The Finnish Diabetes Prevention Study (DPS): Lifestyle intervention and 3-year results on diet and physical activity

OBJECTIVE: To describe the 1) lifestyle intervention used in the Finnish Diabetes Prevention Study, 2) short- and long-term changes in diet and exercise behavior, and 3) effect of the intervention on glucose and lipid metabolism. RESEARCH DESIGN AND METHODS: There were 522 middle-aged, overweight subjects with impaired glucose tolerance who were randomized to either a usual care control group or an intensive lifestyle intervention group. The control group received general dietary and exercise advice at baseline and had an annual physician's examination. The subjects in the intervention group received additional individualized dietary counseling from a nutritionist. They were also offered circuit-type resistance training sessions and advised to increase overall physical activity. The intervention was the most intensive during the first year, followed by a maintenance period. The intervention goals were to reduce body weight, reduce dietary and saturated fat, and increase physical activity and dietary fiber. RESULTS: The intervention group showed significantly greater improvement in each intervention goal. After 1 and 3 years, weight reductions were 4.5 and 3.5 kg in the intervention group and 1.0 and 0.9 kg in the control group, respectively. Measures of glycemia and lipemia improved more in the intervention group. CONCLUSIONS: The intensive lifestyle intervention produced long-term beneficial changes in diet, physical activity, and clinical and biochemical parameters and reduced diabetes risk. This type of intervention is a feasible option to prevent type 2 diabetes and should be implemented in the primary health care system.     

A controlled evaluation of staging dietary patterns to reduce the risk of diabetes in African-American women

OBJECTIVE: This study evaluated the 3-month follow-up data of the Eat Well, Live Well Nutrition Program, a culturally specific, peer-led dietary change program designed to reduce the risk of type 2 diabetes in low-income African-American women. This peer-led program was delivered in the community and was tailored to the participants' stage of change for individual dietary patterns. We report the results of the 3-month intervention and the extent to which dietary changes and other key outcomes were maintained at a 3-month follow-up assessment. RESEARCH DESIGN AND METHODS: Using an experimental control group design, 294 overweight African-American women (ages 25-55 years), recruited in collaboration with a neighborhood organization, completed pre- and posttest and 3-month follow-up interviews of dietary behaviors, knowledge, attitudes, fat intake, and weight. RESULTS: Significant reductions were found in fat intake among women in the treatment condition when compared with women in the control group; these reductions were maintained at 3-month follow-up assessment. Likewise, significant changes in dietary patterns were reported after the study and were maintained, except for one dietary pattern (replacement). CONCLUSIONS: This model of health promotion, which individually tailors dietary patterns through staging and use of peer educators, has the potential for decreasing fat intake and increasing and maintaining specific low-fat dietary patterns among overweight African-American women at risk for diabetes.     

Evaluation of a Peer-Education Program on Heart Disease Prevention with Older Adults

This investigation evaluated the effect of a peer-education program on preventing cardiovascular disease in older persons. Peer leaders at two urban senior housing residences were provided with training on cardiovascular disease and its risk factors, strategies to reduce the risk factors, and communication skills. Baseline and follow-up data were collected on residents at the two intervention and two control sites. The dependent variables were knowledge of cardiovascular disease risk factors; perceived self-efficacy to reduce calories, dietary fat and salt intake, to lose weight, to stop smoking, and to exercise regularly; and self-reported cardiovascular risk behaviors. Analysis of individual change scores between baseline and follow-up surveys showed a statistically significant increase in overall knowledge of heart disease, dietary self-efficacy, and exercise self-efficacy for the intervention group compared with the control group. This program appeared to benefit the individuals who lived in housing residences where the peer educators also resided.     

