Englert, Heike
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Vegane Ernährung
(2020)
Improvements in Cardiovascular Disease Risk Factors from Lifestyle Change: A Real World Application
(2007)
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.
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
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.
Lass los was dich dick macht
(2013)
Antioxidants and HIV/AIDS
(2015)
Lass los was dich dick macht
(2012)
The Effects of Lifestyle Modification on Glycemic Levels and Medication Intake:The Rockford CHIP
(2012)
Introduction: The high prevalence of cardiovascular disease (CVD) in the past 50 years has led to intense research, resulting in many improvements in treatment. At the same time, type 2 diabetes, with its concomitant increase in vascular complications, has become a serious, exploding and costly public health concern . Diabetes now affects 285 million adults worldwide and 344 million with pre-diabetes. Of these, 25.8 million diabetics and 79 million pre-diabetics are found in the United States alone.The current cost of diabetes in the US is likely to exceed the $174 billion estimate, which includes 2/3 for direct medical costs and 1/3 for indirect costs, such as disability, work loss, and premature death, but omits the social cost of intangibles (e.g. pain, suffering, lower quality of life). The diabetes epidemic has been accompanied by a similarly drastic increase in obesity. Although the relationship between the two developments is a matter of debate, both are presumably caused by changes in dietary habits and an increasingly sedentary modern lifestyle . Compelling evidence has shown that lifestyle changes can effectively prevent or delay the occurrence of type 2 diabetes. Because individuals at risk for this disease can usually be identified during the pre-diabetic phase of impaired glucose tolerance, early intervention and lifestyle change offer a logical approach to preventing this disease and its devastating vascular complications. Additionally, community-based lifestyle interventions for high risk groups and for the general population are a cost-effective way of curbing the growing burden of the disease. Solidifying the scientific basis for the prevention, treatment and control of this disease and its implementation on a national level, however, remains a difficult challenge. Moreresearch is needed to provide comprehensive and more effective strategies for weight-loss,especially over time. Therefore, the objectives of this study were to identify diabetics and those at risk (prediabetics) out of the total cohort of 1,517 who selected themselves into an intensive community-based lifestyle intervention program, and to assess its clinical efficacy ineffecting medication status as determined and managed by their personal physicians.
ABSTRACT Background: To determine the accuracy of patient self-reports of specific cardiovascular diagnoses and to identify individual patient characteristics that influence the accuracy. Methods: This investigation was conducted as a part of the randomized controlled ORBITAL study. Patients with hypercholesterolemia were enrolled in 1961 primary-care centers all over Germany. Self-reported questionnaire data of 7640 patients were compared with patients' case report forms (CRFs) and medical records on cardiovascular diseases, using k statistics and binomial logit models. Results: k values ranged from 0.89 for diabetes to 0.04 for angina. The percentage of overreporting varied from 1 percent for diabetes to 17 percent for angina, whereas the percentage of underreporting varied from 8.0 percent for myocardial infarction to 57 percent for heart failure. Individual characteristics such as choice of individual general practitioner, male gender and age were associated with the accuracy of self-report data. Conclusion: Since the agreement between patient self-report and CRFs/medical records varies with specific cardiovascular diagnoses in patients with hypercholesterolemia, the adequacy of this tool seems to be limited. However, the authors recommend additional data validation for certain patient groups and consideration of individual patient characteristics associated with over- and underreporting. Keywords agreement, cardiovascular disease, case report forms, general practitioner information, medical records, orbital study, overreporting, patient self-report, underreporting
Selenium and Immunity
(2019)
Vegane Ernährung
(2016)
Lifestyle diseases are linked with hyper-reactivity of inflammatory and immune cells. These cells generate free radicals in the patients, which results in oxidative stress. Recent studies have brought attention to the role of oxidative stress, defined as an imbalance between reactive oxygen species (ROS) and antioxidants. Our research was focused on studying the effects of a community-based lifestyle intervention program on oxidative stress paraments in the plasma of a rural German community. In our study, we examined 105 participants in the intervention group and 70 participants in the control group. The intervention group received 10 weeks of intensive intervention in the form of seminars and workshops. The plasma levels were analyzed at baseline and after 10 weeks of intervention. This is a first-of-itskind study which elucidates the impact of an intensive lifestyle intervention program on the oxidative stress markers in German rural participants. The primary focus of our study was to motivate and encourage participants to switch over toward a healthier lifestyle by improving their knowledge and making them more aware of the principles of healthy living. This may be a useful community program approach, modifiable for different communities by health-services planners in the coming future.
