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Process Evaluation of a Nutrition and Lifestyle Behavior Peer Support Program for Adults with Metabolic Syndrome.

ABSTRACT: Metabolic Syndrome (MetS) is a cluster of risk factors that increases the risk for diabetes and cardiovascular diseases. Lifestyle intervention is the gold standard of MetS management and prevention. Despite the growing positive influence of peer support-based interventions on management of various chronic diseases, its potential among adults with MetS has not been elucidated. We describe the development and process evaluation of a nutrition and lifestyle behavior "PEeR SUpport program for ADults with mEtabolic syndrome" (PERSUADE) using a systematic five-step approach-(i) review of evidence; (ii) focus group discussions; (iii) behavioral matrix development; (iv) module development; and (v) feasibility and process evaluation. High program adherence was recorded with 81.3% of participants attending all peer sessions. Participants' content satisfaction score was high (93.3%) while peer leadership score was satisfactory (70.0%). There were significant reductions in all anthropometric and metabolic parameters assessed post intervention, except for diastolic blood pressure. Significant correlations were found between reductions in body fat and triglyceride, and content satisfaction. Peer leadership was only significantly correlated with reduction in triglyceride. Future studies can explore aspects of module interactivity, use of social media, and other means to stimulate consistent engagement of participants, as well as extending the implementations to other lifestyle-related diseases.

SUBMITTER: Mahadzir MDA

PROVIDER: S-EPMC7215631 | biostudies-literature | 2020 Apr

REPOSITORIES: biostudies-literature

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Process Evaluation of a Nutrition and Lifestyle Behavior Peer Support Program for Adults with Metabolic Syndrome.

Mahadzir Muhammad Daniel Azlan MDA Quek Kia Fatt KF Ramadas Amutha A

International journal of environmental research and public health 20200412 8

Metabolic Syndrome (MetS) is a cluster of risk factors that increases the risk for diabetes and cardiovascular diseases. Lifestyle intervention is the gold standard of MetS management and prevention. Despite the growing positive influence of peer support-based interventions on management of various chronic diseases, its potential among adults with MetS has not been elucidated. We describe the development and process evaluation of a nutrition and lifestyle behavior "<i>PE</i>e<i>R SU</i>pport pro ...[more]

PMID: 32290570

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Project description:BackgroundRefeeding syndrome is a potentially life-threatening condition characterised by severe intracellular electrolyte shifts, acute circulatory fluid overload and organ failure. The initial symptoms are non-specific but early clinical features are severely low-serum electrolyte concentrations of potassium, phosphate or magnesium. Risk factors for the syndrome include starvation, chronic alcoholism, anorexia nervosa and surgical interventions that require lengthy periods of fasting. The causes of the refeeding syndrome are excess or unbalanced enteral, parenteral or oral nutritional intake. Prevention of the syndrome includes identification of individuals at risk, controlled hypocaloric nutritional intake and supplementary electrolyte replacement.ObjectiveTo determine the occurrence of refeeding syndrome in adults commenced on artificial nutrition support.DesignProspective cohort study.SettingLarge, single site university teaching hospital. Recruitment period 2007-2009.Participants243 adults started on artificial nutrition support for the first time during that admission recruited from wards and intensive care.Main outcome measuresPrimary outcomeoccurrence of the refeeding syndrome. Secondary outcome: analysis of the risk factors which predict the refeeding syndrome. Tertiary outcome: mortality due to refeeding syndrome and all-cause mortality.Results133 participants had one or more of the following risk factors: body mass index <16-18.5?(kg/m(2)), unintentional weight loss >15% in the preceding 3-6 months, very little or no nutritional intake >10 days, history of alcohol or drug abuse and low baseline levels of serum potassium, phosphate or magnesium prior to recruitment. Poor nutritional intake for more than 10 days, weight loss >15% prior to recruitment and low-serum magnesium level at baseline predicted the refeeding syndrome with a sensitivity of 66.7%: specificity was >80% apart from weight loss of >15% which was 59.1%. Baseline low-serum magnesium was an independent predictor of the refeeding syndrome (p=0.021). Three participants (2% 3/243) developed severe electrolyte shifts, acute circulatory fluid overload and disturbance to organ function following artificial nutrition support and were diagnosed with refeeding syndrome. There were no deaths attributable to the refeeding syndrome, but (5.3% 13/243) participants died during the feeding period and (28% 68/243) died during hospital admission. Death of these participants was due to cerebrovascular accident, traumatic injury, respiratory failure, organ failure or end-of-life causes.ConclusionsRefeeding syndrome was a rare, survivable phenomenon that occurred during hypocaloric nutrition support in participants identified at risk. Independent predictors for refeeding syndrome were starvation and baseline low-serum magnesium concentration. Intravenous carbohydrate infusion prior to artificial nutrition support may have precipitated the onset of the syndrome.