Effectiveness of a lifestyle modification programme in weight maintenance in obese subjects after cessation of treatment with Orlistat

OBJECTIVE: To examine the efficacy of a lifestyle modification programme in weight maintenance for obese subjects after cessation of treatment with Orlistat. METHODS: Fifty-five subjects with and without diabetes mellitus were randomized to a lifestyle modification programme or to usual care at the end of 6 months' treatment with Orlistat. The intervention programme was nutritionist led, consisting of components of dietary management, physical activity, peer group support and discussion using techniques of self-monitoring, stimulus control and cognitive restructuring. Anthropometric indices, body composition, basal metabolic rate, blood pressure, fasting glucose, glycosylated haemoglobin, lipid profile, 24-hour urinary albumin excretion, dietary intake, physical activity level, and quality of life were assessed before and after the intervention period. Results Subjects in the intervention group maintained their weight loss and favourable anthropometric, metabolic, dietary intake, physical activity and quality of life profiles, while most parameters deteriorated in the usual care group, being more marked in subjects with diabetes. The magnitude of weight gain was comparable to that lost during Orlistat treatment. CONCLUSION: A specially designed nutritionist-led lifestyle modification programme for obese subjects is effective in weight maintenance after treatment with Orlistat, in the absence of which the benefits of drug treatment were lost. The magnitude of the effect of lifestyle modification is comparable to that observed with Orlistat.     

高血压患者生活方式改变阶段的影响因素

目的评价目前高血压患者生活方式现状并分析其影响因素。方法采用阶段性改变模式对174名高血压患者进行生活方式评估（高盐饮食、高脂饮食、锻炼、吸烟）,并分析其影响因素。结果研究结果显示,在吸烟、缺乏锻炼、高盐、高脂饮食这四项生活方式中,缺乏锻炼的患者在前意向阶段人数最多,目前有高盐饮食不良生活习惯的人最多（93．8％）。年龄、性别与吸烟改变阶段呈正相关（r=0．605,0．159;P〈0．01或P〈0．05）,教育程度、烟龄、每日吸烟支数与吸烟改变阶段呈负相关（r=-0．170,-0．845,-0．871;P〈0．05）。年龄、教育程度、职业、高血压病程与运动改变阶段呈正相关（P〈0．05）,高盐、高脂饮食相关因素较少,高脂饮食只与性别呈正相关（P〈0．05）。Logistic回归分析显示,年龄、烟龄及每日吸烟支数对吸烟改变阶段有预测作用。年龄、受教育程度及高血压病程对运动改变阶段有预测作用。结论为高血压患者设计健康教育措施时,不仅要考虑患者所处改变阶段,而且对于年龄较轻,烟龄长及每日吸烟支数多的吸烟患者需要增加干预次数。对处于前意向阶段、年龄较轻、教育程度低及新发高血压患者需要加强促进规律锻炼的干预措施。在四项生活方式中,需要着重加强低盐饮食健康教育。     

Pretreatment,Psychological, and Behavioral Predictors of Weight Outcomes Among Lifestyle Intervention Participants in the Diabetes Prevention Program (DPP)

OBJECTIVE

To identify the most important pretreatment characteristics and changes in psychological and behavioral factors that predict weight outcomes in the Diabetes Prevention Program (DPP).

RESEARCH DESIGN AND METHODS

Approximately 25% of DPP lifestyle intervention participants (n = 274) completed questionnaires to assess weight history and psychological and behavioral factors at baseline and 6 months after completion of the 16-session core curriculum. The change in variables from baseline to 6 months was assessed with t tests. Multivariate models using hierarchical logistic regression assessed the association of weight outcomes at end of study with each demographic, weight loss history, psychological, and behavioral factor.

RESULTS

At end of study, 40.5% had achieved the DPP 7% weight loss goal. Several baseline measures (older age, race, older age when first overweight, fewer self-implemented weight loss attempts, greater exercise self-efficacy, greater dietary restraint, fewer fat-related dietary behaviors, more sedentary activity level) were independent predictors of successful end-of-study weight loss with the DPP lifestyle program. The DPP core curriculum resulted in significant improvements in many psychological and behavioral targets. Changes in low-fat diet self-efficacy and dietary restraint skills predicted better long-term weight loss, and the association of low-fat diet self-efficacy with weight outcomes was explained by dietary behaviors.

