Implementation of a virtual, shared medical appointment program that focuses on food as medicine principles in a population with obesity: the SLIM program.

Background: Multimodal lifestyle interventions, employing food as medicine, stand as the recommended first-line treatment for obesity. The Shared Medical Appointment (SMA) model, where a physician conducts educational sessions with a group of patients sharing a common diagnosis, offers an avenue for delivery of comprehensive obesity care within clinical settings. SMAs, however, are not without implementation challenges. We aim to detail our experience with three implementation models in launching a virtual integrative health SMA for weight management. Methods: Eligible patients included individuals 18 years of age or older, having a body mass index (BMI) of 30 kg/m2 or 27 kg/m2 or greater with at least one weight related comorbidity. The Practical, Robust Implementation and Sustainability Model (PRISM), Plan, Do, Study, Act (PDSA), and the Framework for Reporting Adaptations and Modifications-Enhanced (FRAME) models were applied to guide the implementation of the Supervised Lifestyle Integrative Medicine (SLIM) program, a virtually delivered, lifestyle medicine focused SMA program, in a weight management clinic within a major health system. We describe how these models, along with attendance for the initial cohorts, were used for decision-making in the process of optimizing the program. Results: 172 patients completed the SLIM program over two years. Attendance was lowest for sessions held at 8:00 AM and 4:00 PM compared to sessions at 10:00 AM, 1:00 PM, and 3:00 PM, leading to only offering midday sessions (p = 0.032). Attendance data along with feedback from patients, facilitators, and administrative partners led to changes in the curriculum, session number and frequency, session reminder format, and intake visit number. Conclusion: The use of implementation and quality improvement models provided crucial insight for deployment and optimization of a virtual, lifestyle medicine focused SMA program for weight management within a large healthcare system.

Four-year longitudinal culinary and lifestyle medicine track for undergraduate medical students: development and implementation.

The importance of culinary and lifestyle medicine education to combat the growing burden of chronic disease is gaining recognition in the United States. However, few medical schools offer in-depth training with a 4-year longitudinal track. The Culinary and Lifestyle Medicine Track (CLMT) is a 4-year curriculum thread created at West Virginia University School of Medicine to address the need for comprehensive culinary and lifestyle medicine education. CLMT teaches concepts of healthy nutrition, physical activity, stress management, and restorative sleep. CLMT students complete approximately 300 h of in-person and virtual culinary and lifestyle medicine education, including hands-on teaching kitchens, distributed over the preclinical and clinical years. Students are selected into the track prior to matriculation after an application and interview process. The students have exceeded expectations for scholarly and community activity. Track graduates have entered into primary care as well as specialty and surgical residencies, demonstrating that lifestyle education plays a role for students interested in a wide range of careers. Exit survey responses from learners reflected tangible and intangible benefits of participation and offered constructive feedback for improvement. Presented here are the components of the curricular design, implementation, and initial outcomes.

Lifestyle Medicine for the Health Care Worker, Workplace, and Community Well-Being: A Butterfly Effect.

Description Burnout is a prevalent and expensive problem in the US, and the National Plan For Health Workforce Well-Being included a goal to institutionalize well-being as a long-term value. Lifestyle Medicine (LM), an evidence-based practice using behavioral interventions to treat, prevent, and reverse certain chronic conditions, can achieve this goal. Implementing small changes in the workplace that support lifestyle medicine has a butterfly effect on both workplace and community well-being. Furthermore, the health of health care workers (HCWs) and patients improves, and health care costs decrease. This can be done with LM wellness programs or LM training for HCWs. LM wellness programs help the individual HCWs' and patients' well-being through the implementation of the 6 pillars of lifestyle medicine (nutrition, diet, stress reduction, social connection, avoiding/reducing toxins, restorative sleep) on an institutional level. LM initiatives, like LM training, help HCWs and their patients embark on this journey of optimal well-being, disease prevention, treatment, or reversal. Aligning policies to support evidence-based lifestyle changes that improve mood and stress reduction would support restorative rest, leaving HCWs less drained and allowing for more energy to be spent devoted to other lifestyle pillars. The Lifestyle Medicine Residency Curriculum is an example of an LM training program that leads to successful lifestyle change in residents' lives, improving their ability to coach patients. Finally, health care delivery that supports lifestyle medicine, such as shared medical appointments, is in alignment with the trend towards a value-based system for the improvement of public health.

Increasing the Efficiency of Lifestyle Medicine Counseling: A Visual Approach.