Project description:BackgroundThe major efficacy trials on diabetes prevention have used resource-intensive approaches to identify high-risk individuals and deliver lifestyle interventions. Such strategies are not feasible for wider implementation in low- and middle-income countries (LMICs). We aimed to evaluate the effectiveness of a peer-support lifestyle intervention in preventing type 2 diabetes among high-risk individuals identified on the basis of a simple diabetes risk score.Methods and findingsThe Kerala Diabetes Prevention Program was a cluster-randomized controlled trial conducted in 60 polling areas (clusters) of Neyyattinkara taluk (subdistrict) in Trivandrum district, Kerala state, India. Participants (age 30-60 years) were those with an Indian Diabetes Risk Score (IDRS) ?60 and were free of diabetes on an oral glucose tolerance test (OGTT). A total of 1,007 participants (47.2% female) were enrolled (507 in the control group and 500 in the intervention group). Participants from intervention clusters participated in a 12-month community-based peer-support program comprising 15 group sessions (12 of which were led by trained lay peer leaders) and a range of community activities to support lifestyle change. Participants from control clusters received an education booklet with lifestyle change advice. The primary outcome was the incidence of diabetes at 24 months, diagnosed by an annual OGTT. Secondary outcomes were behavioral, clinical, and biochemical characteristics and health-related quality of life (HRQoL). A total of 964 (95.7%) participants were followed up at 24 months. Baseline characteristics of clusters and participants were similar between the study groups. After a median follow-up of 24 months, diabetes developed in 17.1% (79/463) of control participants and 14.9% (68/456) of intervention participants (relative risk [RR] 0.88, 95% CI 0.66-1.16, p = 0.36). At 24 months, compared with the control group, intervention participants had a greater reduction in IDRS score (mean difference: -1.50 points, p = 0.022) and alcohol use (RR 0.77, p = 0.018) and a greater increase in fruit and vegetable intake (?5 servings/day) (RR 1.83, p = 0.008) and physical functioning score of the HRQoL scale (mean difference: 3.9 score, p = 0.016). The cost of delivering the peer-support intervention was US$22.5 per participant. There were no adverse events related to the intervention. We did not adjust for multiple comparisons, which may have increased the overall type I error rate.ConclusionsA low-cost community-based peer-support lifestyle intervention resulted in a nonsignificant reduction in diabetes incidence in this high-risk population at 24 months. However, there were significant improvements in some cardiovascular risk factors and physical functioning score of the HRQoL scale.Trial registrationAustralia and New Zealand Clinical Trials Registry ACTRN12611000262909.

Project description:Abstract Objectives A key to a successful personalized nutrition (PN) strategy is tailoring the behavior intervention to achieve sustained behavior change consistent with desired health outcomes. The objective of this study was to evaluate the impact of a digitally-delivered, systems biology-based PN program (Habit, LLC, Oakland, CA), that included nutrition and behavior advice, and meals. Methods In this single-arm, multi-phase, open-label study (clinicaltrials.gov: NCT03424395), participants (n = 107; 67% female), 30–59 years of age, were provided a Fitbit® Activity Tracker and instructions to complete an at-home kit that included collection of DNA and capillary blood before and after (30 and 120 min) consuming a mixed macronutrient challenge beverage. Lifestyle behavior data and activity levels were collected at baseline. Participants completed a 10-week control phase and a 10-week PN program intervention phase that included tailored nutrition and behavior advice, and meals (2 meals/day, 5 days/week). Validated quality of life, perceived stress, diet self-efficacy, and eating behavior questionnaires were administered to assess behavior before and after the intervention. Data from 73 compliant participants (66% female) were included in the analysis. Anthropometric and biological results were used to categorize participants into subgroups including Protein Seekers (PS) and Range Seekers (RS). Results Participants reported feeling fuller faster after the intervention, relative to before (P = 0.002), which could be linked to the dietary recommendations and behavior advice. Analysis by gender showed men reported more control over their eating patterns during negative events at baseline, compared to women (P = 0.005). This difference was not evident at the end of the intervention with women reporting slightly more, and men slightly less control. PS entered the study with a higher weight and BMI (P < 0.001 for both) and reported eating more quickly than RS (P = 0.003). This difference diminished, and by the end of the intervention PS did not differ from RS which could reflect the tailored advice provided. Conclusions These and other data provide novel insights on how a tailored personalized intervention that targeted food behavior may help drive positive changes in health outcomes. Funding Sources Habit, LLC.

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Process Evaluation of a Nutrition and Lifestyle Behavior Peer Support Program for Adults with Metabolic Syndrome.

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Process Evaluation of a Nutrition and Lifestyle Behavior Peer Support Program for Adults with Metabolic Syndrome.

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