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Impact of Body Mass Index and Discomfort on Upper Airway Stimulation: ADHERE Registry 2020 Update.
Suurna, MV, Steffen, A, Boon, M, Chio, E, Copper, M, Patil, RD, Green, K, Hanson, R, Heiser, C, Huntley, C, et al
The Laryngoscope. 2021;(11):2616-2624
Abstract
OBJECTIVES/HYPOTHESIS To provide the ADHERE registry Upper Airway Stimulation (UAS) outcomes update, including analyses grouped by body mass index (BMI) and therapy discomfort. STUDY DESIGN Prospective observational study. METHODS ADHERE captures UAS outcomes including apnea-hypopnea index (AHI), Epworth sleepiness scale (ESS), therapy usage, patient satisfaction, clinician assessment, and safety over a 1-year period. BMI ≤32 kg/m2 (BMI32 ) and 32 < BMI ≤35 kg/m2 (BMI35 ) group outcomes were examined. RESULTS One thousand eight hundred forty-nine patients enrolled in ADHERE, 1,019 reached final visit, 843 completed the visit. Significant changes in AHI (-20.9, P < .0001) and ESS (- 4.4, P < .0001) were demonstrated. Mean therapy usage was 5.6 ± 2.2 hr/day. Significant therapy use difference was present in patients with reported discomfort versus no discomfort (4.9 ± 2.5 vs. 5.7 ± 2.1 hr/day, P = .01). Patients with discomfort had higher final visit mean AHI versus without discomfort (18.9 ± 18.5 vs. 13.5 ± 13.7 events/hr, P = .01). Changes in AHI and ESS were not significantly different. Serious adverse events reported in 2.3% of patients. Device revision rate was 1.9%. Surgical success was less likely in BMI35 versus BMI32 patients (59.8% vs. 72.2%, P = .02). There was a significant therapy use difference: 5.8 ± 2.0 hr/day in BMI32 versus 5.2 ± 2.2 hr/day in BMI35 (P = .028). CONCLUSIONS Data from ADHERE demonstrate high efficacy rates for UAS. Although surgical response rate differs between BMI32 and BMI35 patient groups, the AHI and ESS reduction is similar. Discomfort affects therapy adherence and efficacy. Thus, proper therapy settings adjustment to ensure comfort is imperative to improve outcomes. LEVEL OF EVIDENCE 4 Laryngoscope, 131:2616-2624, 2021.
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The MoveStrong program for promoting balance and functional strength training and adequate protein intake in pre-frail older adults: A pilot randomized controlled trial.
Rodrigues, IB, Wang, E, Keller, H, Thabane, L, Ashe, MC, Brien, S, Cheung, AM, Funnell, L, Jain, R, Loong, D, et al
PloS one. 2021;(9):e0257742
Abstract
BACKGROUND Balance and functional strength training can improve muscle strength and physical functioning outcomes and decrease the risk of falls in older adults. To maximize the benefits of strength training, adequate protein intake is also important. However, the number of older individuals that consume enough protein or routinely engage in strength training remains low at less than 5% and even lower for activities that challenge balance. Our primary aim was to assess the feasibility of implementing a model (MoveStrong) of service delivery to teach older adults about balance and functional strength training and methods to increase protein intake. METHODS This study was a closed cohort stepped wedge randomized controlled trial. We recruited individuals ≥60 years considered pre-frail or frail with at least one chronic condition who were not currently engaging in regular strength training from Northern (rural) and Southern (urban) Ontario sites in Canada. The primary outcome was feasibility of implementation, defined by recruitment, retention, and adherence, and safety (defined by monitoring adverse events). We also reported participants' and providers' experience with MoveStrong, adaptations to the model based on participant's and provider's experience, and program fidelity. RESULTS We recruited 44 participants to the study and the average adherence rate was 72% with a retention of 71%. The program had a high-fidelity score. One person experienced a fall-related injury during exercise, while two other participants reported pain during certain activities. Five individuals experienced injuries or health problems that were not related to the program. Suggestions for future trials include modifying some exercises, exploring volunteer assistance, increasing the diversity of participants enrolled, and considering a different study design. CONCLUSIONS Our pilot trial demonstrates the feasibility of recruitment and adherence for a larger multisite RCT of balance and functional strength training with attention to protein intake in pre-frail and frail older adults.
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Association of Diet, Physical Activity Guidelines and Cardiometabolic Risk Markers in Children.
