Effects of a three-month therapeutic lifestyle modification program to improve bone health in postmenopausal Korean women in a rural community: a randomized controlled trial.

In this randomized controlled trial, we examined the effects of a 3-month therapeutic lifestyle modification (TLM) intervention on knowledge, self-efficacy, and health behaviors related to bone health in postmenopausal women in rural Korea. Forty-one women ages 45 or older were randomly assigned to either the intervention (n = 21) or control (n = 20) group. The intervention group completed a 12-week, 24-session TLM program of individualized health monitoring, group health education, exercise, and calcium-vitamin D supplementation. Compared with the control group, the intervention group showed significant increases in knowledge and self-efficacy and improvement in diet and exercise after 12 weeks, providing evidence that a comprehensive TLM program can be effective in improving health behaviors to maintain bone health in women at high risk of osteoporosis.

Therapeutic lifestyle modification program reduces plasma levels of the chemokines CRP and MCP-1 in subjects with metabolic syndrome.

OBJECTIVE: The purpose of this study was to examine the effects of a 6-month therapeutic lifestyle modification (TLM) program on chemokines related to oxidative stress, inflammation, endothelial dysfunction, and arterial stiffness in subjects with metabolic syndrome (MetS). METHODS: The authors performed a randomized controlled trial, assigning 52 women (mean age 62.7 ± 9.0 years) with MetS to a TLM intervention group (n = 31) or a control group (n = 21). The authors provided the TLM intervention group with health screening, exercise, low-calorie diet, and health education and counseling for 6 months and instructed the control group to maintain their usual lifestyle behaviors. Outcome variables included levels of myeloperoxidase (MPO), oxidized low-density lipoprotein (LDL), adiponectin, leptin, resistin, high-sensitivity C-reactive protein (hs-CRP), interleukin-1ß, interleukin-6, tumor necrosis factor-alpha (TNF-α), CD40L, monocyte chemotactic protein-1 (MCP-1), retinol-binding protein 4 (RBP-4), endothelin-1, and brachial-ankle pulse wave velocity. The authors used generalized estimating equation (GEE) analyses to estimate the effects of the TLM program. RESULTS: After the 6-month TLM program, hs-CRP levels decreased significantly, and MCP-1 levels increased at a significantly slower rate in the TLM group than they did in the control group (all p < .05). CONCLUSION: These results indicate that a TLM program could be effective for improving patient inflammatory states and may also be effective in preventing cardiovascular complications in subjects with MetS.

High-sensitivity C-reactive protein is independently associated with arterial stiffness in women with metabolic syndrome.

BACKGROUND: Metabolic syndrome (MetS) is associated with higher incidences of cardiovascular events and with increased mortality from coronary heart disease. There is increasing evidence that MetS presents as a proinflammatory and prothrombotic state. OBJECTIVES: The purposes of this study were to investigate the relationships among adiponectin (a marker for adipocytokines), high-sensitivity C-reactive protein (hs-CRP, a marker for inflammation), and brachial-ankle pulse-wave velocity (ba-PWV, a marker for arterial stiffness) in MetS and to identify predictors of ba-PWV, which indicates subclinical atherosclerosis. METHODS: The present study is a cross-sectional, secondary analysis of data collected as part of a longitudinal, randomized controlled trial that tested the effectiveness of a therapeutic lifestyle modification for Korean women with MetS (N = 52). We used the definition for MetS suggested by the National Cholesterol Education Program Adult Treatment Panel III. RESULTS: Adiponectin was negatively correlated with hs-CRP (r = -0.316, P = .027) and ba-PWV (r = -0.284, P = .048), and hs-CRP was positively correlated with ba-PWV (r = 0.341, P = .016). Women with high hs-CRP and low adiponectin levels also had greater ba-PWV levels (P = .041). Levels of hs-CRP were independently associated with ba-PWV after adjusting for age, body mass index, and number of MetS components, whereas no independent association was identified for adiponectin. CONCLUSION: Levels of hs-CRP may provide important prognostic information in terms of future cardiovascular risk in women with MetS.

Effects of a therapeutic lifestyle modification program on inflammatory chemokines and insulin resistance in subjects with metabolic syndrome.

BACKGROUND: Although therapeutic lifestyle modification (TLM) effectively improves the values of diagnostic biomarkers of metabolic syndrome, less is known about its effects on inflammatory chemokines and insulin resistance (IR) in patients with this syndrome. Objectives. To examine the effects of a short-term TLM program on inflammatory chemokines (monocyte chemoattractant protein-1 [MCP-1], retinol binding protein-4 [RBP-4]) and IR in subjects with metabolic syndrome. METHOD: Twenty-nine women (aged 66.5 ± 9.5 years) with metabolic syndrome were randomly assigned to the TLM intervention group (n = 16) or control group (n = 13). The TLM intervention group was provided with 4 weeks of health screening, education, exercise, diet, and counseling. Participants in the control group were instructed to maintain their usual lifestyle behavior. Outcome variables measured included MCP-1, RBP-4, fasting glucose, fasting insulin, and homeostasis model assessment (HOMA). An intention-to-treat strategy was not followed, and the final number of subjects in the analysis was 22 (14 in the TLM group and 8 in the control group). RESULTS: After a 4-week TLM program, MCP-1, fasting insulin, and HOMA were significantly decreased in the TLM group compared to those in the control group (all p < .05). CONCLUSIONS: We conclude that a short-term TLM program could be effective for improving inflammatory state and IR, which are significant preceding biomarkers for cardiovascular complications in subjects with metabolic syndrome.

