@article{AnandHengstGellneretal.2023, author = {Anand, Corinna and Hengst, Karin and Gellner, Reinhold and Englert, Heike}, title = {Effects of the healthy lifestyle community program (cohort 1) on stress-eating and weight change after 8 weeks: a controlled study}, series = {Scientific Reports}, volume = {13}, journal = {Scientific Reports}, doi = {10.1038/s41598-022-27063-4}, pages = {1 -- 12}, year = {2023}, abstract = {Stress-eating (eating more or more unhealthily in order to accommodate to stress), contributes to the development and maintenance of obesity. The effect of comprehensive weight loss interventions on changes in stress-eating as well as the contributing role of stress-eating on weight reduction has not been examined. The impact of the 8-week intensive phase of the Healthy Lifestyle Community Programme (HLCP, cohort 1) on emotional, external and restrained eating, as expressions of stress-eating was evaluated in a non-randomized controlled trial. Intervention: 14 seminars (twice per week, including practical units), complemented by stress-regulation and cooking workshops and coaching sessions empowering participants to change their behaviour towards a healthy plant-based diet (ad libitum), stress regulation, regular exercise and to focus on social support. Participants were recruited from the general population. In the intervention group, 91 participants (IG; age: 56 ± 10, 77\% female) and in the control group, 52 (CG; age: 62 ± 14, 57\% female) were enrolled. At baseline, participants of the IG reported higher levels of stress (9.7 ± 5.4 points [P] vs. 7.6 ± 6.2; p < 0.011), and of emotional eating (27.9 ± 9.4 vs. 20.0 ± 7.1; p < 0.001) and external eating (29.1 ± 4.9 vs. 25.5 ± 5.6; p < 0.001) than participants of the CG. Within 8 weeks, in the IG, scores of emotional eating (- 3.5 ± 5.4 P) and external eating significantly decreased (= - 2.0 ± 3.8 P), while restrained eating increased (2.7 ± 5.0 P; p for all < 0.001). Weight change was negatively correlated with change of external eating (R2 = 0.045; CC = - 0.285; p = 0.014), indicating that a greater weight change was associated with a smaller change of external eating. This is the first study to prospectively investigate the role of stress-eating on the weight reduction effect of comprehensive lifestyle interventions. Our data confirm that overweight is associated with EE and external eating and suggest that the HLCP is capable to reduce both, weight and stress-eating.}, language = {en} } @article{KoederAnandHusainetal.2023, author = {Koeder, Christian and Anand, Corinna and Husain, Sarah and Kranz, Ragna-Marie and Schoch, Nora and Alzughayyar, Dima and Bitterlich, Norman and Hahn, Andreas and Englert, Heike}, title = {Exploratory analysis of the effect of a controlled lifestyle intervention on inflammatory markers - the Healthy Lifestyle Community Programme (cohort 2)}, series = {BMC Nutrition}, volume = {9}, journal = {BMC Nutrition}, number = {25}, issn = {2055-0928}, doi = {10.1186/s40795-023-00684-2}, year = {2023}, abstract = {Background Chronic low-grade inflammation is associated with an increased risk of chronic disease and mortality. The objective of the study was to test the effect of a healthy lifestyle intervention on biomarkers of inflammation (among other risk markers). Methods We conducted a non-randomized controlled trial with mostly middle-aged and elderly participants from the general population in rural northwest Germany (intervention: n = 114; control: n = 87). The intervention consisted of a 1-year lifestyle programme focusing on diet (largely plant-based; strongest emphasis), physical activity, stress management, and social support. High-sensitivity C-reactive protein (hs-CRP) was assessed at baseline, 10 weeks, 6 months, and 1 year. Homocysteine (Hcy) was assessed at baseline, 10 weeks, and 1 year. Adiponectin (Apn) was assessed at baseline and 10 weeks. An exploratory analysis of these inflammatory markers assessing the between-group differences with ANCOVA was conducted. Results The 1-year trajectory of hs-CRP was significantly lower in the intervention group compared to control (between-group difference: -0.8 (95\% CI -1.2, -0.3) mg/l; p = 0.001; adjusted for baseline). The 1-year trajectory of Hcy was non-significantly higher in the intervention compared to control (between-group difference: 0.2 (95\% CI -0.3, 0.7) µmol/l; p = 0.439; adjusted for baseline). From baseline to 10 weeks, Apn decreased significantly more in the intervention group compared to control (between-group difference: -1.6 (95\% CI -2.7, -0.5) µg/ml; p = 0.004; adjusted for baseline). Conclusions Our study shows that healthy lifestyle changes can lower hs-CRP and Apn levels and are unlikely to significantly affect Hcy levels within 1 year. Trial registration German Clinical Trials Register (DRKS; reference: DRKS00018775, registered 12 Sept 2019; retrospectively registered; www.drks.de).