for adolescents and their impact in ethnic and racial minorities for the prevention of overweight and obesity. Seven electronic databases were searched from 2005 until March 2019 for randomized controlled trials of lifestyle programs conducted in this population. The main outcome was change in Body Mass Index (BMI) z-score (kg/m2) or change in BMI and secondary outcomes were changes in physical activity and diet. Thirty studies met the inclusion criteria. Seven studies reported and/or conducted subgroup analysis to determine if ethnic/racial group affected weight change. None demonstrated an overall decrease in BMI z-score. However, six of the seven demonstrated changes in secondary measures such as fruit and vegetable intake and screen time. Results did not differ by ethnic/racial group for primary and secondary outcomes. Overweight and obesity prevention among adolescents from ethnic minorities is an area that needs further research. There is a lack of interventions that include analyses of effectiveness in ethnic minorities.

O-162 Metabolic syndrome prevalence and severity during a randomized controlled three-component lifestyle intervention in women with PCOS

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
A Dietz de Loos ◽  
G Jiskoot ◽  
A Beerthuizen ◽  
J Van Busschbach ◽  
J Laven
Keyword(s):  
Metabolic Syndrome ◽  
Weight Loss ◽  
Lifestyle Intervention ◽  
Metabolic Health ◽  
Metabolic Parameters ◽  
Lifestyle Interventions ◽  
Z Score ◽  
Randomized Controlled ◽  
Per Se ◽  
One Year

Abstract Study question What is the impact of a three-component lifestyle intervention on the prevalence and severity of metabolic syndrome (MetS) in women with polycystic ovary syndrome (PCOS)? Summary answer This three-component lifestyle intervention was more successful in improving metabolic health in reproductive-aged women with PCOS compared to minimal treatment. What is known already Women with PCOS have increased risk of MetS, and both PCOS and MetS are associated with excess weight. Moreover, obesity exacerbates many of the metabolic abnormalities associated with PCOS. Multi-component lifestyle interventions are the first line treatment to improve weight. Previous studies in women with PCOS have described improvements in waist circumference, cholesterol, low-density lipoprotein and fasting insulin after (one-, or two-component) lifestyle interventions. However little is known about changes in the prevalence of MetS, continuous MetS severity z-score (cMetS z-score), different metabolic parameters and the effects of changes in weight per se after three-component lifestyle interventions. Study design, size, duration An randomized controlled trial (RCT) was performed and participants were either assigned to a one-year three-component (cognitive behavioural therapy, diet, exercise) lifestyle intervention (LSI), with or without additional short message service (SMS) support (SMS+ and SMS- respectively), both receiving 20 group sessions, or to care as usual (CAU, control) which consisted of advice to lose weight by methods of their own choosing. Overall, 183 women were included between August 2010 and March 2016. Participants/materials, setting, methods Women diagnosed with PCOS according to the Rotterdam 2003 criteria, aged 18-38 years, having a wish to conceive and a BMI >25 kg/m² were included at the Erasmus MC, The Netherlands. Outcome variables were evaluated every three months and included anthropometric measurements, ultrasound and an endocrine assessment. Multilevel linear and logistic regression was applied for longitudinal analyses. Main results and the role of chance The cMetS severity z-score decreased more in the SMS+ group vs CAU after one year (-0.39, p = 0.015). MetS changed with -21.6% (p = 0.037), -16.5% (p = 0.190) and +7.0% (p = 0.509) within the SMS-, SMS+ and CAU group respectively. Moreover, a post hoc analysis on the prevalence of MetS for both LSI groups combined vs CAU resulted in a difference of -25.9% (p = 0.046) after one year in favour of the LSI groups. Weight loss per se resulted in significant favourable effects on all metabolic parameters. Limitations, reasons for caution Dropout during lifestyle interventions is unfortunately a common phenomenon, and our RCT also suffered from considerable discontinuation rates which is a limitation. Therefore, we selected a statistical method (multilevel regression modelling) specifically designed to deal with such missing values. Wider implications of the findings These findings confirm that three-component lifestyle interventions aiming at a 5-10% weight loss should be recommended for all women with PCOS in order to improve metabolic health during their reproductive lifespan. Trial registration number NTR2450

scholarly journals Protocol for a multicenter randomized controlled trial comparing a non-opioid prescription to the standard of care for pain control following arthroscopic knee and shoulder surgery

