Worksite Wellness Interventions on Vascular Function, Insulin Sensitivity, HDL

针对血管功能、胰岛素敏感性、HDL 的工作场所健康干预措施

• 批准号: 8746586
• 负责人: Richard Cannon
• 金额: $ 68.71万
• 依托单位: NATIONAL HEART, LUNG, AND BLOOD INSTITUTE
• 依托单位国家: 美国
• 资助国家: 美国
• 起止时间: 至
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/8746586
• 关键词: Access to Information; Achievement; Affect; Age; Biological Markers; Blood; Blood Vessels; Body Weight Changes; Body Weight decreased; Body mass index; Businesses; C-reactive protein; Cardiovascular system; Cessation of life; Counseling; Coupled; Data; Dietitian; Dual-Energy X-Ray Absorptiometry; Employee; Environment; Epidemic; Exercise; Fatty acid glycerol esters; Female; Food; Goals; Health Benefit; Health Care Costs; High Density Lipoproteins; Home environment; Hormonal; Incentives; Institution; Intake; Internet; Intervention; Maintenance; Measures; Menopause; Metabolic; Methods; Minority; Modeling; National Heart, Lung, and Blood Institute; Non-Insulin-Dependent Diabetes Mellitus; Nutritional; Obesity; Outcome; Overweight; Oxygen Consumption; Participant; Performance; Population; Population Heterogeneity; Population Study; Productivity; Protocols documentation; Randomized; Regression Analysis; Research Personnel; Resources; Risk; Risk Reduction; Societies; Structure; Testing; United States; United States National Institutes of Health; Weight; Wellness Program; Woman; Work; Workplace; adipokines; arterial stiffness; base; brachial artery; cardiovascular disorder risk; cardiovascular risk factor; cohort; fitness; improved; indexing; inflammatory marker; insulin sensitivity; meetings; mortality; non-diabetic; nutrition; nutrition education; programs; sedentary; shear stress; success; trend; weight loss intervention

Obesity in the United States is highly prevalent, approaching 60% for black women. Our hypothesis was that nutrition education at the work place added to internet-based wellness information and exercise resources would facilitate weight and fat mass loss in a racially diverse population of overweight female employees. Methods: 199 (average body mass index 33.96.3 kg/m2) non-diabetic women (57% black) at our institution were randomized to a 6 month program of either internet-based wellness information (WI) combined with dietitian-led nutrition education group sessions (GS) weekly for 3 months and then monthly with shift in emphasis to weight loss maintenance (n=99) or to WI alone (n=100). All were given access to exercise rooms convenient to their work site. Fat mass was measured by dual-energy x-ray absorptiometry. Results: WI+GS subjects lost more weight than WI subjects at 3 months (-2.22.8 vs. -1.03.0 kg, P>0.001). Weight (-2.73.9 vs. -2.03.9 kg) and fat mass (-2.23.1 vs. -1.73.7 kg) loss at 6 months was significant for WI+GS and WI groups (both P<0.001), but without significant difference between groups (both P>0.10); 27 % of the WI+GS group achieved 5% loss of initial weight as did 18% of the WI group (P=0.180). Blacks and whites similarly completed the study (67% versus 74%, P=0.303), lost weight (-1.83.4 versus -3.35.2 kg, P=0.255) and fat mass (-1.62.7 versus -2.54.3 kg, P=0.532), and achieved 5% loss of initial weight (21% versus 32%, P=0.189), irrespective of group assignment. We conclude that overweight women provided with internet-based wellness information and exercise resources at the work site lost weight and fat mass, with similar achievement by black and white women. Sustained benefit of nutrition education sessions, apparent at 3 months, may require continuation of weekly meetings with emphasis on continued weight loss, especially for subjects who fail to achieve weight loss goals. Black women are disproportionately affected by obesity and type 2 diabetes. Interventions have generally produced little weight loss and change in insulin sensitivity in black women, but we considered whether emphasis on mean data may obscure metabolic benefits to some and possible harms of participation in others. Accordingly, we analyzed insulin sensitivity by tertile of changes in fat mass (FM) in black women at NIH participating in a 6 month weight loss program at our institution. Methods: Fifty-four black women age 4510 years (meanSD), BMI range 25.9 to 54.7 kg/m2 completed a 6-month program that included group sessions, internet-based nutrition information and access to exercise facilities at the work site. FM was measured by dual-energy X-ray absorptiometry and insulin sensitivity index (SI) was calculated from the minimal model. Exercise performance was measured by peak oxygen consumption during treadmill exercise. Results: Following completion of the 6 month program, the cohort as a whole lost modest FM (baseline 40.812.4 to 39.412.6 kg, P<0.01), but 17 women gained FM. SI on average did not change (baseline 3.301.71 to 3.211.56, p=0.67), however the tertile with greatest FM loss (-3.6 kg, range -10.7 to -1.7 kg) had increased SI (+0.31.2), whereas the tertile with net FM gain (+0.9 kg, range -0.1 to +3.8 kg) had reduced SI (-0.71.3, P<0.05 for trend). The tertile with greatest FM loss also had improved exercise performance (+2.62.9 mLO2/kg/min) vs. the tertile with net FM gain (-0.32.7 mLO2/kg/min, P<0.05 for trend), but only change in FM remained an independent predictor of change in SI by multivariable regression analysis.We conclude that black women who achieve FM loss may improve insulin sensitivity and exercise performance, but FM gain with opposite outcomes is common. Focusing on participants who fail to achieve FM loss early in an intervention may be required to achieve success.

