title: Study protocol for BeWEL: The impact of a BodyWEight and physicaL activity intervention on adults at risk of developing colorectal adenomas The Healthy Living Partnerships to Prevent Diabetes study: 2-year outcomes of a randomized controlled trial. Is fasting glucose sufficient to define diabetes? Epidemiological data from 20 European studies Sustained body weight reduction by an individual-based lifestyle intervention for workers in the construction industry at risk for cardiovascular disease: results of a randomized controlled trial. Weight loss, exercise, or both and physical function in obese older adults. Translating the Diabetes Prevention Program into the community. The DEPLOY Pilot Study. Weight loss effects from vegetable intake: a 12-month randomised controlled trial Design of a RCT evaluating the (cost-) effectiveness of a lifestyle intervention for male construction workers at risk for cardiovascular disease: The Health under Construction study Comparison of high-fat and high-protein diets with a high-carbohydrate diet in insulin-resistant obese women Description of an Academic Community Partnership Lifestyle Program for Lower Income Minority Adults at Risk for Diabetes Lifestyle intervention can prevent weight gain during menopause: Results from a 5-year randomized clinical trial The Oslo Diet and Exercise Study (ODES): design and objectives. Improvements in glucose tolerance and insulin action induced by increasing energy expenditure or decreasing energy intake: a randomized controlled trial. Effects of a mindfulness-based intervention on mindful eating, sweets consumption, and fasting glucose levels in obese adults: data from the SHINE randomized controlled trial Comparison of Commercial and Self-Initiated Weight Loss Programs in People With Prediabetes: A Randomized Control Trial. The Women on the Move Through Activity and Nutrition (WOMAN) study: final 48-month results. Effects of low-carbohydrate and low-fat diets: a randomized trial. No significant improvement of cardiovascular disease risk indicators by a lifestyle intervention in people with Familial Hypercholesterolemia compared to usual care: results of a randomised controlled trial Aerobic exercise training conserves insulin sensitivity for 1 yr following weight loss in overweight women. Methodology of a diabetes prevention translational research project utilizing a community-academic partnership for implementation in an underserved Latino community Leptin and adiponectin responses in overweight inactive elderly following resistance training and detraining are intensity related. Impact of intensive lifestyle and metformin therapy on cardiovascular disease risk factors in the diabetes prevention program. Prevention of Type II diabetes in subjects with impaired glucose tolerance: the Diabetes Prevention Study (DPS) in Finland
  Study design and 1-year interim report on the feasibility of the lifestyle intervention programme Life-style intervention at the worksite--reduction of cardiovascular risk factors in a randomized study. Randomized controlled trial of a new dietary education program to prevent type 2 diabetes in a high-risk group of Japanese male workers. Translating the Diabetes Prevention Program lifestyle intervention for weight loss into primary care: a randomized trial. Effect of energy-reduced diets high in dairy products and fiber on weight loss in obese adults. Long-term effects of a high-protein, low-carbohydrate diet on weight control and cardiovascular risk markers in obese hyperinsulinemic subjects Long-term effects of popular dietary approaches on weight loss and features of insulin resistance Weight loss with self-help compared with a structured commercial program: a randomized trial. Blood pressure rise with swimming versus walking in older women: the Sedentary Women Exercise Adherence Trial 2 (SWEAT 2) VLCD versus LCD in long-term treatment of obesity A lifestyle program for treated hypertensives improved health-related behaviors and cardiovascular risk factors, a randomized controlled trial. Community Trial of a Faith-Based Lifestyle Intervention to Prevent Diabetes Among African-Americans A comparison of methods for analyzing glucose and insulin areas under the curve following nine months of exercise in overweight adults A clinical trial of the effects of dietary patterns on blood pressure. DASH Collaborative Research Group. Exercise on prescription for women aged 40-74 recruited through primary care: two year randomised controlled trial Independent and Combined Effects of Dietary Weight Loss and Exercise on Leukocyte Telomere Length in Postmenopausal Women Effects of weight loss on a low-carbohydrate diet on flow-mediated dilatation, adhesion molecules and adiponectin. The impact of a bodyweight and physical activity intervention (BeWEL) initiated through a national colorectal cancer screening programme: randomised controlled trial Lifestyle intervention and coronary heart disease risk factor changes over 18 months in postmenopausal women: the Women On the Move through Activity and Nutrition (WOMAN study) clinical trial. Supervised Exercise in Patients with Impaired Fasting Glucose: Impact on Exercise Capacity Weight, weight change, and coronary heart disease in women. Risk within the 'normal' weight range. Long-term effects of a very low calorie diet (Nutrilett®) in obesity treatment. A prospective, randomized, comparison between VLCD and a hypocaloric diet+behavior modification and their combination Milk enriched with "healthy fatty acids" improves cardiovascular risk markers and nutritional status in human volunteers. Effect of impact exercise on physical performance and cardiovascular risk factors. Effects of walking training on weight maintenance after a very-low-energy diet in premenopausal obese women: a randomized controlled trial. A primary care intervention for weight loss: results of a randomized controlled pilot study. Effect of diet and exercise, alone or combined, on weight and body composition in overweight-to-obese postmenopausal women. Maintenance of cardiovascular risk factor changes among middle-aged women in a lifestyle intervention trial. One-year effectiveness of two hypocaloric diets with different protein/carbohydrate ratios in weight loss and insulin resistance. Effects of body composition and exercise capacity on glucose tolerance, insulin, and lipoprotein lipids in healthy older men: a cross-sectional and longitudinal intervention study. Evaluation of a primary care-oriented brief counselling intervention for obesity with and without orlistat. Evaluation of a multicomponent workplace health promotion program conducted in Japan for improving employees' cardiovascular disease risk factors. Lifestyle Intervention in Overweight Individuals With a Family History of Diabetes Short and long-term adherence to swimming and walking programs in older women--the Sedentary Women Exercise Adherence Trial (SWEAT 2). Life style changes improve insulin resistance in hyperinsulinaemic subjects: a one-year intervention study of hypertensives and normotensives in Dalby. Women’s Healthy Lifestyle Project: A Randomized Clinical Trial: Results at 54 Months Diet and exercise in the treatment of obesity: effects of 3 interventions on insulin resistance. Value of structured meals for weight management: risk factors and long-term weight maintenance. Effects of intensive lifestyle changes on erectile dysfunction in men. Effects of diet and exercise in men and postmenopausal women with low levels of HDL cholesterol and high levels of LDL cholesterol. Effects of supervised exercise on gamma-glutamyl transferase levels in patients with isolated impaired fasting glucose and those with impaired fasting glucose plus impaired glucose tolerance. A comparison of the effects of swimming and walking on body weight, fat distribution, lipids, glucose, and insulin in older women--the Sedentary Women Exercise Adherence Trial 2. Glucose and insulin responses following 16 months of exercise training in overweight adults: the Midwest Exercise Trial. Randomized clinical trial of lifestyle interventions in Pima Indians: a pilot study. Effects of Diet and Exercise in Preventing NIDDM in People With Impaired Glucose Tolerance: The Da Qing IGT and Diabetes Study Effect of lifestyle changes on erectile dysfunction in obese men: a randomized controlled trial. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. Translation of the Diabetes Prevention Program for diabetes risk reduction in Chinese immigrants in New York City. Lifestyle Changes May Reverse Development of the Insulin Resistance Syndrome. The Oslo Diet and Exercise Study: a randomized trial Association of 1-y changes in diet pattern with cardiovascular disease risk factors and adipokines: results from the 1-y randomized Oslo Diet and Exercise Study. Effectiveness of a brief theory-based health promotion intervention among adults at high risk of type 2 diabetes: One-year results from a randomised trial in a community setting. Long-term effects of a low carbohydrate, low fat or high unsaturated fat diet compared to a no-intervention control. A risk score for predicting stroke or death in individuals with new-onset atrial fibrillation in the community: the Framingham Heart Study. Effects of TCF7L2 polymorphisms on glucose values after a lifestyle intervention. Effect of weight loss and lifestyle changes on vascular inflammatory markers in obese women: a randomized trial. Improved cardio-respiratory fitness correlates with changes in the number and size of small dense LDL: randomized controlled trial with exercise training and dietary instruction. Long-term effects of a Palaeolithic-type diet in obese postmenopausal women: a 2-year randomized trial Effect of modest weight loss on changes in cardiovascular risk factors: are there differences between men and women or between weight loss and maintenance? Outcomes of a Latino community-based intervention for the prevention of diabetes: the Lawrence Latino Diabetes Prevention Project. Beneficial effects of short-term nutritional counselling at the primary health-care level among Brazilian adults. A low intensity, community based lifestyle programme to prevent weight gain in women with young children: cluster randomised controlled trial The Live Well, Be Well study: a community-based, translational lifestyle program to lower diabetes risk factors in ethnic minority and lower-socioeconomic status adults. Text Message Support for Weight Loss in Patients With Prediabetes: A Randomized Clinical Trial Provider counseling, health education, and community health workers: the Arizona WISEWOMAN project. Prevention of cardiovascular risk factor elevations in healthy premenopausal women. Health-related effects of worksite interventions involving physical exercise and reduced workhours. Long-term follow-up of participants in a health promotion program for treated hypertensives (ADAPT). Cardiovascular mortality, all-cause mortality, and diabetes incidence after lifestyle intervention for people with impaired glucose tolerance in the Da Qing Diabetes Prevention Study: a 23-year follow-up study. Healthy Living Partnerships to Prevent Diabetes (HELP PD): design and methods. Lifestyle educational program strongly increases compliance to nonpharmacologic intervention in hypertensive patients: a 2-year follow-up study. Effectiveness of Prediabetes Nutrition Shared Medical Appointments
abstract: Background Colorectal cancer ( CRC ) is the third most commonly diagnosed cancer and the second highest cause of cancer death in the UK . Most cases occur in people over 50 years and CRC often co-exists with other lifestyle related disorders including obesity , type 2 diabetes mellitus ( T2DM ) and cardiovascular disease ( CVD ) . These diseases share risk factors related to the metabolic syndrome including large body size , abnormal lipids and markers of insulin resistance indicating common aetiological pathways . Methods / Design This 3 year study will be a two-arm , multicentre , r and omised controlled trial comparing the BeWEL lifestyle ( diet , physical activity and behaviour change ) programme against usual care . The pre-trial development will take 6 months and participants will be recruited over a 12 month period and undertake the intervention and follow up for 12 months ( total 24 months recruitment and intervention implementation ) with a further 6 months for data collection , analysis and interpretation . Four hundred and fifty two participants who have had a colorectal adenoma detected and removed ( through the national colorectal screening programme ) will provide 80 % power to detect a weight loss of 7 % over 12 months . Primary outcomes are changes in body weight and waist circumference . Secondary outcomes will include cardiovascular risk factors , psycho-social measures and intervention costs . Discussion The results from this study will enhance the evidence base for lifestyle change in patients at higher risk of chronic disease including obesity related cancers . International St and ard R and omised Controlled Trials No : IS RCT BACKGROUND Since the Diabetes Prevention Project ( DPP ) demonstrated that lifestyle weight-loss interventions can reduce the incidence of diabetes by 58 % , several studies have translated the DPP methods to public health-friendly context s. Although these studies have demonstrated short-term effects , no study to date has examined the impact of a translated DPP intervention on blood glucose and adiposity beyond 12 months of follow-up . PURPOSE To examine the impact of a 24-month , community-based diabetes prevention program on fasting blood glucose , insulin , insulin resistance as well as body weight , waist circumference , and BMI in the second year of follow-up . DESIGN An RCT comparing a 24-month lifestyle weight-loss program ( LWL ) to an enhanced usual care condition ( UCC ) in participants with prediabetes ( fasting blood glucose=95 - 125 mg/dL ) . Data were collected in 2007 - 2011 ; analyses were conducted in 2011 - 2012 . SETTING / PARTICIPANTS 301 participants with prediabetes were r and omized ; 261 completed the study . The intervention was held in community-based sites . INTERVENTION The LWL program was led by community health workers and sought to induce 7 % weight loss at 6 months that would be maintained over time through decreased caloric intake and increased physical activity . The UCC received two visits with a registered dietitian and a monthly newsletter . MAIN OUTCOME MEASURES The main measures were fasting blood glucose , insulin , insulin resistance , body weight , waist circumference , and BMI . RESULTS Intent-to-treat analyses of between-group differences in the average of 18- and 24-month measures of outcomes ( controlling for baseline values ) revealed that the LWL participants experienced greater decreases in fasting glucose ( -4.35 mg/dL ) ; insulin ( -3.01 μU/ml ) ; insulin resistance ( -0.97 ) ; body weight ( -4.19 kg ) ; waist circumference ( -3.23 cm ) ; and BMI ( -1.40 ) , all p-values < 0.01 . CONCLUSIONS A diabetes prevention program administered through an existing community-based system and delivered by community health workers is effective at inducing significant long-term reductions in metabolic indicators and adiposity Aims /hypothesis . The World Health Organisation Consultation recommended new diagnostic criteria for diabetes mellitus including : lowering of the diagnostic fasting plasma glucose to 7.0 mmol/l and introduction of a new category : impaired fasting glycaemia . The diagnostic 2-h glucose concentrations for diabetes and for impaired glucose tolerance were unchanged . This study identifies fasting plasma glucose concentrations predicting a diabetic 2-h plasma glucose of 11.1 mmol/l or more , analyses the sensitivity and specificity of different screening strategies for diabetes and describes the cardiovascular risk profile in people with impaired fasting glycaemia . Methods . European population based studies ( n = 17 ) or large , representative sample s of employees ( n = 3 ) with both fasting and 2-h post load glucose concentrations following 75-g oral glucose tolerance tests were included ( 18 918 men and 10 190 women ) . The Icel and study ( 8881 men and 9407 women ) is presented separately as a 50-g glucose load was used . Results . The fasting plasma glucose predicting a 2-h plasma glucose of 11.1 mmol/l or more with optimal sensitivity and specificity was a ) 5.8 mmol/l in women and 6.4 mmol/l in men ; b ) independent of age ; c ) increased with obesity . Fasting plasma glucose of 7.0/7.8 mmol/l or more predicted a diabetic 2-h plasma glucose with sensitivities of 49.0/29.8 % and specificities of 98.2/99.7 % , respectively . Conclusion /interpretation . If fasting glucose is used alone , the 31 % of diabetic subjects with a non-diabetic fasting glucose but a diabetic 2-h glucose , will not be diagnosed ; impaired fasting glycaemia and impaired glucose tolerance do not identify the same people ; the risk profile of people with impaired fasting glycaemia depends on 2-h glucose concentrations . Obesity is the main confounder in the association between fasting and 2-h glucose . [ Diabetologia ( 1999 ) 42 : 647–654 OBJECTIVE To evaluate the effectiveness of a lifestyle intervention for male workers in the construction industry at risk of cardiovascular disease ( CVD ) . METHODS In a r and omized controlled trial performed in the Netherl and s between 2007 and 2009 , usual care was compared to 6 months of individual counseling using motivational interviewing techniques , delivered face to face and by telephone . Participants aim ed at improving energy balance-related behavior or smoking cessation . Linear regression analyses were performed to determine the effects . RESULTS Body weight had significantly decreased at 6 ( β=-1.9 , 95 % CI -2.6 ; -1.2 ) and 12 months ( β=-1.8 , 95%CI -2.8 ; -1.1 ) . The intervention effects were also significant for diastolic blood pressure at 6 months ( β=-1.7 , 95 % CI -3.3 ; -0.1 ) . Among participants who had aim ed at energy balance , the intervention had a significant favorable effect on body weight at 6 ( β=-2.1 , 95 % CI -2.9 ; -1.3 ) and 12 months ( β=-2.2 , 95 % CI -3.1 ; -1.3 ) and at HDL cholesterol ( β=0.05 , 95 % CI 0.01 ; 0.10 ) and HbA1c ( β=-0.06 , 95%CI -0.12 ; -0.001 ) at 12 months , although there was no intervention effect on these variables over time . CONCLUSION Individual-based counseling result ed in significant beneficial long-term effects on body weight . This is an important finding for occupational health , considering the rising prevalence of obesity and CVD BACKGROUND Obesity exacerbates the age-related decline in physical function and causes frailty in older adults ; however , the appropriate treatment for obese older adults is controversial . METHODS In this 1-year , r and omized , controlled trial , we evaluated the independent and combined effects of weight loss and exercise in 107 adults who were 65 years of age or older and obese . Participants were r and omly assigned to a control group , a weight-management ( diet ) group , an exercise group , or a weight-management-plus-exercise ( diet-exercise ) group . The primary outcome was the change in score on the modified Physical Performance Test . Secondary outcomes included other measures of frailty , body composition , bone mineral density , specific physical functions , and quality of life . RESULTS A total of 93 participants ( 87 % ) completed the study . In the intention-to-treat analysis , the score on the Physical Performance Test , in which higher scores indicate better physical status , increased more in the diet-exercise group than in the diet group or the exercise group ( increases from baseline of 21 % vs. 12 % and 15 % , respectively ) ; the scores in all three of those groups increased more than the scores in the control group ( in which the score increased by 1 % ) ( P<0.001 for the between-group differences ) . Moreover , the peak oxygen consumption improved more in the diet-exercise group than in the diet group or the exercise group ( increases of 17 % vs. 10 % and 8 % , respectively ; P<0.001 ) ; the score on the Functional Status Question naire , in which higher scores indicate better physical function , increased more in the diet-exercise group than in the diet group ( increase of 10 % vs. 4 % , P<0.001 ) . Body weight decreased by 10 % in the diet group and by 9 % in the diet-exercise group , but did not decrease in the exercise group or the control group ( P<0.001 ) . Lean body mass and bone mineral density at the hip decreased less in the diet-exercise group than in the diet group ( reductions of 3 % and 1 % , respectively , in the diet-exercise group vs. reductions of 5 % and 3 % , respectively , in the diet group ; P<0.05 for both comparisons ) . Strength , balance , and gait improved consistently in the diet-exercise group ( P<0.05 for all comparisons ) . Adverse events included a small number of exercise-associated musculoskeletal injuries . CONCLUSIONS These findings suggest that a combination of weight loss and exercise provides greater improvement in physical function than either intervention alone . ( Funded by the National Institutes of Health ; Clinical Trials.gov number , NCT00146107 . ) BACKGROUND The Diabetes Prevention Program ( DPP ) found that an intensive lifestyle intervention can reduce the development of diabetes by more than half in adults with prediabetes , but there is little information about the feasibility of offering such an intervention in community setting s. This study evaluated the delivery of a group-based DPP lifestyle intervention in partnership with the YMCA . METHODS This pilot cluster-r and omized trial was design ed to compare group-based DPP lifestyle intervention delivery by the YMCA to brief counseling alone ( control ) in adults who attended a diabetes risk-screening event at one of two semi-urban YMCA facilities and who had a BMI > or=24 kg/m2 , > or=2 diabetes risk factors , and a r and om capillary blood glucose of 110 - 199 mg/dL. Multivariate regression was used to compare between-group differences in changes in body weight , blood pressures , HbA1c , total cholesterol , and HDL-cholesterol after 6 and 12 months . RESULTS Among 92 participants , controls were more often women ( 61 % vs 50 % ) and of nonwhite race ( 29 % vs 7 % ) . After 6 months , body weight decreased by 6.0 % ( 95 % CI=4.7 , 7.3 ) in intervention participants and 2.0 % ( 95 % CI=0.6 , 3.3 ) in controls ( p<0.001 ; difference between groups ) . Intervention participants also had greater changes in total cholesterol ( -22 mg/dL vs + 6 mg/dL controls ; p<0.001 ) . These differences were sustained after 12 months , and adjustment for differences in race and gender did not alter these findings . With only two matched YMCA sites , it was not possible to adjust for potential clustering by site . CONCLUSIONS The YMCA may be a promising channel for wide-scale dissemination of a