A simple dietary message to improve dietary quality for metabolic syndrome

描述(由申请人提供)：总体目标是比较两种干预方法对代谢综合征患者饮食改变的效果。根据美国国家胆固醇教育计划的成人治疗小组III的描述，代谢综合征影响了近27%的美国成年人，是预防CHD的国家优先事项。减肥是代谢综合征建议中的首要任务。最近的三篇综述文章的结果一致认为，添加膳食纤维可以帮助减肥和保持减肥；膳食纤维还对代谢综合征的几个组成部分发挥临床益处，包括腰围、葡萄糖和脂肪动态平衡以及胰岛素控制。尽管如此，美国成年人的平均纤维摄入量还不到推荐值的一半。此外，针对饮食变化的干预措施通常并不成功，短期内遵守所有建议，长期保持饮食变化。饮食指南的复杂性可能是导致饮食依从性差的一个因素。我们建议一种简化的饮食干预策略，将重点放在饮食质量的一个关键方面，纤维摄入量，将克服通常与饮食干预相关的较差的依从性，并提高总体饮食质量。我们将从初级保健机构招募240名符合代谢综合征诊断标准的超重和肥胖成年人。两种饮食改变干预措施的效果将在一项随机对照试验中进行比较，每组120名患者。这两种方法是1)美国心脏协会(AHA)饮食指南；2)关注增加纤维的简单饮食改变条件。在这两种情况下的患者将接受为期3个月的强化饮食指导，然后是9个月的维持期。这两种情况都将通过注册营养师领导的个人和小组会议接受饮食指导。评估包括饮食、人体测量学、血压、空腹血糖、糖化血红蛋白(HbA1c)、血脂、胰岛素、炎症标志物、用药、抑郁、生活质量和体力活动，将在随机分组后的6个月和12个月进行。为期3个月的强化干预后评估将测量体重、饮食和代谢综合征指标的短期变化。我们假设，与那些随机接受AHA饮食条件的参与者相比，随机接受高纤维饮食条件的参与者在后续的体重减轻、新陈代谢健康改善和饮食质量方面将有明显更大的改善。这种简单的信息，如果在临床环境中被发现对减肥、新陈代谢健康、饮食质量和依从性有效，那么可能是作为公共健康信息进行测试的理想选择。公共健康相关性：确定一个简单的减肥和代谢健康饮食建议，可能会证明一个简单的公共健康信息可能会影响CHD预防和代谢综合征。在一项随机临床试验中，我们建议比较两种饮食改变干预方法在代谢综合征患者中预防冠心病的效果。这两种方法是1)AHA饮食指南；2)注重增加纤维的简单饮食改变条件。我们假设，促进高纤维摄入量的消息可能是有可能产生广泛影响的简单消息。

DESCRIPTION (provided by applicant): The overall goal is to compare the efficacy of two intervention approaches to dietary change among patients with the metabolic syndrome. Metabolic syndrome, which affects nearly 27% of US adults, is a national priority for prevention of CHD as described by the National Cholesterol Education Program's Adult Treatment Panel III. Weight loss is paramount in recommendations for metabolic syndrome. Results from three recent review articles agreed that adding dietary fiber can aid weight loss and weight loss maintenance; dietary fiber also exerts clinical benefits on several components of the metabolic syndrome, including waist circumference, glucose and lipid homeostasis, and insulin control. Despite this, the average fiber intake of adults in the United States is less than half recommended levels. In addition, interventions that target dietary change have typically not been successful with adherence to all recommendations in the short term, and with maintaining changes in diet over the longer term. A contributing factor to poor dietary adherence is likely of the complexity of dietary guidelines. We propose that a simplified dietary intervention strategy that focuses on a key aspect of dietary quality, fiber intake, will overcome the poor adherence typically associated with dietary interventions and improve overall diet quality. We will recruit 240 overweight and obese adults from a primary care setting who meet diagnostic criteria for metabolic syndrome. The efficacy of the two dietary change interventions will be compared in a randomized controlled trial, with 120 patients per group. The two approaches are 1) the American Heart Association (AHA) Dietary Guidelines; and 2) a simple dietary change condition that focuses on increasing fiber. Patients in both conditions will receive intensive dietary instruction for 3 months, followed by a 9 month maintenance phase. Both conditions will receive dietary instructions via individual and group sessions led by registered dietitians. Assessments, including diet, anthropometrics, blood pressure, fasting blood glucose, glycosylated hemoglobin (HbA1c), blood lipids, insulin, inflammatory markers, medication use, depression, quality of life, and physical activity will be conducted at baseline and at 6-, and 12-months after randomization. A 3-month post-intensive intervention assessment will measure short-term changes in body weight, diet, and metabolic syndrome indicators. We hypothesize that participants randomized to the higher fiber condition will have significantly greater weight loss, improvements in metabolic health, and dietary quality at follow-up, compared to those randomized to the AHA diet condition. Such a simple message, if found efficacious for weight loss, metabolic health, dietary quality and adherence in a clinical setting might then be ideal for testing as a public health message. PUBLIC HEALTH RELEVANCE: Identifying a simple dietary recommendation for weight loss and metabolic health may demonstrate potential for a simple public health message to impact CHD prevention and metabolic syndrome. In a randomized clinical trial, we propose to compare the efficacy of two intervention approaches to dietary change for CHD prevention among persons with metabolic syndrome. The two approaches are 1) the AHA Dietary Guidelines; and 2) a simple dietary change condition that focuses on increasing fiber. We hypothesize that a message promoting high fiber intake may be the simple message that has potential to produce broad impact.