Gil-Campos, M, Pérez-Ferreirós, A, Llorente-Cantarero, FJ, Anguita-Ruiz, A, Bedoya-Carpente, JJ, Kalén, A, Moreno, LA, Bueno, G, Gil, Á, Aguilera, CM, et al
Nutrients. 2021;(9)
Abstract
The aim was to identify different dietary and physical activity (PA) patterns in 5- to 14-year-old children with a high prevalence of overweight and obesity using cluster analysis based on their adherence to the Spanish Society of Community Nutrition dietary guidelines and levels of PA, and to determine their associations with age, sex, body composition, and cardiometabolic risk markers. In 549 children, hierarchical cluster analysis was used to identify subgroups with similar adherence to dietary recommendations and level of PA. Three clusters were identified: Cluster 1, with the lowest level of vigorous PA and adherence to dietary recommendations; Cluster 2, with the lowest levels of moderate and vigorous PA and the highest adherence to dietary recommendations; and Cluster 3, with the highest level of PA, especially vigorous PA and a medium level adherence to dietary recommendations. Cluster 3 had lower total body fat and higher lean body mass percentages than Cluster 2. Cluster 2 had lower high-density lipoprotein cholesterol and higher low-density lipoprotein cholesterol levels than Cluster 1. The results from our study suggest that it is important to consider adherence to PA recommendations together with adherence to dietary guidelines to understand patterns of obesogenic habits in pediatric populations with high prevalence of overweight and obesity.
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Association of Cognitive Function Screening Results with Adherence and Performance in a Pedometer-Based Intervention.
Sheshadri, A, Kittiskulnam, P, Delgado, C, Sudore, RL, Lai, JC, Johansen, KL
American journal of nephrology. 2021;(5):420-428
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INTRODUCTION A randomized, controlled trial of a pedometer-based walking intervention with weekly activity goals led to increased walking among dialysis patients. We examined whether impairment per cognitive function screening is associated with adherence and performance in the intervention. METHODS Thirty dialysis patients were randomly assigned to a 3-month pedometer-based intervention with weekly goals. Participants were administered the Telephone Interview of Cognitive Status (TICS), a test of global mental status. We examined the association of levels of impairment on the TICS (≥33: unimpaired, 26-32: ambiguous impairment, 21-25: mild cognitive impairment [MCI]) with adherence, achieving weekly goals, and increasing steps, physical performance (Short Physical Performance Battery, SPPB), and self-reported physical function (PF) through multivariable linear mixed-model and logistic regression analyses adjusted for age, sex, BMI, dialysis modality, baseline steps, baseline SPPB, and stroke status. RESULTS One-third of participants were unimpaired, and 13% had MCI. Participants with worse results on cognitive function screening missed more calls and completed fewer weekly goals than participants with better results. During the intervention, a worse result on cognitive function screening was associated with smaller increases in steps compared to those without impairment: (ambiguous: -620 [95% CI -174, -1,415], MCI: -1,653 [95% CI -120, -3,187]); less improvement in SPPB (ambiguous: -0.22 points [95% CI -0.08, -0.44], MCI: -0.45 [95% CI -0.13, -0.77]); and less improvement in PF (ambiguous: -4.0 points [95% CI -12.2, 4.1], MCI: -14.0 [95% CI -24.9, -3.1]). During the postintervention period, a worse result on cognitive function screening was associated with smaller increases in SPPB (ambiguous: -0.54 [95% CI -1.27, 0.19], MCI: -0.97 [95% CI -0.37, -1.58]) and PF (ambiguous: -3.3 [95% CI -6.5, -0.04], MCI: -10.5 [95% CI -18.7, -2.3]). DISCUSSION/CONCLUSION Participants with worse results on cognitive function screening had worse adherence and derived less benefit from this pedometer-based intervention. Future exercise interventions should be developed incorporating methods to address cognitive impairment, for example, by including caregivers when planning such interventions.
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The association of the level of self-care on adherence to treatment in patients diagnosed with type 2 diabetes.
Krzemińska, S, Lomper, K, Chudiak, A, Ausili, D, Uchmanowicz, I
Acta diabetologica. 2021;(4):437-445
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AIMS: The study aimed to assess the impact of self-care on adherence to treatment in patients diagnosed with type 2 diabetes and effect of complex interaction of social, lifestyle, economic, environmental and behavioural. METHODS The study was carried out between June 2018 and May 2019 on 324 patients (162 females, 162 males) with type 2 diabetes. To measure the levels of self-care, the Self-Care of Diabetes Index (SCODI) questionnaire was used. Adherence to treatment was assessed with the Adherence in Chronic Diseases Scale (ACDS). RESULTS The highest scores of health behaviour were on the subscale of adherence with the mean value of 68.37, and the lowest results on the subscale of blood sugar self-monitoring, with the mean of 56.05. We found that low adherence to treatment was present in 52.47% of respondents, the moderate level in 39.20%, while only 8.33% of patients showed the high level. There were significant positive correlations between the ACDS and SCODI subscales (p < 0.05): self-care maintenance (0.436), self-care management (0.413), self-care monitoring (0.384), and self-care confidence (0.453). CONCLUSIONS Self-care affects on adherence in patients with type 2 diabetes. The higher self-efficacy in each of the areas of functioning, the higher the level of adherence to treatment. We found that demographic variables such as female sex, education and employment status can influence self-care in managing chronic illnesses such as type 2 diabetes.
