Effect of lifestyle interventions on cardiovascular risk factors among adults without impaired glucose tolerance or diabetes: A systematic review and metaanalysis

• Authors: Xuanping Zhang, National Center for Chronic Disease Prevention and Health Promotion; Heather M. Devlin, National Center for Chronic Disease Prevention and Health Promotion; Bryce Smith, National Center for Chronic Disease Prevention and Health Promotion; Giuseppina Imperatore, National Center for Chronic Disease Prevention and Health Promotion; William Thomas, Centers for Disease Control and Prevention; Felipe Lobelo, Emory University; Mohammed Ali, Emory University; Keri Norris, Fulton-DeKalb Hospital Authority; Stephanie Gruss, National Center for Chronic Disease Prevention and Health Promotion; Barbara Bardenheier, National Center for Chronic Disease Prevention and Health Promotion; Pyone Cho, National Center for Chronic Disease Prevention and Health Promotion; Isabel Garcia De Quevedo, National Center for Chronic Disease Prevention and Health Promotion; Uma Mudaliar, Rollins School of Public Health; Christopher D. Jones, National Center for Chronic Disease Prevention and Health Promotion; Jeffrey M. Durthaler, National Center for Chronic Disease Prevention and Health Promotion; Jinan Saaddine, National Center for Chronic Disease Prevention and Health Promotion; Linda S. Geiss, National Center for Chronic Disease Prevention and Health Promotion; Edward W. Gregg, National Center for Chronic Disease Prevention and Health Promotion
• Journal Title: PLoS ONE
• Volume: Volume 12, Number 5
• Publisher: Public Library of Science | 2017-05-01, Pages e0176436-e0176436
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1371/journal.pone.0176436
• Subjects: Health Sciences, Medicine and Surgery; Health Sciences, Public Health

Abstract

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. We systematically searched MEDLINE, EMBASE, CINAHL, Web of Science, the Cochrane Library, and PsychInfo databases, from inception to May 4, 2016. We selected randomized controlled trials of lifestyle interventions, involving physical activity (PA), dietary (D), or combined strategies (PA+D) with follow-up duration 12 months. We excluded all studies that included individuals with IGT, confirmed by 2- hours oral glucose tolerance test (75g), but included all other studies recruiting populations with different glycemic levels. We stratified studies by baseline glycemic levels: (1) lowrange group with mean fasting plasma glucose (FPG) <5.5mmol/L or glycated hemoglobin (A1C) <5.5%, and (2) high-range group with FPG 5.5mmol/L or A1C 5.5%, and synthesized data using random-effects models. Primary outcomes in this review included systolic blood pressure (SBP), diastolic blood pressure (DBP), total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), and triglycerides (TG). Totally 79 studies met inclusion criteria. Compared to usual care (UC), lifestyle interventions achieved significant improvements in SBP (-2.16mmHg[95%CI, -2.93, -1.39]), DBP (-1.83mmHg[-2.34, -1.31]), TC (-0.10mmol/L[-0.15, -0.05]), LDL-C (-0.09mmol/L [-0.13, -0.04]), HDL-C (0.03mmol/L[0.01, 0.04]), and TG (-0.08mmol/L[-0.14, -0.03]). Similar effects were observed among both low-and high-range study groups except for TC and TG. 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 resulted in significant improvements in SBP, DBP, TC, LDL-C, HDL-C, and TG, and might further reduce CVD risk.