Long-term weight loss and improved intermediate cardiovascular outcomes associated with a Mediterranean-style diet in high-risk participants with diabetes: findings from the Heart Healthy Lenoir Project
Public Deposited- Last Modified
- February 28, 2019
- Creator
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Embree, Genevieve
- Affiliation: Gillings School of Global Public Health, Public Health Leadership Program
- Abstract
- Objective: To determine whether a lifestyle intervention promoting a Mediterranean-style diet and physical activity results in improved lifestyle behaviors and weight loss among participants residing in the "stroke belt" of the Southeastern United States, where the rates of cardiovascular disease are disproportionately high, particularly among people with diabetes and African Americans. Research Design and Methods: The study was designed as a two-year prospective cohort study to evaluate the lifestyle intervention with an embedded randomized controlled trial (RCT) of a maintenance weight loss intervention during the second year. There were three phases of the study. Phase I (6 months long) was an individually-tailored lifestyle intervention promoting a Mediterranean-style dietary pattern and increased walking. Phase II (also 6 months long) included an optional 16-week weight loss intervention for participants whose BMI was at least 25 kg/m2 or a maintenance of lifestyle intervention for all others. Phase III (12 months long) included optional participation in a maintenance of weight loss RCT for participants who lost at least 8 lbs or the maintenance of lifestyle intervention for all others. The Phase II weight loss intervention was offered in two formats: 16 weekly group sessions or 5 group sessions and 10 phone calls. Changes in lifestyle behaviors, physiologic cardiovascular intermediate outcomes, and weight were assessed at 6, 12, and 24 month follow-up visits and analyzed to determine differences by diabetes status and then by race within those groups. Results: Baseline characteristics (n=339): mean age 56, 77% female, 65% black, 37% had diabetes; mean weight was 103kg for those with diabetes, 95kg for those without diabetes. Outcomes: Participants with diabetes reported increased walking and activity times at 24 months, particularly among blacks. Systolic and diastolic blood pressures were reduced by over 8 mmHg at 24 months among black participants with diabetes. Participants with diabetes demonstrated greater weight loss than those without diabetes; those with diabetes lost an average of 1.2 kg, 1.5 kg, and 3.7 kg at 6, 12, and 24 months, respectively. The intervention was highly acceptable in this population. Conclusions: Overall, participants with diabetes achieved a 3.7 kg sustained weight loss at 24 months. The study interventions also led to improved blood pressure, physical activity, diet quality, and a trend toward improvement in hemoglobin A1c among participants with diabetes. Further study of the lifestyle intervention is warranted with a RCT.
- Date of publication
- May 2016
- DOI
- Resource type
- Rights statement
- In Copyright
- Note
- Paper type: Research or research design
- Track: HC&P
- Advisor
- Viera, Anthony
- Reviewer
- Keyserling, Thomas
- Degree
- Master of Public Health
- Degree granting institution
- University of North Carolina at Chapel Hill
- Graduation year
- 2016
- Language
- Deposit record
- ad8cc9f5-7bd1-420e-ae3d-97bb34046766
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This work has no parents.
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