The Effects of Lifestyle Modification on Glycemic Levels and Medication Intake: The Rockford CHIP

Introduction: The high prevalence of cardiovascular disease (CVD) in the past 50 years has led to intense research, resulting in many improvements in treatment. At the same time, type 2 diabetes, with its concomitant increase in vascular complications, has become a serious, exploding and costly public health concern . Diabetes now affects 285 million adults worldwide and 344 million with pre-diabetes. Of these, 25.8 million diabetics and 79 million pre-diabetics are found in the United States alone.The current cost of diabetes in the US is likely to exceed the $174 billion estimate, which includes 2/3 for direct medical costs and 1/3 for indirect costs, such as disability, work loss, and premature death, but omits the social cost of intangibles (e.g. pain, suffering, lower quality of life). The diabetes epidemic has been accompanied by a similarly drastic increase in obesity. Although the relationship between the two developments is a matter of debate, both are presumably caused by changes in dietary habits and an increasingly sedentary modern lifestyle . Compelling evidence has shown that lifestyle changes can effectively prevent or delay the occurrence of type 2 diabetes. Because individuals at risk for this disease can usually be identified during the pre-diabetic phase of impaired glucose tolerance, early intervention and lifestyle change offer a logical approach to preventing this disease and its devastating vascular complications. Additionally, community-based lifestyle interventions for high risk groups and for the general population are a cost-effective way of curbing the growing burden of the disease. Solidifying the scientific basis for the prevention, treatment and control of this disease and its implementation on a national level, however, remains a difficult challenge. Moreresearch is needed to provide comprehensive and more effective strategies for weight-loss,especially over time. Therefore, the objectives of this study were to identify diabetics and those at risk (prediabetics) out of the total cohort of 1,517 who selected themselves into an intensive community-based lifestyle intervention program, and to assess its clinical efficacy ineffecting medication status as determined and managed by their personal physicians

Healthy lifestyle changes favourably affect common carotid intima-media thickness: the Healthy Lifestyle Community Programme (cohort 2)

Common carotid intima-media thickness (ccIMT) progression is a risk marker for cardiovascular disease (CVD), whereas healthy lifestyle habits are associated with lower ccIMT. The objective of the present study was to test whether a healthy lifestyle intervention can beneficially affect ccIMT progression. A community-based non-randomised, controlled lifestyle intervention was conducted, focusing on a predominantly plant-based diet (strongest emphasis), physical activity, stress management and social health. Assessments of ccIMT were made at baseline, 6 months and 1 year. Participants had an average age of 57 years and were recruited from the general population in rural northwest Germany (intervention: n 114; control: n 87). From baseline to 1 year, mean ccIMT significantly increased in both the intervention (0.026 [95 % CI 0.012, 0.039] mm) and control group (0.045 [95 % CI 0.033, 0.056] mm). The 1-year trajectory of mean ccIMT was lower in the intervention group (P = 0.022; adjusted for baseline). In a subgroup analysis with participants with high baseline mean ccIMT (≥0.800 mm), mean ccIMT non-significantly decreased in the intervention group (-0.016 [95 % CI -0.050, 0.017] mm; n 18) and significantly increased in the control group (0.065 [95 % CI 0.033, 0.096] mm; n 12). In the subgroup, the 1-year trajectory of mean ccIMT was significantly lower in the intervention group (between-group difference: -0.051 [95 % CI -0.075, -0.027] mm; P < 0.001; adjusted for baseline). The results indicate that healthy lifestyle changes may beneficially affect ccIMT within 1 year, particularly if baseline ccIMT is high

Effect of a 1-Year Controlled Lifestyle Intervention on Body Weight and Other Risk Markers (the Healthy Lifestyle Community Programme, Cohort 2)

Introduction: The prevalence of obesity is high and increasing worldwide. Obesity is generally associated with an increased risk of chronic disease and mortality. The objective of the study was to test the effect of a lifestyle intervention on body weight and other chronic disease risk markers. Methods: A non-randomized controlled trial was conducted, including mostly middle-aged and elderly participants recruited from the general population in rural northwest Germany (intervention: n = 114; control: n = 87). The intervention consisted of a 1-year lifestyle programme, focussing on four key areas: a largely plant-based diet (strongest emphasis), physical activity, stress management, and community support. Parameters were assessed at baseline, 10 weeks, 6 months, and 1 year. The control group received no intervention. Results: Compared to the control, in the intervention group, significantly lower 1-year trajectories were observed for body weight, body mass index (BMI), waist circumference (WC), total cholesterol, calculated LDL cholesterol, non-HDL cholesterol, remnant cholesterol (REM-C), glucose, HbA1c, and resting heart rate (RHR). However, between-group differences at 1 year were small for glucose, HbA1c, and cholesterol (apart from REM-C). No significant between-group differences were found for 1-year trajectories of measured LDL cholesterol, HDL cholesterol, triglycerides, insulin, blood pressure, and pulse pressure. Conclusion: The intervention successfully reduced body weight, BMI, WC, REM-C, and RHR. However, at 1 year, effectiveness of the intervention regarding other risk markers was either very modest or could not be shown

