6 research outputs found
Compositional analysis of the associations between 24-h movement behaviours and cardio-metabolic risk factors in overweight and obese adults with pre-diabetes from the PREVIEW study: cross-sectional baseline analysis
Background: Physical activity, sedentary time and sleep have been shown to be associated with cardio-metabolic
health. However, these associations are typically studied in isolation or without accounting for the effect of all
movement behaviours and the constrained nature of data that comprise a finite whole such as a 24 h day. The aim
of this study was to examine the associations between the composition of daily movement behaviours (including
sleep, sedentary time (ST), light intensity physical activity (LIPA) and moderate-to-vigorous activity (MVPA)) and
cardio-metabolic health, in a cross-sectional analysis of adults with pre-diabetes. Further, we quantified the
predicted differences following reallocation of time between behaviours.
Methods: Accelerometers were used to quantify daily movement behaviours in 1462 adults from eight countries
with a body mass index (BMI) â„25 kg·mâ 2
, impaired fasting glucose (IFG; 5.6â6.9 mmol·l
â 1
) and/or impaired glucose
tolerance (IGT; 7.8â11.0 mmolâąl
â 1 2 h following oral glucose tolerance test, OGTT). Compositional isotemporal
substitution was used to estimate the association of reallocating time between behaviours. Results: Replacing MVPA with any other behaviour around the mean composition was associated with a poorer
cardio-metabolic risk profile. Conversely, when MVPA was increased, the relationships with cardiometabolic risk
markers was favourable but with smaller predicted changes than when MVPA was replaced. Further, substituting ST
with LIPA predicted improvements in cardio-metabolic risk markers, most notably insulin and HOMA-IR.
Conclusions: This is the first study to use compositional analysis of the 24 h movement composition in adults with
overweight/obesity and pre-diabetes. These findings build on previous literature that suggest replacing ST with
LIPA may produce metabolic benefits that contribute to the prevention and management of type 2 diabetes.
Furthermore, the asymmetry in the predicted change in risk markers following the reallocation of time to/from
MVPA highlights the importance of maintaining existing levels of MVPA.
Trial registration: ClinicalTrials.gov (NCT01777893)
Higher protein intake is not associated with decreased kidney function in pre-diabetic older adults following a one-year intervention-a preview sub-study
Concerns about detrimental renal effects of a high-protein intake have been raised due to
an induced glomerular hyperfiltration, since this may accelerate the progression of kidney disease.
The aim of this sub-study was to assess the effect of a higher intake of protein on kidney function in
pre-diabetic men and women, aged 55 years and older. Analyses were based on baseline and one-year
data in a sub-group of 310 participants included in the PREVIEW project (PREVention of diabetes
through lifestyle Intervention and population studies in Europe and around the World). Protein
intake was estimated from four-day dietary records and 24-hour urinary urea excretion. We used
linear regression to assess the association between protein intake after one year of intervention and
kidney function markers: creatinine clearance, estimated glomerular filtration rate (eGFR), urinary
albumin/creatinine ratio (ACR), urinary urea/creatinine ratio (UCR), serum creatinine, and serum
urea before and after adjustments for potential confounders. A higher protein intake was associated
with a significant increase in UCR (p = 0.03) and serum urea (p = 0.05) after one year. There were
no associations between increased protein intake and creatinine clearance, eGFR, ACR, or serum
creatinine. We found no indication of impaired kidney function after one year with a higher protein
intake in pre-diabetic older adults
PREVIEW study-influence of a behavior modification intervention (PREMIT) in over 2300 people with pre-diabetes: intention, self-efficacy and outcome expectancies during the early phase of a lifestyle intervention
Purpose: Onset of type 2 diabetes (T2D) is often gradual and preceded by impaired glucose homeostasis. Lifestyle interventions including weight loss and physical activity may reduce the risk of developing T2D, but adherence to a lifestyle change is challenging. As part of an international T2D prevention trial (PREVIEW), a behavior change intervention supported participants in achieving a healthier diet and physically active lifestyle. Here, our aim was to explore the influence of this behavioral program (PREMIT) on social-cognitive variables during an 8-week weight loss phase.