low-cost approach to lifestyle diabetes prevention Background / Objectives : Direct evidence for the effects of vegetable intake on weight loss is qualified . The study aim ed to assess the effect of higher vegetable consumption on weight loss . Subjects/ Methods : A single blind parallel controlled trial was conducted with 120 overweight adults ( mean body mass index=29.98 kg/m2 ) r and omised to two energy deficit healthy diet advice groups differing only by doubling the serving ( portion ) sizes of vegetables in the comparator group . Data were analysed as intention-to-treat using a linear mixed model . Spearmans rho bivariate was used to explore relationships between percentage energy from vegetables and weight loss . Results : After 12 months , the study sample lost 6.5±5.2 kg ( P<0.001 time ) with no difference between groups ( P>0.05 interaction ) . Both groups increased vegetable intake and lost weight in the first 3 months , and the change in weight was significantly correlated with higher proportions of energy consumed as vegetables ( rho=–0.217 , P=0.024 ) . Fasting glucose , insulin and triglyceride levels decreased ( P<0.001 time ) and high-density lipoprotein cholesterol levels increased ( P<0.001 time ) , with no difference between groups . Weight loss was sustained for 12 months by both groups , but the comparator group reported greater hunger satisfaction ( P=0.005 ) . Conclusions : Advice to consume a healthy low-energy diet leads to sustained weight loss , with reductions in cardiovascular disease risk factors regardless of an emphasis on more vegetables . In the short term , consuming a higher proportion of the dietary energy as vegetables may support a greater weight loss and the dietary pattern appears sustainable Background Of all workers in Dutch construction industry , 20 % has an elevated risk of cardiovascular disease ( CVD ) . A major risk factor for CVD risk is an unhealthy lifestyle . The aim of our study is to design a lifestyle intervention for construction workers with an elevated CVD risk , and to evaluate its ( cost- ) effectiveness . Methods / Design In a RCT , 692 participants will be r and omised to either the control or the intervention group . The control group will receive usual care . For the intervention group , a lifestyle intervention has been design ed based on interviews and current literature . The intervention will last 6 months and will comprise 3 face-to-face and 4 telephone contacts , consisting of individual counselling aim ed at increasing daily physical activity ( PA ) and improving dietary behaviour , and /or smoking cessation . Counselling will take place at the Occupational Health Service ( OHS ) , and will be done according to motivational interviewing ( MI ) . Additional written information about healthy lifestyle will also be provided to those in the intervention group . At baseline , after 6 and after 12 months , measurements will take place . Primary outcome variables will be the lifestyle behaviours of concern , i.e. daily PA , dietary intake , and smoking status . Secondary outcome variables will be body mass index ( BMI ) , systolic and diastolic blood pressure , total and HDL blood cholesterol , Hba1c and cardio-respiratory fitness ( CRF ) . Sickness absenteeism and cost-effectiveness will be assessed as well . Multilevel analysis will be performed to compare all outcome measures between the intervention group and the control group . Discussion By improving lifestyle , CVD risk may be lowered , yielding benefits for both employee and employer . If proven effective , this lifestyle intervention will be implemented on a larger scale within the Occupational Health Services in construction industry . Trial registration Current Controlled Trials IS RCT Aims /hypothesisA diet low in saturated fatty acids and rich in wholegrains , vegetables and fruit is recommended in order to reduce the risk of obesity , cardiovascular disease and type 2 diabetes mellitus . However there is widespread interest in high-fat ( “ Atkins Diet ” ) and high-protein ( “ Zone Diet ” ) alternatives to the conventional high-carbohydrate , high-fibre approach . We report on a r and omised trial that compared these two alternative approaches with a conventional diet in overweight insulin-resistant women . Methods Ninety-six normoglycaemic , insulin-resistant women ( BMI > 27 kg/m2 ) were r and omised to one of three dietary interventions : a high-carbohydrate , high-fibre ( HC ) diet , the high-fat ( HF ) Atkins Diet , or the high-protein ( HP ) Zone Diet . The experimental approach was design ed to mimic what might be achieved in clinical practice : the recommendations involved advice concerning food choices and were not prescriptive in terms of total energy . There were supervised weight loss and weight maintenance phases ( 8 weeks each ) , but there was no contact between the research team and the participants during the final 8 weeks of the study . Outcome was assessed in terms of body composition and indicators of cardiovascular and diabetes risk . Results Body weight , waist circumference , triglycerides and insulin levels decreased with all three diets but , apart from insulin , the reductions were significantly greater in the HF and HP groups than in the HC group . These observations suggest that the popular diets reduced insulin resistance to a greater extent than the st and ard dietary advice did . When compared with the HC diet , the HF and HP diets were shown to produce significantly ( p<0.01 ) greater reductions in several parameters , including weight loss ( HF −2.8 kg , HF −2.7 kg ) , waist circumference ( HF −3.5 cm , HF −2.7 cm ) and triglycerides ( HF −0.30 mmol/l , HF −0.22 mmol/l ) . LDL cholesterol decreased in individuals on the HC and HP diets , but tended to fluctuate in those on the HF diet to the extent that overall levels were significantly lower in the HP group than in the HF group ( −0.28 mmol/l , 95 % CI 0.04–0.52 , p=0.02 ) . Of those on the HF diet , 25 % showed a > 10 % increase in LDL cholesterol , whereas this occurred in only 13 % of subjects on the HC diet and 3 % of those on the HP diet . Conclusions /interpretationIn routine practice a reduced-carbohydrate , higher protein diet may be the most appropriate overall approach to reducing the risk of cardiovascular disease and type 2 diabetes . To achieve similar benefits on a HC diet , it may be necessary to increase fibre-rich wholegrains , legumes , vegetables and fruits , and to reduce saturated fatty acids to a greater extent than appears to be achieved by implementing current guidelines . The HF approach appears successful for weight loss in the short term , but lipid levels should be monitored . The potential deleterious effects of the diet in the long term remain a concern Purpose Translating strategies and approaches from the successful clinical ly based Diabetes Prevention Program ’s lifestyle intervention to community setting s is a key next step . This article describes a lifestyle program developed in partnership by research ers at a major university and public health professionals at a local health department . Methods The Live Well , Be Well ( LWBW ) program was design ed to meet the needs of lower income , minority , and low-literacy adults at risk for diabetes . It was adapted from interventions with demonstrated efficacy and delivered in Spanish and English by health department staff . The program consisted of a 6-month active phase and a 6-month maintenance phase and was primarily telephone based , with one in-person planning session and several group workshops . In-person and group sessions were held in convenient community-based setting s. Counselors provided education and skills training to modify diet and increase physical activity . Self-selected and attainable goal - setting and action plans were emphasized to enhance self-efficacy . LWBW is the intervention component of a r and omized trial with primary outcomes of fasting glucose , weight , and other clinical measures . Conclusions The program provides a unique translational model for implementing diabetes risk reduction programs for underserved population s. Individually tailored and non-prescriptive , it utilized existing health department infrastructure , focused on telephone counseling , used culturally appropriate , low-literacy material s , and was delivered in local , community-based facilities Context : Menopausal-related weight gain and increased waist circumference have major cardiovascular health implication s for older women . The efficacy of a dietary and physical activity lifestyle intervention to prevent weight gain and elevations in cardiovascular disease ( CVD ) risk factors from the peri- to postmenopause is unknown . Objective : To report the 54-month results of a lifestyle dietary and physical activity program on weight , body composition , physical activity , diet , and other CVD risk factors . Design : Data are from a 5-year r and omized clinical trial known as the Women ’s Healthy Lifestyle Project , conducted from 1992 to 1999 . Participants : 535 healthy , premenopausal women ages 44 to 50 at study entry enrolled into the trial . Intervention : Participants were r and omly assigned to either a lifestyle intervention group receiving a 5-year behavioral dietary and physical activity program or to an assessment -only control group . The lifestyle intervention group was given modest weight loss goals ( 5–15 lb , or approximately 2.3–6.8 kg ) to prevent subsequent gain above baseline weight by the end of the trial . To achieve weight loss and lower low-density lipoprotein cholesterol levels , intervention participants followed an eating pattern consisting of 1,300 kcal/day ( 25 % total fat , 7 % saturated fat , 100 mg of dietary cholesterol ) and increased their physical activity expenditure ( 1,000–1,500 kcal/week).Main Outcome Measures : Regarding weight gain prevention , 55 % ( 136/246 ) of intervention participants were at or below baseline weight compared with 26 % ( 68/261 ) of controls after 4.5 years , χ(2 , N = 507 ) = 45.0 , p < .001 . The mean weight change in the intervention group was 0.1 kg below baseline ( SD = 5.2 kg ) compared with an average gain of 2.4 kg ( SD = 4.9 kg ) observed in the control group . Waist circumference also significantly decreased more in the intervention group compared with controls ( M = −2.9 cm , SD = 5.3 vs. M = −0.5 cm , SD = 5.6 , p < .001 ) . Moreover , participants in the lifestyle intervention group were consistently more physically active and reported eating fewer calories and less fat than controls . Long-term adherence to physical activity and a low-fat eating pattern was associated with better weight maintenance . Conclusions : In healthy women , weight gain and increased waist circumference during the peri- to postmenopause can be prevented with a long-term lifestyle dietary and physical activity intervention The Oslo Diet and Exercise Study ( ODES ) is an unmasked r and omized 2 x 2 factorial trial of 1-year duration for each participant . During 1990 - 1991 219 participants ( 198 males and 21 females ) aged 41 - 50 were r and omized into one of four treatment groups ; no treatment ( control ) , dietary changes alone , exercise alone , or a combination of the two treatments . At inclusion , the participants had no overt heart disease  , but they had increased body weight ; slightly increased blood pressure , serum triglycerides , and total cholesterol  , and they had decreased  HDL cholesterol . Further , they were all inactive at leisure time . The primary aim of the trial is to compare the isolated and combined effects of the four treatments on the variables fibrinogen , fibrinolytic capacity , coagulation factor VII , and platelet volume . A series of secondary hypotheses will also be tested , such as the effects on other coagulation and fibrinolytic components and activities ; lipids and lipoproteins ; fatty acids ; glucose and insulin response to a glucose load ; clinical , physiological , and anthropometric variables ; and quality of life . The dietary treatments are adapted according to each participant 's risk profile ( level of total cholesterol , HDL cholesterol , triglycerides , blood pressure , and body weight ) . Fish and fish products are recommended . Special emphasis is put on caloric restriction in those who are overweight and those with elevated blood pressure .  Exercise sessions take place three times a week under the guidance of highly qualified instructors . The aim is to increase peak oxygen uptake through aerobic endurance training . Adherence to the exercise program is monitored closely BACKGROUND Weight loss , through calorie restriction or increases in energy expenditure via exercise , improves glucose tolerance and insulin action . However , exercise-induced energy expenditure may further improve glucoregulation through mechanisms independent of weight loss . OBJECTIVE The objective was to assess the hypothesis that weight loss through exercise-induced energy expenditure improves glucoregulation and circulating factors involved in insulin action to a greater extent than does similar weight loss through calorie restriction . DESIGN Sedentary men and women aged 50 - 60 y with a body mass index ( kg/m(2 ) ) of 23.5 - 29.9 were r and omly assigned to 1 of 2 weight-loss interventions [ 12 mo of exercise training ( EX group ; n = 18 ) or calorie restriction ( CR group ; n = 18 ) ] or to a healthy lifestyle ( HL ) control group ( n = 10 ) . The insulin sensitivity index and areas under the curve for glucose and insulin were assessed with an oral-glucose-tolerance test . Adiponectin and tumor necrosis factor alpha concentrations were measured in fasting serum . Fat mass was measured by dual-energy X-ray absorptiometry . RESULTS Yearlong energy deficits were not significantly different between the EX and CR groups , as evidence d by body weight and fat mass changes . The insulin sensitivity index increased and the glucose and insulin areas under the curve decreased in the EX and CR groups , remained unchanged in the HL group , and did not differ significantly between the EX and CR groups . Marginally significant increases in adiponectin and decreases in the ratio of tumor necrosis factor alpha to adiponectin occurred in the EX and CR groups but not in the HL group . CONCLUSIONS Weight loss induced by exercise training or calorie restriction improves glucose tolerance and insulin action in nonobese , healthy , middle-aged men and women . However , it does not appear that exercise training-induced  weight loss results in greater improvements than those that result from calorie restriction alone We evaluated changes in mindful eating as a potential mechanism underlying the effects of a mindfulness-based intervention for weight loss on eating of sweet foods and fasting glucose levels . We r and omized 194 obese individuals ( M age = 47.0 ± 12.7 years ; BMI = 35.5 ± 3.6 ; 78 % women ) to a 5.5-month diet-exercise program with or without mindfulness training . The mindfulness group , relative to the active control group , evidence d increases in mindful eating and maintenance of fasting glucose from baseline to 12-month assessment . Increases in mindful eating were associated with decreased eating of sweets and fasting glucose levels among mindfulness group participants , but this association was not statistically significant among active control group participants . Twelve-month increases in mindful eating partially mediated the effect of intervention arm on changes in fasting glucose levels from baseline to 12-month assessment . Increases in mindful eating may contribute to the effects of mindfulness-based weight loss interventions on eating of sweets and fasting glucose levels OBJECTIVES To determine if a widely available weight-management program ( Weight Watchers ) could achieve sufficient weight loss in persons with prediabetes compared with a Diabetes Prevention Program-based individual counseling program supported by National Diabetes Education Program material s. METHODS We conducted an individual , r and omized intervention trial in Indianapolis , Indiana , in 2013 to 2014 , in 225 persons with prediabetes . We compared the Weight Watchers weight-management program ( n = 112 ) with Your Game Plan to Prevent Type 2 Diabetes , a program developed by the National Diabetes Education Program . Outcomes were weight and metabolic markers measured at baseline , 6 months , and 12 months . RESULTS Intervention participants lost significantly more weight than controls at 6 months ( 5.5 % vs 0.8 % ) and 12 months ( 5.5 % vs 0.2 % ; both P < .001 ) . The intervention group also had significantly greater improvements in hemoglobin A1c and high-density lipoprotein cholesterol level than did controls . CONCLUSIONS A large weight-management program is effective for achieving lifestyle changes associated with diabetes prevention . Such programs could significantly increase the availability of diabetes prevention programs worldwide making an immediate and significant public health impact The Women on the Move through Activity and Nutrition ( WOMAN ) study was design ed to test whether a nonpharmacological intervention including qualitative and quantitative dietary changes to induce weight loss and increased physical activity levels would reduce blood triglyceride levels and number of low-density lipoprotein particles ( LDL-P ) . Such decreases in lipoproteins and other risk factors could reduce or slow progression of sub clinical cardiovascular disease ( CVD ) . Study participants were r and omized to either the intervention ( Lifestyle Change ) or assessment ( Health Education ) group . Most of the intervention ended at the 30-month visit . The last 48-month examination was completed in 9/2008 . There was very substantial weight loss and increased exercise during the first 30 months of the trial result ing in significant decreases in CV risk factors . Most of the intervention effect was lost through 48 months . Weight loss was 3.4 kg in Lifestyle Intervention and 0.2 kg in the Health Education at 48 months ( P = 0.000 ) . There were no significant changes at 48 months in lipid levels , blood pressure ( BP ) , glucose , insulin , or in the sub clinical measures of coronary calcium , carotid intima media thickness , or plaque . There was a significant decrease in long-distance corridor walk time in the Lifestyle vs. Health Education groups . Significant lifestyle changes can be achieved that result in decreases in CV risk factors . Whether such changes reduce CV outcomes is still untested in clinical trials of weight loss or exercise . Long-term maintenance of successful lifestyle changes , weight loss and reduced risk factors is the hurdle for lifestyle interventions attempting to prevent CV and other chronic diseases BACKGROUND Low-carbohydrate diets are popular for weight loss , but their cardiovascular effects have not been well-studied , particularly in diverse population s. OBJECTIVE To examine the effects of a low-carbohydrate diet compared with a low-fat diet on body weight and cardiovascular risk factors . DESIGN A r and omized , parallel-group trial . ( Clinical Trials.gov : NCT00609271 ) . SETTING A large academic medical center . PARTICIPANTS 148 men and women without clinical cardiovascular disease and diabetes . INTERVENTION A low-carbohydrate ( < 40 g/d ) or low-fat ( < 30 % of daily energy intake from total fat [ < 7 % saturated fat ] ) diet . Both groups received dietary counseling at regular intervals throughout the trial . MEASUREMENTS Data on weight , cardiovascular risk factors , and dietary composition were collected at 0 , 3 , 6 , and 12 months . RESULTS Sixty participants ( 82 % ) in the low-fat group and 59 ( 79 % ) in the low-carbohydrate group completed the intervention . At 12 months , participants on the low-carbohydrate diet had greater decreases in weight ( mean difference in change , -3.5 kg [ 95 % CI , -5.6 to -1.4 kg ] ; P = 0.002 ) , fat mass ( mean difference in change , -1.5 % [ CI , -2.6 % to -0.4 % ] ; P = 0.011 ) , ratio of total-high-density lipoprotein ( HDL ) cholesterol ( mean difference in change , -0.44 [ CI , -0.71 to -0.16 ] ; P = 0.002 ) , and triglyceride level ( mean difference in change , -0.16 mmol/L [ -14.1 mg/dL ] [ CI , -0.31 to -0.01 mmol/L { -27.4 to -0.8 mg/dL } ] ; P = 0.038 ) and greater increases in HDL cholesterol level ( mean difference in change , 0.18 mmol/L [ 7.0 mg/dL ] [ CI , 0.08 to 0.28 mmol/L { 3.0 to 11.0 mg/dL } ] ; P < 0.001 ) than those on the low-fat diet . LIMITATION Lack of clinical cardiovascular disease end points . CONCLUSION The low-carbohydrate diet was more effective for weight loss and cardiovascular risk factor reduction than the low-fat diet . Restricting carbohydrate may be an option for persons seeking to lose weight and reduce cardiovascular risk factors . PRIMARY FUNDING SOURCE National Institutes of Health Background People with Familial Hypercholesterolemia ( FH ) may benefit from lifestyle changes supporting their primary treatment of dyslipidaemia . This project evaluated the efficacy of an individualised tailored lifestyle intervention on lipids ( low density lipoprotein cholesterol ( LDL-C ) , high density lipoprotein cholesterol ( HDL-C ) , total cholesterol ( TC ) and triglycerides ) , systolic blood pressure , glucose , body mass index ( BMI ) and waist circumference in people with FH . Methods Adults with FH ( n = 340 ) , recruited from a Dutch cascade screening program , were r and omly assigned to either a control group or an intervention group . The personalised intervention consisted of web-based tailored lifestyle advice and personal counselling . The control group received care as usual .  