The healthful plant-based diet index as a tool for obesity prevention—The healthy lifestyle community program cohort 3 study

Background: World-wide the prevalence of obesity is high, and promoting a shift toward more healthful and more plant-based dietary patterns appears to be one promising strategy to address this issue. A dietary score to assess adherence to a healthy plant-based diet is the healthful plant-based diet index. While there is evidence from cohort studies that an increased healthful plant-based diet index is associated with improved risk markers, evidence from intervention studies is still lacking. Methods: A lifestyle intervention was conducted with mostly middle-aged and elderly participants from the general population (n = 115). The intervention consisted of a 16-month lifestyle program focusing on a healthy plant-based diet, physical activity, stress management, and community support. Results: After 10 weeks, significant improvements were seen in dietary quality, body weight, body mass index, waist circumference, total cholesterol, measured and calculated low-density lipoprotein (LDL) cholesterol, oxidized LDL particles, non-high-density lipoprotein cholesterol, remnant cholesterol, glucose, insulin, blood pressure, and pulse pressure. After 16 months, significant decreases were seen in body weight (−1.8 kg), body mass index (−0.6 kg/m2), and measured LDL cholesterol (−12 mg/dl). Increases in the healthful plant-based diet index were associated with risk marker improvements. Conclusions: The recommendation of moving toward a plant-based diet appears acceptable and actionable and may improve body weight. The healthful plant-based diet index can be a useful parameter for intervention studies

Exploratory analysis of the effect of a controlled lifestyle intervention on inflammatory markers – the Healthy Lifestyle Community Programme (cohort 2)

Background: Chronic low-grade inflammation is associated with an increased risk of chronic disease and mortality. The objective of the study was to test the effect of a healthy lifestyle intervention on biomarkers of inflammation (among other risk markers). Methods: We conducted a non-randomized controlled trial with mostly middle-aged and elderly participants from the general population in rural northwest Germany (intervention: n = 114; control: n = 87). The intervention consisted of a 1-year lifestyle programme focusing on diet (largely plant-based; strongest emphasis), physical activity, stress management, and social support. High-sensitivity C-reactive protein (hs-CRP) was assessed at baseline, 10 weeks, 6 months, and 1 year. Homocysteine (Hcy) was assessed at baseline, 10 weeks, and 1 year. Adiponectin (Apn) was assessed at baseline and 10 weeks. An exploratory analysis of these inflammatory markers assessing the between-group differences with ANCOVA was conducted. Results: The 1-year trajectory of hs-CRP was significantly lower in the intervention group compared to control (between-group difference: -0.8 (95% CI -1.2, -0.3) mg/l; p = 0.001; adjusted for baseline). The 1-year trajectory of Hcy was non-significantly higher in the intervention compared to control (between-group difference: 0.2 (95% CI -0.3, 0.7) µmol/l; p = 0.439; adjusted for baseline). From baseline to 10 weeks, Apn decreased significantly more in the intervention group compared to control (between-group difference: -1.6 (95% CI -2.7, -0.5) µg/ml; p = 0.004; adjusted for baseline). Conclusions: Our study shows that healthy lifestyle changes can lower hs-CRP and Apn levels and are unlikely to significantly affect Hcy levels within 1 year. Trial registration: German Clinical Trials Register (DRKS; reference: DRKS00018775, registered 12 Sept 2019; retrospectively registered; www.drks.de)