Description Too much to counsel on, too little time? We would like to present a unique and innovative perspective on lifestyle medicine counseling through the lens of a homemade flyer, designed to bridge the gap between conventional health care practices and personalized, holistic well-being. In the promising field of health care humanities, the homemade lifestyle medicine flyer serves as a tangible manifestation of individual agency in promoting health and vitality. The flyer encapsulates a diverse range of self-care practices, dietary insights, and mindfulness techniques, emphasizing the inherent connection between mind, body, and spirit in one's health journey. This double-sided document highlights the significance of empowering individuals to take an active role in their own health journey. Included are a broad range of tips for building a solid health and well-being foundation, as well as a QR code with resources to make those changes happen. Patients may understand that they need to eat healthy foods and spend time outdoors but may not know how best to implement those changes in their area. Although there is limited time for the average office visit, something as simple as a visual aid can go quite far in creating ripples of change beyond the clinic. As a take-home document, it can become an opportunity to share and empower others in the patient's own sphere of influence as well. The flyer acts as a tangible artifact, becoming a conduit for fostering a sense of community engagement, encouraging dialogue, and promoting shared experiences in the pursuit of well-being.

Lifestyle Medicine in Focus: A Cross-Sectional Study Comparing Domestic and International Students.

This study investigated lifestyle factors among Hungarian and international students, utilizing lifestyle medicine principles to enhance overall well-being. Conducted at the University of Debrecen through a cross-sectional survey, we examined selected lifestyle factors, more specifically sleep patterns, weight management, nutrition, physical activity, mental well-being, and alcohol use. Hungarian (N = 122) and international (N = 139) students were compared, revealing significant differences. Hungarian students slept less (p = 0.041), desired weight loss (p = 0.040), ate more fruits and vegetables (p = 0.014), exercised longer (p = 0.002), and reported higher purpose and social support (p = 0.009), with higher alcohol use (p < 0.001). These findings highlight distinct experiences and challenges faced by these student groups including variations in sleep, weight management, diet, exercise, and social support. Targeted interventions and tailored support are essential to address their specific needs. To promote the well-being of both Hungarian and international students, educational programs addressing various facets of a healthy lifestyle are crucial. This study offers valuable insights into lifestyle factors and health outcomes among Hungarian and international students and underscores the importance of addressing the unique needs of each group through tailored interventions.

Effects of Ayurvedic practices on quality of life of health professionals in Brazil: trends from a quasi experimental study.

Integral health encompasses the way individuals live, considering their quality of life. An inadequate lifestyle can harm human health, increasing the risk of developing chronic non-communicable diseases, which represent 71% of the causes of death worldwide and 54.7% in Brazil. The COVID-19 pandemic has led to impacts on quality of life, resulting from lifestyle changes, especially among health professionals. This constitutes an important factor in the health-disease relationship and the core of the healthcare approach embraced by Ayurveda. The present study evaluated the role of daily Ayurvedic practices in improving the quality of life of health professionals working in the Family Health Strategy of SUS in Paty do Alferes/RJ, Brazil. Ayurveda practices based on Trayopastamba were introduced to 30 health professionals through lectures and guided activities from July to October 2021, spanning three months. Quality of life was assessed using the WHOQOL-BREF questionnaire before and after the intervention. An improvement in perceived quality of life was observed in the physical, psychological, and environmental domains (p > 0.05), while the social domain did not show statistically significant results. The physical domain demonstrated the most substantial score increase (10.95). Conversely, the social domain displayed the smallest rise in scores (5.83). In conclusion, the daily Ayurvedic practices demonstrated the potential to enhance the quality of life in this group, contributing to health promotion in a practical and economically accessible manner.

Effects of intensive lifestyle changes on the progression of mild cognitive impairment or early dementia due to Alzheimer's disease: a randomized, controlled clinical trial.

