Effects of a 2-Year Primary Care Lifestyle Intervention on Cardiometabolic Risk Factors: A Cluster-Randomized Trial.
Effects of a 2-Year Primary Care Lifestyle Intervention on Cardiometabolic Risk Factors: A Cluster-Randomized Trial.
复制标题
DOI：
10.1161/circulationaha.120.051328
复制
发表时间：
2021-03-23
期刊：
影响因子：
37.8
通讯作者：
PROPEL Research Group
中科院分区：
文献类型：
--
作者：
Höchsmann C;Dorling JL;Martin CK;Newton RL Jr;Apolzan JW;Myers CA;Denstel KD;Mire EF;Johnson WD;Zhang D;Arnold CL;Davis TC;Fonseca V;Lavie CJ;Price-Haywood EG;Katzmarzyk PT;PROPEL Research Group
强化生活方式干预（ILI）是有效治疗肥胖和管理相关心脏代谢风险因素的一线方法。由于很少有人在学术健康中心获得ILI，初级保健必须实施类似的方法，对肥胖和心脏代谢疾病的患病率产生有意义的影响。然而，迄今为止，在初级保健中有效的基于生活方式的肥胖治疗是有限的。我们研究了一个实用的ILI减肥提供的初级保健中的种族多样化，低收入人群的肥胖改善心脏代谢危险因素超过24个月的有效性。在路易斯安那州的初级保健中促进成功减肥（PROPEL）试验随机分配了18个诊所，平均分配到常规护理（UC）或ILI，随后招募了803名（351名UC，452名ILI）成年人（67%非裔美国人; 84%女性）。UC组继续接受正常的初级保健。ILI组接受了为期24个月的高强度基于生活方式的肥胖治疗计划，该计划嵌入在诊所环境中，由健康教练在最初的每周会议和7至24个月的每月会议中提供。如最近所证实的，ILI在24个月内的体重减轻明显多于UC（平均差异为-4.51%[95%CI：-5.93，-3.10; P<0.01]）。与UC相比，ILI患者在12个月时空腹血糖下降更多（平均差异为−7.1 mg/dL [95% CI：−12.0，−2.1; P<0.01]），但在24个月时没有下降（平均差异为−0.8 mg/dL [95% CI：−6.2，4.6; P=0.76]）。在两个时间点，ILI患者的HDL胆固醇升高均大于UC患者（24个月时的平均差异：4.6 mg/dL [95% CI：2.9，6.3; P<0.01]）。总：在两个时间点，ILI的HDL胆固醇比率和代谢综合征严重程度（z评分）下降幅度大于UC，24个月时的变化平均差异分别为-0.31（95% CI：-0.47，-0.14; P<0.01）和-0.21（95% CI：-0.36，-0.06; P=0.01）。在任何时间点，两组间总胆固醇、LDL胆固醇、甘油三酯和血压的变化均无显著差异。一个务实的ILI符合国家指导方针，并提供了训练有素的健康教练在初级保健产生临床相关的改善心脏代谢健康的服务不足的人口超过24个月。
Intensive lifestyle interventions (ILI) are the first-line approach to effectively treat obesity and manage associated cardiometabolic risk factors. Because few people have access to ILI in academic health centers, primary care must implement similar approaches for a meaningful impact on obesity and cardiometabolic disease prevalence. To date, however, effective lifestyle-based obesity treatment in primary care is limited. We examined the effectiveness of a pragmatic ILI for weight loss delivered in primary care among a racially diverse, low-income population with obesity for improving cardiometabolic risk factors over 24 months. The PROmoting Successful Weight Loss in Primary CarE in Louisiana (PROPEL) trial randomly allocated 18 clinics equally to usual care (UC) or an ILI and subsequently enrolled 803 (351 UC, 452 ILI) adults (67% African American; 84% female) with obesity from participating clinics. The UC group continued to receive their normal primary care. The ILI group received a 24-month high-intensity lifestyle-based obesity treatment program, embedded in the clinic setting and delivered by health coaches in weekly sessions initially and monthly sessions in months 7 through 24. As recently demonstrated, ILI lost significantly more weight over 24 months than UC (mean difference −4.51% [95% CI: −5.93, −3.10; P<0.01]). Fasting glucose decreased more in ILI compared to UC at 12 months (mean difference −7.1 mg/dL [95% CI: −12.0, −2.1; P<0.01]) but not 24 months (mean difference −0.8 mg/dL [95% CI: −6.2, 4.6; P=0.76]). Increases in HDL cholesterol were greater in ILI than UC at both timepoints (mean difference at 24 months: 4.6 mg/dL [95% CI: 2.9, 6.3; P<0.01]). Total:HDL cholesterol ratio and metabolic syndrome severity (z-score) decreased more in ILI than UC at both timepoints with significant mean differences of the change of −0.31 (95% CI: −0.47, −0.14; P<0.01) and −0.21 (95% CI: −0.36, −0.06; P=0.01) at 24 months, respectively. Changes in total cholesterol, LDL cholesterol, triglycerides, and blood pressure did not differ significantly between groups at any timepoint. A pragmatic ILI consistent with national guidelines and delivered by trained health coaches in primary care produced clinically relevant improvements in cardiometabolic health in an underserved population over 24 months.