CONCLUSIONS

Health care providers who translate the DPP lifestyle intervention should be aware of pretreatment characteristics that may hamper or enhance weight loss, consider prioritizing strategies to improve low-fat diet self-efficacy and dietary restraint skills, and examine whether taking these actions improves weight loss outcomes.The Diabetes Prevention Program (DPP) demonstrated that a lifestyle intervention aimed at 7% weight loss and 150 min of physical activity per week reduced the risk of diabetes by 58% over 2.8 years in 1,079 ethnically diverse participants at high risk to develop diabetes (1). Weight loss was the predominant predictor of diabetes prevention, and for every kilogram of weight loss, there was a 16% risk reduction in development of diabetes for lifestyle intervention participants (2). Of the DPP lifestyle intervention participants, 49% achieved the 7% weight loss goal at 6 months after completion of a core curriculum, and 37% maintained the 7% weight loss at end of study (3). Weight loss in DPP was greater for those who were older, engaged in more frequent self-monitoring of fat intake, reported a lower percentage of calories from fat, and increased physical activity (2,3). However, many participants did not achieve study weight loss targets.Little has been published about the potential role of other modifiable psychological and behavioral variables on the ability to achieve and maintain weight loss. Understanding participant characteristics that independently predict weight loss and maintenance is critical for DPP clinical translation efforts and will help identify those who are most likely to succeed with this evidence-based lifestyle intervention to prevent or delay type 2 diabetes. Moreover, additional insights on the most important modifiable predictors of weight outcomes should help health care providers focus on enhancing abilities and skills of participants in relevant, change-worthy, cognitive-behavioral domains.On the basis of previous research (4–11), we hypothesized that achievement and maintenance of weight loss in DPP lifestyle group participants at 6 months and end of study would be greater for those with the following pretreatment characteristics: fewer previous self-implemented weight loss attempts and weight loss programs; higher self-efficacy for diet, exercise, and weight loss; lower perceived stress; less frequent emotional eating; less binge eating; and more dietary restraint. In addition, we hypothesized that changes in several cognitive and behavioral factors targeted during the initial active weight loss intervention period of the trial, including improvements in self-efficacy and dietary restraint and reductions in emotional eating and binge eating, would predict greater weight loss at end of study.     

Metabolic syndrome: time for action

The constellation of dyslipidemia (hypertriglyceridemia and low levels of high-density lipoprotein cholesterol), elevated blood pressure, impaired glucose tolerance, and central obesity is identified now as metabolic syndrome, also called syndrome X. Soon, metabolic syndrome will overtake cigarette smoking as the number one risk factor for heart disease among the U.S. population. The National Cholesterol Education Program-Adult Treatment Panel III has identified metabolic syndrome as an indication for vigorous lifestyle intervention. Effective interventions include diet, exercise, and judicious use of pharmacologic agents to address specific risk factors. Weight loss significantly improves all aspects of metabolic syndrome. Increasing physical activity and decreasing caloric intake by reducing portion sizes will improve metabolic syndrome abnormalities, even in the absence of weight loss. Specific dietary changes that are appropriate for addressing different aspects of the syndrome include reducing saturated fat intake to lower insulin resistance, reducing sodium intake to lower blood pressure, and reducing high-glycemic-index carbohydrate intake to lower triglyceride levels. A diet that includes more fruits, vegetables, whole grains, monounsaturated fats, and low-fat dairy products will benefit most patients with metabolic syndrome. Family physicians can be more effective in helping patients to change their lifestyle behaviors by assessing each patient for the presence of specific risk factors, clearly communicating these risk factors to patients, identifying appropriate interventions to address specific risks, and assisting patients in identifying barriers to behavior change.     

Effects of an exercise intervention on other health behaviors in overweight/obese post-menopausal women

BACKGROUND: Little is known about whether initiating physical activity induces change in other health-related behaviors. If other behaviors do change with increasing physical activity, this would complicate interpretation of differences in study outcomes in exercise intervention trials. DESIGN: Randomized controlled trial. SETTING/PARTICIPANTS: 173 sedentary, overweight (body mass index between 24.0 and 25.0 kg/m2 with body fat>33% or BMI>or=25.0 kg/m2), postmenopausal women, ages 50 to 75 years, not using hormone therapy, and living in the Seattle, WA area. INTERVENTION: Participants were randomly assigned to an exercise intervention (n=87) or a stretching-control group (n=86). The exercise intervention included facility and home-based moderate-intensity exercise. MAIN OUTCOME MEASURES: Changes in dietary intake, alcohol consumption, and medication and supplement use were compared from baseline to 3- and 12-month follow-up between exercise and control groups, and by tertiles of exercise adherence. Data were collected between January 1998 and July 2001. RESULTS: In general, changes in dietary intake between the exercise and control group were not statistically different. The exercise group had a greater increase in the proportion of participants who used multivitamins (+5%) compared to the control group (-10%) at 3 months (p-interaction=0.04), but not at 12 months (p-interaction=0.58). Furthermore, there were few differences when comparing changes in health behaviors across exercise adherence tertiles. CONCLUSIONS: Our results suggest that participation in a year-long exercise intervention trial among post-menopausal women has little effect on other health behaviors. These findings suggest that additional behavior changes in exercise trials are minimal and unlikely to bias primary study results.     