美国的肥胖症非常普遍，黑人妇女接近60％。我们的假设是，在工作地点的营养教育增加了基于互联网的健康信息和锻炼资源，将促进种族多元化的超重女性雇员的体重和脂肪质量损失。方法：199（平均体重指数33.96.3 kg/m2）我们机构的非糖尿病妇女（57％黑色）被随机分为一个为期6个月的基于互联网的健康信息（WI）的计划，与Detitian领导的营养教育小组会议（GS）相结合3个月，每周3个月，然后每月与单独的重量减肥（n = 99）（n = 99）（n = 99）（n = 99）。 所有人都可以进入他们的工作现场的运动室。通过双能X射线吸收法测量脂肪质量。结果：WI+GS受试者在3个月时的体重降低了比WI受试者的体重更多（-2.22.8 vs. -1.03.0 kg，p> 0.001）。重量（-2.73.9 vs. -2.03.9 kg）和脂肪质量（-2.23.1 vs. -1.73.7 kg）在6个月时的损失对于Wi+GS和Wi组显着（均为P <0.001），但组之间没有显着差异（两者均P> 0.10）； WI+GS组的27％与WI组的18％相同（p = 0.180）达到了5％的初始体重损失。 Blacks and whites similarly completed the study (67% versus 74%, P=0.303), lost weight (-1.83.4 versus -3.35.2 kg, P=0.255) and fat mass (-1.62.7 versus -2.54.3 kg, P=0.532), and achieved 5% loss of initial weight (21% versus 32%, P=0.189), irrespective of group assignment.我们得出的结论是，在工作现场提供了基于互联网的健康信息和锻炼资源的超重女性减轻体重和脂肪质量，黑人和白人妇女的成就相似。营养教育课程的持续利益在3个月时显而易见，可能需要继续每周的会议，重点是继续减肥，尤其是对于未能实现减肥目标的受试者而言。 黑人妇女受肥胖和2型糖尿病的影响不成比例。干预措施通常会导致黑人妇女的体重减轻和胰岛素敏感性的变化，但是我们考虑了对平均数据的强调是否可能掩盖某些人参与其他人的代谢益处。因此，我们分析了NIH黑人女性脂肪质量变化（FM）的胰岛素敏感性，该妇女参加了我们机构的6个月减肥计划。方法：54岁的黑人妇女4510岁（平均值），BMI范围25.9至54.7 kg/m2完成了一个为期6个月的计划，其中包括小组会议，基于Internet的营养信息和工作现场的锻炼设施。通过双能X射线吸收仪测量FM，并根据最小模型计算胰岛素灵敏度指数（SI）。运动性能是通过跑步机运动期间的氧气消耗量来衡量的。 结果：在完成6个月计划后，整个损失的FM损失（基线40.812.4至39.412.6 kg，p <0.01），但有17名妇女获得了FM。 SI平均没有变化（基线3.301.71至3.211.56，p = 0.67），但是FM损失最大（-3.6 kg，范围-10.7至-1.7 kg）的三位数增加了Si（+0.31.2），而fm int fl fm增益（+0.9 kg，+0.9 kg，+0.9 kg，+0.9 kg，+0.9 kg） （-0.71.3，趋势的p <0.05）。 FM损失最大的三重量也提高了运动表现（+2.62.9 MLO2/kg/min）与具有净FM增益的三分线（-0.32.7 Mlo2/kg/min，趋势的p <0.05，p <0.05），但只有FM的变化仅是si损失的独立预测。 FM获得相反的结果很常见。可能需要在干预中未能实现FM损失的参与者才能取得成功。