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Impact of mobile phone text messaging intervention on adherence among patients with diabetes in a rural setting: A randomized controlled trial.
Owolabi, EO, Goon, DT, Ajayi, AI
Medicine. 2020;(12):e18953
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BACKGROUND Nonadherence to prescribed therapy is a significant challenge at the primary healthcare level of South Africa. There are documented evidence of the potential impact of mobile health technology in improving adherence and compliance to treatment. This study assessed the effect of unidirectional text messaging on adherence to dietary and activity regimens among adults living with diabetes in a rural setting of Eastern Cape, South Africa. METHODS This was a 2-arm, multicenter, parallel, randomized controlled trial, involving a total of 216 patients with diabetes with uncontrolled glycemic status randomly assigned into the intervention (n = 108) and the control group (n = 108). Participants in the intervention arm received daily educational text messages on diabetes and reminders for 6 months, while the control arm continued with standard care only. A validated, self-developed adherence scale was used to assess participants' adherence to diets and physical activity. Descriptive statistics and linear regression were used to assess changes in adherence and the effect of the intervention on adherence to therapy. RESULTS On a scale of 8, the mean medication adherence level for the intervention group was 6.90 (SD ± 1.34) while that of the control group was 6.87 (SD ± 1.32) with no statistical difference (P = .88). The adjusted mean change in the medication adherence level was 0.02 (-0.33 to 0.43) with no significant difference (P = .79). There was however a low level of adherence to dietary recommendations (1.52 ± 1.62), and physical activity (1.48 ± 1.58) at baseline, and both groups demonstrated a nonsignificant increase in dietary (P = .98) and physical activity adherence (P = .99) from baseline to the follow-up period. CONCLUSION There is a moderate level of adherence to medication and a low level of adherence to dietary and physical activity recommendation in this setting. The text messaging intervention did not bring about any significant improvement in medication, dietary and physical activity adherence levels. There is a need to design effective strategies for improving adherence to recommended lifestyle changes in this setting.
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Longitudinal changes in Mediterranean diet and transition between different obesity phenotypes.
Konieczna, J, Yañez, A, Moñino, M, Babio, N, Toledo, E, Martínez-González, MA, Sorlí, JV, Salas-Salvadó, J, Estruch, R, Ros, E, et al
Clinical nutrition (Edinburgh, Scotland). 2020;(3):966-975
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BACKGROUND & AIMS Little is known about the impact of specific dietary patterns on the development of obesity phenotypes. We aimed to determine the association of longitudinal changes in adherence to the traditional Mediterranean diet (MedDiet) with the transition between different obesity phenotypes. METHODS Data of 5801 older men and women at high cardiovascular risk from PREDIMED trial were used. Adherence to MedDiet was measured with the validated 14p-Mediterranean Diet Adherence Screener (MEDAS). Using the simultaneous combination of metabolic health- and body size-related parameters participants were categorized into one of four phenotypes: metabolically healthy and abnormal obese (MHO and MAO), metabolically healthy and abnormal non-obese (MHNO and MANO). Cox regression models with yearly repeated measures during 5-year of follow-up were built with use of Markov chain assumption. RESULTS Each 2-point increase in MEDAS was associated with the following transitions: in MAO participants, with a 16% (95% CI 3-31%) greater likelihood of becoming MHO; in MHO participants with a 14% (3-23%) lower risk of becoming MAO; in MHNO participants with a 18% (5-30%) lower risk of becoming MHO. In MANO women, but not in men, MEDAS was associated with 20% (5-38%) greater likely of becoming MHNO (p for interaction by gender 0.014). No other significant associations were observed. CONCLUSIONS Better adherence to the traditional MedDiet is associated with transitions to healthier phenotypes, promoting metabolic health improvement in MAO, MANO (only in women), and MHO, as well as protecting against obesity incidence in MHNO subjects.
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Dietary Quality Changes According to the Preceding Maximum Weight: A Longitudinal Analysis in the PREDIMED-Plus Randomized Trial.