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Aaron Gazendam ◽  
◽  
Seper Ekhtiari ◽  
Nolan S. Horner ◽  
Nicole Simunovic ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Pain Control ◽  
Shoulder Arthroscopy ◽  
Controlled Trial ◽  
Arthroscopic Surgery ◽  
Standard Of Care ◽  
Opioid Prescription ◽  
Randomized Controlled ◽  
Secondary Outcomes ◽  
Arthroscopic Knee

Abstract Background Opioids continue to be the analgesic of choice for postoperative pain control following arthroscopic knee and shoulder surgery. Despite their widespread use, there are limited evidence-based clinical practice guidelines for postoperative opioid prescribing. The Non-Opioid Prescriptions after Arthroscopic Surgery in Canada (NO PAin) Trial is a randomized controlled trial (RCT) designed to determine whether a non-opioid analgesia approach to postoperative pain, compared to usual care, reduces oral morphine equivalents (OME) consumed in patients undergoing outpatient knee and shoulder arthroscopy. Methods This is a multi-centre, RCT with a target sample size of 200 patients. Adult (18+ years of age) patients undergoing outpatient knee and shoulder arthroscopy will be randomized to a non-opioid postoperative protocol (intervention) or the current standard of care (control). The intervention will consist of a standardized non-opioid analgesic prescription, a limited rescue opioid prescription, and a patient education infographic. The control is defined as the treating surgeons’ pre-trial postoperative analgesic regimen. Exclusion criteria include chronic opioid use, concomitant open surgery, contraindications to the prescribed analgesics or ongoing workers compensation/litigation. The primary outcome is OMEs consumed at 6 weeks postoperatively. Secondary outcomes will include patient-reported pain and satisfaction, quantity of OMEs prescribed, number of opioid refills, and any adverse events up to 6 weeks postoperatively. Utilizing the intention to treat principle for all analyses, independent samples t-test and presented with a p-value as well as a mean difference (MD) with 95% confidence intervals (CIs) will be performed for primary and secondary outcomes. Discussion The ongoing opioid epidemic and overprescribing of opioids in orthopaedics serve as the rationale for this trial. There is a lack of evidence upon which to develop post-operative pain management guidelines for patients undergoing arthroscopic surgery. A prospective evaluation of this relatively inexpensive intervention will demonstrate whether an explicit effort to reduce the number of opioids prescribed results in a reduction in the amount of opioids consumed and help to inform future studies and guidelines. Trial registration The NO PAin trial has been prospectively registered with clinicaltrials.gov (NCT04566250).

scholarly journals Robotic natural orifice specimen extraction surgery versus traditional robotic-assisted surgery (NOTR) for patients with colorectal cancer: a study protocol for a randomized controlled trial

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Rui Luo ◽  
Fangfang Zheng ◽  
Haobo Zhang ◽  
Weiquan Zhu ◽  
Penghui He ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Randomized Controlled Trial ◽  
Controlled Trial ◽  
Natural Orifice ◽  
Specimen Extraction ◽  
Natural Orifice Specimen Extraction ◽  
Robotic Assisted ◽  
Randomized Controlled ◽  
Robotic Assisted Surgery ◽  
Secondary Outcomes

Abstract Background Natural orifice specimen extraction surgery for colorectal cancer has been introduced in order to reduce the abdominal incision, demonstrating major development potential in minimally invasive surgery. We are conducting this randomized controlled trial to assess whether robotic NOSES is non-inferior to traditional robotic-assisted surgery for patients with colorectal cancer in terms of primary and secondary outcomes. Method/design Accordingly, a prospective, open-label, randomized controlled, parallel-group, multicenter, and non-inferiority trial will be conducted to discuss the safety and efficacy of robotic natural orifice extraction surgery compared to traditional robotic-assisted surgery. Here, 550 estimated participants will be enrolled to have 80% power to detect differences with a one-sided significance level of 0.025 in consideration of the non-inferiority margin of 10%. The primary outcome is the incidence of surgical complications, which will be classified using the Clavien-Dindo system. Discussion This trial is expected to reveal whether robotic NOSES is non-inferior to traditional robotic-assisted surgery, which is of great significance in regard to the development of robotic NOSES for patients with colorectal cancer in the minimally invasive era. Furthermore, robotic NOSES is expected to exhibit superiority to traditional robotic-assisted surgery in terms of both primary and secondary outcomes. Trial registration ClinicalTrials.govNCT04230772. Registered on January 15, 2020.