Motivation to modify lifestyle risk behaviors in women treated for breast cancer

OBJECTIVE: To determine motivators of health behaviors (relevant to risk for chronic disease and cancer recurrence) after a cancer diagnosis. PATIENTS AND METHODS: Eighty-six women who had been treated for breast cancer (mean age, 54.8 years; median time since diagnosis, 23.5 months) participated in this cross-sectional study (1997-1998). Respondents completed a questionnaire assessing overweight or obesity status, dietary fat intake, energy expenditure, motivational readiness for exercise and weight loss, and variables associated with readiness for exercise adoption and weight loss. RESULTS: Forty-six women (54%) were overweight or obese, and 47 women (55%) reported dietary fat intake of 30% or higher. Sixty-one women (72%) were in action/ maintenance stages for exercise adoption. A majority believed that diet and exercise can change the course of cancer. Overweight and obese women in the sample were more likely to be in early stages of motivational readiness for weight loss, and they reported significantly lower exercise self-efficacy and lower eating self-efficacy than their nonoverweight peers. However, they endorsed more benefits associated with weight loss than the nonoverweight subgroup. Thirty-three women (39%) reported both a low-fat diet and exercising at recommended levels. CONCLUSIONS: Only a minority of respondents reported consuming a diet low in fat and exercising at recommended levels, which suggests a need to improve both diet and exercise behaviors among women treated for breast cancer. Overweight and obese women reported low self-efficacy for exercise and eating, suggesting that interventions should focus on increasing self-efficacy for behavior change.     

Lifestyle counseling for type 2 diabetes risk reduction in Dutch primary care: results of the APHRODITE study after 0.5 and 1.5 years

OBJECTIVE To study the overall effect of the Active Prevention in High-Risk Individuals of Diabetes Type 2 in and Around Eindhoven (APHRODITE) lifestyle intervention on type 2 diabetes risk reduction in Dutch primary care after 0.5 and 1.5 years and to evaluate the variability between general practices. RESEARCH DESIGN AND METHODS Individuals at high risk for type 2 diabetes (Finnish Diabetes Risk Score ≥13) were randomly assigned into an intervention group (n = 479) or a usual-care group (n = 446). Comparisons were made between study groups and between general practices regarding changes in clinical and lifestyle measures over 1.5 years. Participant, general practitioner, and nurse practitioner characteristics were compared between individuals who lost weight or maintained a stable weight and individuals who gained weight. RESULTS Both groups showed modest changes in glucose values, weight measures, physical activity, energy intake, and fiber intake. Differences between groups were significant only for total physical activity, saturated fat intake, and fiber intake. Differences between general practices were significant for BMI and 2-h glucose but not for energy intake and physical activity. In the intervention group, the nurse practitioners' mean years of work experience was significantly longer in individuals who were successful at losing weight or maintaining a stable weight compared with unsuccessful individuals. Furthermore, successful individuals more often had a partner. CONCLUSIONS Risk factors for type 2 diabetes could be significantly reduced by lifestyle counseling in Dutch primary care. The small differences in changes over time between the two study groups suggest that additional intervention effects are modest. In particular, the level of experience of the nurse practitioner and the availability of partner support seem to facilitate intervention success.     