}, language = {en} } @article{AnandKranzHusainetal.2022, author = {Anand, Corinna and Kranz, Ragna-Marie and Husain, Sarah and Koeder, Christian and Schoch, Nora and Karam Alzughayyar, Dima and Gellner, Reinhold and Hengst, Karin and Englert, Heike}, title = {Bridging the gap between science and society: long-term effects of the Healthy Lifestyle Community Programme (HLCP, cohort 1) on weight and the metabolic risk profile: a controlled study}, series = {BMJ Nutrition, Prevention \& Health}, journal = {BMJ Nutrition, Prevention \& Health}, doi = {10.1136/bmjnph-2021-000340}, year = {2022}, abstract = {Background The potential of adopting a healthy lifestyle to fight non-communicable diseases (NCDs) is not fully used. We hypothesised that the Healthy Lifestyle Community Programme (HLCP, cohort 1) reduces weight and other risk markers compared with baseline and control. Methods 24-month, non-randomised, controlled intervention trial. Intervention: intensive 8-week phase with seminars, workshops and coaching focusing on a healthy lifestyle (eg, plant-based diet, physical activity, stress management) and group support followed by a 22-month alumni phase. Weight reduction as the primary outcome and other NCD risk parameters were assessed at six time points. Participants were recruited from the general population. Multiple linear regression analyses were conducted. Results 143 participants (58±12 years, 71\% female) were enrolled (91 in the intervention (IG) and 52 in the control group (CG)). Groups' baseline characteristics were comparable, except participants of IG were younger, more often females, overweight and reported lower energy intake (kcal/day). Weight significantly decreased in IG at all follow-ups by -1.5 ± 1.9 kg after 8 weeks to -1.9 ± 4.0 kg after 24 months and more than in CG (except after 24 months). Being male, in the IG or overweight at baseline and having a university degree predicted more weight loss. After the intervention, there were more participants in the IG with a 'high' adherence (+12\%) to plant-based food patterns. The change of other risk parameters was most distinct after 8 weeks and in people at elevated risk. Diabetes-related risk parameters did not improve. Conclusion The HLCP was able to reduce weight and to improve aspects of the NCD risk profile. Weight loss in the IG was moderate but maintained for 24 months. Participants of lower educational status might benefit from even more practical units. Future interventions should aim to include more participants at higher risk. Trial registration number DRKS00018821.}, language = {en} } @article{KoederHusainKranzetal.2022, author = {Koeder, Christian and Husain, Sarah and Kranz, Ragna-Marie and Anand, Corinna and Alzughayyar, Dima and Schoch, Nora and Hahn, Andrea and Englert, Heike}, title = {Healthy lifestyle changes favourably affect common carotid intima-media thickness: the Healthy Lifestyle Community Programme (cohort 2)}, series = {Journal of Nutritional Science}, volume = {11}, journal = {Journal of Nutritional Science}, doi = {10.1017/jns.2022.46}, year = {2022}, abstract = {Common carotid intima-media thickness (ccIMT) progression is a risk marker for cardiovascular disease (CVD), whereas healthy lifestyle habits are associated with lower ccIMT. The objective of the present study was to test whether a healthy lifestyle intervention can beneficially affect ccIMT progression. A community-based non-randomised, controlled lifestyle intervention was conducted, focusing on a predominantly plant-based diet (strongest emphasis), physical activity, stress management and social health. Assessments of ccIMT were made at baseline, 6 months and 1 year. Participants had an average age of 57 years and were recruited from the general population in rural northwest Germany (intervention: n 114; control: n 87). From baseline to 1 year, mean ccIMT significantly increased in both the intervention (0⋅026 [95 \% CI 0⋅012, 0⋅039] mm) and control group (0⋅045 [95 \% CI 0⋅033, 0⋅056] mm). The 1-year trajectory of mean ccIMT was lower in the intervention group (P = 0⋅022; adjusted for baseline). In a subgroup analysis with participants with high baseline mean ccIMT (≥0⋅800 mm), mean ccIMT non-significantly decreased in the intervention group (-0⋅016 [95 \% CI -0⋅050, 0⋅017] mm; n 18) and significantly increased in the control group (0⋅065 [95 \% CI 0⋅033, 0⋅096] mm; n 12). In the subgroup, the 1-year trajectory of mean ccIMT was significantly lower in the intervention group (between-group difference: -0⋅051 [95 \% CI -0⋅075, -0⋅027] mm; P < 0⋅001; adjusted for baseline). The results indicate that healthy lifestyle changes may beneficially affect ccIMT within 1 year, particularly if baseline ccIMT is high.