Sonographic diagnosis of "acute abdomen" in children and adults

Introduction The acute abdomen is the main term for an at first unclear emergency situation of the abdominal cavity. The acute abdomen belongs to the three most important reasons for the admission of patients into the emergency room. Further, this illness ranks 40% of all consultations in the ambulant care sector. The acute abdomen requires an early and direct diagnosis because of its potential of having a life threatening differential diagnosis. This HTA report aimed to assess the ultrasound diagnosis of the acute abdomen considering children and adults. This will be done from a medical and economic perspective. The differential diagnosis respectively the cause of the acute abdomen binds high direct treatment costs, especially in the stationary sector. Ultrasound diagnosis is a procedure that plays a big part in the differential diagnosis process and it is widely used in practise. Other research methods of diagnosing acute abdominal illness are: clinical examinations with inspection and palpation, surgical exploration and laparocopy as well as computer tomography and x-ray examination. Objectives The main objective of this HTA report is to assess what significance sonography should have within the examination strategy of the acute abdomen from the medical and economical view. Second, this HTA report will evaluate under which circumstances the ultrasonographic diagnosis of the acute abdomen, considering medical and economical quality classifications, is the alternative of choice to comparable diagnostic measures. Methods The target population this HTA report is aimed at are children and adults with acute abdomen or embedded differential diagnosis. A systematic literature search was conducted covering all relevant medical and HTA-databases. Furthermore, handsearch was conducted inside of the known data bases of HTA-institutions as well as from medical and economical journals. The following databases were searched in cooperation with DIMDI to identify relevant literature: Biosis-Previews (BA93), Biotechnobase (ET80), Cab-Health (AZ72), Elsevier Biobase (EB94), EMBASE (EM74), Embase Alert (EA08), Ethmed (ED93), Euroethics (EU93), Gerolit (GE79), Heclinet (HN69), IHTA ( HT83), IPA (IA70), MEDLINE (ME90, Medline Alert (MEOA) and SciSearch (IS74). The search parameters were orientated by the embedded differential diagnosis's as well as diagnostic measures considering the acute abdomen. The bibliographic search covered the period from 1990 to 2003. The relevant languages are English, German in connection to French. The evaluation of the information has been graduated. It must be clear that the abstract follows the topic of the acute abdomen. The as such identified literature will be structured by its methodological quality and relevance. This will be analysed and later valued after it is clear that the minimum requirements are met. Results The identified and assessed primary studies, reviews and metaanalytic studies demonstrated the medical effectiveness as well as the economical efficiency of the sonographical diagnosis for individual questions or indications. The evaluated papers of the target population 'children' demonstrated that sonography resp. ultrasound as the basic examination is recommended for children with acute abdominal pain. Discussion The identified studies have not used an extensive setting of the ultrasound diagnosis of the acute abdomen. Instead they focus only on small sections, orientated on certain indications. Blinded medical studies have not been identified. Also, there is no health-economics study that evaluated the diagnostic measures by comparing all available technologies. Altogether, the identified and assessed publications show that sonography is an alternative of choice considering particular questions in comparison to other diagnostic measures of analyzing the acute abdomen. A general deflected dominance from the sonography facing the computer tomography for instance can not be seen as the result of this structured review of the published literature. Conclusion During a structured examination strategy, e.g. guidelines, sonography of children has become the diagnostic method of choice. Taking up sonography as a primary diagnostic evaluation into the guidelines of the analysis of the considered literature is recommended. The usage of already existing ultrasound systems is also recommended. Seeing that existing publications of this subject are scarce, it is not possible to prognose the economical effects of an obligatory primary sonographical diagnostic.Einleitung Das akute Abdomen ist der Oberbegriff für eine ätiologisch zunächst unklare Akutsituation im Bereich des Abdomens. Als 'akuter Bauch(schmerz)' gehört das Syndrom zu den drei wichtigsten