Lipids , systolic blood pressure , glucose , BMI , and waist circumference were measured at baseline and after 12 months . Regression analyses were conducted to examine differences between both groups . Results After 12 months , no significant between-group differences of cardiovascular disease ( CVD ) risk indicators were observed . LDL-C levels had decreased in both the intervention and control group . This difference between intervention and control group was not statistically significant . Conclusions This project suggests that an individually tailored lifestyle intervention did not have an additional effect in improving CVD risk indicators among people with FH . The cumulative effect of many small improvements in all indicators on long term CVD risk remains to be assessed in future studies .Trial registration NTR1899 at The objectives of this study were to 1 ) identify the independent effects of exercise ( aerobic or resistance training ) and weight loss on whole body insulin sensitivity and 2 ) determine if aerobic or resistance training would be more successful for maintaining improved whole body insulin sensitivity 1 yr following weight loss . Subjects were 97 healthy , premenopausal women , body mass index ( BMI ) 27 - 30 kg/m(2 ) . Following r and omized assignment to one of three groups , diet only , diet + aerobic , or diet + resistance training until a BMI < 25 kg/m(2 ) was achieved , body composition , fat distribution , and whole body insulin sensitivity were determined at baseline , in the weight reduced state , and at 1-yr follow up . The whole body insulin sensitivity index ( S(I ) ) was determined using a frequently sample d intravenous glucose tolerance test . Results of repeated- measures ANOVA indicated a significant improvement in S(I ) following weight loss . However , there were no group or group × time interactions . At 1-yr follow up , there were no significant time or group interactions for S(I ; ) however , there was a significant group × time interaction for S(I ) . Post hoc analysis revealed that women in the aerobic training group showed a significant increased S(I ) from weight reduced to 1-yr follow up ( P < 0.05 ) , which was independent of intra-abdominal adipose tissue and % fat . No significant differences in S(I ) from weight reduced to 1-yr follow up were observed for diet only or diet + resistance groups . Additionally , multiple linear regression analysis revealed that change in whole body insulin sensitivity from baseline to 1-yr follow up was independently associated with the change in Vo(2max ) from baseline to 1-yr follow up ( P < 0.05 ) . These results suggest that long-term aerobic exercise training may conserve improvements in S(I ) following weight loss and that maintaining cardiovascular fitness following weight loss may be important for maintaining improvements in S(I ) Background Latinos comprise the largest racial/ethnic group in the United States and have 2–3 times the prevalence of type 2 diabetes mellitus as Caucasians . Methods and design The Lawrence Latino Diabetes Prevention Project ( LLDPP ) is a community-based translational research study which aims to reduce the risk of diabetes among Latinos who have a ≥ 30 % probability of developing diabetes in the next 7.5 years per a predictive equation . The project was conducted in Lawrence , Massachusetts , a predominantly Caribbean-origin urban Latino community . Individuals were identified primarily from a community health center 's patient panel , screened for study eligibility , r and omized to either a usual care or a lifestyle intervention condition , and followed for one year . Like the efficacious Diabetes Prevention Program ( DPP ) , the LLDPP intervention targeted weight loss through dietary change and increased physical activity . However , unlike the DPP , the LLDPP intervention was less intensive , tailored to literacy needs and cultural preferences , and delivered in Spanish . The group format of the intervention ( 13 group sessions over 1 year ) was complemented by 3 individual home visits and was implemented by individuals from the community with training and supervision by a clinical research nutritionist and a behavioral psychologist . Study measures included demographics , Stern predictive equation components ( age , gender , ethnicity , fasting glucose , systolic blood pressure , HDL-cholesterol , body mass index , and family history of diabetes ) , glycosylated hemoglobin , dietary intake , physical activity , depressive symptoms , social support , quality of life , and medication use . Body weight was measured at baseline , 6-months , and one-year ; all other measures were assessed at baseline and one-year . All surveys were orally administered in Spanish . Results A community-academic partnership enabled the successful recruitment , intervention , and assessment of Latinos at risk of diabetes with a one-year study retention rate of 93%.Trial registration CONTEXT Adiponectin and leptin are closely related to weight control and energy balance , whereas exercise affects elderly metabolic regulation and functional capacity . OBJECTIVE The objective of this study was to investigate leptin and adiponectin responses in elderly males after exercise training and detraining .  DESIGN The study design was a 1-yr r and omized controlled trial . SETTING The study was performed at the Laboratory of Physical Education and Sport Science Department . PARTICIPANTS Fifty inactive men [ age , 65 - 78 yr ; body mass index ( BMI ) , 28.7 - 30.2 kg/m2 ] were recruited from a volunteer data base by word of mouth and fliers sent to medical practitioners , physiotherapists , and nursing homes in the local community . INTERVENTION(S ) Participants were r and omly assigned to a control ( n = 10 ) , low-intensity ( n = 14 ) , moderate-intensity ( n = 12 ) , or high-intensity training ( HI ; n = 14 ) group . Resistance training ( 6 months , 3 d/wk , 10 exercises/three sets ) was followed by 6 months of detraining . MAIN OUTCOME MEASURE(S ) Strength , exercise energy cost , skinfold sum , body weight , maximal oxygen consumption , resting metabolic rate ( RMR ) , and plasma leptin and adiponectin were determined at baseline and after training and detraining . RESULTS Strength , maximal oxygen consumption , RMR , and exercise energy cost increased ( P < 0.05 ) after training in an intensity-dependent manner . Skinfold sum and BMI were reduced by resistance training ( P < 0.05 ) , with HI being more effective ( P < 0.05 ) than moderate-intensity/low-intensity training . Leptin was diminished ( P < 0.05 ) by all treatments , whereas adiponectin increased ( P < 0.05 ) only in HI . Detraining maintained training-induced changes only in HI . The percent leptin decrease was associated ( P < 0.05 ) with the percent BMI decrease and the percent RMR increase , whereas the percent adiponectin increase was associated ( P < 0.05 ) with the percent BMI decrease . CONCLUSIONS Resistance training and detraining may alter leptin and adiponectin responses in an intensity-dependent manner . Leptin and adiponectin changes were strongly associated with RMR and anthropometric changes OBJECTIVE The Diabetes Prevention Program demonstrated the ability to delay or prevent type 2 diabetes in participants with impaired glucose tolerance ( IGT ) . Participants with IGT are at high risk for cardiovascular disease ( CVD ) , with a marked increase in the number and severity of CVD risk factors . We prospect ively assessed the impact of our interventions on hypertension , dyslipidemia , and CVD events . RESEARCH DESIGN AND METHODS The study group consisted of 3,234 individuals with IGT r and omly assigned to receive intensive lifestyle intervention , metformin , or placebo . Annual assessment of blood pressure , lipids , electrocardiogram , and CVD events was undertaken . RESULTS Hypertension was present in 30 % of participants at study entry and then increased in the placebo and metformin groups , although it significantly decreased with intensive lifestyle intervention . Triglyceride levels fell in all treatment groups , but fell significantly more with intensive lifestyle intervention . Total cholesterol and LDL cholesterol levels were similar among treatment groups . Intensive lifestyle intervention significantly increased the HDL cholesterol level and reduced the cumulative incidence of the proatherogenic LDL phenotype B. At 3 years of follow-up , the use for pharmacologic therapy to achieve established goals in the intensive lifestyle group was 27 - 28 % less for hypertension and 25 % less for hyperlipidemia compared with placebo and metformin groups . Over an average of 3 years , 89 CVD events from 64 participants were positively adjudicated study wide , with no differences among treatment groups . CONCLUSIONS Lifestyle intervention improves CVD risk factor status compared with placebo and metformin therapy . Although no differences in CVD events were noted after 3 years , achieved risk factor modifications suggest that longer intervention may reduce CVD event rates Aims /hypothesis . The aim of the Diabetes Prevention Study is to assess the efficacy of an intensive diet-exercise programme in preventing or delaying  Type II ( non-insulin-dependent ) diabetes mellitus in subjects with impaired glucose tolerance , to evaluate the effects of the intervention programme on cardiovascular risk factors and to assess the determinants for the progression to diabetes in persons with impaired glucose tolerance . Methods . A total of 523 overweight subjects with impaired glucose tolerance ascertained by two oral glucose tolerance tests were r and omised to either a control or intervention group . The control subjects received general information at the start of the trial about the lifestyle changes necessary to prevent diabetes and about annual follow-up visits . The intervention subjects had seven sessions with a nutritionist during the first year and a visit every 3 months thereafter aim ed at reducing weight , the intake of saturated fat and increasing the intake of dietary fibre . Intervention subjects were also guided individually to increase their physical activity .  Results . During the first year , weight loss in the first 212 study subjects was 4.7 ± 5.5 vs 0.9 ± 4.1 kg in the intervention and control group , respectively ( p < 0.001 ) . The plasma glucose concentrations ( fasting : 5.9 ± 0.7 vs 6.4 ± 0.8 mmol/l , p < 0.001 ; and 2-h 7.8 ± 1.8 vs 8.5 ± 2.3 mmol/l , p < 0.05 ) were significantly lower in the intervention group after the first year of intervention . Favourable changes were also found in blood pressure , serum lipids and anthropometric indices in the intervention group . Conclusion /interpretation . The interim results show the efficacy and feasibility of the lifestyle intervention programme . [ Diabetologia ( 1999 ) 42 : 793–801 OBJECTIVES This study tested a feasible method for screening for cardiovascular risk at the worksite and investigated the effects of a long-term comprehensive program of life-style intervention to prevent cardiovascular disease . METHODS Employees in the public sector filled out a self-administered question naire with questions on social , medical , and work-related factors . The respondents numbered 454 ( 80 % ) . A score sum for cardiovascular risk was calculated ( range 1 - 20 , median 7.0 ) , and the 128 subjects with a sum above 8 were invited to a health examination including blood sampling . Thereafter the subjects were invited to participate , following r and omization , in a comprehensive , 18-month , life-style intervention program to improve cardiovascular risk or in a control group . RESULTS The intervention group significantly decreased body mass index , diastolic blood pressure , heart rate , low-density lipoprotein ( LDL ) cholesterol , and smoking habits during the intervention . The initially elevated serum cortisol , as a marker of stress reaction , normalized in the intervention group . In the control group LDL cholesterol also decreased , but the glucose and triglyceride levels increased , and smoking habits were unchanged . Sick days for a given period decreased after 1 year in the intervention group but not in the control group . CONCLUSIONS Several cardiovascular risk factors can be improved and morning serum cortisol normalized during a long-term life-style intervention program with a r and omized design using a worksite population of middle-aged subjects . The use of a 2-step screening program , with an initial question naire followed by a health check of subjects with elevated risk , is feasible for worksite setting OBJECTIVE The aim of this study was to assess the effectiveness of a new dietary education ( NDE ) program in reducing plasma glucose ( PG ) levels in Japanese male workers at high risk for type 2 diabetes through a r and omized controlled trial . RESEARCH DESIGN AND METHODS We r and omly assigned 173 high-risk men ( mean age , 55 years ) to either the NDE or the  control ( conventional dietary education )  group . Each subject in the NDE group received two individualized interventions especially aim ed at reducing total energy intake at dinner by modifying dietary intake . The control group received conventional group counseling . An " overintake/underintake fraction " for total energy intake was used to measure the status of dietary intake . Our hypothesis was that the NDE group would have a 10 % decrease in 2-h PG 1 year after the start of the education . Outcome measures were compared with ANCOVA by adjusting for baseline values . RESULTS The NDE group had a significantly lower total energy intake at dinner and daily than the control group . The adjusted differences in changes from baseline in the absolute value of the ' overintake/underintake fraction ' were -15.3 % ( 95 % CI -24.6 to -6.0 % , P = 0.002 ) for dinner and -6.0 % ( -9.8 to -2.2 % , P = 0.002 ) for daily [ corrected ] . The NDE group had a decreased 2-h PG after 1 year , whereas that value was increased in the control group . The adjusted difference in the percent change of 2-h PG was significant ( -15.2 % , -22.0 to -8.4 % , P < 0.001 ) . CONCLUSIONS The NDE was shown to reduce glucose levels in high-risk subjects for type 2 diabetes BACKGROUND The Diabetes Prevention Program ( DPP ) lifestyle intervention reduced the incidence of type 2 diabetes mellitus ( DM ) among high-risk adults by 58 % , with weight loss as the dominant predictor . However , it has not been adequately translated into primary care . METHODS We evaluated 2 adapted DPP lifestyle interventions  among overweight or obese adults who were recruited from 1 primary care clinic and had pre-DM and /or metabolic syndrome . Participants were r and omized to ( 1 ) a coach-led group intervention ( n = 79 ) , ( 2 ) a self-directed DVD intervention ( n = 81 ) , or ( 3 ) usual care ( n = 81 ) . During a 3-month intensive intervention phase , the DPP-based behavioral weight-loss curriculum was delivered by lifestyle coach-led small groups or home-based DVD . During the maintenance phase , participants in both interventions received lifestyle change coaching and support remotely-through secure email within an electronic health record system and the American Heart Association Heart360 website for weight and physical activity goal setting and self-monitoring . The primary outcome was change in body mass index ( BMI ) ( calculated as weight in kilograms divided by height in meters squared ) from baseline to 15 months . RESULTS At baseline , participants had a mean ( SD ) age of 52.9 ( 10.6 ) years and a mean BMI of 32.0 ( 5.4 ) ; 47 % were female ; 78 % , non-Hispanic white ; and 17 % , Asian/Pacific Isl and er . At month 15 , the mean ± SE change in BMI from baseline was -2.2 ± 0.3 in the coach-led group vs -0.9 ± 0.3 in the usual care group ( P < .001 ) and -1.6 ± 0.3 in the self-directed group vs usual care ( P = .02 ) . The percentages of participants who achieved the 7 % DPP-based weight-loss goal were 37.0 % ( P = .003 ) and 35.9 % ( P = .004 ) in the coach-led and self-directed groups , respectively , vs 14.4 % in the usual care group . Both interventions also achieved greater net improvements in waist circumference and fasting plasma glucose level . CONCLUSION Proven effective in a primary care setting , the 2 DPP-based lifestyle interventions are readily scalable and exportable with potential for substantial clinical and public health impact . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00842426 OBJECTIVE Studies suggest that high-dairy and high-fiber/low-glycemic index diets may facilitate weight loss , but data are conflicting . The effects on weight loss and body fat of a high-dairy diet and a diet high in dairy and fiber and low in glycemic index were compared with a st and ard diet . RESEARCH METHODS AND PROCEDURES Ninety obese subjects were recruited into a r and omized trial of three diets design ed to provide a calorie deficit of 500 calories/d over a 48-week period . The study compared a moderate ( not low)-calcium diet with a high-calcium diet . RESULTS Seventy-two subjects completed the study . Significant weight and fat loss occurred with all three diets . A diet with 1400 mg of calcium did not result in greater weight ( 11.8 + /- 6.1 kg ) or fat ( 9.0 + /- 6.0 kg ) loss than a diet with 800 mg of calcium ( 10.0 + /- 6.8 and 7.5 + /- 6.6 kg , respectively ) . A diet with 1400 mg of calcium , increased fiber content , and fewer high-glycemic index foods did not result in greater weight ( 10.6 + /- 6.8 kg ) or fat ( 8.5 + /- 7.8 kg ) loss than the st and ard diet with 800 mg of calcium . Lipid profile , high-sensitivity C-reactive protein , leptin , fasting glucose , and insulin improved significantly , but there were no significant differences between the experimental diets and the control diet . DISCUSSION We found no evidence that diets higher than 800 mg of calcium in dairy products or higher in fiber and lower in glycemic index enhance weight reduction beyond what is seen with calorie restriction alone OBJECTIVE : To compare the long-term compliance and effects of two low-fat diets differing in carbohydrate to protein ratio on body composition and biomarkers of cardiovascular disease risk in obese subjects with hyperinsulinemia . DESIGN : Outpatient , parallel , clinical intervention study of two groups of subjects r and omly assigned to either a st and ard protein ( SP ; 15 % protein , 55 % carbohydrate ) or high-protein ( HP ; 30 % protein , 40 % carbohydrate ) diet , during 12 weeks of energy restriction ( ∼6.5 MJ/day ) and 4 weeks of energy balance ( ∼8.3 MJ/day ) . Subsequently , subjects were asked to maintain the same dietary pattern for the succeeding 52 weeks with minimal professional support . SUBJECTS : A total of 58 obese , nondietetic subjects with hyperinsulinemia ( 13 males/45 females , mean age 50.2 y , mean body mass index ( BMI ) 34.0 kg/m2 , mean fasting insulin 17.8 mU/l ) participated in the study .  MEASUREMENTS : Body composition , blood pressure , blood lipids , fasting glucose , insulin , CRP and sICAM-1 were measured at baseline and at weeks 16 and 68 . Urinary urea/creatinine ratio was measured at baseline , week 16 and at 3 monthly intervals thereafter . RESULTS : In total , 43 subjects completed the study with similar dropouts in each group ( P=0.76 ) . At week 68 , there was net weight loss ( SP −2.9±3.6 % , HP −4.1±5.8 % ; P<0.01 ) due entirely to fat loss ( P<0.001 ) with no diet effect . Both diets significantly increased HDL cholesterol concentrations ( P<0.001 ) and decreased fasting insulin , insulin resistance , sICAM-1 and CRP levels ( P<0.05 ) . Protein intake was significantly greater in HP during the initial 16 weeks ( P<0.001 ) , but decreased in HP and increased in SP during 52-week follow-up , with no difference between groups at week 68 , indicating poor long-term dietary adherence behaviour to both dietary patterns . CONCLUSION : Without active ongoing dietary advice , adherence to dietary intervention is poor . Nonetheless , both dietary patterns achieved net weight loss and improvements in cardiovascular risk factors Objective : High-carbohydrate (HC)–high-fibre diets are recommended for weight loss and for treating and preventing diseases such as diabetes and cardiovascular disease . We report a r and omised trial comparing high-fat ( HF ) and high-protein ( HP ) diets with the conventional approach . Research design and methods : A total of 93 overweight insulin-resistant women received advice following r and omisation to HF , HP or HC dietary regimes , to achieve weight loss followed by weight maintenance over 12 months . Weight , body composition and measures of carbohydrate and lipid metabolism were investigated . Results : Retention rates were 93 % for HP and 75 % for HC and HF .  Features of the metabolic syndrome improved in all groups during the first 6 months , to a greater extent on HF and HP than an HC . During the second 6 months the HF group had increases in waist circumference ( mean difference 4.4 cm ( 95 % CI 3.0 , 5.8 ) ) , fat mass ( 2.3 kg ( 1.5 , 3.1 ) ) , triglycerides ( 0.28 mmol/l ( 0.09 , 0.46 ) ) and 2 h glucose ( 0.70 mmol/l ( 0.22 , 1.18 ) ) . Overall there was substantial sustained improvement in waist circumference , triglycerides and insulin in the HP group and sustained but more modest changes on HC .  