Pragmatic lifestyle changes could reduce cardiometabolic risk in a young population
medwireNews: A study has found that a pragmatic lifestyle modification program can significantly reduce predictors of cardiometabolic disease in a young, urban, at-risk South Asian population.
Janaka Karalliedde (King’s College London, UK) and colleagues take the view that, “in South Asian subjects, who are known to be at enhanced and premature risk of [type 2 diabetes] and [cardiovascular disease], early interventions that can delay or prevent onset of cardio-metabolic endpoints are of clinical importance.”
The researchers randomly assigned 4672 healthy Sri Lankan participants aged 6–40 years with two or more of four risk factors (parental family history of type 2 diabetes, physical inactivity, raised body mass index [BMI], or increased waist circumference) to attend a pragmatic lifestyle modification program every 3 months (P-LSM) or every 12 months (control group).
The programs were identical, with peer educators delivering one-to-one advice on the importance of a healthy diet and lifestyle, with the aim of reducing weight, encouraging regular exercise, and managing psychosocial stress. The primary endpoint was a composite of cardiometabolic risk predictors, comprising new-onset diabetes, hypertension, impaired glucose tolerance (IGT), impaired fasting glycemia (IFG), and markers of cardiorenal disease.
The participants were followed up for a median of 3 years, during which time 479 of 1726 participants in the P-LSM group versus 561 of 1813 in the control group met the primary composite endpoint, representing 74 versus 96 per 1000 person–years, respectively, and a significant incidence rate ratio of 0.89.
Post-hoc analyses found that new-onset dysglycemia, comprising type 2 diabetes, IFG, and IGT, was the major contributor to cardiometabolic risk and was significantly reduced in the P-LSM group compared with the control group, with an incidence rate ratio of 0.90.
“Interestingly, the beneficial effects of P-LSM on the primary composite cardiometabolic endpoint, new-onset [type 2 diabetes mellitus], new IGT and hypertension were observed in participants below 18 years of age,” write Karalliedde and colleagues in BMC Medicine.
For the 1725 participants of this age, the incidence was 48.0 per 1000 person–years in the P-LSM group, compared with 55.4 per 1000 person–years in the control group, giving a significant incidence rate ratio of 0.83.
The researchers speculate that “this younger population may be more ‘responsive’ and amenable to change compared to older participants, particularly when [the intervention is] delivered by peers.”
They continue: “Importantly, any reduction in the future risk of dysglycaemia and hypertension would be of significant health impact, especially in view of the growing worldwide burden of cardio-metabolic disease in younger populations.”
This study, say the researchers, “highlights the importance of early intervention and establishes the proof of concept and rationale for further pragmatic lifestyle modification intervention studies in young South Asian participants at risk of cardio-metabolic disease.”
By Catherine Booth
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