scholarly journals A Comprehensive, Multidisciplinary, Personalized, Lifestyle Intervention Program is Associated with Increased Leukocyte Telomere Length in Children and Adolescents with Overweight and Obesity

Nutrients ◽  
2021 ◽  
Vol 13 (8) ◽  
pp. 2682
Author(s):  
George Paltoglou ◽  
Christina Raftopoulou ◽  
Nicolas C. Nicolaides ◽  
Sofia M. Genitsaridi ◽  
Sofia I. Karampatsou ◽  
...  
Keyword(s):  
Children And Adolescents ◽  
Telomere Length ◽  
Lifestyle Intervention ◽  
Intervention Program ◽  
Overweight And Obesity ◽  
Initial Assessment ◽  
Biological Aging ◽  
Childhood And Adolescence ◽  
Lifestyle Interventions ◽  
Lifestyle Intervention Program

Leucocyte telomere length (LTL) is a robust marker of biological aging and is associated with obesity and cardiometabolic risk factors in childhood and adolescence. We investigated the effect of a structured, comprehensive, multidisciplinary, personalized, lifestyle intervention program of healthy diet and physical exercise on LTL in 508 children and adolescents (239 males, 269 females; 282 prepubertal, 226 pubertal), aged 10.14 ± 0.13 years. Participants were classified as obese (n = 267, 52.6%), overweight (n = 174, 34.2%), or of normal BMI (n = 67, 13.2%) according to the International Obesity Task Force (IOTF) cutoff points and were studied prospectively for one year. We demonstrated that LTL increased significantly after 1 year of the lifestyle interventions, irrespective of gender, pubertal status, or body mass index (BMI). Waist circumference was the best negative predictor of LTL at initial assessment. The implementation of the lifestyle interventions also resulted in a significant improvement in clinical (BMI, BMI z-score and waist to height ratio) and body composition indices of obesity, inflammatory markers, hepatic enzymes, glycated hemoglobin (HbA1C), quantitative insulin sensitivity check index (QUICKI), and lipid profile in all participants. These findings indicate that the increased LTL may be associated with a more favorable metabolic profile and decreased morbidity later in life.

scholarly journals Protocol of a study to evaluate a lifestyle intervention during pregnancy

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
F Nawabi ◽  
L Lorenz ◽  
F Krebs ◽  
A Alayli ◽  
I Lück ◽  
...  
Keyword(s):  
Chronic Diseases ◽  
Scale Up ◽  
Overweight And Obesity ◽  
Vulnerable Groups ◽  
Computer Assisted ◽  
Lifestyle Interventions ◽  
Health Services Use ◽  
Mother And Child ◽  
Low Threshold ◽  
Prenatal Visits

Abstract Background The risk of developing obesity and chronic diseases (e.g. diabetes mellitus) in children is influenced by the mother's lifestyle during pregnancy (prenatal programming). This study evaluates a computer-assisted preventive lifestyle counseling carried out during prenatal visits and infant check-ups. GeMuKi (acronym for 'strengthening health promotion: enhanced check-up visits for mother and child') is a complex intervention consisting of multiple components implemented by different cooperating healthcare providers. Methods GeMuKi supplements regular prenatal visits and infant check-ups with an additional counseling regarding physical activity, nutrition and alcohol and tobacco use. Providers, who carry out the counseling, receive communication training using motivational interviewing techniques. Pregnant women in 4 intervention regions in Germany receive GeMuKi from gynecologists, midwives and pediatricians, while participants in the 4 control regions receive standard care. As part of a hybrid effectiveness-implementation trial with 1860 participants, questionnaires are filled in at 4 time points. Weight development and health data of the mother and child are recorded. Health services use will be analyzed using statutory health insurance claims data. Interviews will be conducted to evaluate the implementation process. Results Targeted preventive measures at the beginning of pregnancy intend to reduce the risk of inadequate gestational weight gain (primary outcome). Secondary endpoints are amongst others maternal lifestyle, infant weight development and body composition. Conclusions GeMuKi is set up as a long-term, low-threshold, multimodal intervention in living environments and existing structures. Findings will add to the evidence on lifestyle interventions during pregnancy to reduce the risk for overweight and obesity. Results will contribute to the prevention of early programming of chronic disease and will inform decisions about scale up and public funding. Key messages Lifestyle interventions provided from the beginning of pregnancy intent to be beneficial for the health of both mother and child to prevent obesity and chronic diseases. Low-threshold interventions embedded in regular prenatal visits are accessible for the complete pregnant population, including vulnerable groups.

