Lifestyle Modification for Metabolic Syndrome: A Systematic Review
Lifestyle Modification for Metabolic Syndrome: A Systematic Review
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DOI：
10.1016/j.amjmed.2014.06.035
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发表时间：
2014-12-01
影响因子：
5.9
通讯作者：
Stone, Neil J.
中科院分区：
文献类型：
--
作者：
Bassi, Nikhil;Karagodin, Ilya;Stone, Neil J.
背景：代谢综合征的所有 5 种症状均已被证明可以通过改变生活方式和饮食来改善。需要新的策略来实现坚持有意义的生活方式改变，以优化动脉粥样硬化心血管风险的降低。我们根据系统评价和荟萃分析框架的首选报告项目 (PRISMA) 进行了系统性文献综述，研究了实现代谢综合征生活方式改变的最佳方法。方法：我们向 PubMed Central、CINAHL、Web of Science 和 Ovid 数据库提交了标准化搜索术语。在这些结果中，我们选择了随机对照试验（RCT），这些试验提出了改变患有一种或多种代谢综合征的患者生活方式的独特方法。使用人群、干预、比较器、结果和偏倚风险框架 (PICO) 提取数据来比较以下终点：代谢综合征的患病率、个体代谢综合征成分的患病率、代谢综合征成分的平均数量以及实现的体重减轻量。 结果：纳入了 28 项随机对照试验（6372 名患者）。八项随机对照试验证明一年后代谢综合征危险因素有所改善。以团队为基础的互动方法，与积极主动的患者进行频繁接触，产生了最大、最持久的影响。研究发现，技术是实现生活方式改变的有用工具，但与个人接触相比，效果不佳。结论：导致改善生活方式依从性的患者动机是实现减少代谢综合征成分的关键因素。这些要素可以通过与医疗保健系统的频繁接触来增强。使用移动和互联网通信等技术可以提高代谢综合征生活方式改变的有效性，但不应取代个人接触作为治疗的基石。我们得出定量结论的能力受到研究间结果测量不一致、个别研究的低功效和同质性、研究人群的积极性、随访期短、随访缺失以及盲法的缺乏或不完全等因素的限制。 (C) 2014 Elsevier Inc. 保留所有权利。
BACKGROUND: All 5 components of metabolic syndrome have been shown to improve with lifestyle and diet modification. New strategies for achieving adherence to meaningful lifestyle change are needed to optimize atherosclerotic cardiovascular risk reduction. We performed a systematic literature review, based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses framework (PRISMA), investigating optimal methods for achieving lifestyle change in metabolic syndrome.METHODS: We submitted standardized search terms to the PubMed Central, CINAHL, Web of Science, and Ovid databases. Within those results, we selected randomized controlled trials (RCTs) presenting unique methods of achieving lifestyle change in patients with one or more components of the metabolic syndrome. Data extraction using the population, intervention, comparator, outcome, and risk of bias framework (PICO) was used to compare the following endpoints: prevalence of metabolic syndrome, prevalence of individual metabolic syndrome components, mean number of metabolic syndrome components, and amount of weight loss achieved.RESULTS: Twenty-eight RCTs (6372 patients) were included. Eight RCTs demonstrated improvement in metabolic syndrome risk factors after 1 year. Team-based, interactive approaches with high-frequency contact with patients who are motivated made the largest and most lasting impact. Technology was found to be a useful tool in achieving lifestyle change, but ineffective when compared with personal contact.CONCLUSION: Patient motivation leading to improved lifestyle adherence is a key factor in achieving reduction in metabolic syndrome components. These elements can be enhanced via frequent encounters with the health care system. Use of technologies such as mobile and Internet-based communication can increase the effectiveness of lifestyle change in metabolic syndrome, but should not replace personal contact as the cornerstone of therapy. Our ability to derive quantitative conclusions is limited by inconsistent outcome measures across studies, low power and homogeneity of individual studies, largely motivated study populations, short follow-up periods, loss to follow-up, and lack of or incomplete blinding. (C) 2014 Elsevier Inc. All rights reserved.