Dietary compliance at 12 months was poor in all groups . Conclusions : HP and HC approaches appear to be appropriate options for insulin-resistant individuals . When recommending HP diets appropriate composition of dietary fat must be ensured . HC diet recommendations must include advice regarding appropriate high-fibre , low glycaemic index foods CONTEXT Although commercial weight loss programs provide treatment to millions of clients , their efficacy has not been evaluated in rigorous long-term trials . OBJECTIVE To compare weight loss and health benefits achieved and maintained through self-help weight loss vs with a structured commercial program . DESIGN AND SETTING A 2-year , multicenter r and omized clinical trial with clinic visits at 12 , 26 , 52 , 78 , and 104 weeks conducted at 6 academic research centers in the United States between January 1998 and January 2001 . PARTICIPANTS Overweight and obese men ( n = 65 ) and women ( n = 358 ) ( body mass index , 27 - 40 ) aged 18 to 65 years . INTERVENTION R and om assignment to either a self-help program ( n = 212 ) consisting of two 20-minute counseling sessions with a nutritionist and provision of self-help re sources or to a commercial weight loss program ( n = 211 ) consisting of a food plan , an activity plan , and a cognitive restructuring behavior modification plan , delivered at weekly meetings . MAIN OUTCOME MEASURES Weight change was the primary outcome measure . Secondary outcomes included waist circumference , body mass index , blood pressure , serum lipids , glucose , and insulin levels . RESULTS At 2 years , 150 participants ( 71 % ) in the commercial group and 159 ( 75 % ) in the self-help group completed the study . In the intent-to-treat analysis , mean ( SD ) weight loss of participants in the commercial group was greater than in the self-help group at 1 year ( -4.3 [ 6.1 ] kg vs -1.3 [ 6.1 ] kg , respectively ; P<.001 ) and at 2 years ( -2.9 [ 6.5 ] kg vs -0.2 [ 6.5 ] kg , respectively ; P<.001 ) . Waist circumference ( P = .003 ) and body mass index ( P<.001 ) decreased more in the commercial group . Changes in blood pressure , lipids , glucose , and insulin levels were related to changes in weight in both groups , but between-group differences in biological parameters were mainly nonsignificant by year 2 . CONCLUSION The structured commercial weight loss program provided modest weight loss but more than self-help over a 2-year period Objective Swimming is often recommended in the prevention and treatment of  hypertension . Few studies have investigated the effect of swimming training on blood pressure ( BP ) . Our objective was to evaluate 6 months of supervised moderate swimming or walking on BP in previously sedentary , normotensive , older women . Design Women aged 50–70 years ( n = 116 ) were r and omly assigned to a supervised 6-month swimming or walking programme . They were further r and omized to receive usual care or a behavioural intervention package . Methods Exercise comprised 3 sessions/week with a warm-up , cool down , and 30-min of moderate intensity walking or swimming . BP was recorded for 20 min supine , and 5 min st and ing . Assessment s were made at 0 and 6 months . Results At baseline , mean supine BP ( ± SD ) was 115.7 ± 1.3/66.8 ± 0.7 mmHg . Swimming  improved swim distance by 78.1 m ( 29.3 % ) [ 95 % confidence interval ( CI ) ; 66.7 , 89.4 ] and walk time by 0.58 min ( 3.8 % ) ( 0.41 , 0.74 ) . Walking decreased walk time by 1.0 min ( 6.5 % ) ( 0.81 , 1.19 ) . After adjustment for initial BP , age , hypertension treatment status and change in weight , swimming increased supine and st and ing systolic BP relative to walking by 4.4 mmHg ( 1.2 , 7.5 ) ( P = 0.008 ) and 6.0 mmHg ( 2.6 , 9.5 ) ( P = 0.001 ) , respectively . Supine and st and ing diastolic BP increased by 1.4 mmHg ( −0.14 , 3.0 ) ( P = 0.07 ) and 1.8 mmHg ( −0.02 , 3.5 ) ( P = 0.05 ) , respectively . Conclusion Relative to moderately paced walking , regular swimming significantly elevates BP in previously sedentary , normotensive , older women . This finding may have important implication s for exercise prescription in older subjects OBJECTIVE : To compare the long-term effects of three different programs including initial 6 weeks (V)LCD diets 420 kcal/d , 530 kcal/d , 880 kcal/d ) on sustained weight loss , attrition and obesity associated conventional cardio-vascular risk factors . DESIGN : Prospect i ve , r and omized clinical 52 weeks trial . Two weeks of a booster (V)LCD period after week 26 . SETTING : University outpatient obesity clinic . SUBJECTS : Ninety-three middle-aged obese patients ( 30 men ) , initial mean BMI 38.7 kg/m2 , age 20–65 y , from the waiting list . MAIN OUTCOME MEASURES : Weight loss pattern , attrition , reported side effects , blood pressure , blood glucose and serum lipid levels . Repeated frequent measurements up to week 26 , intermittently up to final measurements at week 52 . RESULTS : One year attrition ( 30–45 % ) , sustained weight loss ( 8–15 % of initial body weight ) and changes in obesity associated risk parameters were similar in all three group . Fewer adverse events were reported in the LCD group . CONCLUSION : The results compare favorably with most previous reports of similar design . VLCD ( 420 kcal or 530 kcal/d and LCD 880 kcal/d ) were equally effective in long term treatment of obesity . The tendency to less side effects with LCD suggests that such preparations deserve further attention OBJECTIVE To assess effects of a cognitively based program on health-related behaviors and cardiovascular risk factors in overweight drug-treated hypertensives . STUDY DESIGN AND SETTING In a clinical trials center , volunteers , recruited by advertisement , were r and omized to usual care ( N=118 ) or to a 4-month program ( N=123 ) incorporating weight loss ; a low-sodium diet , high in fruit , vegetables , and fish ; and increased physical activity .  Diet , physical activity , weight , blood lipids , glucose , and insulin were measured at 4 and 16 months . RESULTS Ninety-eight usual care and 106 program participants completed the 4-month assessment ; 90 and 102 , respectively , completed follow-up . Using intention-to-treat analysis , relative to usual care , net changes with the program at 4 months were as follows : dietary fat ( -2.6 % energy ; P<0.001 ) ; sodium ( -290mg/d ; P=0.004 ) ; energy ( -313mJ/d ; P=0.005 ) ; fish ( + 2.1 serves/wk ; P<0.001 ) ; vegetables ( + 3.0 serves/wk ; P<0.001 ) ; physical activity ( + 37min/wk ; P=0.004 ) ; weight ( -2.8 kg ; P<0.001 ) ; waist girth ( -3.1 cm ; P<0.001 ) ; total cholesterol ( -0.2mmol/L ; P=0.017 ) ; and triacylglycerols ( -0.12mmol/L ; P=0.002 ) . One year later , net changes included dietary fat ( -2.2 % energy ; P<0.001 ) ; sodium ( -150mg/d ; P=0.029 ) ; fish ( + 2.0 serves/wk ; P<0.001 ) ; vegetables ( + 4.3 serves/wk ; P<0.001 ) ; weight ( -2.5 kg ; P=0.001 ) ; waist girth ( -3.1 cm ; P<0.001 ) ; high-density lipoprotein cholesterol ( + 0.03mmol/L ; P=0.031 ) . CONCLUSION Improvements in behaviors and risk factors , several maintained long term , suggest the potential for long-term benefits in hypertensives Abstract About 75 % of African-Americans ( AAs ) ages 20 or older are overweight and nearly 50 % are obese , but community-based programs to reduce diabetes risk in AAs are rare . Our objective was to reduce weight and fasting plasma glucose ( FPG ) and increase physical activity ( PA ) from baseline to week-12 and to month-12 among overweight AA parishioners through a faith-based adaptation of the Diabetes Prevention Program called Fit Body and Soul ( FBAS ) . We conducted a single-blinded , cluster r and omized , community trial in 20 AA churches enrolling 604 AAs , aged 20–64 years with BMI ≥ 25 kg/m2 and without diabetes . The church ( and their parishioners ) was r and omized to FBAS or health education ( HE ) . FBAS participants had a significant difference in adjusted weight loss compared with those in HE ( 2.62 vs. 0.50 kg , p = 0.001 ) at 12-weeks and ( 2.39 vs. −0.465 kg , p = 0.005 ) at 12-months and were more likely ( 13 % ) than HE participants ( 3 % ) to achieve a 7 % weight loss ( p < 0.001 ) at 12-weeks and a 7 % weight loss ( 19 vs. 8 % , p < 0.001 ) at 12-months . There were no significant differences in FPG and PA between arms . Of the 15.2 % of participants with baseline pre-diabetes , those in FBAS had , however , a significant decline in FPG ( 10.93 mg/dl ) at 12-weeks compared with the 4.22 mg/dl increase in HE ( p = 0.017 ) , and these differences became larger at 12-months ( FBAS , 12.38 mg/dl decrease ; HE , 4.44 mg/dl increase ) ( p = 0.021 ) . Our faith-based adaptation of the DPP led to a significant reduction in weight overall and in FPG among pre-diabetes participants . Clinical Trials.gov Identifier NCT01730196 OBJECTIVE : We examined three methods for calculating the area under the curve ( AUC ) following an oral glucose tolerance test ( OGTT ) in overweight adults prior to and after 9 months of exercise . METHOD : Subjects ( n=27 ) were r and omly assigned to a control  ( CON , n=9 ) or intervention  ( INT , n=18 ) group . INT performed supervised exercise 5 days per week , 45 min per session , at 65 % of heart rate reserve . OGTTs were administered pre- and post-training . Blood was collected during a 75 g OGTT and analyzed for glucose ( GLU ) and insulin ( INS ) concentrations . AUCs were calculated using the incremental , positive incremental , and total AUC methods and the difference scores for pre- and post-training were determined . RESULTS : No differences were observed among the methods for glucose AUC for either group . Significant differences were observed for INT insulin AUC with total AUC ( 1525±3291 µU/1/180 min ) significantly greater than incremental AUC ( 1112±3229 µU/1/180 min ) or positive incremental AUC ( 1085±3195 µU/I/180 min ) . Total insulin AUC was significantly reduced following training for INT , while incremental and positive incremental insulin AUCs showed no change . CONCLUSION : These data suggest that the method of used to calculate AUC may affect the interpretation of whether or not an intervention was effective BACKGROUND It is known that obesity , sodium intake , and alcohol consumption factors influence blood pressure . In this clinical trial , Dietary Approaches to Stop Hypertension , we assessed the effects of dietary patterns on blood pressure . METHODS We enrolled 459 adults with systolic blood pressures of less than 160 mm Hg and diastolic blood pressures of 80 to 95 mm Hg . For three weeks , the subjects were fed a control diet that was low in fruits , vegetables , and dairy products , with a fat content typical of the average diet in the United States . They were then r and omly assigned to receive for eight weeks the control diet , a diet rich in fruits and vegetables , or a " combination " diet rich in fruits , vegetables , and low-fat dairy products and with reduced saturated and total fat . Sodium intake and body weight were maintained at constant levels . RESULTS At base line , the mean ( + /-SD ) systolic and diastolic blood pressures were 131.3+/-10.8 mm Hg and 84.7+/-4.7 mm Hg , respectively . The combination diet reduced systolic and diastolic blood pressure by 5.5 and 3.0 mm Hg more , respectively , than the control diet ( P<0.001 for each ) ; the fruits- and -vegetables diet reduced systolic blood pressure by 2.8 mm Hg more ( P<0.001 ) and diastolic blood pressure by 1.1 mm Hg more than the control diet ( P=0.07 ) . Among the 133 subjects with hypertension ( systolic pressure , > or = 140 mm Hg ; diastolic pressure , > or = 90 mm Hg ; or both ) , the combination diet reduced systolic and diastolic blood pressure by 11.4 and 5.5 mm Hg more , respectively , than the control diet ( P<0.001 for each ) ; among the 326 subjects without hypertension , the corresponding reductions were 3.5 mm Hg ( P<0.001 ) and 2.1 mm Hg ( P=0.003 ) . CONCLUSIONS A diet rich in fruits , vegetables , and low-fat dairy foods and with reduced saturated and total fat can substantially lower blood pressure . This diet offers an additional nutritional approach to preventing and treating hypertension Objective To assess the effectiveness of a primary care based programme of exercise on prescription among relatively inactive women over a two year period . Design R and omised controlled trial . Setting 17 primary care practice s in Wellington , New Zeal and Participants 1089 women aged 40 - 74 not undertaking 30 minutes of moderate intensity physical activity on at least five days of the week  Intervention Brief physical activity intervention led by nurse with six month follow-up visit and monthly telephone support over nine months . Main outcome measure Physical activity assessed at baseline and 12 and 24 months . Secondary outcomes were quality of life ( SF-36 ) , weight , waist circumference , blood pressure , concentrations of fasting serum lipids , glycated haemoglobin ( HbA1c ) , glucose , insulin , and physical fitness . Results Mean age was 58.9 ( SD 7 ) years . Trial retention rates were 93 % and 89 % at 12 and 24 months , respectively . At baseline , 10 % of intervention participants and 11 % of control participants were achieving 150 minutes of at least moderate intensity physical activity a week . At 12 months rates increased to 43 % and 30 % and at 24 months to 39.3 % and 32.8 % ( P<0.001 ) , respectively . SF-36 physical functioning ( P=0.03 ) and mental health ( P<0.05 ) scores improved more in intervention compared with control participants , but role physical scores were significantly lower ( P<0.01 ) . There were no significant differences in clinical outcomes . More falls ( P<0.001 ) and injuries ( P=0.03 ) were recorded in the intervention group . Conclusions This programme of exercise on prescription increased physical activity and quality of life over two years , although falls and injuries also increased . This finding supports the use of exercise on prescription programmes as part of population strategies to reduce physical inactivity . Trial registration Australian New Zeal and Clinical Trials Registry ( ANZCTR ) ANZCTRN012605000490673 Objective Investigate the effects of 12 months of dietary weight loss and /or aerobic exercise on leukocyte telomere length in postmenopausal women . Design and Methods 439 overweight or obese women ( 50–75 y ) were r and omized to : i ) dietary weight loss ( N=118 ) ; ii ) aerobic exercise ( N=117 ) , iii ) diet + exercise ( N=117 ) , or iv ) control ( N=87 ) . The diet intervention was a group-based program with a 10 % weight loss goal . The exercise intervention was 45 mins/day , 5 days/week of moderate-to-vigorous aerobic activity .  Fasting blood sample s were taken at baseline and 12 months . DNA was extracted from isolated leukocytes and telomere length was measured by quantitative-polymerase chain reaction ( qPCR ) . Mean changes were compared between groups ( intent-to-treat ) using generalized estimating equations . Results Baseline telomere length was inversely associated with age ( r=−0.12 p<0.01 ) and positively associated with maximal oxygen uptake ( r=0.11 , p=0.03 ) , but not with BMI or % body fat . Change in telomere length was inversely correlated with baseline telomere length ( r=−0.47 , p<0.0001 ) . No significant difference in leukocyte telomere length was detected in any intervention group compared to controls , nor was the magnitude of weight loss associated with telomere length at 12 months . Conclusions Twelve-months of dietary weight loss and exercise did not change telomere length in postmenopausal women Our aim was to determine whether short-term weight loss on a low-carbohydrate/low-saturated fat diet improved endothelial function compared with a conventional high-carbohydrate diet , as this diet is expected to lower both blood glucose and LDL-cholesterol . In a r and omised parallel design of two energy-restricted diets in an outpatient setting , thirty-six subjects ( BMI 33 ( sem 4 ) kg/m2 ) were r and omised to a low- or high-carbohydrate diet both low in saturated fat .  Flow-mediated dilatation ( FMD ) , fasting glucose , insulin , lipids , adiponectin and adhesion molecules were measured at baseline , during weight loss and at 52 weeks . FMD did not change with either diet ( 5.2 ( sem 0.6 ) to 5.5 ( sem 0.6 ) % ) despite weight loss of 5 % and significant reductions in glucose and insulin and LDL-cholesterol and was not different after sustained weight loss of 5 % at 52 weeks . Adiponectin fell by 6 % at 12 weeks ( P = 0.1 ) with weight loss but rose by 17 % at 12 months ( P < 0.05 ) with 5 % weight loss . There were no effects of diet . In contradistinction , adhesion molecules fell at 12 weeks , vascular cell adhesion molecule-1 by 14 % and intracellular adhesion molecule-1 by 13 % ( both P < 0.05 ) . There were correlations between change in adiponectin at 12 months and change in HDL ( r 0.778 , P < 0.01 ) and glucose ( r - 0.563 , P = 0.057 ) . In summary , weight loss does not improve FMD . Novel cardiovascular risk factors improved at 12 weeks but the improvement in adiponectin was delayed Objective To evaluate the impact of a diet and physical activity intervention ( BeWEL ) on weight change in people with a body mass index > 25 weight (kg)/height (m)2 at increased risk of colorectal cancer and other obesity related comorbidities . Design Multicentre , parallel group , r and omised controlled trial . Setting Four Scottish National Health Service health boards . Participants 329 overweight or obese adults ( aged 50 to 74 years ) who had undergone colonoscopy after a positive faecal occult blood test result , as part of the national bowel screening programme , and had a diagnosis of adenoma confirmed by histopathology . 163 were r and omised to intervention and 166 to control . Intervention Participants were r and omised to a control group ( weight loss booklet only ) or 12 month intervention group ( three face to face visits with a lifestyle counsellor plus monthly 15 minute telephone calls ) . A goal of 7 % reduction in body weight was set and participants received a personalised energy prescription ( 2508 kJ ( 600 kcal ) below that required for weight maintenance ) and bodyweight scales . Motivational interviewing techniques explored self assessed confidence , ambivalence , and personal values concerning weight . Behavioural strategies included goal setting , identifying intentions of implementation , self monitoring of body weight , and counsellor feedback about reported diet , physical activity , and weight change . Main outcome measures The primary outcome was weight change over 12 months . Secondary outcomes included changes in waist circumference , blood pressure , fasting cardiovascular biomarkers , and glucose metabolism variables , physical activity , diet , and alcohol consumption . Results At 12 months , data on the primary outcome were available for 148 ( 91 % ) participants in the intervention group and 157 ( 95 % ) in the control group . Mean weight loss was 3.50 kg ( SD 4.91 ) ( 95 % confidence interval 2.70 to 4.30 ) in the intervention group compared with 0.78 kg ( SD 3.77 ) ( 0.19 to 1.38 ) in the control group . The group difference was 2.69 kg ( 95 % confidence interval 1.70 to 3.67 ) . Differences between groups were significant for waist circumference , body mass index , blood pressure , blood glucose level , diet , and physical activity . No reported adverse events were considered to be related to trial participation . Conclusions Significant weight loss can be achieved by a diet and physical activity intervention initiated within a national colorectal cancer screening programme , offering considerable potential for risk reduction of disease in older adults . Trial registration Current Controlled Trials IS RCT N53033856 OBJECTIVES In this paper , we present the results of changes in risk factors by use of hormone therapy ( HT ) at 18 months in the Women On the Move through Activity and Nutrition ( WOMAN ) r and omized trial . METHODS The trial was design ed to test the hypothesis that aggressive dietary changes and increased physical activity to reduce weight , waist circumference ( WC ) , glucose , insulin , and lipoproteins would reduce progression of sub clinical atherosclerosis , carotid intimal media thickness and plaque , coronary artery calcification , and pulse wave velocity ( PWV ) . The study focused on postmenopausal women ( n = 508 ) , mean age of 57 , who were r and omized to the Lifestyle Change ( LC ) or Health Education ( HE ) group .  RESULTS At 18 months of follow-up , there was significant , 17 lb , weight loss and 10 cm WC decrease in the LC group . There were significant differences in changes in low-density lipoprotein cholesterol ( LDL-C ) , insulin , glucose , large LDL , and LDL particles between the LC and HE groups . Risk factor changes were greater for women in the LC who lost a significant amount of weight ( > or=18.8 lb ) . Participants at 18 months were subdivided into women who had stayed on HT , 125 ( 28 % ) ; stopped HT after r and omization , 145 ( 33 % ) ; and not on HT at baseline but stopped an average of 7 months prior to r and omization , 173 ( 39 % ) . Weight loss in the LC was similar for all three groups , but LDL lipoprotein response was better for women who stopped HT after r and omization or were not on HT at baseline . CONCLUSIONS The trial has been successful in increasing exercise and diet changes and reduction in weight and WC and variables related to metabolic syndrome Objective : To compare the effects of counseling alone with that of additional participation in supervised training courses on exercise capacity in patients with impaired fasting glucose . Design : R and omized , controlled intervention trial using a nested cohort approach . Setting : Primary care centers in western Austria . Patients : Thirty-six patients with impaired fasting glucose ( 16 males , 20 females ; mean age , 57.5 ± 6.9 years ) . Interventions : Participants of both groups were instructed about the preventive effectiveness of changing their lifestyle , especially losing weight and increasing physical activity . One group had additionally been offered supervised , progressive , individually tailored aerobic exercise programs for 1 hour twice a week . Main Outcome Measures : Changes in the levels of exercise capacity , body mass , and fasting blood glucose . Results : The subjects with supervised exercise participated in this program for 1.8 hours ( ± 0.3 ) per week over 12 months . Supervised exercise was sufficient to maintain exercise capacity , whereas counseling alone was not ( + 4.4 % versus -6.9 % ; P = 0.01 ) . After the 12-month intervention period , body mass was reduced in the supervised exercise group ( -3.0 % ) compared with the counseling alone group ( + 1.0 % ) ( P = 0.03 ) and fasting plasma glucose levels had similarly improved by counseling for adequate lifestyle changes alone ( -8.2 % ) and in combination with supervised exercise ( -6.0 % ) . Conclusion : In contrast to counseling alone , 2 sessions of supervised training per week , besides the self-chosen physical activity and nutritional measures , are sufficient to maintain exercise capacity in patients with impaired fasting glucose OBJECTIVE --To assess the validity of the 1990 US weight guidelines for women that support a substantial gain in weight at approximately 35 years of age and recommend a range of body mass index ( BMI ) ( defined as weight in kilograms divided by the square of height in meters ) from 21 to 27 kg/m2 , in terms of coronary heart disease ( CHD ) risk in women . DESIGN -- Prospect i ve cohort study . SETTING --Female registered nurses in the United States . PARTICIPANTS --A total of 115,818 women aged 30 to 55 years in 1976 and without a history of previous CHD . MAIN OUTCOME MEASURE -- Incidence of CHD defined as nonfatal myocardial infa rct ion or fatal CHD . RESULTS --During 14 years of follow-up , 1292 cases of CHD were ascertained . After controlling for age , smoking , menopausal status , postmenopausal hormone use , and parental history of CHD and using as a reference women with a BMI of less than 21 kg/m2 , relative risks ( RRs ) and 95 % confidence intervals ( CIs ) for CHD were 1.19 ( 0.97 to 1.44 ) for a BMI of 21 to 22.9 kg/m2 , 1.46 ( 1.20 to 1.77 ) for a BMI of 23 to 24.9 kg/m2 , 2.06 ( 1.72 to 2.48 ) for a BMI of 25 to 28.9 kg/m2 , and 3.56 ( 2.96 to 4.29 ) for a BMI of 29 kg/m2 or more . Women who gained weight from 18 years of age were compared with those with stable weight ( + /- 5 kg ) in analyses that controlled for the same variables as well as BMI at 18 years of age . The RRs and CIs were 1.25 ( 1.01 to 1.55 ) for a 5- to 7.9-kg gain , 1.64 ( 1.33 to 2.04 ) for an 8- to 10.9-kg gain , 1.92 ( 1.61 to 2.29 ) for an 11- to 19-kg gain , and 2.65 ( 2.17 to 3.22 ) for a gain of 20 kg or more . Among women with the BMI range of 18 to 25 kg/m2 , weight gain after 18 years of age remained a strong predictor of CHD risk . CONCLUSIONS --Higher levels of body weight within the " normal " range , as well as modest weight gains after 18 years of age , appear to increase risks of CHD in middle-aged women . These data provide evidence that current US weight guidelines may be falsely reassuring to the large proportion of women older than 35 years who are within the current guidelines but have potentially avoidable risks of CHD OBJECTIVES . To compare weight loss on a balanced hypocaloric diet to that of a Very Low Calorie Diet ( VLCD ) after two months of treatment and to further compare 26 months of weight maintenance and safety with or without VLCD assistance in obese patients . DESIGN . Prospect i ve , r and omized , controlled intervention trial , initially with two and later with three parallel groups . SETTING . Swedish