scholarly journals Efficacy of metformin and fermentable fiber combination therapy in adolescents with severe obesity and insulin resistance: study protocol for a double-blind randomized controlled trial

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Edward C. Deehan ◽  
Eloisa Colin-Ramirez ◽  
Lucila Triador ◽  
Karen L. Madsen ◽  
Carla M. Prado ◽  
...  
Keyword(s):  
Insulin Resistance ◽  
Randomized Controlled Trial ◽  
Combination Therapy ◽  
Gut Microbiome ◽  
Controlled Trial ◽  
Fecal Microbiota ◽  
Metabolic Effects ◽  
Microbiota Composition ◽  
Randomized Controlled ◽  
Secondary Outcomes

Abstract Background Accumulating evidence suggests that the metabolic effects of metformin and fermentable fibers are mediated, in part, through diverging or overlapping effects on the composition and metabolic functions of the gut microbiome. Pre-clinical animal models have established that the addition of fiber to metformin monotherapy improves glucose tolerance. However, possible synergistic effects of combination therapy (metformin plus fiber) have not been investigated in humans. Moreover, the underlying mechanisms of synergy have yet to be elucidated. The aim of this study is to compare in adolescents with obesity the metabolic effects of metformin and fermentable fibers in combination with those of metformin or fiber alone. We will also determine if therapeutic responses correlate with compositional and functional features of the gut microbiome. Methods This is a parallel three-armed, double-blinded, randomized controlled trial. Adolescents (aged 12–18 years) with obesity, insulin resistance (IR), and a family history of type 2 diabetes mellitus (T2DM) will receive either metformin (850 mg p.o. twice/day), fermentable fibers (35 g/day), or a combination of metformin plus fiber for 12 months. Participants will be seen at baseline, 3, 6, and 12 months, with a phone follow-up at 1 and 9 months. Primary and secondary outcomes will be assessed at baseline, 6, and 12 months. The primary outcome is change in IR estimated by homeostatic model assessment of IR; key secondary outcomes include changes in the Matsuda index, oral disposition index, body mass index z-score, and fat mass to fat-free mass ratio. To gain mechanistic insight, endpoints that reflect host-microbiota interactions will also be assessed: obesity-related immune, metabolic, and satiety markers; humoral metabolites; and fecal microbiota composition, short-chain fatty acids, and bile acids. Discussion This study will compare the potential metabolic benefits of fiber with those of metformin in adolescents with obesity, determine if metformin and fiber act synergistically to improve IR, and elucidate whether the metabolic benefits of metformin and fiber associate with changes in fecal microbiota composition and the output of health-related metabolites. This study will provide insight into the potential role of the gut microbiome as a target for enhancing the therapeutic efficacy of emerging treatments for T2DM prevention. Trial registration ClinicalTrials.gov NCT04578652. Registered on 8 October 2020.

scholarly journals Task-oriented exercises improve disability of working patients with surgically-treated proximal humeral fractures. A randomized controlled trial with one-year follow-up

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Marco Monticone ◽  
Igor Portoghese ◽  
Daniele Cazzaniga ◽  
Valentina Liquori ◽  
Giuseppe Marongiu ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Controlled Trial ◽  
Rehabilitation Program ◽  
Group Differences ◽  
Randomized Controlled ◽  
Secondary Outcomes ◽  
One Year ◽  
Task Oriented