BACKGROUND: Evidence links lifestyle factors with Alzheimer's disease (AD). We report the first randomized, controlled clinical trial to determine if intensive lifestyle changes may beneficially affect the progression of mild cognitive impairment (MCI) or early dementia due to AD. METHODS: A 1:1 multicenter randomized controlled phase 2 trial, ages 45-90 with MCI or early dementia due to AD and a Montreal Cognitive Assessment (MoCA) score of 18 or higher. The primary outcome measures were changes in cognition and function tests: Clinical Global Impression of Change (CGIC), Alzheimer's Disease Assessment Scale (ADAS-Cog), Clinical Dementia Rating-Sum of Boxes (CDR-SB), and Clinical Dementia Rating Global (CDR-G) after 20 weeks of an intensive multidomain lifestyle intervention compared to a wait-list usual care control group. ADAS-Cog, CDR-SB, and CDR-Global scales were compared using a Mann-Whitney-Wilcoxon rank-sum test, and CGIC was compared using Fisher's exact test. Secondary outcomes included plasma Aß42/40 ratio, other biomarkers, and correlating lifestyle with the degree of change in these measures. RESULTS: Fifty-one AD patients enrolled, mean age 73.5. No significant differences in any measures at baseline. Only two patients withdrew. All patients had plasma Aß42/40 ratios <0.0672 at baseline, strongly supporting AD diagnosis. After 20 weeks, significant between-group differences in the CGIC (p= 0.001), CDR-SB (p= 0.032), and CDR Global (p= 0.037) tests and borderline significance in the ADAS-Cog test (p= 0.053). CGIC, CDR Global, and ADAS-Cog showed improvement in cognition and function and CDR-SB showed significantly less progression, compared to the control group which worsened in all four measures. Aß42/40 ratio increased in the intervention group and decreased in the control group (p = 0.003). There was a significant correlation between lifestyle and both cognitive function and the plasma Aß42/40 ratio. The microbiome improved only in the intervention group (p <0.0001). CONCLUSIONS: Comprehensive lifestyle changes may significantly improve cognition and function after 20 weeks in many patients with MCI or early dementia due to AD. TRIAL REGISTRATION: Approved by Western Institutional Review Board on 12/31/2017 (#20172897) and by Institutional Review Boards of all sites. This study was registered retrospectively with clinicaltrials.gov on October 8, 2020 (NCT04606420, ID: 20172897).

Reversal of Autism Symptoms among Dizygotic Twins through a Personalized Lifestyle and Environmental Modification Approach: A Case Report and Review of the Literature.

The prevalence of autism has been increasing at an alarming rate. Even accounting for the expansion of autism spectrum disorder diagnostic (ASD) criteria throughout the 1990's, there has been an over 300% increase in ASD prevalence since the year 2000. The often debilitating personal, familial, and societal sequelae of autism are generally believed to be lifelong. However, there have been several encouraging case reports demonstrating the reversal of autism diagnoses, with a therapeutic focus on addressing the environmental and modifiable lifestyle factors believed to be largely underlying the condition. This case report describes the reversal of autism symptoms among dizygotic, female twin toddlers and provides a review of related literature describing associations between modifiable lifestyle factors, environmental exposures, and various clinical approaches to treating autism. The twins were diagnosed with Level 3 severity ASD "requiring very substantial support" at approximately 20 months of age following concerns of limited verbal and non-verbal communication, repetitive behaviors, rigidity around transitions, and extensive gastrointestinal symptoms, among other common symptoms. A parent-driven, multidisciplinary, therapeutic intervention involving a variety of licensed clinicians focusing primarily on addressing environmental and modifiable lifestyle factors was personalized to each of the twin's symptoms, labs, and other outcome measures. Dramatic improvements were noted within several months in most domains of the twins' symptoms, which manifested in reductions of Autism Treatment Evaluation Checklist (ATEC) scores from 76 to 32 in one of the twins and from 43 to 4 in the other twin. The improvement in symptoms and ATEC scores has remained relatively stable for six months at last assessment. While prospective studies are required, this case offers further encouraging evidence of ASD reversal through a personalized, multidisciplinary approach focusing predominantly on addressing modifiable environmental and lifestyle risk factors.

Exercise and endometriosis-is there a promising future? A narrative review.

BACKGROUND: Endometriosis is the leading cause of chronic pelvic pain in women of reproductive age with debilitating effects on quality of life, yet no cure exists. Exercise yields the potential in providing women with a non-invasive, non-pharmacological method of symptom control. AIM(S): Present up-to-date knowledge regarding how exercise may contribute to the management of endometriosis-related symptoms. OBJECTIVE(S): Discuss: 1. The pathophysiology surrounding exercise and endometriosis. 2. The role of exercise in endometriosis symptom control. RATIONALE: Scientific literature has alluded to exercise being a favourable factor in the management of endometriosis-related symptoms. Moreover, current clinical guidelines for endometriosis fail to reflect the aforementioned benefits of exercise. SEARCH STRATEGY: A search strategy using the terms 'endometriosis', 'endometriomas', 'exercise', and 'physical activity' was devised. Pubmed, Medline, Cochrane reviews, and Embase were reviewed. INCLUSION CRITERIA: Interventional studies, within-subjects studies, randomised-control trials, systematic reviews, meta-analysis, cohort studies, publication since 2000. EXCLUSION CRITERIA: Non-English publications, non-human studies. RESULTS: Numerous studies have suggested positive effects for endometriosis patients who performed exercise exclusively or in conjunction with other therapies. Improvements in pain levels, quality of life, anxiety, and depression were noted. DISCUSSION: Current research outlines promise regarding the potential benefit of exercise prescribing in patients with endometriosis as well as a synergy between exercise and hormonal therapies for the management of endometriosis-related symptoms. However, the current paucity of high-quality robust studies investigating these aspects of endometriosis management is an apparent obstacle to progression in this area. CONCLUSION: For clinicians to incorporate exercise in managing endometriosis, clear recommendations regarding advice and benefits are needed.