University out-patient obesity clinic . SUBJECTS . Eighty-one obese patients of both gender with a BMI ≥30 kg/m2 from the waiting list participated in a structured weight reduction+weight maintenance programme . INTERVENTION . Twenty-seven patients ( group A ) were r and omized to a balanced diet of 6720 kJ/d ( 1600 kcal/d ) during the whole treatment period . The other patients ( n=54 ) were r and omized to VLCD ( Nutrilett ® ) 1764 kJ/d ( 420 kcal/d ) diet during the first two months . The VLCD treated patients were rer and omized after the initial treatment to the well balanced hypocaloric diet ( 6720 kJ/d ) with ( group C ) or without ( group B ) 1 MJ of VLCD to be taken during the evening . MAIN OUTCOME MEASURES . During the first two-month period , the mean body weight loss in the VLCD group was 18.9±7.1 kg compared to 7.2±4.8 kg in the diet treated group , with a similar relative fat loss assessed by bioimpedance of 68 % and 76 % respectively . The maintained weight loss in all groups after 28 months of treatment was 10.9±10.2 kg in the 52 % who completed the programme . Weight losses and drop-out rates were similar in all three groups . CONCLUSIONS . Twenty-four months weight maintenance and drop out rates are independent of whether the initial treatment commences with VLCD or a hypocaloric diet . One MJ nutrition powder taken freely does not affect 24 months weight maintenance on a hypocaloric ( 6.7 MJ/d ) diet OBJECTIVE The main goal of the present study was to evaluate the effect of a commercially available milk containing small amounts of eicosapentaenoic acid and docosahexaenoic acid , oleic acid , and vitamins A , B6 , D , E , and folic acid compared with semi-skimmed and skimmed milk in volunteers with moderate cardiovascular risk . METHODS Two hundred ninety-seven subjects 25 to 65 y of age with moderate cardiovascular risk were r and omly allocated into three groups . In addition to their diets , one group consumed 500 mL/d of the enriched milk , another group consumed 500 mL/d of skimmed milk , and a control group consumed 500 mL/d of semi-skimmed milk . All groups consumed the dairy drinks for 1 y and blood sample s were taken at 0 and 12 mo . RESULTS Consumption of enriched milk for 1 y produced significant ( P < 0.05 ) increases in serum folate ( 58 % ) and high-density lipoprotein cholesterol ( 4 % ) . Plasma triacylglycerols ( 10 % ) , total cholesterol ( 4 % ) , and low-density lipoprotein cholesterol ( 6 % ) were reduced significantly only in the supplemented group . Serum glucose , homocysteine , and C-reactive protein remained unchanged . In the skimmed milk and semi-skimmed milk groups , the only significant decreases were in serum folate ( 17 % and 11 % , respectively ) . CONCLUSION Daily intake of a milk enriched with fish oil , oleic acid , and vitamins improved the nutritional status and cardiovascular risk markers of volunteers , whereas skimmed milk and semi-skimmed milk did not INTRODUCTION Impact exercise is known to be beneficial for bones , but information regarding its effects on other health aspects is scarce . The aim of this study was to assess the effects of high-impact exercise on physical performance and glucose and lipid profiles . METHODS We performed a 12-month , population -based , r and omized controlled trial with 120 women ( 60 in the exercise group and 60 in the control group ; ages 35 - 40 yr ) . The exercise regimen comprised supervised , progressive , high-impact exercises two to three times per week and an additional home program .  Physical activity was continuously recorded using an accelerometer-based method and was analyzed as the daily number of impacts within five acceleration ranges between 0.3 and 9.2 g ( g = acceleration of gravity : 9.81 m x s(-2 ) ) . The changes in physical performance and in glucose and lipid profiles were determined . RESULTS Thirty-nine women in the exercise group and 41 women in the control group completed the study . Maximal oxygen uptake ( 6.2 vs 3.1 mL x kg(-1 ) x min(-1 ) ; P = 0.008 ) and countermovement ( 2.3 vs -0.3 cm ; P < 0.001 ) and static ( 1.4 vs -0.3 cm ; P = 0.004 ) jump heights increased significantly more in the exercise group than in the control group . Exercise training also decreased waist ( -1.1 vs 0.9 cm ; P = 0.048 ) and hip circumference ( -1.0 vs 1.1 cm ; P = 0.037 ) . Total cholesterol and LDL cholesterol decreased significantly more in women , with the highest number of impacts compared with the lowest quartile at intensities exceeding 1.1 g , with differences being up to -0.5 mM ( P = 0.005 ) . Additionally , poor baseline values predicted greater exercise effects . CONCLUSION The moderate-intensity exercise regimen , initially targeted at weight-bearing bones , improved cardiorespiratory fitness , speed-strength , and lipid profiles . In addition to bone health , impact exercise may be recommended for prevention of cardiovascular diseases BACKGROUND Maintenance of weight loss is a core problem in the treatment of obesity . Physical activity may improve maintenance and metabolic risk factors associated with obesity . HYPOTHESES ( 1 ) A walking training program of moderate intensity , started after weight reduction by a very-low-energy diet , improves maintenance of weight loss and obesity-related metabolic disorders ; and ( 2 ) the effect of the training program is related to the prescribed amount of physical activity , ie , a higher amount ( energy expenditure ) leads to more favorable results . METHODS The participants were premenopausal women with a mean body mass index of 34.0 kg/m(2 ) . Eighty-two participants were r and omized to this study ; 74 participated in the follow-up assessment . A 12-week weight reduction by mostly a very-low-energy diet was followed by a 40-week maintenance program r and omized in 3 groups : a control group with no increase in habitual exercise and with counseling on diet and relapse prevention ; a walk-1 group , with a walking program targeted to expend 4.2 MJ/wk and diet counseling ; and a walk-2 group , with a walking program of 8 . 4 MJ/wk and diet counseling . R and om permuted blocks within strata were used , with weight loss ( in 3 classes ) as the stratifying factor . After the intervention , the subjects were followed up for 2 years . MAIN OUTCOME MEASURES Primary outcomes were body weight , fat mass , and waist circumference at the 2-year follow-up . Secondary outcomes were the levels of serum lipoproteins and lipids , plasma glucose , insulin , and blood pressure . RESULTS The mean weight loss after weight reduction was 13.1 kg . The main outcome variables remained stable during the maintenance program , but increased during the follow-up period . Compared with the end of weight reduction , weight regain at the 2-year follow-up was 3.5 kg less ( 95 % confidence interval , 0.2 - 6.8 ) and waist circumference regain 3.8 cm less ( 95 % confidence interval , 0.3 - 7.3 ) in the walk-1 group vs controls . The secondary outcomes showed a partial relapse during the maintenance program , and a further regain during the follow-up period . CONCLUSIONS Inclusion of a walking program of moderate training regimen into a weight maintenance program improved maintenance of losses in weight and waist circumference Most primary care providers ( PCPs ) , constrained by time and re sources , can not provide intensive behavioral counseling for obesity . This study evaluated the effect of using medical assistants ( MAs ) as weight loss counselors . The study was a r and omized controlled trial conducted in two primary care offices at an academic medical center . Patients ( n = 50 ) had a BMI of 27 - 50 kg/m(2 ) and no contraindications to weight loss . They were r and omized to quarterly PCP visits and weight loss material s ( Control group ) or to the same approach combined with eight visits with a MA over 6 months ( Brief Counseling ) . Outcomes included change in weight and cardiovascular risk factors ( glucose , lipids , blood pressure , and waist circumference ) . Patients in the Brief Counseling and Control groups lost 4.4 + /- 0.6 kg ( 5.1 + /- 0.7 % of initial weight ) and 0.9 + /- 0.6 kg ( 1.0 + /- 0.7 % ) , respectively , at month 6 ( P < 0.001 ) . There were no significant differences between groups for changes in cardiovascular risk factors . Brief Counseling patients regained weight between month 6 and month 12 , when MA visits were discontinued . Attrition was 10 % after 6 months and 6 % after 12 months . Brief Counseling by MAs induced significant weight loss during 6 months . Office-based obesity treatment should be tested in larger trials and should include weight loss maintenance counseling Lifestyle interventions for weight loss are the cornerstone of obesity therapy , yet their optimal design is debated . This is particularly true for postmenopausal women ; a population with a high prevalence of obesity yet toward whom fewer studies are targeted . We conducted a year-long , 4-arm r and omized trial among 439 overweight-to-obese postmenopausal sedentary women to determine the effects of a calorie-reduced , low-fat diet ( D ) , a moderate-intensity , facility-based aerobic exercise program ( E ) , or the combination of both interventions ( D+E ) , vs. a no-lifestyle-change control ( C ) on change in body weight and composition . The group-based dietary intervention had a weight-reduction goal of ≥10 % , and the exercise intervention consisted of a gradual escalation to 45-min aerobic exercise 5 day/week . Participants were predominantly non-Hispanic whites ( 85 % ) with a mean age of 58.0 ± 5.0 years , a mean BMI of 30.9 ± 4.0 kg/m(2 ) and an average of 47.8 ± 4.4 % body fat .  Baseline and 12-month weight and adiposity measures were obtained by staff blinded to participants ' intervention assignment . Three hundred and ninety nine women completed the trial ( 91 % retention ) . Using an intention-to-treat analysis , average weight loss at 12 months was -8.5 % for the D group ( P < 0.0001 vs. C ) , -2.4 % for the E group ( P = 0.03 vs. C ) , and -10.8 % for the D+E group ( P < 0.0001 vs. C ) , whereas the C group experienced a nonsignificant -0.8 % decrease . BMI , waist circumference , and % body fat were also similarly reduced . Among postmenopausal women , lifestyle-change involving diet , exercise , or both combined over 1 year improves body weight and adiposity , with the greatest change arising from the combined intervention The Women 's Healthy Lifestyle Project is a 5-year r and omized clinical testing whether a behavioral intervention aim ed at lifestyle changes in diet and physical activity can prevent the rise in weight and low-density lipoprotein cholesterol ( LDL-c ) observed during menopause . Cardiovascular risk factor and behavioral data from 489 participants ( intervention group n = 236 ; control group n = 253 ) who attended baseline , 6-month , and 18-month clinical assessment s were analyzed to determine how well initial improvements achieved at 6 months were maintained over the subsequent year of follow-up . Results indicated that the treatment effect persisted at 18 months for weight , body mass index , total cholesterol , LDL-c , systolic blood pressure ( SBP ) , and glucose levels . Intervention participants maintained improvements in physical activity , caloric intake , dietary cholesterol , SBP , and glucose levels between 6 and 18 months , although weight , total cholesterol , and LDL-c began to rise during this period . Eighty percent of intervention participants compared to 45 % of controls were at or under baseline weight at 18 months , suggesting that promoting modest weight loss may be an effective approach to preventing weight gain in these women BACKGROUND The maintenance of weight loss may be influenced by the distribution of macronutrients in the diet and insulin sensitivity . OBJECTIVE The objective of the study was to evaluate the longterm effect of two hypocaloric diets with different protein/carbohydrate ratios in overweight and obese individuals either with insulin resistance ( IR ) or without insulin resistance ( IS ) . DESIGN Prospect i ve , r and omized , clinical intervention study . Forty patients were classified as IR/IS after a 75 g oral glucose tolerance test and then r and omized to a diet with either 40 % carbohydrate/30 % protein/30 % fat ( diet A ) or 55 % carbohydrate/15 % protein/30 % fat ( diet B ) . RESULTS After one year of follow-up there was no difference in weight loss between diets A and B in each group , but the IS group maintained weight loss better than the IR group [ -5.7 ( 3.9 ) vs. -0.6 ( 4.1 ) ; P = 0.04 ] . No differences were found in either Homeostasis Model Assessment ( HOMA ) or other metabolic glucose parameters except lower insulin at 120 minutes with diet A [ 21.40 ( 8.30 ) vs. 71.40 ( 17.11 ) ; P = 0.02 ] . CONCLUSIONS The hypocaloric diets with different protein/carbohydrate ratios produced similar changes in weight . Insulin resistance may play a negative role in maintaining weight loss The relationships of age , body composition , and physical conditioning status to glucose tolerance , insulin , and lipoprotein levels were examined in 77 healthy , nonsmoking white male volunteers , aged 46 to 73 years with no evidence of coronary artery or endocrine-metabolic disease . The men had a wide range of body fat ( 13 % to 39 % ) , indexed as waist-to-hip ratio ( WHR , 0.84 to 1.08 ) , and maximal aerobic capacity ( VO2max , 17 to 48 mL/kg.min ) . Multiple regression analysis with age , VO2max , WHR , and percent body fat as independent variables demonstrated that fasting plasma insulin , triglyceride ( TG ) , and high density lipoprotein cholesterol ( HDL-C ) levels were independently related to both percent body fat and WHR . In contrast , fasting plasma glucose levels and insulin responses during oral glucose tolerance tests ( OGTT ) correlated independently with percent body fat , and glucose responses to OGTT correlated only with WHR . Although fasting plasma TG and HDL-C correlated with glucose and insulin levels , in multiple regression analyses only percent body fat and WHR were the significant independent variables . Fasting total and low density lipoprotein cholesterol values were not related to these variables . To test the effects of weight loss and exercise training on these relationships , 20 obese men of comparable age , percent body fat , WHR , and  VO2max were r and omly assigned to weight loss or aerobic exercise training programs . A 12 % + /- 3 % loss in body weight ( P less than .01 , mean + /- SD ) result ed in a 19 % + /- 9 % decline in body fat ( P less than .01 ) with no change in fat free mass , WHR , or VO2max . ( ABSTRACT TRUNCATED AT 250 WORDS OBJECTIVE There is a significant need for an obesity treatment model suitable for the primary care environment . We examined the effectiveness of a brief counselling intervention alone , in combination with orlistat , and drug-alone in a 12-month r and omized- clinical trial at a medical school obesity centre . METHODS Participants ( N = 250 ) with body mass index ( BMI ) > or=27 were r and omized .  Changes in body weight , lipids , blood pressure and serum glucose were examined . Drug adherence and attendance were also evaluated . RESULTS Completers analysis was conducted on 136 participants with data at baseline , 6 and 12 months and intention-to-treat analyses ( ITT ) for the total sample . Amongst completers , participants in the drug only ( P = 0.012 ) and drug + brief counselling ( P = 0.001 ) groups lost more weight ( mean + /- SD : -3.8 + /- 5.8 kg and -4.8 + /- 4.4 kg , respectively ) than participants in the brief counselling only group at 6 months ( -1.7 + /- 3.3 kg ) , but there were no significant group differences at 12 months . ITT model results were similar to completers at 6 months and remained significant at 12 months , but the weight losses were more modest ( <3 kg ) for both groups receiving orlistat . For brief counselling alone , participants gained weight ( 1.7 + /- 4.2 kg ) . Cardiovascular disease ( CVD ) parameter changes were negligible . CONCLUSIONS Pharmacotherapy alone or combined with brief counselling result ed in modest weight losses that had minimal impact on cardiovascular parameters , but were greater than brief counselling alone . Whilst brief interventions and primary pharmacotherapy have been suggested as viable treatments for implementation in primary care setting s , our study suggests that such minimal interventions provide minimal benefits BACKGROUND The long-term effectiveness of multicomponent worksite health promotion programs targeting cardiovascular disease risk factors remains unclear in Japan . This study was conducted to evaluate the effectiveness of such a health promotion program consisting of a main program provided over 4 days and a follow-up program provided over 1 year . METHODS The subjects of this r and omized controlled trial were male employees working for a building maintenance company in Japan . The intervention group ( n = 152 ) and the control group ( n = 150 ) consisted of employees having abnormal findings in at least one of the following items at baseline health examination : body mass index ( BMI ) , systolic ( SBP )  or  diastolic blood pressure , total cholesterol , HDL cholesterol , triglycerides , and fasting blood glucose . Evaluation was conducted at 18 months after the main program . RESULTS BMI , SBP , total cholesterol , and triglycerides improved significantly in the intervention group compared with the control group ( P < 0.05 ) . When comparisons were limited to those who showed abnormality at baseline , BMI , total cholesterol , and triglycerides improved significantly in the intervention group ( P < 0.05 ) . CONCLUSIONS The multicomponent health promotion program provided to employees was shown to be effective in improving obesity , high blood pressure , and hyperlipidemia when evaluated 18 months after the main intervention program OBJECTIVE To assess the effect of lifestyle intervention over 2 years on changes in weight , coronary heart disease ( CHD ) risk factors , and incidence of diabetes in overweight individuals with a parental history of diabetes . RESEARCH DESIGN AND METHODS Participants ( n = 154 ) , who were 30–100 % over ideal body weight , had one or both parents with diabetes , and were currently nondiabetic , were r and omly assigned to 2-year treatments focused on diet ( decreasing calories and fat intake ) , exercise ( goal of 1,500 kcal/week of moderate activity ) , or the combination of diet plus exercise or to a no-treatment control group . Subjects were reassessed at 6 months , 1 year , and 2 years . RESULTS At 6 months , the groups differed significantly on measures of eating , exercise , and fitness ; weight losses in the diet and diet-plus-exercise groups were significantly > in the exercise and control conditions . Weight losses were associated with positive changes in CHD risk factors . After 6 months , there was gradual deterioration of behavioral and physiological changes , so that at 2 years , almost no between-group differences were maintained . Differences between groups in risk of developing diabetes were of borderline significance ( P = 0.08 ) . Strongest predictors were impaired glucose tolerance at baseline , which was positively related to risk of developing diabetes , and weight loss from baseline to 2 years , which was negatively related ; in all treatment groups , a modest weight loss of 4.5 kg reduced the risk of type 2 diabetes by ∼ 30 % compared with no weight loss . CONCLUSIONS Although initially successful , the interventions studied here were not effective in producing long-term changes in behavior , weight , or physiological parameters . However , weight loss from 0 to 2 years reduced the risk of developing type 2 diabetes . Since modest weight loss significantly reduced risk of type 2 diabetes , further research is needed to determine how best to increase the percentage of subjects achieving at least a modest weight loss OBJECTIVE To examine in previously sedentary older women the effects of exercise mode and a behavioural intervention on short and long-term retention and adherence . METHODS Healthy , sedentary women aged 50 - 70 years ( N=116 ) were r and omly assigned to a supervised 6-month swimming or walking program 3 sessions a week . They were further r and omised to usual care or a behavioural intervention . The same program was further continued unsupervised for 6 months . We assessed retention , adherence , stage of exercise behaviour and changes in fitness . RESULTS One hundred women ( 86 % ) completed 6 months and 86 ( 74 % ) continued for 12 months . Retention rates were similar for both exercise modes at 6 and 12 months . Adherence to swimming or walking was similar after 6 months ( 76.3 ( 95 % CI : 69.5 , 83.1)% vs. 74.3 ( 67.7 , 80.9)% ) and 12 months ( 65.8 ( 57.9 , 73.8)% vs. 62.2 ( 54.6 , 70.0)% ) . The behavioural intervention did not enhance retention or adherence . Fitness improved for both exercise modes after 6 months and was maintained at 12 months . CONCLUSIONS Either swimming or walking programs initiated with careful supervision over 6 months result ed in similar high retention and adherence rates by highly motivated older women over 12 months . Behavioural intervention in this setting did not improve these rates further OBJECTIVE Insulin resistance and hyperinsulinaemia are , in some prospect i ve studies , linked to an increased cardiovascular risk , at least in men . We tested the hypothesis that hyperinsulinaemia may be reduced by non-pharmacological methods independently of other cardiovascular risk factors . DESIGN In a non-pharmacological intervention study for 1 year three groups of subjects ( hypertensives as well as normotensives ) were selected after stratification for insulin level at baseline . Half of the hyperinsulinaemic subjects were r and omly assigned to active intervention with physical exercise and dietary regulation ( HI-A group ) , the other half were followed passively during the study period ( HI-P group ) . Normo-insulinaemics and hypo(low)-insulinaemics also underwent active intervention ( NI-A and LI-A groups , respectively ) . SETTING Primary health care in Sweden . RESULTS During the 1-year follow-up subjects in the HI-A group reduced their weight , waist : hip ratio and systolic and diastolic blood pressure , as well as their low : high-density lipoprotein (LDL : HDL)-cholesterol ratio . Glucose levels before and during an oral glucose tolerance test did not change . However , plasma insulin and plasma-C-peptide decreased both in the fasting state and after 1 and 2 h of oral glucose tolerance testing . This decrease was independent of the previously mentioned reduction in weight , waist : hip ratio , blood pressure and LDL : HDL-cholesterol ratio . No reduction in insulin levels was seen in the HI-P , NI-A or LI-A groups , but in the HI-P group there was a slight decrease in fasting plasma-C-peptide