}, language = {en} } @article{AnandHengstGellneretal.2022, author = {Anand, Corinna and Hengst, Karin and Gellner, Reinhold and Englert, Heike}, title = {Eight weeks of lifestyle change: What are the effects of the Healthy Lifestyle Community Programme (cohort 1) on Cortisol Awakening Response (CAR) and perceived stress?}, series = {Chronic Stress}, journal = {Chronic Stress}, doi = {10.1177/24705470221099206}, pages = {accepted}, year = {2022}, language = {en} } @article{AnandHengstGellneretal.2022, author = {Anand, Corinna and Hengst, Karin and Gellner, Reinhold and Englert, Heike}, title = {Eight Weeks of Lifestyle Change: What are the Effects of the Healthy Lifestyle Community Programme (Cohort 1) on Cortisol Awakening Response (CAR) and Perceived Stress?}, series = {Chronic stress}, volume = {2022}, journal = {Chronic stress}, number = {6}, doi = {10.1177/24705470221099206}, pages = {1 -- 13}, year = {2022}, abstract = {Background: Stress and cortisol dysregulation are linked to NCDs. Moreover, stress favours unhealthy lifestyle patterns, which increase the risk for NCDs. The role of the Cortisol Awakening Response (CAR) and the effect of lifestyle interventions on the same remain unclear. Methods: The impact of the intensive 8-week phase of the Healthy Lifestyle Community Programme (HLCP, cohort 1) on parameters of the CAR, ie cortisol values 0 (sample [S]1), 30), 45 and 60 minutes post-awakening, average peak, S1-peak delta and area under the increase curve (AUCI), and perceived stress levels (PSL) was evaluated in a non-randomized, controlled trial. Covariates of the CAR (eg sleep measures) and irregularities in sampling were assessed. The intervention focussed on stress management, a healthy diet, regular exercise, and social support. Participants were recruited from the general population. Multiple linear regression analyses were conducted. Results: 97 participants (age: 56 ± 10 years; 71\% female), with 68 in the intervention group (IG; age: 55 ± 8, 77\% female) and 29 participants in the control group (CG; age: 59 ± 12, 59\% female), were included in the analysis. The baseline characteristics of both groups were comparable, except participants of IG were younger. On average, the PSL at baseline was low in both groups (IG: 9.7 ± 5.4 points; CG: 8.5 ± 6.9 points; p = .165), but 22\% (n = 15) in the IG and 20\% (n = 6) in the CG reported a high PSL. Most participants reported irregularities in CAR sampling, eg interruption of sleep (IG: 80\% CG: 81\%). After 8 weeks, most CAR parameters and the PSL decreased in the IG and CG, resulting in no differences of change between the groups. In the IG only, a decrease of PSL was linked to an increase of CAR parameters, eg AUCI (correlation coefficient = -0.307; p = .017). Conclusion: The HLCP may potentially reduce PSL and change the CAR, but results cannot be clearly attributed to the programme. Methodological challenges and multiple confounders, limit suitability of the CAR in the context of lifestyle interventions. Other measures (eg hair-cortisol) may give further insights. Trial registration: German Clinical Trials Register (DRKS); DRKS00018821; www.drks.de}, language = {en} } @article{KoederHahnEnglert2021, author = {Koeder, Christian and Hahn, Andreas and Englert, Heike}, title = {Effect of a 6-Month Controlled Lifestyle Intervention on Common Carotid Intima-Media Thickness}, series = {The journal of nutrition, health \& aging}, journal = {The journal of nutrition, health \& aging}, doi = {10.1007/s12603-021-1628-0}, year = {2021}, language = {en} } @article{KoederHahnEnglert2021, author = {Koeder, Christian and Hahn, Andreas and Englert, Heike}, title = {No clear association of sleep duration or bedtime with common carotid intima-media thickness}, series = {Atherosclerosis}, journal = {Atherosclerosis}, doi = {10.1016/j.atherosclerosis.2021.06.452}, pages = {e150 -- e151}, year = {2021}, language = {en} } @article{KranzEnglert2021, author = {Kranz, Ragna-Marie and Englert, Heike}, title = {Effect of a community-based lifestyle intervention programme on quality of life among German women}, series = {European Journal of Public Health}, volume = {Volume 31}, journal = {European Journal of Public Health}, doi = {10.1093/eurpub/ckab165.389}, year = {2021}, abstract = {Background Quality of life is an important concept in the field of health, which can be influenced by various lifestyle factors. The objective was to test if a community-based lifestyle programme would beneficially affect the health-related quality of life of German women. Methods The controlled intervention study had a total duration of 24 months. Quality of life (EQ-5D-3L), anthropometrics, vital and blood parameters as well as diagnosed diseases and health economic parameters were collected at baseline (t0), after 10 weeks (t1) and after 6 months (t2). For the intervention group (n = 65) a 10-week intensive lifestyle programme followed by monthly alumni meetings were conducted. The intensive phase consisted of 14 consecutive seminars about a healthy lifestyle, which focused on a plant-based diet, physical activity, stress management and community support. The control group (n = 35) received no intervention. Results The first descriptive health profile results of the subgroup analysis showed that 59\% women of the intervention group at t0 (t1: 37\%; t2: 48\%) and 60\% of the control group at t0 (t1: 54\%; t2: 49\%) reported problems in at least one of the EQ-5D dimensions (mobility, selfcare, activities, pain, and anxiety). A significant difference in EQ VAS change between women in intervention (7,15 [95\% CI 4,32; 9,98]; EQ VAS t0: 75,35 [SD 13,71]) and control group (-2,63 [95\% CI -5,40; 0,15]; EQ VAS t0: 78,80 [SD 18,51]) from t0 to t1 was observed (p < 001; adjusted for baseline). No significant differences in mean EQ VAS change from t0 to t2 and in mean EQ-5D index change from t0 to t1 and t0 to t2 between the groups were observed (p > 0,05; adjusted for baseline). Conclusions The preliminary results suggest that the lifestyle intervention programme can have a positive short-time effect on some aspects of quality of life, such as the health profile and EQ VAS. However, the long-term results will be shown in the future. Key messages - A healthy lifestyle can affect the quality of life in a positive way. - The community-based lifestyle programme had a short-time influence on the descriptive health profile and EQ VAS of German women, whereby the EQ index didńt change significantly between the groups.}, language = {en} } @article{KoederHahnEnglert2021, author = {Koeder, Christian and Hahn, Andreas and Englert, Heike}, title = {Is fruit intake associated with common carotid intima-media thickness?}, series = {European Journal of Public Health}, journal = {European Journal of Public Health}, doi = {10.1093/eurpub/ckab165.391}, year = {2021}, abstract = {Background Common carotid intima-media thickness (ccIMT) is an established risk marker for cardiovascular events, including myocardial infarction and stroke, which are of high public health relevance. While a higher fruit intake is generally considered beneficial for cardiovascular health, recent studies have shown that a fruit intake of > 2 portions per day may be harmful. Therefore, we tested if there is an association between categories of fruit intake and mean ccIMT. Methods We conducted an exploratory, non-prespecified, cross-sectional analysis of baseline values of 167 mostly middle-aged participants of a controlled lifestyle intervention, recruited from the general population in rural northwest Germany (male: n = 58; female: n = 109). Fruit intake was classified into low (<1 portion of fruit/day), intermediate (1-2 portions of fruit/day), and high (>2 portions of fruit/day). Mean ccIMT was measured in accordance with the Mannheim consensus. Between-group differences in mean ccIMT were assessed with analysis of covariance. Results Mean age was 57.3 ± 0.7 years (mean ± SEM). Mean fruit intake was 1.6 ± 0.1 portions/day. Average mean ccIMT was 0.679 ± 0.010 mm. There was a significant difference in mean ccIMT between subjects with low (0.676 ± 0.020 mm; n = 50), intermediate (0.653 ± 0.014 mm; n = 72), and high fruit intake (0.724 ± 0.019 mm; n = 45; p = 0.016). But this difference was attenuated when adjusting for age, sex, and homocysteine (p = 0.418). Conclusions We found only a non-significant association between consuming >2 portions of fruit per day and ccIMT. Thus, our study could not confirm a negative effect of fruit intake on ccIMT. Age, sex, and homocysteine may confound this association. Key messages Current recommendations of 2 portions of fruit per day seem adequate and do not negatively influence carotid intima-media thickness. Future studies should address confounding of the association between fruit intake and cardiovascular risk markers.}, language = {en} }