Counseling lifestyle medicine in oncology: A qualitative analysis of interprofessional patient-nurse-physician interactions.

OBJECTIVES: Counseling plays a key role in promoting health behaviors, providing evidence-based information, and supporting patients with cancer during and after treatment. This study aimed to evaluate an interprofessional counseling service on Complementary and Integrative Health (CIH) for patients being treated at Comprehensive Cancer Centers (CCCs) in Southern Germany. METHODS: Patients participating in the CCC-Integrativ study received three CIH counseling sessions within three months in addition to their conventional cancer treatment. Medical and nursing staff participated in a study-specific blended learning training program before conducting the counseling. As part of the process evaluation, 30 audio-recorded counseling sessions were transcribed verbatim and analyzed by conducting a content analysis using MAXQDA 2020. RESULTS: Throughout the counseling, patients were conceded to address various health issues, which mainly revolved around symptom management interlaced with the areas of nutrition, exercise, and relaxation. The interprofessional teams conducted the counseling in a structured and patient-oriented manner. They worked together to motivate the patients to apply procedures from the CIH field independently, even if patients sometimes experienced difficulties in implementation. CONCLUSIONS: Interprofessional collaboration improved healthcare quality, as patients received comprehensive and evidence-based advice on their supportive needs and lifestyle issues. Both professions could equally contribute their areas of knowledge and expertise and apply them to the benefit of the patients. PRACTICE IMPLICATIONS: Providing an integrative counseling service and adequate training on interpersonal communication and CIH for healthcare professionals will improve patient-centered care.

Using the Values of Integrative Medicine to Create the Future of Healthcare.

The ideal future state of health for the world's populations requires a cohesive model that considers the synergistic roles of communities, public health and healthcare. This future state reaffirms the importance of the relationship between practitioner and patient, focuses on the whole person, is informed by evidence, and makes use of all appropriate therapeutic and lifestyle approaches, healthcare professionals and disciplines to achieve optimal health and healing. This is the definition of Integrative Medicine. We are far from this idealistic future. Healthcare costs continue to escalate while life expectancy declines. We train our future healthcare professionals in our current disease-based model that prioritizes siloed pharmaceutical and interventional approaches over whole person prevention focused care. As healthcare professionals, we disregard our capacity to influence the leading risk factors for disease-related death and disability which include health behaviors, social, economic and environmental drivers. Burnout is high and rising. Rapid shifts are expected in the coming years as the current system's cost becomes untenable. We need a sustainable future for healthcare. That means we must figure out how to re-center on the patient, on a full spectrum of prevention and treatment, and how to influence public and community health. The future model must focus on health behaviors at its foundation, use systems thinking, be environmentally sustainable, and approach health from a population lens. The future will require an ability to consider complex systems approaches to health and wellbeing that include a focus on both the patient and the healthcare team. Research strategies must not only consider effectiveness but also reach, implementation and institutionalization in a multi-dimensional capacity that looks at whole person health as an outcome while looking at individuals in the context of where they live and work.  The Integrative Medicine community has an opportunity to help lead the way to a sustainable and health focused future.

Case Report of Lifestyle Management of a Complex Patient With Type 2 Diabetes Mellitus, Hypertension, and Multiple Co-Morbidities.

