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

Department of Internal Medicine, University of Turin, Turin, Italy.
Journal of General Internal Medicine (Impact Factor: 3.42). 01/2008; 22(12):1695-703. DOI: 10.1007/s11606-007-0399-6
Source: PubMed

ABSTRACT Intensive lifestyle intervention significantly reduces the progression to diabetes in high-risk individuals.
It is not known whether a program of moderate intervention might effectively reduce metabolic abnormalities in the general population.
Two-arm randomized controlled 1-year trial.
Three hundred and thirty-five patients participated from a dysmetabolic population-based cohort of 375 adults aged 45-64 years in northwestern Italy.
We compared the effectiveness of a general recommendation-based program of lifestyle intervention carried out by trained professionals versus standard unstructured information given by family physicians at reducing the prevalence of multiple metabolic and inflammatory abnormalities.
At baseline, clinical/anthropometric/laboratory and lifestyle characteristics of the intervention (n = 169) and control (n = 166) groups were not significantly different. The former significantly reduced total/saturated fat intake and increased polyunsaturated fat/fiber intake and exercise level compared to the controls. Weight, waist circumference, high-sensitivity C-reactive protein, and most of the metabolic syndrome components decreased in the intervention group and increased in the controls after 12 months. Lifestyle intervention significantly reduced metabolic syndrome (odds ratio [OR] = 0.28; 95% CI 0.18-0.44), with a 31% (21-41) absolute risk reduction, corresponding to 3.2 (2-5) patients needing to be treated to prevent 1 case after 12 months. The intervention significantly reduced the prevalence of central obesity (OR = 0.33; 0.20-0.56), and hypertriglyceridemia (OR = 0.48; 0.31-0.75) and the incidence of diabetes (OR = 0.23; 0.06-0.85).
A lifestyle intervention based on general recommendations was effective in reducing multiple metabolic/inflammatory abnormalities. The usual care by family physicians was ineffective at modifying progressive metabolic deterioration in high-risk individuals.

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    • "Australia 56 0.56 NA 30.1 <30% TF, <10% SF moderate intensity, 30 min/S, most days/wk 12 Bo et al. 2007 [31] Italy 56 0.58 MS 30.0 reduced TF and SF intake moderate intensity (i. e. brisk walking), ~150 min/wk 13 Arciero et al. 2006 [32] USA 43 0.48 NA 27.8 high protein (40%) and low fat (20%) diet resistance and cardiovascular training, 20 min/S, 4–6 S/wk 14 Brekke et al. 2005 [33] Sweden 42 0.37 NA 26.1 <30% TF intake, <10% SF intake walking or more intensive exercise, 30 min/S, 4–5 S/wk 15 Watkins et al. 2003 [34] USA 50 0.50 NA 33.7 500 kcal/d restriction, <20% TF cycle ergometry and jogging, or walking, ~60 min/S, 3–4 S/wk 16 Lindstrom et al. 2003 [35] Finland 55 0.66 IGT 31.3 200 kcal/d restriction, <30% TF, <10% SF endurance exercise & resistance training, >30 min/S 17 Esposito et al. 2003 [36] Italy 35 1.00 NA 34.5 1400 kcal/d, 55% carbohydrate, 30% TF, <10% SF aerobic exercise (walking and swimming) 18 Mensink et al. 2003 [37] Netherlands 56 0.43 IGT 29.5 >55% carbohydrate, <30% TF, <10% SF moderate physical activity, >30 min/S, 5 S/wk 19 McAuley et al. 2002 [38] New Zealand 46 0.71 IR 34.5 400 kcal/d restriction, 27% TF, 9% SF Moderate exercise plus resistance training, >20 min/S, 5 S/wk 20 Miller et al. 2002 [39] USA 54 0.62 NA 33.7 500 kcal/d restriction, 27% TF, 6% SF aerobic (brisk walking and biking), 30–45 min/S, 3 S/wk 21 Reseland et al. 2001 [40] Norway 45 0.00 MS 27.5 400 kcal/d restriction, <30% TF endurance exercise, 1 h/S, 3 S/wk 22 Oldroyd et al. 2001 [41] UK 58 0.40 IGT 30.2 <30% TF intake, ~50% carbohydrate aerobic exercise, 20–30 min/S, 2–3 S/wk 23 Kuller et al. 2001 [42] USA 47 1.00 NA 25.0 Calorie restriction upto 1300 kcal, 25% TF, 7% SF increasing physical activity to 1250 kcal expended weekly 24 Ornish et al. 1998 [43] USA 60 0.09 NA 26.9 10%-fat vegetarian diet moderate-intensity aerobic, 1 h/S, 5 S/wk 25 Stefanick et al. 1998 (female) [16] USA 57 1.00 NA 25.6 <30% TF intake, <7% SF intake aerobic (jogging and brisk walking), 60 min/S, 3 S/wk 26 Stefanick et al. 1998 (male) [16] USA 48 1.00 NA 27.8 <30% TF intake, <7% SF intake aerobic (jogging and brisk walking), 60 min/S, 3 S/wk variance τ 2 . "
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    • "This finding suggests that a 4-week TLM program targeting a 5–10% weight reduction could improve the inflammatory state and IR of subjects with metabolic syndrome. The positive effects of the TLM program on MCP-1, fasting insulin, and HOMA were consistent with the findings of previous studies (Bo et al., 2007; Trøseid et al., 2004). MCP-1 may be linked to a chronic state of low-grade inflammation and is thought to play a central role in the recruitment of monocytes to atherosclerotic lesions and in the development of intimal hyperplasia after arterial injury (Sell & Eckel, 2007). "
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