Nutrition & Metabolism | |
Mitigating preventable chronic disease: Progress report of the Cleveland Clinic's Lifestyle 180 program | |
Michael F Roizen2  Edward J Mascha1  Leif Saager3  Dongsheng Yang1  Mladen Golubić2  Elizabeth HW Ricanati2  | |
[1] Quantitative Health Sciences, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA;Wellness Institute, Cleveland Clinic, 1950 Richmond Road, TR2-341, Lyndhurst, OH 44124, USA;Outcomes Research, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA | |
关键词: Diabetes; Hypertension; Hyperlipidemia; Obesity; Chronic disease; Stress Management; Exercise; Nutrition; Lifestyle; | |
Others : 820233 DOI : 10.1186/1743-7075-8-83 |
|
received in 2011-07-05, accepted in 2011-11-23, 发布年份 2011 | |
【 摘 要 】
Background
Poor lifestyle choices are key in development and progression of preventable chronic diseases. The purpose of the study was to design and test a program to mitigate the physical and fiscal consequences of chronic diseases.
Methods
Here we report the outcomes for 429 participants with one or more chronic conditions, including obesity, hypertension, hyperlipidemia and diabetes mellitus, many of whom had failed traditional disease management programs, who enrolled into a comprehensive lifestyle intervention. The Lifestyle 180 program integrates nutrition, physical activity and stress management interventions and was conducted at the Wellness Institute of the Cleveland Clinic, United States. An intensive 6 week immersion course, with 8 hours of group instruction per week, was followed by 3 follow-up, 4 hour-long sessions over the course of 6 months.
Results
Changes in biometric (weight, height, waist circumference, resting heart rate and blood pressure) and laboratory variables (fasting lipid panel, blood glucose, insulin, hemoglobin A1c, ultra sensitive C-reactive protein) at 6 months were compared with baseline (pre-post analysis). At week 30, biometric and laboratory data were available for 244 (57%) and 299 (70%) participants, respectively. These had a mean ± SD reduction in weight (6.8 ± 6.9 kg, P < 0.001), waist circumference (6.1 ± 7.3 cm, P < 0.001), glucose (4.5 ± 29.6 mg/dL or 0.25 ± 1.64 mmol/L, P = 0.009), triglycerides (26.4 ± 58.5 mg/dL or 0.30 ± 0.66 mmol/L, P < 0.001), low-density lipoprotein cholesterol (LDL) (7.9 ± 25.1 mg/dL or 0.2 ± 0.65 mmol/L, P < 0.001), hemoglobin A1c (HgbA1c) (0.20 ± 0.64%, P = 0.001), insulin (3.8 ± 11 microU/ml or 26.6 ± 76.4 ρmol, P < 0.001) and ultra sensitive C-reactive protein (US - CRP) (0.9 ± 4.8 mg/dL or 7.3 ± 40.2 nmol/L, P = 0.012), an increase in mean high-density lipoprotein cholesterol (HDL) (3.7 ± 8.4 mg/dL or 0.1 ± 0.22, P < 0.001), and decreased use of medications.
Conclusion
Implementation of a comprehensive lifestyle modification program among adults with common chronic conditions results in significant and clinically meaningful improvements in biometric and laboratory outcomes after 6 months.
【 授权许可】
2011 Ricanati et al; licensee BioMed Central Ltd.
【 预 览 】
Files | Size | Format | View |
---|---|---|---|
20140712032851313.pdf | 641KB | download | |
Figure 2. | 32KB | Image | download |
Figure 1. | 41KB | Image | download |
【 图 表 】
Figure 1.
Figure 2.
【 参考文献 】
- [1]Willett WC: Balancing Life-Style and Genomics Research for Disease Prevention. Science 2002, 296:695-698.
- [2]World Health Organization: Diet, Nutrition and the Prevention of Chronic Diseases. WHO Technical Report Series 916 2003.
- [3]Ford ES, Bergmann MM, Kröger J, Schienkiewitz A, Weikert C, Boeing H: Healthy living is the best revenge: findings from the European Prospective Investigation Into Cancer and Nutrition-Potsdam study. Arch Intern Med 2009, 169(15):1355-62.
- [4]American College of Preventive Medicine: Lifestyle Medicine-Evidence Review [http://www.acpm.org/lifestyleMedicine.htm] webcite 2009. Accessed July 4, 2010
- [5]Ornish D, Scherwitz LW, Billings JH, Brown SE, Gould KL, Merritt TA, et al.: Intensive Lifestyle Changes for Reversal of coronary heart disease. JAMA 1998, 280(23):2001-7.