Bouzas, C, Bibiloni, MDM, Garcia, S, Mateos, D, Martínez-González, MÁ, Salas-Salvadó, J, Corella, D, Schröder, H, Martínez, JA, Alonso-Gómez, ÁM, et al
Nutrients. 2020;(10)
Abstract
One-year dietary quality change according to the preceding maximum weight in a lifestyle intervention program (PREDIMED-Plus trial, 55-75-year-old overweight or obese adults; n = 5695) was assessed. A validated food frequency questionnaire was used to assess dietary intake. A total of 3 groups were made according to the difference between baseline measured weight and lifetime maximum reported weight: (a) participants entering the study at their maximum weight, (b) moderate weight loss maintainers (WLM), and (c) large WLM. Data were analyzed by General Linear Model. All participants improved average lifestyle. Participants entering the study at their maximum weight were the most susceptible to improve significantly their dietary quality, assessed by adherence to Mediterranean diet, DII and both healthful and unhealthful provegetarian patterns. People at maximum weight are the most benefitted in the short term by a weight management program. Long term weight loss efforts may also reduce the effect of a weight management program.
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Adherence to a priori dietary indexes and baseline prevalence of cardiovascular risk factors in the PREDIMED-Plus randomised trial.
Alvarez-Alvarez, I, Toledo, E, Lecea, O, Salas-Salvadó, J, Corella, D, Buil-Cosiales, P, Zomeño, MD, Vioque, J, Martinez, JA, Konieczna, J, et al
European journal of nutrition. 2020;(3):1219-1232
Abstract
PURPOSE Cardiovascular disease remains the global leading cause of death. We evaluated at baseline the association between the adherence to eight a priori high-quality dietary scores and the prevalence of individual and clustered cardiovascular risk factors (CVRF) in the PREDIMED-Plus cohort. METHODS All PREDIMED-Plus participants (6874 men and women aged 55-75 years, with overweight/obesity and metabolic syndrome) were assessed. The prevalence of 4 CVRF (hypertension, obesity, diabetes, and dyslipidaemia), using standard diagnoses criteria, were considered as outcomes. The adherence to eight a priori-defined dietary indexes was calculated. Multivariable models were fitted to estimate differences in mean values of factors and prevalence ratios for individual and clustered CVRF. RESULTS Highest conformity to any dietary pattern did not show inverse associations with hypertension. The modified Mediterranean Diet Score (PR = 0.95; 95% CI 0.90-0.99), Mediterranean Diet Adherence Score (MEDAS) (PR = 0.94; 95% CI 0.89-0.98), the pro-vegetarian dietary pattern (PR = 0.95; 95% CI 0.90-0.99) and the Alternate Healthy Eating Index 2010 (PR = 0.92; 95% CI 0.87-0.96) were inversely associated with prevalence of obesity. We identified significant inverse trend among participants who better adhered to the MEDAS and the Prime Diet Quality Score (PDQS) in the mean number of CVRF across categories of adherence. Better adherence to several high-quality dietary indexes was associated with better blood lipid profiles and anthropometric measures. CONCLUSIONS Highest adherence to dietary quality indexes, especially Mediterranean-style and PDQS scores, showed marginal associations with lower prevalence of individual and clustered CVRF among elderly adults with metabolic syndrome at high risk of cardiovascular disease.
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Glycemic qualification rate and frequency of self-monitoring blood glucose glycemic qualification rate and frequency of self-monitoring blood glucose (SMBG) in women with gestational diabetes mellitus (GDM).
Tian, Y, Zhang, S, Huang, F, Shi, F, Li, Y, Chen, X, Zhang, C, Zhong, H, Ma, W, Liu, C, et al
Diabetes research and clinical practice. 2020;:108482
Abstract
AIMS: To explore the relationship between blood glucose (BG) control rate and self-monitoring blood glucose (SMBG) compliance of women with gestational diabetes mellitus (GDM). METHODS Women with GDM (n = 309) were randomized to receive routine clinical prenatal care or additional online management. Follow-up visits were conducted every two weeks (noted here as T) from enrollment to delivery. SMBG records were used for the analysis. RESULTS Both the intervention group and the control group had an increasing BG control rate and decreasing SMBG compliance during the whole follow-up period. Detailed data analysis on separate follow-up periods showed that the SMBG frequency was negatively correlated with the BG control rate in most Ts and that the BG control rate of Tn-1 was negatively correlated with the SMBG frequency of Tn in the adjacent T. Only in the intervention group was T2 SMBG compliance not under the influence of the T1 BG control rate. CONCLUSIONS Our data suggested that regardless of management approach, the BG control rate increased, and the SMBG frequency decreased as gestational weeks increased in women with GDM. Even in separate follow-up periods, the SMBG frequency was negatively correlated with the BG control rate both within one follow-up period and between two adjacent follow-up periods.