Ursachen bei der Aufnahme von Patienten in die Notaufnahme und stellt bis zu 40% der Konsultationen im ambulanten Bereich. Das akute Abdomen erfordert aufgrund seiner potenziell lebensbedrohlichen Differenzialdiagnosen eine frühzeitige und unmittelbare Diagnostik. Ziel dieses HTA-Berichts ist es, die sonographische Diagnostik des akuten Abdomens bei Kindern und Erwachsenen aus medizinischer und aus ökonomischer Perspektive zu bewerten. Die Differenzialdiagnosen bzw. die Ursachen des akuten Abdomens bedingen hohe direkte Behandlungskosten, die in der Regel aufgrund der potenziell lebensbedrohlichen Lage im stationären Bereich anfallen. Als bildgebendes Verfahren ist die Sonographie an der Differenzialdiagnostik beteiligt und in der Praxis bereits weit verbreitet. Neben der Sonographie werden die Untersuchungsmethoden der klinischen Untersuchung mit Inspektion und Palpation, chirurgische Exploration und Laparoskopie, sowie die bildgebenden Verfahren Computertomographie (CT) und Röntgenuntersuchung bei der Diagnostik des akuten Abdomens angewandt. Fragestellung Es ist zu bewerten, welchen Stellenwert die Sonographie innerhalb der Untersuchungsstrategie beim akuten Abdomen aus medizinischer und aus ökonomischer Sicht einnimmt. Dieser HTA-Bericht wird insbesondere die Frage beantworten, unter welchen Bedingungen die sonographische Diagnostik des akuten Abdomens hinsichtlich medizinischer und ökonomischer Gütekriterien eine Alternative der ersten Wahl zu anderen vergleichbaren diagnostischen Maßnahmen ist. Methodik Die Zielpopulation dieses HTA-Berichts sind Kinder und Erwachsene mit akutem Abdomen oder einer der eingeschlossenen Differenzialdiagnosen. Die Literaturrecherche erfolgt per Handrecherche in den Datenbanken der bekannten HTA-Institutionen, in verschiedenen medizinischen und ökonomischen Fachzeitschriften sowie strukturiert mit Hilfe des DIMDI in den Datenbanken Biosis-Previews (BA93), Biotechnobase (ET80), Cab-Health (AZ72), Elsevier Biobase (EB94), EMBASE (EM74), EMBASE Alert (EA08), Ethmed (ED93), Euroethics (EU93), Gerolit (GE79), Heclinet (HN69), IHTA (HT83), IPA (IA70), MEDLINE (ME90), MEDLINE Alert (ME0A) und SciSearch (IS74). Die Suchparameter orientieren sich an den eingeschlossenen Differenzialdiagnosen sowie den diagnostischen Maßnahmen beim akuten Abdomen. Der Suchzeitraum beginnt 1990. Relevante Sprachen sind englisch, deutsch sowie im Zusammenhang mit der Handrecherche französisch. Die Bewertung der Information erfolgt gestaffelt. Aus der Zusammenfassung muss hervorgehen, dass sich dieses mit dem berücksichtigten Themenumfeld des akuten Abdomens befasst. Die so identifizierte Literatur wird strukturiert hinsichtlich ihrer methodischen Qualität und Relevanz analysiert und anschließend bei Erfüllung qualitativer Mindestanforderungen im Rahmen dieses HTA-Berichts bewertet. Ergebnisse Die medizinische Effektivität sowie die ökonomische Effizienz der sonographischen Diagnostik können anhand der identifizierten und bewerteten Studien, Metaanalysen und Übersichtsarbeiten für einzelne Fragestellungen bzw. Indikationen gezeigt werden. Die beurteilten Arbeiten für die Zielpopulation Kinder kommen zu dem Ergebnis, dass die Sonographie als Basisuntersuchung bei akuten abdominellen Schmerzen bei Kindern zu empfehlen ist. Diskussion Die vorliegenden Studien verdeutlichen kein breites und ganzheitliches Bild von der sonographischen Diagnostik des akuten Abdomens, sondern geben jeweils nur einen kleinen Ausschnitt wieder. Leider fehlen weitestgehend medizinische Studien, die eine Verblindung vorgenommen haben. Des Weiteren gibt es keine gesundheitsökonomischen Arbeiten, die die derzeit verfügbaren Technologien bei der Diagnostik des akuten Abdomens im Vergleich zueinander beurteilen. Insgesamt jedoch zeigen die identifizierten und bewerteten Publikationen, dass die Sonographie bei einzelnen Fragestellungen die Alternative der ersten Wahl im Vergleich zu anderen diagnostischen Maßnahmen bei der Untersuchung des akuten Abdomens ist. Eine sich daraus ableitende allgemeine Dominanz der Sonographie gegenüber z. B. der CT kann auf Basis der vorliegenden Literatur nicht bestätigt werden. Schlussfolgerung Im Rahmen einer strukturierten Untersuchungsstrategie, z. B. Leitlinien, ist die Sonographie bei Kindern bereits heute das diagnostische Mittel der ersten Wahl. Die Aufnahme der Sonographie als Primärdiagnostik in die noch aufzustellende Leitlinie für die Untersuchung des akuten Abdomens beim Erwachsenen kann sowohl auf Basis der berücksichtigten Literatur, als auch der bereits breiten Verfügbarkeit sonographischer Geräte empfohlen werden. Konkrete ökonomische Auswirkungen einer obligatorischen sonographischen Primärdiagnostik beim akuten Abdomen können aufgrund der nur begrenzt vorhandenen Publikationen nicht prognostiziert werden