Lifestyle changes after a health dialogue. Results from the Live for Life health promotion programme

OBJECTIVE: To evaluate the effect of a health dialogue on lifestyle habits, and to relate the lifestyle changes to changes of biological risk markers for ischaemic heart disease. DESIGN: Cross-sectional study, intervention and follow-up. SETTING: The community of Habo, population 9500, located in Skaraborg, Sweden. PATIENTS: All 35-year-old inhabitants in Habo were invited to a health examination during a study period between 1989 and 1992. A community intervention programme was combined with a health examination consisting of a health dialogue with a specially trained nurse and use of a "health curve" as an educational tool. The effect of the health examination was examined by comparing baseline characteristics of participants in 1989-1992 with their follow-up data in 1993. RESULTS: Participants in the health dialogue who were re-examined reported lifestyle improvements including less smoking, decreased dietary fat intake and increased physical activity. Those who reported improved dietary intake and increased physical activity improved their biological risk markers correspondingly (body mass index, waist to hip ratio, serum cholesterol concentration). CONCLUSIONS: The combination of a community and an individually based health programme can be effective with respect to lifestyle variables and, in those improving their lifestyle, in biological risk markers.     

Quality of dietary fatty acids, insulin sensitivity and type 2 diabetes.

Epidemiological evidence and intervention studies clearly indicate that the quality of dietary fat influences insulin sensitivity in humans, in particular, saturated fat worsens it, while monounsaturated and omega-6 polyunsaturated fats improve it. Long chain omega-3 fatty acids do not seem to have any effect on insulin sensitivity, at least in humans. Moreover, there is also good epidemiological evidence that the quality of dietary fat may influence the risk of type 2 diabetes, again with saturated fat increasing and unsaturated fat decreasing this risk. No intervention study is available at the moment on this specific point, even if in the Finnish Diabetes Prevention Study the incidence of type 2 diabetes was reduced by a multifactorial intervention, which also included a reduction of saturated fat intake.     

2型糖尿病高危人群强化生活方式干预的效果研究

目的探索强化生活方式干预管理对2型糖尿病（DM）高危人群生活方式的影响。方法选择符合2型糖尿病高危人群的社区居民60名,由专职医务人员一对一进行18个月的运动、膳食和心理等干预指导,通过宣传相关知识,使其逐渐建立合理的饮食结构及适当的运动量,注意保持乐观平静的心境。结果本组60名高危人群干预后,每天三餐搭配合理,三种主要营养素、食用油、食盐、蔬菜摄人合理,总运动量、有效运动量及有效运动量／总运动量、体重指数、腹围等,均优于干预前（P〈0．05,P〈0．01）。结论强化干预有助于2型糖尿病高危人群逐步建立健康的生活方式,减低发病危险因素,达到逐步从源头上控制2型糖尿病的发生与发展。     

Biologic and quality-of-life outcomes from the Mediterranean Lifestyle Program: a randomized clinical trial

OBJECTIVE: Few multiple lifestyle behavior change programs have been designed to reduce the risk of coronary heart disease in postmenopausal women with type 2 diabetes. This study tested the effectiveness of the Mediterranean Lifestyle Program (MLP), a comprehensive lifestyle self-management program (Mediterranean low-saturated fat diet, stress management training, exercise, group support, and smoking cessation), in reducing cardiovascular risk factors in postmenopausal women with type 2 diabetes. RESEARCH DESIGN AND METHODS: Postmenopausal women with type 2 diabetes (n = 279) were randomized to either usual care (control) or treatment (MLP) conditions. MLP participants took part in an initial 3-day retreat, followed by 6 months of weekly meetings, to learn and practice program components. Biological end points were changes in HbA(1c), lipid profiles, BMI, blood pressure, plasma fatty acids, and flexibility. Impact on quality of life was assessed. RESULTS: Multivariate ANCOVAs revealed significantly greater improvements in the MLP condition compared with the usual care group on HbA(1c), BMI, plasma fatty acids, and quality of life at the 6-month follow-up. Patterns favoring intervention were seen in lipids, blood pressure, and flexibility but did not reach statistical significance. CONCLUSIONS: These results demonstrate that postmenopausal women with type 2 diabetes can make comprehensive lifestyle changes that may lead to clinically significant improvements in glycemic control, some coronary heart disease risk factors, and quality of life.     