Abstract Background General physiotherapy is a common means of rehabilitation after surgery for proximal humeral fracture (PHF). Better-targeted exercises seem worthy of investigation and the aim of this study was to assess the efficacy of a rehabilitation program including task-oriented exercises in improving disability, pain, and quality of life in patients after a PHF. Methods By means of a randomized controlled trial with one-year follow-up, 70 working patients (mean age of 49 ± 11 years; 41 females), who were selected for open reduction and internal fixation with plates caused by PHF, were randomized to be included in an experimental (n = 35) or control group (n = 35). There was a permuted-block randomization plan, and a list of program codes was previously created; subsequently, an automatic assignment system was used to conceal the allocation. The first group underwent a supervised rehabilitation program of task-oriented exercises based on patients’ specific job activities, and occupational therapy. The second group underwent general physiotherapy, including supervised mobility, strengthening and stretching exercises. Both groups individually followed programs of 60-min session three times per week for 12 weeks in the outpatient setting. The Disability Arm Shoulder Hand questionnaire (DASH; scores range from 0 to 100; primary outcome), a Pain intensity Numerical Rating Scale (scores range 0 to 10; secondary outcomes), and the Short-Form Health Survey (scores range from 0 to 100; secondary outcomes) assessed the interventions. Participants were evaluated before surgery, before and after rehabilitation (primary endpoint), and at the one-year follow-up (secondary endpoint). A linear mixed model analysis for repeated measures was carried out for each outcome measure (p < 0.05). Results Time, group and time by group showed significant effects for all outcome measures in favour of the experimental group. The DASH and the DASH work achieved clinically important between-group differences of 16.0 points (95% confidence interval [C.I.] 7.3 to 24.7) and 19.7 (95% C.I. 9.0 to 30.5) at follow-up, respectively. The NRS achieved a between-group difference of 2.9 (95% C.I. 1.0 to 3.9) at follow-up. As for SF-36, there were between-group differences ranging from 17.9 to 37.0 at follow-up. Conclusions A rehabilitation program based on task-oriented exercises was useful in improving disability, pain, and quality of life in working patients after PHFs. Improvements lasted for at least 12 months. Trial registration On 16/12/2019, the trial was retrospectively registered in the ISRCTN registry with the ID number 17996552.

scholarly journals Effects of Three Different Family-Based Interventions in Overweight and Obese Children: The “4 Your Family” Randomized Controlled Trial

Nutrients ◽  
2021 ◽  
Vol 13 (2) ◽  
pp. 341
Author(s):  
Panagiotis Varagiannis ◽  
Emmanuella Magriplis ◽  
Grigoris Risvas ◽  
Katerina Vamvouka ◽  
Adamantia Nisianaki ◽  
...  
Keyword(s):  
Physical Activity ◽  
Body Weight ◽  
Screen Time ◽  
Overweight And Obesity ◽  
Z Score ◽  
Obese Children ◽  
Group 3 ◽  
Group 2 ◽  
Family Based ◽  
Family Based Interventions

Childhood overweight and obesity prevalence has risen dramatically in the past decades, and family-based interventions may be an effective method to improve children’s eating behaviors. This study aimed to evaluate the effectiveness of three different family-based interventions: group-based, individual-based, or by website approach. Parents and school aged overweight or obese children, 8–12 years of age, were eligible for the study. A total of 115 children were randomly allocated in one of the three interventions, and 91 completed the study (79% compliance); Group 1 (n = 36) received group-based interventions by various experts; Group 2 (n = 30) had interpersonal family meetings with a dietitian; and Group 3 (n = 25) received training through a specifically developed website. Anthropometric, dietary, physical activity, and screen time outcomes were measured at baseline and at the end of the study. Within-group comparisons indicated significant improvement in body weight, body mass index (BMI)-z-score, physical activity, and screen time from baseline in all three study groups (p < 0.05). Furthermore, total body fat percentage (%TBF) was also decreased in Groups 2 and 3. Between-group differences varied with body weight and %TBF change, being larger in Group 3 compared to Groups 1 and 2, in contrast to BMI-z-score, screen time, and health behaviors, which were significantly larger in Group 2 than the other two groups. In conclusion, personalized family-based interventions are recommended to successfully improve children’s lifestyle and body weight status.

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