Loss of zinc transporters ZIP1 and ZIP3 augments platelet reactivity in response to thrombin and accelerates thrombus formation in vivo

Zinc (Zn2+) is considered as important mediator of immune cell function, thrombosis and haemostasis. However, our understanding of the transport mechanisms that regulate Zn2+ homeostasis in platelets is limited. Zn2+ transporters, ZIPs and ZnTs, are widely expressed in eukaryotic cells. Using mice globally lacking ZIP1 and ZIP3 (ZIP1/3 DKO), our aim was to explore the potential role of these Zn2+ transporters in maintaining platelet Zn2+ homeostasis and in the regulation of platelet function. While ICP-MS measurements indicated unaltered overall Zn2+ concentrations in platelets of ZIP1/3 DKO mice, we observed a significantly increased content of FluoZin3-stainable free Zn2+, which, however, appears to be released less efficiently upon thrombin-stimulated platelet activation. On the functional level, ZIP1/3 DKO platelets exhibited a hyperactive response towards threshold concentrations of G protein-coupled receptor (GPCR) agonists, while immunoreceptor tyrosine-based activation motif (ITAM)-coupled receptor agonist signalling was unaffected. This resulted in enhanced platelet aggregation towards thrombin, bigger thrombus volume under flow ex vivo and faster in vivo thrombus formation in ZIP1/3 DKO mice. Molecularly, augmented GPCR responses were accompanied by enhanced Ca2+ and PKC, CamKII and ERK1/2 signalling. The current study thereby identifies ZIP1 and ZIP3 as important regulators for the maintenance of platelet Zn2+ homeostasis and function

Entwicklung des Lebensstilprogramms „Gemeinsam Gesund“

&lt;jats:title&gt;Zusammenfassung&lt;/jats:title&gt;&lt;jats:sec&gt; &lt;jats:title&gt;Hintergrund&lt;/jats:title&gt; &lt;jats:p&gt;Zivilisationserkrankungen (NCD) werden in Deutschland mit nahezu allen Sterbefällen assoziiert. Durch einen gesunden Lebensstil lässt sich das Erkrankungsrisiko jedoch maßgeblich beeinflussen. Daraus leitet sich ein großes Potenzial für Lebensstilinterventionen zur Prävention und Gesundheitsförderung ab. Das community-basierte Lebensstilprogramm „Gemeinsam Gesund“ kombiniert verhaltens- und verhältnispräventive Maßnahmen zur NCD-Prävention.&lt;/jats:p&gt; &lt;/jats:sec&gt;&lt;jats:sec&gt; &lt;jats:title&gt;Fragestellung&lt;/jats:title&gt; &lt;jats:p&gt;Wie lässt sich das Programm „Gemeinsam Gesund“ mithilfe des Intervention-Mapping-Ansatzes (IMA) entwickeln und strukturieren?&lt;/jats:p&gt; &lt;/jats:sec&gt;&lt;jats:sec&gt; &lt;jats:title&gt;Methodik&lt;/jats:title&gt; &lt;jats:p&gt;Die Planung des Lebensstilprogramms erfolgte mithilfe des IMA. Die theoretische Planungsmethode ermöglichte eine in Teilschritte untergliederte Programmentwicklung, die von einer Analyse der Ausgangssituation und Zielfindung über die Maßnahmenfestlegung bis hin zur Evaluationsplanung reichte.&lt;/jats:p&gt; &lt;/jats:sec&gt;&lt;jats:sec&gt; &lt;jats:title&gt;Ergebnisse&lt;/jats:title&gt; &lt;jats:p&gt;Die Bedarfs- und Bestandsanalyse (Schritt I) konnte die Bedarfe und bereits etablierte Gesundheitsangebote der Community aufzeigen. Daraus konnten konkrete Ziele entwickelt (Schritt II) sowie Maßnahmenformate und -inhalte (Schritt III) festgelegt werden. Es wurden Gesundheitschecks und ein 10-wöchiges intensives Lebensstilprogramm mit anschließenden Alumni-Treffen konzipiert. Für alle Interventionsinhalte wurden Materialien entwickelt (Schritt IV) und die Akteure für die Implementierung vor Ort identifiziert (Schritt V). Für die Evaluation (Schritt VI) wurde eine Kombination aus einer Effekt- und Prozessevaluation geplant.&lt;/jats:p&gt; &lt;/jats:sec&gt;&lt;jats:sec&gt; &lt;jats:title&gt;Diskussion&lt;/jats:title&gt; &lt;jats:p&gt;Der IMA eignet sich gut zur Planung von komplexen Lebensstilprogrammen. Die Anwendung der Methode konnte zu einer sehr zielgruppenorientierten Interventionsentwicklung beitragen, wenngleich einige Abweichungen von der normalen Vorgehensweise des IMA notwendig waren.&lt;/jats:p&gt; &lt;/jats:sec&gt