Oxidative stress plays a critical role in the pathogenesis of chronic diseases. Therefore, improvement of oxidative stress status through lifestyle intervention can play a vital role in preventing and treating chronic diseases. This systematic review aims to provide an overview of articles published in the last decade examining the association between lifestyle intervention and oxidative stress biomarkers in the context of non-communicable diseases. The electronic databases PubMed and Web of Science were searched for relevant studies, following the PRISMA (Preferred Reporting of Systematic Reviews and Meta-Analyses) guidelines. This systematic review focused on the four important oxidative stress biomarkers; glutathione (GSH), superoxide dismutase (SOD), catalase, and malondialdehyde. 671 articles were identified, of which nine met the inclusion criteria. A trend emerged, showing that lifestyle modifications that focus on diet and physical health can improve oxidative stress in the form of an increase in superoxide dismutase and CAT levels and a decrease in Malondialdehyde levels in participants with non-communicable diseases (NCDs), GSH levels were not affected. However, the results are difficult to compare because of the heterogeneity of the methods of the biomarkers studied. Our review indicates that oxidative stress can be influenced by lifestyle modifications and may be an effective tool for the prevention and management of non-communicable diseases. This review also elucidated the importance of analyzing multiple oxidative stress biomarkers to evaluate oxidative stress, it further highlights the need to conduct long-term lifestyle intervention studies on oxidative stress biomarkers to understand the connection between oxidative stress biomarkers, NCDs and Lifestyle intervention.
Background
Worldwide the prevalence of obesity is high, and promoting a shift towards more healthful and more plant-based dietary patterns appears to be one promising strategy to address this issue. A dietary score to assess adherence to a healthy plant-based diet is the healthful plant-based diet index. While there is evidence from cohort studies that an increased healthful plant-based diet index is associated with improved risk markers, evidence from intervention studies is still lacking.
Methods
A lifestyle intervention was conducted with mostly middle-aged and elderly participants from the general population (n = 115). The intervention consisted of a 16-month lifestyle program focusing on a healthy plant-based diet, physical activity, stress management, and community support.
Results
After 10 weeks, significant improvements were seen in dietary quality, body weight, body mass index, waist circumference, total cholesterol, measured and calculated LDL cholesterol, oxidized LDL particles, non-HDL cholesterol, remnant cholesterol, glucose, insulin, blood pressure, and pulse pressure. After 16 months, significant decreases were seen in body weight (-1.8 kg), body mass index (-0.6 kg/m2), and measured LDL cholesterol (-12 mg/dl). Increases in the healthful plant-based diet index were associated with risk marker improvements.
Conclusions
The recommendation of moving towards a plant-based diet appears acceptable and actionable and may improve body weight. The healthful plant-based diet index can be a useful parameter for intervention studies.
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).
Introduction: Many disease processes are accompanied and promoted
by increased inflammation in the body. Increased concentrations of high-sensitivity C-reactive protein (hs-CRP) in the blood are an indicator of subclinical inflammation, increased disease risk, and an increased risk of early death. A healthy plant-based diet and increased physical activity have been shown to reduce hs-CRP concentrations.
Objectives: Our objective was to test if a healthy lifestyle intervention program can improve hs-CRP levels and other risk factors.
Methodology: We are conducting a non-randomized, controlled intervention study with 6 times of measurement (baseline, after 2.5, 6, 12, 18 and 24 months). Participants in the intervention group (n = 104) took part in a 2.5-month intensive lifestyle program focusing on a plant-based diet (PBD), physical activity, stress management and group support. Currently they are in the less intensive phase (monthly seminars) which will be completed after 24 months. The control group (n = 62) did not take part in any program. In both groups hs-CRP was assessed, and participants with an infection/common cold at any of the times of measurement were excluded from the analyses.
Results: In the intervention group (n = 97) we observed a reduction in hsCRP from baseline to 2.5 months (p < 0.001). In the control group (n = 46) hs-CRP levels increased non-significantly. The changes from baseline to 2.5 months were significantly different between intervention and control (p < 0.01).
Conclusion: Our program led to a clinically relevant reduction in hs-CRP.
Continued follow-up will show if this improvement can be maintained in the intervention group. Our study confirms that a PBD and healthier lifestyle choices can lower hs-CRP.
Effect of a 6-Month Controlled Lifestyle Intervention on Common Carotid Intima-Media Thickness
(2021)
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.
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.
Introduction: Moving towards a more plant-based dietary pattern would likely be beneficial in terms of a variety of sustainability dimensions.
Methodology: We conducted a 2-year intervention study with six measurement time points (baseline, 10 weeks, 6 months, 1 year, 1½ years, 2 years) in rural northwest Germany. The intervention consisted of a lifestyle programme, and dietary recommendations were to move towards a healthy, plant-based diet. The control group received no intervention. Diet quality was assessed with the healthful plant-based diet index (hPDI).
Results: In the intervention group (n = 67), the 2-year trajectory of hPDI was significantly higher compared to control (n = 39; p 0.001; between-group difference: 5.7 (95% CI 4.0, 7.3) food portions/day; adjusted for baseline). The 2-year trajectory of meat intake was significantly lower in the intervention group (n = 79) compared to control (n = 40; p 0.001; between-group difference: -0.7 (95% CI -0.9, -0.5) portions/day; adjusted for baseline).
Conclusion: Our study confirms that plant-based nutrition education in the general population is likely to result in at least modest dietary improvements in terms of general healthfulness and meat reduction.