Methods: PREVIEW consisted of an initial weight loss, Phase I, followed by a weightmaintenance, Phase II, for those achieving the 8-week weight loss target of â„ 8% from initial bodyweight. Overweight and obese (BMI â„25 kg/m2) individuals aged 25 to 70 years with confirmed pre-diabetes were enrolled. Uni- and multivariate statistical methods were deployed to explore differences in intentions, self-efficacy, and outcome expectancies between those who achieved the target weight loss (âachieversâ) and those who did not (ânon-achieversâ).
Results: At the beginning of Phase I, no significant differences in intentions, self-efficacy and outcome expectancies between âachieversâ (1,857) and ânon-achieversâ (163) were found. âNon-achieversâ tended to be younger, live with child/ren, and attended the PREMIT sessions less frequently. At the end of Phase I, âachieversâ reported higher intentions (healthy eating Ï2 (1)=2.57; P <0.008, exercising Ï2 (1)=0.66; P <0.008), self-efficacy (F(2; 1970)=10.27, P <0.005), and were more positive about the expected outcomes (F(4; 1968)=11.22, P <0.005).
Conclusion: Although statistically significant, effect sizes observed between the two groups were small. Behavior change, however, is multi-determined. Over a period of time, even small differences may make a cumulative effect. Being successful in behavior change requires that the ânewâ behavior is implemented time after time until it becomes a habit. Therefore, having even slightly higher self-efficacy, positive outcome expectancies and intentions may over time result in considerably improved chances to achieve long-term lifestyle changes
Men and women respond differently to rapid weight loss: Metabolic outcomes of a multi-centre intervention study after a low-energy diet in 2500 overweight, individuals with pre-diabetes (PREVIEW)
Aims: The PREVIEW lifestyle intervention study (ClinicalTrials.gov Identifier: NCT01777893) is, to date, the largest, multinational study concerning prevention of type-2 diabetes. We hypothesized that the initial, fixed low-energy diet (LED) would induce different metabolic outcomes in men vs women.
Materials and methods: All participants followed a LED (3.4 MJ/810 kcal/daily) for 8 weeks (Cambridge Weight Plan). Participants were recruited from 8 sites in Europe, Australia and New Zealand. Those eligible for inclusion were overweight (BMI â„ 25 kg/m2 ) individuals with pre-diabetes according to ADA-criteria. Outcomes of interest included changes in insulin resistance, fat mass (FM), fat-free mass (FFM) and metabolic syndrome Z-score.
Results: In total, 2224 individuals (1504 women, 720 men) attended the baseline visit and 2020 (90.8%) completed the follow-up visit. Following the LED, weight loss was 16% greater in men than in women (11.8% vs 10.3%, respectively) but improvements in insulin resistance were similar. HOMA-IR decreased by 1.50 ± 0.15 in men and by 1.35 ± 0.15 in women (ns). After adjusting for differences in weight loss, men had larger reductions in metabolic syndrome Z-score, C-peptide, FM and heart rate, while women had larger reductions in HDL cholesterol, FFM, hip circumference and pulse pressure. Following the LED, 35% of participants of both genders had reverted to normo-glycaemia.
Conclusions: An 8-week LED induced different effects in women than in men. These findings are clinically important and suggest gender-specific changes after weight loss. It is important to investigate whether the greater decreases in FFM, hip circumference and HDL cholesterol in women after rapid weight loss compromise weight loss maintenance and future cardiovascular health
Compositional analysis of the associations between 24-h movement behaviours and cardio-metabolic risk factors in overweight and obese adults with pre-diabetes from the PREVIEW study: cross-sectional baseline analysis
Background: Physical activity, sedentary time and sleep have been shown to be associated with cardio-metabolic
health. However, these associations are typically studied in isolation or without accounting for the effect of all
movement behaviours and the constrained nature of data that comprise a finite whole such as a 24 h day. The aim
of this study was to examine the associations between the composition of daily movement behaviours (including
sleep, sedentary time (ST), light intensity physical activity (LIPA) and moderate-to-vigorous activity (MVPA)) and
cardio-metabolic health, in a cross-sectional analysis of adults with pre-diabetes. Further, we quantified the
predicted differences following reallocation of time between behaviours.