levels . In the HI-A group dietary improvements were observed during the study period , with a reduction in energy intake , fat consumption and cholesterol intake . Fibre intake was increased . No major changes were seen in the HI-P group . CONCLUSIONS We conclude that in hypertensive and normotensive subjects with hyperinsulinaemia insulin levels can be reduced by active non-pharmacological treatment for 1 year without altering glucose tolerance . This shows that insulin resistance may be lowered by non-pharmacological treatment , which may be of considerable importance , and not only for hypertensives Background —The Women ’s Healthy Lifestyle Project Clinical Trial tested the hypothesis that reducing saturated fat and cholesterol consumption and preventing weight gain by decreased caloric and fat intake and increased physical activity would prevent the rise in LDL cholesterol and weight gain in women during perimenopause to postmenopause . Methods and Results —There were 275 premenopausal women r and omized into the assessment only group and 260 women into the intervention group . The mean age of participants at baseline was 47 years , and 92 % of the women were white . The mean LDL cholesterol was 115 mg/dL at baseline , and mean body mass index was 25 kg/m2 . The follow-up through 54 months was excellent . By 54 months , 35 % of the women had become postmenopausal . At the 54-month examination , there was a 3.5-mg/dL increase in LDL cholesterol in the intervention group and an 8.9-mg/dL increase in the assessment -only group ( P = 0.009 ) . Weight decreased 0.2 lb in the intervention and increased 5.2 lb in the assessment -only group ( P = 0.000 ) . Triglycerides and glucose also increased significantly more in the assessment -only group than in the intervention group . Waist circumference decreased 2.9 cm in the intervention compared with 0.5 cm in the assessment -only group ( P = 0.000 ) . Conclusions —The trial was successful in reducing the rise in LDL cholesterol during perimenopause to postmenopause but could not completely eliminate the rise in LDL cholesterol . The trial was also successful in preventing the increase in weight from premenopause to perimenopause to postmenopause . The difference in LDL cholesterol between the assessment and intervention groups was most pronounced among postmenopausal women and occurred among hormone users and nonusers BACKGROUND In short-term studies , diet and exercise both improve insulin sensitivity . OBJECTIVE To determine the effects of a 48-week supervised diet and exercise program on weight and insulin sensitivity after initial weight loss and weight maintenance , and then subsequent weight regain over 96 weeks . METHODS Forty-five obese women were r and omly assigned to 1 of 3 treatment groups : ( 1 ) diet alone , ( 2 ) diet and aerobic training , and ( 3 ) diet and strength training . All subjects received the same 48-week group behavior modification program and diet ( approximately 3879 kJ/d [ approximately 925 kcal/d ] for the first 16 weeks ; approximately 6276 kJ/d [ approximately 1500 kca/d ] thereafter ) . Exercising subjects were provided 3 supervised exercise sessions per week for the first 28 weeks and 2 sessions weekly until week 48 . During weeks 48 to 96 , subjects were unsupervised . Oral glucose tolerance tests were performed at baseline and weeks 16 , 24 , 44 , and 96 . RESULTS Subjects across the 3 conditions achieved a mean weight loss of 13.8 kg by week 16 , which was associated with decreased insulin levels ( 61.8 % of baseline ) There were no significant differences among groups in changes in body mass index , which is a measure of weight in kilograms divided by the square of the height in meters , weight , glucose tolerance , or insulin levels at weeks 16 , 24 , and 44 . No additional beneficial effect of aerobic or strength exercise on insulin resistance , as reflected by serum insulin levels before and after a glucose load , was demonstrated . The 22 subjects who were studied at week 96 maintained a loss of approximately 10 % of initial weight . Insulin levels , however , had returned to pretreatment levels . CONCLUSIONS This study confirms the beneficial effect of weight reduction on hyperinsulinemia in obese individuals . Participation in supervised exercise did not result in additional improvement in weight loss or insulin sensitivity . We also observed a marked increase in insulin levels with only partial weight regain . Determining the amount of sustained weight loss necessary for continued improvement in insulin sensitivity will require further study OBJECTIVE To examine changes in biomarkers of disease risk after 51 months of reduced energy intake and sustained weight loss . RESEARCH METHODS AND PROCEDURES This study was conducted as a prospect i ve , r and omized , two-arm , parallel intervention for 12 weeks followed by a prospect i ve , single-arm , 4-year trial in a university-based hospital clinic . One hundred patients were r and omly assigned to one of two dietary interventions for 3 months . Group A was prescribed an energy-restricted diet of 1200 to 1500 kcal/d , and group B was prescribed an isocaloric diet , whereby two of three meals were replaced with nutrient-fortified liquid meal replacements . After 3 months , the patients were prescribed the same caloric reduction and used once-daily replacements for the succeeding 4 years . Body weight and blood pressure were checked monthly . Biomarkers of disease risk were measured after 3 , 9 , 15 , 27 , and 51 months . RESULTS During the 3-month weight-loss period , body weight was reduced by 1.5 + /- 0.4 % and 7.8 + /- 0.5 % ( mean + /- SEM ) for groups A and B , respectively . After 4 years , 75 % of the patients were evaluated . Total mean weight loss was 3.3 + /- 0.8 % and 8.4 + /- 0.8 % for groups A and B , respectively . Both groups of patients showed significant improvement in glucose , insulin , triacylglycerol , and systolic blood pressure . Cholesterol concentrations were reduced in patients with high initial cholesterol levels and maintenance of a 7 % weight loss . DISCUSSION Providing a structured meal plan with liquid meal replacements is an effective treatment for obese subjects . Long-term maintenance of weight loss with meal replacements improves biomarkers of disease risk INTRODUCTION Limited data are available supporting the notion that treatment of lifestyle risk factors may improve erectile dysfunction ( ED ) . AIM In the present study , we analyzed the effect of a program of changing in lifestyle design ed to improve erectile function  in subjects with ED or at increasing risk for ED . METHODS Men were identified in our data base of subjects participating in r and omized controlled trials evaluating the effect of lifestyle changes . A total of 209 subjects were r and omly assigned to one of the two treatment groups . The 104 men r and omly assigned to the intervention program received detailed advice about how to reduce body weight , improve quality of diet , and increase physical activity .  The 105 subjects in the control  group were given general information about healthy food choices and general guidance on increasing their level of physical activity . MAIN OUTCOME MEASURES Changes in erectile function score ( International Index of Erectile Function-5 [ IIEF-5 ] ; items 5 , 15 , 4 , 2 , and 7 from the full-scale IIEF-15 ) and dependence of the restoration of erectile function on the changes in lifestyle that were achieved . RESULTS Erectile function score improved in the intervention group . At baseline , 35 subjects in the intervention group and 38 subjects in the control group had normal erectile function ( 34 % and 36 % , respectively ) . After 2 years , these figures were 58 subjects in the intervention group and 40 subjects in the control group , respectively ( 56 % and 38 % , P = 0.015 ) . There was a strong correlation between the success score and restoration of erectile function . CONCLUSIONS It is possible to achieve an improvement of erectile function  in men at risk by means of nonpharmacological intervention aim ing at weight loss and increasing physical activity BACKGROUND Guidelines established by the National Cholesterol Education Program ( NCEP ) promote exercise and weight loss for the treatment of abnormal lipoprotein levels . Little is known , however , about the effects of exercise or the NCEP diet , which is moderately low in fat and cholesterol , in persons with lipoprotein levels that place them at high risk for coronary heart disease . METHODS We studied plasma lipoprotein levels in 180 postmenopausal women , 45 through 64 years of age , and 197 men , 30 through 64 years of age , who had low high-density lipoprotein ( HDL ) cholesterol levels ( < or = 59 mg per deciliter in women and < or = 44 mg per deciliter in men ) and moderately elevated levels of low-density lipoprotein ( LDL ) cholesterol ( > 125 mg per deciliter but < 210 mg per deciliter in women and > 125 mg per deciliter but < 190 mg per deciliter in men ) . The subjects were r and omly assigned to aerobic exercise , the NCEP Step 2 diet , or diet plus exercise , or to a control group , which received no intervention . RESULTS Dietary intake of fat and cholesterol decreased during the one-year study ( P<0.001 ) , as did body weight , in women and men in either the diet group or the diet-plus-exercise group , as compared with the controls ( P<0.001 ) and the exercise group ( P<0.05 ) , in which dietary intake and body weight were unchanged . Changes in HDL cholesterol and triglyceride levels and the ratio of total to HDL cholesterol did not differ significantly among the treatment groups , for subjects of either sex . The serum level of LDL cholesterol was significantly reduced among women ( a decrease of 14.5+/-22.2 mg per deciliter ) and men ( a decrease of 20.0+/-17.3 mg per deciliter ) in the diet-plus-exercise group , as compared with the control group ( women had a decrease of 2.5+/-16.6 mg per deciliter , P<0.05 ; men had a decrease of 4.6+/-21.1 mg per deciliter , P<0.001 ) . The reduction in LDL cholesterol in men in the diet-plus-exercise group was also significant as compared with that among the men in the exercise group ( 3.6+/-18.8 mg per deciliter , P<0.001 ) . In contrast , changes in LDL cholesterol levels were not significant among the women ( a decrease of 7.3+/-18.9 mg per deciliter ) or the men ( 10.8+/-18.8 mg per deciliter ) in the diet group , as compared with the controls . CONCLUSIONS The NCEP Step 2 diet failed to lower LDL cholesterol levels in men or women with high-risk lipoprotein levels who did not engage in aerobic exercise . This finding highlights the importance of physical activity in the treatment of elevated LDL cholesterol levels AIM To study the effects of a supervised exercise program on serum gamma-glutamyl transferase ( GGT ) , glycemic control and cardiovascular risk factors in pre-diabetic patients with isolated impaired fasting glucose ( IFG ) and those with IFG plus impaired glucose tolerance ( IGT ) . METHODS Out of 60 pre-diabetic patients ( 30 with isolated IFG and 30 with IFG + IGT ) 24 were r and omly assigned to the  supervised exercise program  ( 1 h twice a week ) and 36 only obtained counselling on the risk of diabetes and its prevention . Patients have been followed over a 12-month period . RESULTS The main findings were that patients with IFG + IGT had increased GGT levels at baseline ( 49.2±27.4 U/L ) compared to subjects with isolated IFG ( 28.1±21.9 U/L ) ( p<0.01 ) , and that GGT levels improved only after the supervised exercise intervention within the IFG + IGT subjects ( - 17.7±19.6 U/L ) . Similarly , baseline triglyceride levels were also higher in IFG + IGT patients ( p<0.001 ) and there was a decrease through exercise intervention in these patients only ( p<0.05 ) . CONCLUSION GGT is an unspecific marker of oxidative stress and both high plasma glucose and triglycerides levels may produce oxidative stress . Thus , patients with IFG + IGT seem to have higher levels of oxidative stress than those with isolated IFG . Based on the known association between GGT levels and cardiovascular risk factors , IFG + IGT patients may be at higher risk for the development of cardiovascular diseases . The specific effect of regular exercise  on GGT in pre-diabetic patients may contribute to the underst and ing of the preventive effects related to exercise All types of aerobic exercise are assumed to affect cardiovascular risk similarly . There are few studies of swimming , but complex responses to water-based exercise suggest its potential for differential effects . The aim of the study was to compare the effects of swimming and walking on fitness , body weight , lipids , glucose , and insulin in older women . Sedentary women aged 50 to 70 years ( N = 116 ) , r and omly assigned to swimming or walking plus usual care or a behavioral intervention , completed 3 sessions per week of moderate-intensity exercise , supervised for 6 months then unsupervised for 6 months . After 6 months , 1.6-km walk time decreased in walkers and swimmers , with greater improvement in walkers ( 1.0 vs 0.6 minute , P = .001 ) . In swimmers , but not walkers , distance swum in 12 minutes increased ( 78.1 vs -2.2 m , P = .021 ) . Waist and hip circumferences ( 80.8 vs 83.1 cm and 101.8 vs 102.4 cm ; P = .023 and P = .042 , respectively ) and insulin area under the curve ( oral glucose tolerance test ) ( 5128 vs 5623 μU/[L 120 min ] , P < .05 ) were lower with swimming . Lipids did not differ between groups . At 12 months , fitness was maintained . Relative to walking , swimming  reduced body weight by ( 1.1 kg , P = .039 ) and result ed in lower total and low-density lipoprotein cholesterol ( 0.3 and 0.2 mmol/L ; P = .040 and P = .049 , respectively ) . The magnitude of the difference in the reduction of insulin area under the curve between swimming and walking was greater at 12 months ; however , the significance was attenuated ( 4677 vs 5240 μU/[L 120 min ] , P = .052 ) . Compared with walking , swimming  improved body weight , body fat distribution , and insulin in the short term and , in the longer term , body weight and lipid measures . These findings suggest that the type of exercise can influence health benefits The current study examined the insulin and glucose response during an oral glucose tolerance test ( OGTT ) in overweight young adults prior to and following exercise training in the Midwest Exercise Trial ( MET ) . Subjects ( N = 66 ) were r and omly assigned to  non-exercise control ( CON ; 16 females , 13 males ) or exercise ( EX ; 22 females , 15 males ) groups . EX performed supervised and verified exercise on 3 to 5 days per week in 20- to 45-minute sessions at 60 % to 75 % of heart rate reserve . OGTTs and assessment s for body mass , body composition , and maximal oxygen consumption ( Vo(2 ) max ) were performed at baseline , and after 9 and 16 months of training . Blood was collected during a 75-g OGTT and analyzed for glucose and insulin concentrations with the total area under the glucose and insulin curves used in the analysis . The EX males had significant decreases from baseline to 9 months in body mass ( 94.8 + /- 12.5 to 89.2 + /- 9.8 kg ) and percent fat ( 28.3 + /- 4.8 to 24.2 + /- 3.9 ) with no further changes at 16 months . CON females had significant increases in body mass ( 78.2 + /- 6.4 to 81.1 + /- 8.1 kg ) and percent fat ( 36.6 + /- 4.2 to 37.8 + /- 4.7 ) from baseline to 16 months . Vo(2 ) max increased significantly from baseline to 9 months in the EX males ( 3.67 + /- 0.62 to 4.36 + /- 0.55 L/min ) and EX females ( 2.53 + /- 0.32 to 2.99 + /- 0.42 L/min ) . For glucose area under the curve , there were no significant differences between EX or CON across the 16 months of the study . For insulin area under the curve , there was a significant decrease for male EX from baseline to 9 months ( 12,535 + /- 6,114 to 8,390 + /- 4,231 microU/L/180 min ) . We conclude that regular exercise in healthy , previously sedentary overweight adult males leads to improvements in Vo(2 ) max and weight loss and a reduction in the insulin concentration required to dispose of a set glucose load . In females , improvement in Vo(2 ) max without weight loss does not lead to improvement in insulin sensitivity A pilot trial was conducted to test adherence to specific lifestyle interventions among Pima Indians of Arizona , and to compare them for changes in risk factors for diabetes mellitus . Ninety-five obese , normoglycaemic men and women , aged 25 - 54 years , were r and omized to treatments named ' Pima Action ' ( Action ) and ' Pima Pride ' ( Pride ) , which were tested for 12 months . Action involved structured activity and nutrition interventions , and Pride included unstructured activities emphasizing Pima history and culture . Adherence to interventions , changes in self-reported activity and diet , and changes in weight , glucose concentrations , and other risk factors were assessed regularly . Thirty-five eligible subjects who had declined r and omization were also followed as an ' observational ' group and 22 members of this group were examined once at a median of 25 months for changes in weight and glucose concentration . After 12 months of intervention , members of both intervention groups reported increased levels of physical activity ( median : Action 7.3 h month(-1 ) , Pride 6.3 h month(-1 ) , p < 0.001 for each ) , and Pride members reported decreased starch intake ( 28 g , p = 0.008 ) . Body mass index , systolic and diastolic blood pressures , weight , 2-h glucose and 2-h insulin had all increased in Action members ( p < 0.003 for each ) , and waist circumference had decreased in Pride members ( p = 0.05 ) . Action members gained more weight than Pride members ( 2.5 kg vs 0.8 kg , p = 0.06 ) , and had a greater increase in 2-h glucose than Pride members ( 1.33 mM vs 0.03 mM , p = 0.007 ) . Members of the observational group gained an average of 1.9 kg year(-1 ) in weight and had an increase of 0.36 mM year(-1 ) in 2-h glucose . Sustaining adherence in behavioural interventions over a long term was challenging . Pimas may find a less direct , less structured , and more participative intervention more acceptable than a direct and highly structured approach OBJECTIVE Individuals with impaired glucose tolerance ( IGT ) have a high risk of developing NIDDM . The purpose of this study was to determine whether diet and exercise interventions in those with IGT may delay the development of NIDDM , i.e. , reduce the incidence of NIDDM , and thereby reduce the overall incidence of diabetic complications , such as cardiovascular , renal , and retinal disease , and the excess mortality attributable to these complications . RESEARCH DESIGN AND METHODS In 1986 , 110,660 men and women from 33 health care clinics in the city of Da Qing , China , were screened for IGT and NIDDM . Of these individuals , 577 were classified ( using World Health Organization criteria ) as having IGT . Subjects were r and omized by clinic into a clinical trial , either to a control group or to one of three active treatment groups : diet only , exercise only , or diet plus exercise . Follow-up evaluation examinations were conducted at 2-year intervals over a 6-year period to identify subjects who developed NIDDM . Cox 's proportional hazard analysis was used to determine if the incidence of NIDDM varied by treatment assignment . RESULTS The cumulative incidence of diabetes at 6 years was 67.7 % ( 95 % CI , 59.8–75.2 ) in the control group compared with 43.8 % ( 95 % CI , 35.5–52.3 ) in the diet group , 41.1 % ( 95 % CI , 33.4–49.4 ) in the exercise group , and 46.0 % ( 95 % CI , 37.3–54.7 ) in the diet-plus-exercise group ( P < 0.05 ) . When analyzed by clinic , each of the active intervention groups differed significantly from the control clinics ( P < 0.05 ) . The relative decrease in rate of development of diabetes in the active treatment groups was similar when subjects were stratified as lean or overweight ( BMI < or ≥ 25 kg/m2 ) . In a proportional hazards analysis adjusted for differences in baseline BMI and fasting glucose , the diet , exercise , and diet-plus-exercise interventions were associated with 31 % ( P < 0.03 ) , 46 % ( P < 0.0005 ) , and 42 % ( P < 0.005 ) reductions in risk of developing diabetes , respectively . CONCLUSIONS Diet and /or exercise interventions led to a significant decrease in the incidence of diabetes over a 6-year period among those with IGT CONTEXT Healthy lifestyle factors are associated with maintenance of  erectile function in men . OBJECTIVE To determine the effect of weight loss and increased physical activity on erectile and endothelial functions in obese men . DESIGN , SETTING , AND PATIENTS R and omized , single-blind trial of 110 obese men ( body mass index > or = 30 ) aged 35 to 55 years , without diabetes , hypertension , or hyperlipidemia , who had erectile dysfunction that was determined by having a score of 21 or less on the International Index of Erectile Function ( IIEF ) . The study was conducted from October 2000 to October 2003 at a university hospital in Italy . INTERVENTIONS The 55 men r and omly assigned to the intervention group received detailed advice about how to achieve a loss of 10 % or more in their total body weight by reducing caloric intake and increasing their level of physical activity .  