Intensive lifestyle changes are necessary to improve insulin sensitivity: a randomized controlled trial

OBJECTIVE: The extent to which lifestyle must be altered to improve insulin sensitivity has not been established. This study compares the effect on insulin sensitivity of current dietary and exercise recommendations with a more intensive intervention in normoglycemic insulin-resistant individuals. RESEARCH DESIGN AND METHODS: Seventy-nine normoglycemic insulin-resistant (determined by the euglycemic insulin clamp) men and women were randomized to either a control group or one of two combined dietary and exercise programs. One group (modest level) was based on current recommendations and the other on a more intensive dietary and exercise program. Insulin sensitivity was measured using a euglycemic insulin clamp, body composition was measured using dual-energy X-ray absorptiometry, and anthropometry and aerobic fitness were assessed before and after a 4-month intervention period. Four-day dietary intakes were recorded, and fasting glucose, insulin, and lipids were measured. RESULTS: Only the intensive group showed a significant improvement in insulin sensitivity (23% increase, P=0.006 vs. 9% in the modest group, P=0.23). This was associated with a significant improvement in aerobic fitness (11% increase in the intensive group, P=0.02 vs. 1% in the modest group, P=0.94) and a greater fiber intake, but no difference in reported total or saturated dietary fat. CONCLUSIONS: Current clinical dietary and exercise recommendations, even when vigorously implemented, did not significantly improve insulin sensitivity; however, a more intensive program did. Improved aerobic fitness appeared to be the major difference between the two intervention groups, although weight loss and diet composition may have also played an important role in determining insulin sensitivity.     

Diabetes risk factors in low-income Mexican-American children.

OBJECTIVE: To learn if Mexican-American children from low income neighborhoods have excess diabetes risk factors. RESEARCH DESIGN AND METHODS: The study involved 173 Mexican-American children aged 9 years. This is the age before type 2 diabetes usually develops in youths and where the disparity in body fat between Mexican-American and non-Hispanic white children is evident. The study also targets poor children because diabetes and being overweight are more common in Mexican-American adults from a lower than from a higher socioeconomic status. The diabetes risk factors measured were percent body fat, dietary fat intake, daily fruit and vegetable intake, and physical fitness. Body fat was measured by bioelectric impedance, dietary intake was measured by three 24-h dietary recalls, and physical fitness was measured by a modified Harvard step test. RESULTS: According to self-reported dietary recalls, Mexican-American children ate higher than recommended fat servings and had higher percent energy from fat and saturated fat. On the other hand, their reported daily fruit and vegetable intake was half of that recommended by national dietary guidelines. A large percentage of these children were at unacceptable physical fitness levels. Percent body fat was higher in these Mexican-American children than that reported for non-Hispanic white children. Finally, 60% of the children had a first- or second-degree relative with diabetes. CONCLUSIONS: Because diabetes is highly prevalent in Mexican-American adults, type 2 diabetes in increasing in Mexican-American youths, and diabetes risk factors are more common in Mexican-American children, a prudent measure would be to explore early-age diabetes risk factor prevention programs in this population.     

Project SMART parent program: preliminary results of a chronic disease risk reduction trail

Project SMART Parent Program is a school-based healthy lifestyle promotion program designed to reduce chronic disease risk in adults and to provide a health-conscious home environment for children through the adoption of healthy lifestyle by their parents. Parents in the high involvement condition received comprehensive health status appraisals, and a program designed to reduce dietary fat intake, and increase aerobic activity levels. Parents in the low involvement condition received only the comprehensive health status appraisals. ANCOVA, using treatment condition as the independent variable and change scores as the dependent variables, were used to assess program outcomes. At the first posttest measure, the intervention group compared to the control group had a significantly greater decrease in blood cholesterol, a greater gain in aerobic fitness, a greater weight loss, and a greater decrease in body fat. At the second posttest measure, the intervention group had significantly greater gain in aerobic fitness, a greater decrease in body fat, a greater decrease in systolic blood pressure, and a marginally significant decrease in weight. Preliminary results provide strong support for the effectiveness of the Parent Program in reducing chronic disease risks.     