Methods: Accelerometers were used to quantify daily movement behaviours in 1462 adults from eight countries
with a body mass index (BMI) â„25 kg·mâ 2
, impaired fasting glucose (IFG; 5.6â6.9 mmol·l
â 1
) and/or impaired glucose
tolerance (IGT; 7.8â11.0 mmolâąl
â 1 2 h following oral glucose tolerance test, OGTT). Compositional isotemporal
substitution was used to estimate the association of reallocating time between behaviours. Results: Replacing MVPA with any other behaviour around the mean composition was associated with a poorer
cardio-metabolic risk profile. Conversely, when MVPA was increased, the relationships with cardiometabolic risk
markers was favourable but with smaller predicted changes than when MVPA was replaced. Further, substituting ST
with LIPA predicted improvements in cardio-metabolic risk markers, most notably insulin and HOMA-IR.
Conclusions: This is the first study to use compositional analysis of the 24 h movement composition in adults with
overweight/obesity and pre-diabetes. These findings build on previous literature that suggest replacing ST with
LIPA may produce metabolic benefits that contribute to the prevention and management of type 2 diabetes.
Furthermore, the asymmetry in the predicted change in risk markers following the reallocation of time to/from
MVPA highlights the importance of maintaining existing levels of MVPA.
Trial registration: ClinicalTrials.gov (NCT01777893)
Acute heart failure congestion and perfusion status â impact of the clinical classification on in-hospital and long-term outcomes; insights from the ESC-EORP-HFA Heart Failure Long-Term Registry
Aims: Classification of acute heart failure (AHF) patients into four clinical profiles defined by evidence of congestion and perfusion is advocated by the 2016 European Society of Cardiology (ESC)guidelines. Based on the ESC-EORP-HFA Heart Failure Long-Term Registry, we compared differences in baseline characteristics, in-hospital management and outcomes among congestion/perfusion profiles using this classification. Methods and results: We included 7865 AHF patients classified at admission as: âdry-warmâ (9.9%), âwet-warmâ (69.9%), âwet-coldâ (19.8%) and âdry-coldâ (0.4%). These groups differed significantly in terms of baseline characteristics, in-hospital management and outcomes. In-hospital mortality was 2.0% in âdry-warmâ, 3.8% in âwet-warmâ, 9.1% in âdry-coldâ and 12.1% in âwet-coldâ patients. Based on clinical classification at admission, the adjusted hazard ratios (95% confidence interval) for 1-year mortality were: âwet-warmâ vs. âdry-warmâ 1.78 (1.43â2.21) and âwet-coldâ vs. âwet-warmâ 1.33 (1.19â1.48). For profiles resulting from discharge classification, the adjusted hazard ratios (95% confidence interval) for 1-year mortality were: âwet-warmâ vs. âdry-warmâ 1.46 (1.31â1.63) and âwet-coldâ vs. âwet-warmâ 2.20 (1.89â2.56). Among patients discharged alive, 30.9% had residual congestion, and these patients had higher 1-year mortality compared to patients discharged without congestion (28.0 vs. 18.5%). Tricuspid regurgitation, diabetes, anaemia and high New York Heart Association class were independently associated with higher risk of congestion at discharge, while beta-blockers at admission, de novo heart failure, or any cardiovascular procedure during hospitalization were associated with lower risk of residual congestion. Conclusion: Classification based on congestion/perfusion status provides clinically relevant information at hospital admission and discharge. A better understanding of the clinical course of the two entities could play an important role towards the implementation of targeted strategies that may improve outcomes. © 2019 The Authors. European Journal of Heart Failure © 2019 European Society of Cardiolog