Men in the control group ( n = 55 ) were given general information about healthy food choices and exercise . MAIN OUTCOMES MEASURES Erectile function score , levels of cholesterol and triglycerides , circulating levels of interleukin 6 , interleukin 8 , and C-reactive protein , and endothelial function as assessed by vascular responses to l-arginine . RESULTS After 2 years , body mass index decreased more in the intervention group ( from a mean [ SD ] of 36.9 [ 2.5 ] to 31.2 [ 2.1 ] ) than in the control group ( from 36.4 [ 2.3 ] to 35.7 [ 2.5 ] ) ( P<.001 ) , as did serum concentrations of interleukin 6 ( P = .03 ) , and C-reactive protein ( P = .02 ) . The mean ( SD ) level of physical activity increased more in the intervention group ( from 48 [ 10 ] to 195 [ 36 ] min/wk ; P<.001 ) than in the control group ( from 51 [ 9 ] to 84 [ 28 ] min/wk ; P<.001 ) . The mean ( SD ) IIEF score improved in the intervention group ( from 13.9 [ 4.0 ] to 17 [ 5 ] ; P<.001 ) , but remained stable in the control group ( from 13.5 [ 4.0 ] to 13.6 [ 4.1 ] ; P = .89 ) . Seventeen men in the intervention group and 3 in the control group ( P = .001 ) reported an IIEF score of 22 or higher . In multivariate analyses , changes in body mass index ( P = .02 ) ,  physical activity ( P = .02 ) , and C-reactive protein ( P = .03 ) were independently associated with changes in IIEF score . CONCLUSION Lifestyle changes are associated with improvement in sexual function in about one third of obese men with erectile dysfunction at baseline BACKGROUND Type 2 diabetes affects approximately 8 percent of adults in the United States . Some risk factors -- elevated plasma glucose concentrations in the fasting state and after an oral glucose load , overweight , and a sedentary lifestyle -- are potentially reversible . We hypothesized that modifying these factors with a lifestyle-intervention program or the administration of metformin would prevent or delay the development of diabetes . METHODS We r and omly assigned 3234 nondiabetic persons with elevated fasting and post-load plasma glucose concentrations to placebo , metformin ( 850 mg twice daily ) , or a lifestyle-modification program  with the goals of at least a 7 percent weight loss and at least 150 minutes of physical activity per week . The mean age of the participants was 51 years , and the mean body-mass index ( the weight in kilograms divided by the square of the height in meters ) was 34.0 ; 68 percent were women , and 45 percent were members of minority groups . RESULTS The average follow-up was 2.8 years . The incidence of diabetes was 11.0 , 7.8 , and 4.8 cases per 100 person-years in the placebo , metformin , and lifestyle groups , respectively . The lifestyle intervention reduced the incidence by 58 percent ( 95 percent confidence interval , 48 to 66 percent ) and metformin by 31 percent ( 95 percent confidence interval , 17 to 43 percent ) , as compared with placebo ; the lifestyle intervention was significantly more effective than metformin . To prevent one case of diabetes during a period of three years , 6.9 persons would have to participate in the lifestyle-intervention program , and 13.9 would have to receive metformin . CONCLUSIONS Lifestyle changes and treatment with metformin both reduced the incidence of diabetes in persons at high risk . The lifestyle intervention was more effective than metformin AIMS To evaluate the effectiveness and feasibility of implementing a linguistically and culturally tailored Diabetes Prevention Program among Chinese immigrants with prediabetes living in New York City . METHODS A total of 60 Chinese immigrants with prediabetes were r and omized into either a Diabetes Prevention Program lifestyle intervention ( n = 30 ) consisting of 12 bi-weekly core sessions and six monthly post-core sessions or the control intervention ( n = 30 ) , consisting of quarterly mailing of diabetes prevention information . Each Diabetes Prevention Program intervention session lasted 1.5 - 2 h and covered topics such as healthy eating , physical activity , stress reduction and problem-solving skills . Outcomes such as percent change in weight , BMI , and HbA1c concentration were assessed at baseline , 6 and 12 months . A mixed-effects linear regression was applied to test the intervention effect at months 6 and 12 . Data were collected in the period 2012 - 2013 and analysed in 2014 . RESULTS The participant attrition rate was < 5 % ( 2 out of 60 ) at 12 months . There was a significantly greater percent weight loss in the intervention group ( -3.5 vs. -0.1 % ; P = 0.0001 ) at 6 months , which was largely maintained at 12 months ( -3.3 vs. 0.3 % ; P = 0.0003 ) . CONCLUSIONS Participants in a Diabetes Prevention Program-based intervention achieved greater weight loss and improvements in HbA1c concentration than control participants . Evaluation of the Chinese Diabetes Prevention Program curriculum in a larger trial is warranted OBJECTIVE To compare and assess the single and joint effect of diet and exercise intervention for 1 year on insulin resistance and the development leading toward the insulin resistance syndrome . RESEARCH DESIGN AND METHODS An unmasked , r and omized 2 × 2 factorial intervention trial was applied with a duration of 1 year for each participant . The trial comprised 219 men and women with diastolic blood pressure of 86–99 mmHg , HDL cholesterol < 1.20 mmol/l , triglycerides > 1.4 mmol/l , total cholesterol of 5.20–7.74 mmol/l , and BMI > 24 kg/m2 . Participants were r and omly allocated to diet group ( n = 35 ) , diet and exercise group ( n = 67 ) , exercise group ( n = 54 ) , and control group ( n = 43 ) . The diet included increased intake of fish and reduced total fat intake . The exercise program entailed supervised endurance exercise three times a week . Baseline cross-sectional changes and 1-year changes in insulin resistance , fasting serum levels of insulin , C-peptide , proinsulin , glucose , and lipids as well as weight , mean blood pressure , and plasminogen activator inhibitor 1 ( PAI-1 ) values were recorded . RESULTS The cross-sectional results at baseline showed significant correlations between the calculated insulin resistance and BMI ( r = 0.54 ) and correlations between the mean blood pressure ( mBP ) ( r = 0.26 ) and PAI-1 ( r = 0.40 ) . The 1-year diet intervention gave a significant decrease in the calculated insulin resistance from 4.6 to 4.2 and a positive correlation between the changes in insulin resistance and changes in BMI ( r = 0.40 ) . The diet and exercise intervention also led to significantly decreased insulin resistance ( from 5.0 to 4.0 ) . The exercise intervention did not significantly change insulin resistance . CONCLUSIONS The cross-sectional and 1-year intervention results supported each other and underscored the important connection between increased BMI and the development leading toward the insulin resistance syndrome BACKGROUND We hypothesized that favorable changes in dietary patterns would lead to a reduction in body size and an improvement in metabolic status . OBJECTIVE The objective was to study changes in diet patterns relative to changes in body size , blood pressure , and circulating concentrations of lipids , glucose , insulin , adiponectin , and other cytokines in the context of a 1-y r and omized intervention study . DESIGN For 1 y , 187 men aged 45 + /- 2 y , approximately 50 % of whom met the criteria of the metabolic syndrome , were r and omly assigned to a diet protocol ( n = 45 ) , an exercise protocol ( n = 48 ) , a protocol of diet plus exercise ( n = 58 ) , or a control protocol ( n = 36 ) . A previously defined a priori diet score was created by summing tertile rankings of 35 food group variables ; a higher score generally reflected recommended dietary changes in the trial ( mean + /- SD at baseline : 31 + /- 6.5 ; range : 15 - 47 ) . RESULTS Over the study year , the diet score increased by approximately 2 + /- 5.5 in both diet groups , with a decrease of an equivalent amount in the exercise and control groups . The weight change was -3.5 + /- 0.6 kg/10-point change in diet score ( P < 0.0001 ) , similarly within each intervention group , independently of the change in energy intake or baseline age and smoking status . Weight change was attenuated but remained significant after adjustment for intervention group and percentage body fat . Subjects with an increased diet score had more favorable changes in other body size variables , systolic blood pressure , and blood lipid , glucose , insulin , and adiponectin concentrations . Change in diet score was unrelated to resistin and several cytokines . CONCLUSION The change toward a more favorable diet pattern was associated with improved body size and metabolic profile AIM To examine the effect of a brief theory-based health promotion intervention delivered in the community on health behaviour and diabetes-related risk factors among Danish adults at high risk of diabetes . METHODS A r and omised trial was conducted among 127 individuals aged 28 to 70 with fasting plasma glucose : 6.1 - 6.9 mmol/l and /or HbA1c : 6.0-<6.5 % ( 42-<48 mmol/mol ) recruited from general practice in Holstebro , Denmark . Participants were r and omised to a control group or to receive the intervention delivered over four 2h group sessions during five weeks , and two further sessions after one and six months . Question naire data and clinical measures were collected at baseline , three months and one year after intervention . Primary outcomes ; total-fat intake < 30 % of energy intake ; saturated-fat intake < 10 % of energy intake ; fibre-intake ≥15 g/1000 kcal ; weight reduction > 5 % ; changes in physical activity . RESULTS 85 % attended one-year follow-up . After adjusting for gender , age and education , Odds ratio ( OR ) ( 95 % CI ) intervention vs control : total-fat intake < 30 % energy intake : 0.52 ( 0.22;1.20 ) , saturated-fat intake < 10 % energy intake : 1.22 ( 0.52;2.87 ) , fibre intake ≥ 15 g/1000 kcal : 1.18 ( 0.48;2.92 ) , weight reduction > 5 % : 2.47 ( 0.95 ; 6.39 ) . β ( 95 % CI ) between intervention vs control in changes from baseline : IPAQ , MET min/week : -236 ( -2760 ; 2288 ) , waist circumference , cm : -2.5 ( -4.5 ; -0.5 ) ; systolic blood pressure , mmHg : -4.6 ( -8.8 ; -0.3 ) . CONCLUSION A brief theory-based health promotion intervention delivered in the community indicated effect on weight , waist circumference and systolic blood pressure at one year among Danish adults at high risk of diabetes . No effect was shown on diets or physical activity BACKGROUND AND AIM Very low carbohydrate ad libitum diets have been shown to enhance weight loss without increasing cardiometabolic risk factors but no kilojoule-controlled trials have been conducted relative to no intervention . The aim of this study was to compare the changes in weight and other cardiovascular risk factors in 3 isocaloric energy-restricted diets to no-intervention control after 1 year . METHODS AND RESULTS One hundred and thirteen subjects ( age 47 ± 10 years , BMI 32 ± 6 kg/m(2 ) with one additional cardiovascular risk factor ) were r and omly allocated to one of three isocaloric diets ( VLC-very low carbohydrate , 60 % fat , 4 % carbohydrate , n=30 ; VLF-very low fat , 10 % fat , n = 30 ; HUF-high unsaturated fat , 30 % fat , n = 30 ) with intensive support for 3 months followed by minimal support for 12 months compared to a control group ( no intervention , n = 23 ) . The estimated weight change was -3.0 ± 0.2 kg for VLC , -2.0 ± 0.1 kg for VLF , -3.7 ± 0.01 kg for HUF and 0.8 ± 0.5 kg for controls ( P=0.065 ) . After correcting for baseline values , decreases in body weight and diastolic blood pressure in the diet groups ( -2.9 ± 5.2 ) were significantly different to the increase in the control group ( 0.8 ± 5.0 ) ( P<0.05 ) . No differences in cardiovascular risk factors were observed between the diet groups . CONCLUSION Significant cardiometabolic risk factor reduction was observed equally with VLC , VLF and HUF diets after 15 months , compared to an exacerbation of risk factors in the control group . At a modest level of adherence , 3 months of intensive support on these dietary patterns confer an improvement in cardiometabolic profile compared to no dietary intervention after 15 months CONTEXT Prior risk stratification schemes for atrial fibrillation ( AF ) have been based on r and omized trial cohorts or Medicare administrative data bases , have included patients with established AF , and have focused on stroke as the principal outcome . OBJECTIVE To derive risk scores for stroke alone and stroke or death in community-based individuals with new-onset AF . DESIGN , SETTING , AND PARTICIPANTS Prospect i ve , community-based , observational cohort in Framingham , Mass. We identified 868 participants with new-onset AF , 705 of whom were not treated with warfarin at baseline . Risk scores for stroke ( ischemic or hemorrhagic ) and stroke or death were developed with censoring when warfarin initiation occurred during follow-up . Event rates were examined in low-risk individuals , as defined by the risk score and 4 previously published risk schemes . MAIN OUTCOME MEASURES Stroke and the combination of stroke or death . RESULTS During a mean follow-up of 4.0 years free of warfarin use , stroke alone occurred in 83 participants and stroke or death occurred in 382 participants . A risk score for stroke was derived that included the following risk predictors : advancing age , female sex , increasing systolic blood pressure , prior stroke or transient ischemic attack , and diabetes . With the risk score , 14.3 % of the cohort had a predicted 5-year stroke rate < or = 7.5 % ( average annual rate < or = 1.5 % ) , and 30.6 % of the cohort had a predicted 5-year stroke rate < or = 10 % ( average annual rate < or = 2 % ) . Actual stroke rates in these low-risk groups were 1.1 and 1.5 per 100 person-years , respectively . Previous risk schemes classified 6.4 % to 17.3 % of subjects as low risk , with actual stroke rates of 0.9 to 2.3 per 100 person-years . A risk score for stroke or death is also presented . CONCLUSION These risk scores can be used to estimate the absolute risk of an adverse event in individuals with AF , which may be helpful in counseling patients and making treatment decisions BACKGROUND TCF7L2 is the strongest locus linked to type 2 diabetes that has been identified thus far , and rs7903146 is the most significantly associated variant . Few intervention studies have shown that it has negative effects on metabolic improvement after lifestyle programs . OBJECTIVE Our objective was to assess the effects of this variant on lifestyle intervention-induced  changes in glucose values and metabolic variables at 1- and 4-y follow-ups . DESIGN The rs7903146 variant was genotyped in 335 nondiabetic , dysmetabolic participants in a r and omized lifestyle intervention trial . RESULTS Subjects with the unfavorable TT genotype showed higher values of fasting glucose and lower homeostasis model assessment of beta cell function at baseline . Lifestyle modifications were successful in the amelioration of metabolic traits in all genetic subgroups after 1 y. At 4-y follow-up most of the metabolic benefits had disappeared . In a multiple regression model , values for glucose and homeostasis model assessment of beta cell function at 4 y were significantly associated with the T allele ( for glucose and homeostasis model assessment s , respectively : beta = 6.6 ; 95 % CI : 2.5 , 10.7 ; P = 0.001 ; and beta = -0.37 ; 95 % CI : -0.54 , -0.20 ; P < 0.001 ) but not with intervention . There was no interaction between genotype and intervention . After 1 y , impaired fasting glucose and diabetes incidence were inversely associated with intervention . After 4 y , the presence of a T allele was associated with impaired fasting glucose ( odds ratio : 3.04 ; 95 % CI : 1.53 , 6.04 ; P = 0.001 ) and diabetes ( odds ratio : 2.63 ; 95 % CI : 1.00 , 6.96 ; P = 0.05 ) but not with intervention . CONCLUSIONS Lifestyle modifications improved the metabolic pattern in all genetic subgroups . At the end of the trial , however , weight gain occurred , and carriers of the T allele developed first hyperglycemia and decreased insulin secretion , which suggests the need for different " after-care " preventive approaches tailored to each genotype 's metabolic risk CONTEXT Obesity is an independent risk factor for cardiovascular disease , which may be mediated by increased secretion of proinflammatory cytokines by adipose tissue . OBJECTIVE To determine the effect of a program of changes in lifestyle design ed to obtain a sustained reduction of body weight on markers of systemic vascular inflammation and insulin resistance . DESIGN AND SETTING R and omized single-blind trial conducted from February 1999 to February 2002 at a university hospital in Italy . PATIENTS One hundred twenty premenopausal obese women ( body mass index > or = 30 ) aged 20 to 46 years without diabetes , hypertension , or hyperlipidemia . INTERVENTIONS The 60 women r and omly assigned to the intervention group received detailed advice about how to achieve a reduction of weight of 10 % or more through a low-energy Mediterranean-style diet and increased physical activity . The control group ( n = 60 ) was given general information about healthy food choices and exercise . MAIN OUTCOME MEASURES Lipid and glucose intake ; blood pressure ; homeostatic model assessment of insulin sensitivity ; and circulating levels of interleukin 6 ( IL-6 ) , interleukin 18 ( IL-18 ) , C-reactive protein ( CRP ) , and adiponectin . RESULTS After 2 years , women in the intervention group consumed more foods rich in complex carbohydrates ( 9 % corrected difference ; P<.001 ) , monounsaturated fat ( 2 % ; P = .009 ) , and fiber ( 7 g/d ; P<.001 ) ; had a lower ratio of omega-6 to omega-3 fatty acids ( -5 ; P<.001 ) ; and had lower energy ( -310 kcal/d ; P<.001 ) , saturated fat ( -3.5 % ; P = .007 ) , and cholesterol intake ( -92 mg/d ; P<.001 ) than controls . Body mass index decreased more in the intervention group than in controls ( -4.2 ; P<.001 ) , as did serum concentrations of IL-6 ( -1.1 pg/mL ; P = .009 ) , IL-18 ( -57 pg/mL ; P = .02 ) , and CRP ( -1.6 mg/L ; P = .008 ) , while adiponectin levels increased significantly ( 2.2 microg/mL ; P = .01 ) . In multivariate analyses , changes in free fatty acids ( P = .008 ) , IL-6 ( P = .02 ) , and adiponectin ( P = .007 ) levels were independently associated with changes in insulin sensitivity . CONCLUSION In this study , a multidisciplinary program aim ed to reduce body weight in obese women through lifestyle changes was associated with a reduction in markers of vascular inflammation and insulin resistance OBJECTIVE To investigate the correlation between lifestyle improvements , in particular increased cardio-respiratory fitness and changes in the blood lipid profile . METHODS The participants were 217 residents of Fuji and Yamato Towns , Saga City , with mildly abnormal blood pressure , serum lipids or blood glucose detected at health check-ups in 2003 . Participants were r and omly allocated to an Intervention  ( 108 subjects ) or  Control group ( 109 subjects ) , matched for age and various conditions . The Intervention group was given exercise advice and prescription and dietary instructions . Cardio-respiratory fitness was evaluated using the work rate at double product breaking point . Changes of lipid parameters were compared before and after intervention , and examined the relationship with cardio-respiratory fitness . RESULTS Seventy nine subjects in each group could be followed up for 17 months without requiring pharmacotherapy . Body mass index , waist circumference , systolic blood pressure , homeostasis model assessment insulin resistance , and triglycerides were decreased in the Intervention group . Furthermore , apolipoprotein B levels were lower ( p<0.05 ) , and the ratio of LDL cholesterol to apolipoprotein B ( LDL/ApoB ) was higher ( p<0.001 ) . When all subjects were divided into 3 subgroups according to the degree of improvement in cardio-respiratory fitness , LDL/ApoB increased and apolipoprotein B decreased as the degree of improvement increased ( p<0.05 ) . CONCLUSION Improvement was seen in atherosclerotic risk factors through lifestyle modification . In particular , improved cardiorespiratory fitness was associated with qualitative and quantitative changes in LDLs Background / Objectives : Short-term studies have suggested beneficial effects of a Palaeolithic-type diet ( PD ) on body weight and metabolic balance . We now report the long-term effects of a PD on anthropometric measurements and metabolic balance in obese postmenopausal women , in comparison with a diet according to the Nordic Nutrition Recommendations (NNR).Subjects/ Methods : Seventy obese postmenopausal women ( mean age 60 years , body mass index 33 kg/m2 ) were assigned to an ad libitum PD or NNR diet in a 2-year r and omized controlled trial . The primary outcome was change in fat mass as measured by dual-energy X-ray absorptiometry . Results : Both groups significantly decreased total fat mass at 6 months ( −6.5 and −2.6 kg ) and 24 months ( −4.6 and −2.9 kg ) , with a more pronounced fat loss in the PD group at 6 months ( P<0.001 ) but not at 24 months ( P=0.095 ) . Waist circumference and sagittal diameter also decreased in both the groups , with a more pronounced decrease in the PD group at 6 months ( −11.1 vs−5.8 cm , P=0.001 and −3.7 vs−2.0 cm , P<0.001 , respectively ) . Triglyceride levels decreased significantly more at 6 and 24 months in the PD group than in the NNR group ( P<0.001 and P=0.004 ) . Nitrogen excretion did not differ between the groups . Conclusions : A PD has greater beneficial effects vs an NNR diet regarding fat mass , abdominal obesity and triglyceride levels in obese postmenopausal women ; effects not sustained for anthropometric measurements at 24 months . Adherence to protein intake was poor in  the PD group . The long-term consequences of these changes remain to be studied The aim of this work was to determine whether the effects of weight loss on coronary heart disease ( CHD ) risk factors are comparable in men and women and whether the long term impact of modest weight loss is as great as the initial response . Changes in CHD risk factors were examined at 6 month intervals in 159 moderately overweight subjects who were participating in an 18 month behavioral weight loss program .  Men experienced greater decreases in blood pressure , triglycerides , and waist-to-hip ratio ( WHR ) and greater increases in HDL-cholesterol with weight loss than women . Most of these gender differences were removed by adjusting for baseline values and changes in BMI . After these adjustments , improvements in WHR at 18 months were shown to be greater in women than in men . Participants ( n = 39 ) who lost 4.5 kg or more from baseline to 6 months ( mean weight loss of 11.8 kg or 13 % of initial body weight ) and maintained this weight loss within + /- 2.3 kg had significant long term improvements ( through 18 months ) in triglycerides , HDL and LDL-cholesterol , WHR , systolic and diastolic blood pressure , and fasting and 2 h insulin . Changes in HDL-cholesterol , the HDL : Total cholesterol ratio , and WHR actually increased between 6 and 18 months and improvements in all other parameters were maintained over time . Men have greater improvements in CHD risk factors with weight loss than women , but this gender difference appears to derive from differences in CHD risk factors at baseline and differences in weight loss . ( ABSTRACT TRUNCATED AT 250 WORDS OBJECTIVES We tested the effectiveness of a community-based , literacy-sensitive , and culturally tailored lifestyle intervention on weight loss and diabetes risk reduction among low-income , Spanish-speaking Latinos at increased diabetes risk . METHODS Three hundred twelve participants from Lawrence , Massachusetts , were r and omly assigned to lifestyle intervention care ( IC ) or usual care ( UC ) between 2004 and 2007 . The intervention was implemented by trained Spanish-speaking individuals from the community . Each participant was followed for 1 year . RESULTS The participants ' mean age was 52 years ; 59 % had less than a high school education . The 1-year retention rate was 94 % . Compared with the UC group , the IC group had a modest but significant weight reduction ( -2.5 vs 0.63 lb ; P = .04 ) and a clinical ly meaningful reduction in hemoglobin A1c ( -0.10 % vs -0.04 % ; P = .009 ) . Likewise , insulin resistance improved significantly in the IC compared with the UC group . The IC group also had greater reductions in percentage of calories from total and saturated fat . CONCLUSIONS We developed an inexpensive , culturally sensitive diabetes prevention program that result ed in weight loss , improved HbA1c , and improved insulin resistance in a high-risk Latino population OBJECTIVE To evaluate the impact of a low-cost nutritional intervention in changing the lifestyle of adults . DESIGN R and omised clinical trial . SETTING Primary health-care centre in São José do Rio Preto , São Paulo State , Brazil . SUBJECTS We r and omly assigned 104 adults ( 83 women and 21 men aged 30 - 65 years , body mass index 24 - 35 kg m(-2 ) , non-diabetic ) into two groups : nutrition counselling and control . Each subject in the intervention group received three individualised nutritional counselling sessions during the first 6 months aim ed at increasing intakes of fruits , vegetables and olive oil , reducing saturated fat and improving physical activity .  