Effects of a 6-month lifestyle modification intervention on the cardiometabolic risk factors and health-related qualities of life in women with metabolic syndrome.

Although therapeutic lifestyle modification (TLM) has been recommended as a cornerstone treatment of metabolic syndrome (MetS), little is known about the biobehavioral effects of a TLM program for patients in a community. The purpose of this study was to examine the effects of a 6-month TLM program on MetS risk factors and health-related qualities of life (HRQOL) among middle-aged and older women in a community in Korea. Fifty-two women (mean age, 62.7 +/- 9.0 years) with MetS were recruited from 3 community health centers and were randomly assigned to the intervention (n = 31) or control (n = 21) groups. The patients in the intervention group participated in supervised TLM sessions for 6 months. The TLM program included health monitoring, counseling, health education, exercise, and dieting. Metabolic risk factors and HRQOL were measured at baseline, during the study (month 3), at completion (month 6), and post completion (month 12) of the TLM program. Compared with the control group, the TLM group showed significantly greater reductions in body weight (P < .001) and waist circumference (P < .001); these effects were sustained for 6 months after intervention. With regard to HRQOL, the TLM group showed greater improvements in physical function (P = .017), general health (P < .001), vitality (P = .008), and mental health (P = .027). These improvements, however, were not sustained after the intervention. The results indicate that a nurse-led systematic TLM program may be an effective strategy for managing middle-aged and older women with MetS at a community level.

Prevalence and clinical characteristics of metabolic syndrome for at-risk people in a rural community.

BACKGROUND: Substantial socioeconomic and demographic changes have resulted in an increase in the incidence of metabolic syndrome in Korea, especially in aged, postmenopausal women and in rural populations. As rural populations age, metabolic syndrome is expected to be a significant health problem. The purpose of this study was to determine the prevalence and clinical characteristics of metabolic syndrome for an at-risk population in a rural community health-care center. METHODS: Data were collected from 136 people who were defined as being at risk for metabolic syndrome by being over 40 years of age and being treated for hypertension, diabetes mellitus, dyslipidemia, or central obesity at a rural community health-care center in Korea. Prevalence and clinical characteristics were evaluated by the diagnostic guidelines of National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATP III) and World Health Organization Asia-Pacific (WHO-AP). RESULTS: The prevalence of metabolic syndrome among this group was 64.7% and 74.3% according to the NCEP-ATP III and WHO-AP criteria, respectively. The prevalence of metabolic syndrome increased with age and was higher in women. Of the five risk factors, fasting blood sugar and central obesity in women were the most prevalent (81.6%), followed by systolic hypertension (80.1%). CONCLUSION: The prevalence of metabolic syndrome for at-risk people was high in the rural Korean health-care center used in this study. Population-wide management strategies are apparently needed.

A randomized controlled trial of therapeutic lifestyle modification in rural women with metabolic syndrome: a pilot study.

The aim of the study was to identify the effects of the therapeutic lifestyle modification (TLM) program on women with the metabolic syndrome in rural areas. Thirty-two women with the metabolic syndrome were randomly assigned to the intervention or control group. The women in the intervention group participated in a 4-week TLM program consisting of health screening, education, exercise, diet, and counseling. Those in the control group received a booklet with basic education for metabolic syndrome. Repeated-measures analysis of variance was used for analyzing the effects of the TLM intervention on anthropometric indicators, serologic assays, and psychosocial outcomes. The participants in the intervention group showed significant reductions in body weight (-4.6 kg vs -2.0 kg), waist circumference (-6.2 cm vs -1.7 cm), and triglyceride levels (-52.2 mg/dL vs -2.2 mg/dL) compared with those in the control group at 4 weeks (P < .01). In addition, the TLM intervention group showed significant positive behavior changes; almost all of the women tried to control their intake of food and their weight and to exercise 3 times per week. The TLM intervention showed no group and time interaction effect on systolic blood pressure, fasting glucose, high-density lipoprotein cholesterol, or low-density lipoprotein cholesterol levels. However, there was a positive time effect; after the program, high-density lipoprotein cholesterol levels increased and systolic blood pressure, fasting glucose, and low-density lipoprotein cholesterol decreased compared with levels before the intervention in both groups. These results indicate that a well-developed comprehensive TLM intervention can improve metabolic syndrome over a short-term period.

[Knowledge, perception and health behavior about metabolic syndrome for an at risk group in a rural community area].

PURPOSE: This study was to identify knowledge, perception and health behavior about metabolic syndrome for an at risk group in a rural community area. METHODS: A descriptive cross-sectional survey design was used. A total of 575 adults with hypertension, diabetes mellitus, dyslipidemia, and/or abdominal obesity were recruited from 11 rural community health care centers. A questionnaire was developed for this study. Anthropometric measures were measured and blood data was reviewed from the health record. RESULTS: Knowledge about the metabolic syndrome was low as evidenced by only a 47% correct answer rate. Only 9% of the subjects ever heard about the disease, and 87% answered they do not know the disease at all. 87% of the subjects were not performing regular exercise, 31% drank alcohol more than once a month, 12.5% were current smokers, and 33.6% are did not have a regular health check-up. CONCLUSION: Development of systematic public health care programs are needed to prevent future increases in cardiovascular complications and to decrease health care costs. These might include educational programs for the primary health care provider and an at risk group, a therapeutic lifestyle modification program, and a health screening program to identify potential groups.