- [6]Silberman A, Banthia R, Estay IS, Kemp C, Studley J, Hareras D, Ornish D: The effectiveness and efficacy of an intensive cardiac rehabilitation program in 24 sites. Am J Health Promot 2010, 24(4):260-6.
- [7]Kalter-Leibovici O, Younis-Zeidan N, Atamna A, Lubin F, Alpert G, Chetrit A, et al.: Lifestyle intervention in obese Arab women: a randomized controlled trial. Arch Intern Med 2010, 170(11):970-6.
- [8]Sullivan S, Samuel S: Effect of short-term Pritikin diet therapy on the metabolic syndrome. J Cardiometab Syndr 2006, Fall; 1(5):308-12.
- [9]Albu JB, Heilbronn LK, Kelley DE, Smith SR, Azuma K, Berk ES, Pi-Sunyer FX, Ravussin E: Look AHEAD Adipose Research Group. Metabolic changes following a 1-year diet and exercise intervention in patients with type 2 diabetes. Diabetes 2010, 59(3):627-33. Epub 2009 Dec 22
- [10]Hyman MA, Ornish D, Roizen M: Lifestyle medicine: treating the causes of disease. Altern Ther Health Med 2009, 15(6):12-4.
- [11]National Cholesterol Education Program (NCEP) Expert Panel on Detection, Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III): Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation 2002, 106(25):3143-421.
- [12]Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults--The Evidence Report. National Institutes of Health Obes Res 1998, 6(Suppl 2):51S.
- [13]American Diabetes Association: Diagnosis and Classification of Diabetes Mellitus. Diabetes Care 2011, 34:S62-S69.
- [14]The IDF consensus worldwide definition of the metabolic syndrome [http://www.idf.org/webdata/docs/MetS_def_update2006.pdf] webciteIDF 2006.
- [15]Harris MOR, Flomo D: Changing and Adhering to Lifestyle Change: What are the Keys? American Journal of Lifestyle Medicine 2007, 1(3):214-219.
- [16]Serra-Majem L, Roman B, Estruch R: Scientific evidence of interventions using the Mediterranean diet: a systematic review. Nutr Rev 2006, 64(2 Pt 2):S27-47.
- [17]de Kok TM, de Waard P, Wilms LC, van Breda SG: Antioxidative and antigenotoxic properties of vegetables and dietary phytochemicals: the value of genomics biomarkers in molecular epidemiology. Mol Nutr Food Res 2010, 54(2):208-17.
- [18]Wing RR, Goldstein MG, Acton KJ, Birch LL, Jakicic JM, Sallis JF Jr, et al.: Behavioral science research in diabetes: lifestyle changes related to obesity, eating behavior, and physical activity. Diabetes Care 2001, 24(1):117-23.
- [19]Murphy CT, McCarroll SA, Bargmann CI, Fraser A, Kamath RS, Ahringer J, Li H, Kenyon C: Genes that act downstream of DAF-16 to influence the lifespan of Caenorhabditis elegans. Nature 2003, 424(6946):277-83. Epub 2003 Jun 29
- [20]Lee SJ, Murphy CT, Kenyon C: Glucose shortens the life span of C. elegans by downregulating DAF-16/FOXO activity and aquaporin gene expression. Cell Metab 2009, 10(5):379-91.
- [21]Buckland G, Bach A, Serra-Majem L: Obesity and the Mediterranean diet: a systematic review of observational and intervention studies. Obes Rev 2008, 9(6):582-93. Epub 2008 Jun 10
- [22]U.S. Department of Health and Human Services. 2008 Physical Activity Guidelines for Americans [http://www.health.gov/paguidelines] webciteHyattsville, MD: U.S. Department of Health and Human Services; 2008. Accessed July 26, 2010
- [23]Tresierras MA, Balady GJ: Resistance training in the treatment of diabetes and obesity: mechanisms and outcomes. J Cardiopulm Rehabil Prev 2009, 29(2):67-75.
- [24]Roizen MF, Hafen T, Armour LA: The RealAge workout: maximum health, minimum work. 1st edition. New York: Collins; 2006:xv. 216
- [25]Bravata DM, Smith-Spangler C, Sundaram V, Gienger AL, Lin N, Lewis R, Stave CD, Olkin I, Sirard JR: Using pedometers to increase physical activity and improve health: a systematic review. JAMA 2007, 298(19):2296-304.