Body composition , biochemical indicators and lifestyle were assessed at baseline and at 6 months and 1 year in both groups . RESULTS After 6 months of follow-up , body weight , waist circumference , diastolic blood pressure , fasting blood glucose , total and low-density lipoprotein cholesterol , total and saturated fat , and dietary energy and cholesterol levels showed a more significant decrease among subjects in the intervention group than in the control group ( P < 0.05 ) . Moreover , the intervention group showed significantly greater improvement in each intervention goal , such as reduced intake of saturated fat and increased intakes of fruits , vegetables , fibre and olive oil ( P < 0.05 ) . After 12 months of follow-up , most of the outcomes were maintained . CONCLUSIONS The low-cost nutritional intervention programme improved serum lipids profile and weight control , and appeared to be feasible for use at a primary health-care centre in a developing country Objective To develop and evaluate the effectiveness of a community behavioural intervention to prevent weight gain and improve health related behaviours in women with young children . Design Cluster r and omised controlled trial . Setting A community setting in urban Australia . Participants 250 adult women with a mean age of 40.39 years ( SD 4.77 , range 25 - 51 ) and a mean body mass index of 27.82 kg/m2 ( SD 5.42 , range 18 - 47 ) were recruited as clusters through 12 primary ( elementary ) schools . Intervention Schools were r and omly assigned to the intervention or the control . Mothers whose schools fell in the intervention group ( n=127 ) attended four interactive group sessions that involved simple health messages , behaviour change strategies , and group discussion , and received monthly support using mobile telephone text messages for 12 months . The control group ( n=123 ) attended one non-interactive information session based on population dietary and physical activity guidelines . Main outcome measures The main outcome measures were weight change and difference in weight change between the intervention group and the control group at 12 months . Secondary outcomes were changes in serum concentrations of fasting lipids and glucose , and changes in dietary behaviours , physical activity , and self management behaviours . Results All analyses were adjusted for baseline values and the possible clustering effect . Women in the control group gained weight over the 12 month study period ( 0.83 kg , 95 % confidence interval ( CI ) 0.12 to 1.54 ) , whereas those in the intervention group lost weight ( −0.20 kg , −0.90 to 0.49 ) . The difference in weight change between the intervention group and the control group at 12 months was −1.13 kg ( −2.03 to −0.24 kg ; P<0.05 ) on the basis of observed values and −1.11 kg ( −2.17 to −0.04 ) after multiple imputation to account for possible bias created by missing values . Secondary analyses after multiple imputation showed a difference in the intervention group compared with the control group for total cholesterol concentration ( −0.35 mmol/l , −0.70 to −0.001 ) , self management behaviours ( diet score 0.18 , 0.13 to 0.33 ; physical activity score 0.24 , 0.05 to 0.43 ) , and confidence to control weight ( 0.40 , 0.11 to 0.69 ) . Regular self weighing was associated with weight loss in the intervention group only ( −1.98 kg , −3.75 to −0.23 ) . Conclusions Weight gain  in women with young children could be prevented using a low intensity self management intervention delivered in a community setting . Self management of health behaviours improved with the intervention . The response rate of 12 % , although comparable with that in other community studies , might limit the ability to generalise to other population s. Trial registration Australian New Zeal and Clinical Trials Registry number ACTRN12608000110381 OBJECTIVES We evaluated a community-based , translational lifestyle program to reduce diabetes risk in lower-socioeconomic status ( SES ) and ethnic minority adults . METHODS Through an academic-public health department partnership , community-dwelling adults at risk for diabetes were r and omly assigned to individualized lifestyle counseling delivered primarily via telephone by health department counselors or a wait-list control group . Primary outcomes ( 6 and 12 months ) were fasting glucose level , triglycerides , high- and low-density lipoprotein cholesterol , weight , waist circumference , and systolic blood pressure . Secondary outcomes included diet , physical activity , and health-related quality of life . RESULTS Of the 230 participants , study retention was 92 % . The 6-month group differences for weight and triglycerides were significant . The intervention group lost 2 pounds more than did the control group ( P=.03 ) and had decreased triglyceride levels ( difference in change , 23 mg/dL ; P=.02 ) . At 6 months , the intervention group consumed 7.7 fewer grams per day of fat ( P=.05 ) and more fruits and vegetables ( P=.02 ) than did control participants . CONCLUSIONS Despite challenges design ing effective translational interventions for lower-SES and minority communities , this program modestly improved some diabetes risk factors . Thus , individualized , telephone-based models may be a promising alternative to group-based interventions OBJECTIVE Although the benefits of in-person Diabetes Prevention Program ( DPP ) classes for diabetes prevention have been demonstrated in trials , effectiveness in clinical practice is limited by low participation rates . This study explores whether text message support enhances weight loss in patients offered DPP classes . RESEARCH DESIGN AND METHODS English- and Spanish-speaking patients with prediabetes ( n = 163 ) were r and omized to the control group , which only received an invitation to DPP classes as defined by the Centers for Disease Control and Prevention , or to the text message – augmented intervention group , which also received text messages adapted from the DPP curriculum for 12 months .  RESULTS Mean weight decreased 0.6 pounds ( 95 % CI −2.7 to 1.6 ) in the control group and 2.6 pounds ( 95 % CI −5.5 to 0.2 ) in the intervention group ( P value 0.05 ) . Three percent weight loss was achieved by 21.5 % of participants in the control group ( 95 % CI 12.5–30.6 ) , compared with 38.5 % in the intervention group ( 95 % CI 27.7–49.3 ) ( absolute difference 17.0 % ; P value 0.02 ) . Mean glycated hemoglobin ( HbA1c ) increased by 0.19 % or 2.1 mmol/mol ( 95 % CI −0.1 to 0.5 % ) and decreased by 0.09 % or 1.0 mmol/mol ( 95 % CI −0.2 to 0.0 % ) in the control group and intervention participants , respectively ( absolute difference 0.28 % ; P value 0.07 ) . Stratification by language demonstrated a significant treatment effect in Spanish speakers but not in English speakers . CONCLUSIONS Text message support can lead to clinical ly significant weight loss in patients with prediabetes . Further study assessing effect by primary language and in an operational setting is warranted BACKGROUND The Arizona Well-Integrated Screening and Evaluation for Women Across the Nation ( WISEWOMAN ) project used provider counseling , health education , and community health workers ( CHWs ) to target chronic disease risk factors in uninsured , primarily Hispanic women over age 50 . METHODS Participants were recruited from two Tucson clinics participating in the National Breast and Cervical Cancer Early Detection Program ( NBCCEDP ) . Women were r and omly assigned into one of three intervention groups : ( 1 ) provider counseling , ( 2 ) provider counseling and health education , or ( 3 ) provider counseling , health education , and CHW support . At baseline and 12 months ( 1998 - 2000 ) , participants were measured for height , weight , waist and hip circumference , and blood pressure . Blood tests were conducted to check blood glucose , cholesterol , and triglyceride levels . At each time point , participants also completed 24-hour dietary recalls and question naires focusing on their physical activity levels . RESULTS A total of 217 women participated in baseline and 12-month follow-up . Three fourths were Hispanic . All three intervention groups showed an increase in self-reported weekly minutes of moderate-to-vigorous physical activity , with no significant differences between the groups . Significantly more women who received the comprehensive intervention of provider counseling , health education , and CHW support progressed to eating five fruits and vegetables per day , compared with participants who received only provider counseling or provider counseling plus health education . CONCLUSIONS All three interventions increased moderate-to-vigorous physical activity but not fruit and vegetable consumption . The intervention group with provider counseling , health education , and CHW support significantly increased the number of women meeting national recommendations for fruit and vegetable consumption BACKGROUND A number of factors contribute to increased risk of coronary heart disease ( CHD ) among postmenopausal women , including atherogenic changes in serum cholesterol profiles , weight gain , and decreases in physical activity during the menopause . To date , no study has attempted to prevent elevations in primary CHD risk factors as women experience menopause . METHODS A sample of 535 healthy premenopausal women , ages 44 - 50 , were recruited for an ongoing 5-year r and omized prevention trial testing whether increases in low-density lipoprotein cholesterol ( LDL-C ) and body weight can be prevented during the menopause with a dietary and behavioral intervention . The aim was to reduce total dietary and saturated fat and cholesterol , prevent weight gain , and increase physical activity levels . Changes in CHD risk factors after the first 6 months of treatment were analyzed comparing 253 intervention and 267 assessment -only control participants . RESULTS The intervention group showed significant reductions in total cholesterol ( -0.34 mmol/liter ) , LDL-C ( -0.28 mmol/liter ) , triglycerides ( -0.04 mmol/liter ) , weight ( -4.8 kg ) , waist-hip ratio ( -0.008 ) , systolic blood pressure ( -3.5 mm Hg ) , diastolic blood pressure ( -2.2 mm Hg ) , serum glucose levels ( -0.06 mmol/liter ) , and HDL-C ( -0.06 mmol/liter ) and significant increases in physical activity ( + 383 kcal ) . No significant changes were observed in the control group . CONCLUSION Six-month results suggested that participants were receptive to the preventive approach to CHD risk reduction and were successful in making initial positive lifestyle changes . Follow-up data will evaluate long-term adherence to the intervention and the interaction between adherence and physiological changes during menopause OBJECTIVES This study examined the health-related effects of two worksite interventions , physical exercise and reduced workhours , on women employed in dentistry . METHODS Six workplaces were r and omized to one of the following three conditions : ( i ) 2.5 hours of weekly , m and atory physical exercise of middle-to-high intensity to be performed during workhours ( N=62 ) , ( ii ) a reduction of full-time weekly workhours from 40 to 37.5 hours ( N=50 ) , and ( iii ) reference . In all , 177 women participated . Biomarkers and self-ratings in question naires were obtained before the intervention ( T ( 1 ) ) , and six ( T ( 2 ) ) and 12 months ( T ( 3 ) ) after the intervention . RESULTS The results showed increased levels of physical activity and exercise in all of the groups , the level of physical exercise being significantly greater in the physical exercise group . Repeated- measures analyses of variance using data from T ( 1 ) and T (3)for biological measures and all three time points for self-ratings produced significant interaction effects for glucose , waist-to-hip ratio , and work ability and clear trends for general symptoms and upper-extremity disorders . Posthoc analyses showed that the results of the health-related measures differed between the interventions , decreased glucose and upper-extremity disorders in the exercise group , and increased high-density lipoprotein and waist-to-hip ratio among those working reduced hours . CONCLUSIONS These results show that the two interventions had small and varied effects on biomarkers and self-reports of different aspects of health among women . It is suggested that interventions involving a modest reduction in workhours seem to be more effective if these hours are used for physical exercise BACKGROUND AND AIMS Improvements in a lifestyle modification program for hypertensives were maintained 1 year later . Longer follow-up in such studies is limited ; we therefore re-assessed participants after an additional 2 years in which there was no contact with program facilitators . METHODS AND RESULTS Participants r and omised to usual care ( N=118 ) or a 4-month lifestyle program ( N=123 ) were previously assessed after 4 months and 1 year . After a further 2 years , diet , alcohol intake , physical activity , weight , waist girth , ambulatory blood pressure ( BP ) , blood lipids , glucose and insulin were measured ( usual care N=64 ; program N=76 ) . Statistically significant net changes , relative to usual care , included blood cholesterol ( -0.2 mmol/L , 95 % CI 0.1 - 0.4 ) ; physical activity ( 53 min/week , 95 % CI 15 - 91 ) ; dietary saturated fat ( -1.9 % energy , 95 % CI -0.1 to -3.8 ) ; fish ( 3.2 serves/month , 95 % CI 0.7 - 5.7 ) ; vegetables ( 9.1 serves/month , 95 % CI 3.2 - 15.1 ) ; and sweet foods ( -6.2 serves/month , 95 % CI -1.1 to -11.3 ) . Between-group changes in weight ( -0.7 kg , 95 % CI -1.8 - 0.4 ) , BP ( systolic 1.4 mmHg , 95 % CI -0.7 - 3.5)/diastolic 1.0 mmHg , 95 % CI -0.3 - 2.4 ) and Framingham risk ( usual care : men 12.1 % , women 3.7 % ; program : men 12.2 % ; women 3.5 % ) did not differ significantly . CONCLUSION Continued reinforcement with long-term follow-up is needed in lifestyle modification programs BACKGROUND Lifestyle interventions among people with impaired glucose tolerance reduce the incidence of diabetes , but their effect on all-cause and cardiovascular disease mortality is unclear . We assessed the long-term effect of lifestyle intervention on long-term outcomes among adults with impaired glucose tolerance who participated in the Da Qing Diabetes Prevention Study . METHODS The study was a cluster r and omised trial in which 33 clinics in Da Qing , China-serving 577 adults with impaired glucose tolerance-were r and omised ( 1:1:1:1 ) to a control group or lifestyle intervention groups ( diet or exercise or both ) . Patients were enrolled in 1986 and the intervention phase lasted for 6 years . In 2009 , we followed up participants to assess the primary outcomes of cardiovascular mortality , all-cause mortality , and incidence of diabetes in the intention-to-treat population . FINDINGS Of the 577 patients , 439 were assigned to the intervention group and 138 were assigned to the control group ( one refused baseline examination ) . 542 ( 94 % ) of 576 participants had complete data for mortality and 568 ( 99 % ) contributed data to the analysis . 174 participants died during the 23 years of follow-up ( 121 in the intervention group vs 53 in the control group ) . Cumulative incidence of cardiovascular disease mortality was 11.9 % ( 95 % CI 8.8 - 15.0 ) in the intervention group versus 19.6 % ( 12.9 - 26.3 ) in the control group ( hazard ratio [ HR ] 0.59 , 95 % CI 0.36 - 0.96 ; p=0.033 ) . All-cause mortality was 28.1 % ( 95 % CI 23.9 - 32.4 ) versus 38.4 % ( 30.3 - 46.5 ; HR 0.71 , 95 % CI 0.51 - 0.99 ; p=0.049 ) . Incidence of diabetes was 72.6 % ( 68.4 - 76.8 ) versus 89.9 % ( 84.9 - 94.9 ; HR 0.55 , 95 % CI 0.40 - 0.76 ; p=0.001 ) . INTERPRETATION A 6-year lifestyle intervention programme for Chinese people with impaired glucose tolerance can reduce incidence of cardiovascular and all-cause mortality and diabetes . These findings emphasise the long-term clinical benefits of lifestyle intervention for patients with impaired glucose tolerance and provide further justification for adoption of lifestyle interventions as public health measures to control the consequences of diabetes . FUNDING Centers for Disease Control and Prevention , WHO , the China-Japan Friendship Hospital , Da Qing First Hospital Although the Diabetes Prevention Program ( DPP ) developed a lifestyle weight loss intervention that has been demonstrated to prevent type 2 diabetes in high-risk individuals , it has yet to be widely adopted at the community level . The Healthy Living Partnership to Prevent Diabetes study ( HELP PD ) was design ed to translate the DPP approach for use in community setting s as a cost-effective intervention led by Community Health Workers ( CHW 's ) and administered through a Diabetes Care Center ( DCC ) . Approximately 300 overweight and obese ( BMI 25 - 40 kg/m(2 ) ) individuals with prediabetes ( fasting blood glucose 95 - 124 mg/dl ) were r and omly assigned to either a lifestyle weight loss intervention ( LW ) or an enhanced usual care comparison condition ( UC ) . The goal of LW is > or=7 % weight loss achieved through increases in physical activity ( 180 min/wk ) and decreases in caloric intake ( approximately 1500 kcal/day ) . The intervention consists of CHW-led group-mediated cognitive behavioral meetings that occur weekly for 6 months and monthly thereafter for 18 months . UC consists of 2 individual meetings with a registered dietitian and a monthly newsletter . The primary outcome is change in fasting blood glucose . Secondary outcomes include cardiovascular risk factors , health-related quality of life , and social cognitive variables . Outcomes are masked and are collected every 6 months . The cost-effectiveness of the program will also be assessed . A community-based program that is administered through local DCC 's and that harnesses the experience of community members ( CHW 's ) may be a promising strategy for the widespread dissemination of interventions effective at preventing type 2 diabetes in high risk individuals The authors investigated the efficacy of a lifestyle educational program , organized in small group meetings , in improving the outcome of a nonpharmacologic intervention .  One hundred and eighty-eight hypertensive patients with stable blood pressure ( BP ) levels and drug therapy in the previous 6 months were r and omly divided into educational care ( EC ) and usual care ( UC ) groups . They were followed at 3-month intervals up to 2 years . In addition to the visits in an outpatient clinic , patients in the EC program participated in small group meetings in order to improve their knowledge of the disease and reinforce their motivation for treatment . At baseline , EC and UC groups were similar for age , sex , body mass index ( BMI ) , blood pressure ( BP ) levels , and pharmacologic treatment . Patients in the EC group had significantly reduced total energy , total and saturated fats , and sodium intake . Physical activity was significantly increased in the EC group as well . At the end of the 1-year follow-up , BMI ( P<.001 ) , visceral fat ( P<.001 ) , and BP ( P<.001 ) were significantly lower in the EC group compared with the UC group . Pharmacologic treatment during the study was similar for all classes of drugs apart from diuretics whose dose was higher in the UC group at the end of the study Purpose The purpose of this study is to evaluate the effectiveness of a nutrition-based shared medical appointment ( SMA ) intervention in the treatment of prediabetes compared to the individualized counseling st and ard of care . Methods A r and omized controlled trial design comparing health outcomes in patients with prediabetes attending either an individualized counseling ( control group ) or three 90-minute nutrition SMA ( intervention group ) sessions .  Demographic , anthropometric ( weight and body mass index ) , clinical ( blood pressure ) , and biochemical ( lipid profile , fasting blood sugar , glycated hemoglobin , albumin-to-creatinine ratio ) measures were obtained from all participants at baseline , at 3 months , and at 1 year . Results Ninety-four participants were r and omized into the 2 study groups with a 69 % completion rate at 1 year ( n = 34 SMA , n = 31 control ) . The average participant was Caucasian ( 64 % ) , male ( 54 % ) , 58.3 ± 9.6 years , had a BMI of 30.8 ± 4.9 kg/m2 ( obese ) , and fasting blood glucose of 109 ± 9.5 mg/dL. The SMA and control participants lost a mean of 6.6 pounds and 3.6 pound , respectively ; neither group met the 5 % modest weight loss expected . The SMA and control group experienced a mean drop in fasting blood glucose of 6 mg/dL. Conclusions As dem and s on health care providers continue to rise , finding innovative ways to manage the patient load while providing quality health care is increasingly important . SMA health outcomes were equivalent to individual counseling outcomes , while increasing the provider ’s productivity by treating 6 to 8 people with prediabetes in 90 minutes compared to 1 patient in 60 minutes
target: Similar effects also appeared in SBP and DBP categories regardless of follow-up duration .
  PA+D interventions had larger improvement effects on CVD risk factors than PA alone interventions .
  In adults without IGT or diabetes , lifestyle interventions result ed in significant improvements in SBP , DBP , TC , LDL-C , HDL-C , and TG , and might further reduce CVD risk
background: Structured lifestyle interventions can reduce diabetes incidence and cardiovascular disease ( CVD ) risk among persons with impaired glucose tolerance ( IGT ) , but it is unclear whether they should be implemented among persons without IGT .
  We conducted a systematic review and meta-analyses to assess the effectiveness of lifestyle interventions on CVD risk among adults without IGT or diabetes .