Biologically based complementary and alternative medicine use among breast cancer survivors: relationship to dietary fat consumption and exercise

Previous literature has shown that more than half of all female cancer survivors use some form of complementary and alternative medicine (CAM). Although the prevalence of CAM use in this population is becoming apparent, few researchers have examined the relationship between CAM use and lifestyle factors that could influence patients’ well-being. The present study examined whether breast cancer survivors who use biologically based CAM are more likely than CAM nonusers to follow a low-fat diet and maintain moderate or vigorous exercise. Sixty-five female breast cancer survivors who were within 3 months of completing primary treatment were recruited. CAM use was measured by self-reported use of one or more of a list of 15 supplements. Dietary fat was measured by a 23-item self-report measure estimating fat consumption in the past month. Dietary fat stage of change and moderate and vigorous exercise stage of change were assessed using measures based on the Transtheoretical Model of Behavior Change. Results showed that biologically based CAM users maintained a lower percentage of calories from fat in their diet (t=2.12, p<0.05), and there was a trend for CAM users to be more likely than CAM nonusers to be in the action or maintenance stage for dietary fat consumption (p<0.09). However, this study did not find that CAM users were more likely to be in the action or maintenance stage of change for moderate or vigorous exercise. These findings suggest that biologically based CAM use among breast cancer survivors is associated with some, but not all, healthy lifestyle behaviors.     

Prevention of diabetes mellitus: the future of German diabetology

One of the challenges in clinical diabetology today is to develop and implement diabetes prevention management programs for clinical practice. Recent studies have convincingly demonstrated that lifestyle intervention, addressing diet and exercise as well as pharmacologic preventive strategies reduced the risk of progressing from impaired glucose tolerance to diabetes. With respect to the worldwide burden of diabetes these studies offer a compelling evidence-base for the important translation of the research findings into community-based prevention strategies and the development of a National Diabetes Prevention Program. The workgroup "diabetes prevention" from the German Diabetes Association together with the National Action Forum Diabetes and the German Diabetes Foundation developed a concept for a National Program. This comprises a 3-step-intervention: in a first step individuals at high risk to develop type 2 diabetes are identified. The second step provides an intensive group intervention to prevent diabetes and in a third step continuous intervention should facilitate motivation maintenance and evaluation. This third step is the crucial step to maintain the effect in changing lifestyle. Recently, a compendium for diabetes prevention was developed as a practical guideline explaining how to implement prevention programs. This guideline also includes the structure of a national prevention program with a prevention manager having a central role in the concept and suggestions for evaluation and quality control.     

行为转变理论在空腹血糖受损人群生活方式干预中的应用

目的探讨行为转变理论(trans-theoretical model of behavior,TTM)在空腹血糖受损(impaired fasting glucose,IFG)人群生活方式干预中的应用效果。方法便利抽样法选取2012年3月至2013年3月在无锡市人民医院体检中心体检且符合IFG诊断的40例患者为研究对象。由研究团队根据TTM理论,制定综合、分阶段干预措施,一对一进行为期1年的运动、医学营养、糖尿病知识和心理等干预,使其逐步建立合理的饮食结构及适当的运动量,形成健康的生活方式。结果应用TTM方法干预生活方式后,IFG人群体质量指数(body mass index,BMI)、收缩压、舒张压、三酰甘油(triglyceride,TG)、总胆固醇(total cholesterol,TC)、低密度脂蛋白(low density lipoprotein,LDL)、空腹血糖(fasting plasma glucose,FPG)明显低于干预前,差异均有统计学意义(均P0.05);但是腰围(waist circumference,WC)、高密度脂蛋白(high-density lipoprotein,HDL)较干预前好转不明显,差异均无统计学意义(均P0.05)。干预后,IFG人群三餐饮食搭配合理例数明显高于干预前,差异有统计学意义(P0.01)。每天摄入三种主要营养素、食用油、食盐、蔬菜摄入的合理例数明显高于干预前,差异有统计学意义(P0.01)。IFG人群每天有效运动时间、总运动量、有效运动量均明显增加,与干预前比较,差异均有统计学意义(均P0.01)。结论应用TTM干预有助于帮助IFG人群逐步建立和维持合理的膳食、适当的运动、改善代谢指标,从而降低发病危险因素,达到健康的生活方式,逐步从源头上控制2型糖尿病的发生与发展。