- [26]Roizen MF, Oz M: You, on a diet: the owner's manual for waist management. Rev. and expanded. New York: Free Press; 2009.
- [27]Nakao M, Fricchione G, Myers P, Zuttermeister PC, Baim M, Mandle CL, Medich C, Wells-Federman CL, Martin Arcari P, Ennis M, Barsky AJ, Benson H: Anxiety is a good indicator for somatic symptom reduction through behavioral medicine intervention in a mind/body medicine clinic. Psychother Psychosom 2001, 70(1):50-7.
- [28]Stevens J, Truesdale KP, McClain JE, Cai J: The definition of weight maintenance. Int J Obes (Lond) 2006, 30(3):391-9.
- [29]Frattaroli J, Weidner G, Dnistrian AM, Kemp C, Daubenmier JJ, Marlin RO, Crutchfield L, Yglecias L, Carroll PR, Ornish D: Clinical events in prostate cancer lifestyle trial: results from two years of follow-up. Urology 2008, 72(6):1319-23.
- [30]Dattilo AM, Kris-Etherton PM: Effects of weight reduction on blood lipids and lipoproteins: a meta-analysis. Am J Clin Nutr 1992, 56(2):320-8.
- [31]Nam BH, Kannel WB, D'Agostino RB: Search for an optimal atherogenic lipid risk profile: from the Framingham Study. Am J Cardiol 2006, 97(3):372-5.
- [32]Katcher HI, Hill AM, Lanford JL, Yoo JS, Kris-Etherton PM: Lifestyle approaches and dietary strategies to lower LDL-cholesterol and triglycerides and raise HDL-cholesterol. Endocrinol Metab Clin North Am 2009, 38(1):45-78.
- [33]Dattilo AM, Kris-Etherton PM: Effects of weight reduction on blood lipids and lipoproteins: a meta-analysis. Am J Clin Nutr 1992, 56(2):320-8.
- [34]Poobalan A, Aucott L, Smith WC, Avenell A, Jung R, Broom J, Grant AM: Effects of weight loss in overweight/obese individuals and long-term lipid outcomes--a systematic review. Obes Rev 2004, 5(1):43-50.
- [35]Bayturan O, Tuzcu EM, Lavoie A, Hu T, Wolski K, Schoenhagen P, Kapadia S, Nissen SE, Nicholls SJ: The metabolic syndrome, its component risk factors, and progression of coronary atherosclerosis. Arch Intern Med 2010, 170(5):478-84.
- [36]da Luz PL, Favarato D, Faria-Neto JR Jr, Lemos P, Chagas AC: High ratio of triglycerides to HDL-cholesterol predicts extensive coronary disease. Clinics (Sao Paulo) 2008, 63(4):427-32.
- [37]Ornish D: Avoiding revascularization with lifestyle changes: The Multicenter Lifestyle Demonstration Project. Am J Cardiol 1998, 82(10B):72T-76T.
- [38]Nathan C, Ding A: Nonresolving inflammation. Cell 2010, 140(6):871-82.
- [39]Beavers KM, Nicklas BJ: Effects of lifestyle interventions on inflammatory markers in the metabolic syndrome. Front Biosci (Schol Ed) 2011, 3:168-77.
- [40]Lim S, Norman R, Clifton P, Noakes M: The effect of comprehensive lifestyle intervention or metformin on obesity in young women. Nutr Metab Cardiovasc Dis 2011, 21(4):261-8.
- [41]Iqbal N, Vetter ML, Moore RH, Chittams JL, Dalton-Bakes CV, Dowd M, Williams-Smith C, Cardillo S, Wadden TA: Effects of a Low-intensity Intervention That Prescribed a Low-carbohydrate vs. a Low-fat Diet in Obese, Diabetic Participants. Obesity (Silver Spring) 2010, 18(9):1733-8.
- [42]Murawski ME, Milsom VA, Ross KM, Rickel KA, DeBraganza N, Gibbons LM, Perri MG: Problem solving, treatment adherence, and weight-loss outcome among women participating in lifestyle treatment for obesity. Eat Behav 2009, 10(3):146-51.
- [43]Fappa E, Yannakoulia M, Pitsavos C, Skoumas I, Valourdou S, Stefanadis C: Lifestyle intervention in the management of metabolic syndrome: could we improve adherence issues? Nutrition 2008, 24(3):286-91. Epub 2008 Jan 16
- [44]Sullivan S, Cloninger CR, Przybeck TR, Klein S: Personality characteristics in obesity and relationship with successful weight loss. Int J Obes (Lond) 2007, 31(4):669-74.