Objective: This case report depicts the application of lifestyle medicine to an adult, non-Hispanic, African American patient in their late 40s, with poorly controlled hypertension and associated co-morbidities of obesity, Type 2 diabetes mellitus (T2DM), depression and multiple degenerative joint disease (DJD). The patient was managed via telehealth for 1 year. Background: Chronic diseases are major risks to population health. Among these, diabetes, obesity, and hypertension are the most prevalent. United States (U.S.) prevalence estimates 34.2 million (10.5%) people of all ages are diagnosed diabetes cases and 7.3 million (2.8%) adults met diagnostic criteria but are but are not formally diagnosed. As such, diabetes ranked eighth for U.S all-cause mortality. The incidence of diabetes varied across the country from 1.2 to 46.2 per 1000 persons in 2016. Among these, 89.0% were overweight or obese, 38.0% were physically inactive and 68.4% were reported with a blood pressure of 140/90 mmHg or above. In 2017, the total cost of diagnosed diabetes was calculated at 327 billion dollars. In 2019, Hypertension (HTN) was reported as a primary or contributing cause in more than half a million deaths in the U.S. In the U.S. the HTN prevalence is 47%, or 116 million. Blood pressure (BP) control is higher among non-Hispanic white adults (32%) than non-Hispanic black adults (25%), non-Hispanic Asian adults (19%), or Hispanic adults (25%). Obesity is a modifiable risk factor for cardiometabolic disease. This especially appears true with less active to non-active lifestyles of this modern century where people tend to eat more easily accessible, unhealthy and processed food. Pandemic isolation has further enhanced people's sedentary lifestyle. An answer for many of these issues is behavioral lifestyle modification. Lifestyle management is a flexible and a multi-focused approach program based on detecting individual health risks, barriers, and goal development through motivational interviewing and clinical coaching.

Pilot Plant-Based Lifestyle Medicine Program in an Urban Public Healthcare System: Evaluating Demand and Implementation.

Lifestyle interventions that optimize nutrition, physical activity, sleep health, social connections, and stress management, and address substance use, can reduce cardiometabolic risk. Despite substantial evidence that healthful plant-based diets are beneficial for long-term cardiometabolic health and longevity, uncertainty lies in how to implement plant-based lifestyle programs in traditional clinical settings, especially in safety-net contexts with finite resources. In this mixed-methods implementation evaluation of the Plant-Based Lifestyle Medicine Program piloted in a large public healthcare system, we surveyed participants and conducted qualitative interviews and focus groups with stakeholders to assess program demand in the eligible population and feasibility of implementation within the safety-net setting. Program demand was high and exceeded capacity. Participants' main motivations for joining the program included gaining more control over life, reducing medication, and losing weight. The program team, approach, and resources were successful facilitators. However, the program faced administrative and payor-related challenges within the safety-net setting, and participants reported barriers to access. Stakeholders found the program to be valuable, despite challenges in program delivery and access. Findings provide guidance for replication. Future research should focus on randomized controlled trials to assess clinical outcomes as a result of program participation.

Exploring the Interplay Between Lifestyle Medicine and Oral Health: A Bidirectional Relationship.

Lifestyle medicine, characterized by its evidence-based approach, recognizes the profound impact of lifestyle choices on overall health. The six pillars of lifestyle medicine encompass nutrition, physical activity, stress management, sleep, avoidance of risky substances, and social connections. While their significance in promoting general health is well-established, their specific influence on oral health is an area of growing interest. A balanced and nutritious diet contributes to strong teeth and healthy gums, while regular physical activity enhances blood circulation and salivary flow, which is vital for maintaining optimal oral health. Effective stress management techniques can mitigate oral health issues related to anxiety and bruxism. Quality sleep supports oral health, allowing for tissue repair and immune system rejuvenation. Avoiding risky substances like tobacco and excessive alcohol consumption reduces the risk of oral diseases such as periodontitis and oral cancer. Lastly, social connections and supportive networks positively influence oral health by promoting positive oral hygiene behaviors and providing access to dental care resources. Understanding the impact of lifestyle medicine's six pillars on oral health offers valuable insights for healthcare professionals and individuals seeking to improve their oral well-being.

Employee Sleep Promotion Programs in Workplace Settings: An Exciting, Viable Area for Lifestyle Medicine.

In the past several decades, our population sleep health has fallen short of recommendations. Moreover, there has been an increase in sleep difficulties amidst COVID-19. Work consumes a huge proportion of our waking lives, and the nature of our work can impact the quantity and quality of employee sleep. Conversely, employee sleep also matters for work-related outcomes as evidence demonstrates poor employee sleep health is associated with increased presenteeism, absenteeism, and health care costs. Given the prevalence of poor sleep health in our population, the changing nature of work and increasing demands on capped time, the worksite represents a promising and potentially underexplored venue for lifestyle medicine practitioners to consider employee sleep health and, where possible, novel employee sleep health promotion programs. This article outlines the impact of work on sleep and reviews the potential for incorporating sleep into lifestyle interventions in workplace settings.

4 C's Approach to Meaningful and Lasting Positive Behavior Change.

Making intentional and sustainable positive behavior changes is difficult for most individuals. Knowledge and even expert coaching have shown meager results in guiding individuals towards a healthier diet and lifestyle. It is clear from the current research that additional approaches, which can help stem the tide of obesity and other chronic diseases, are needed. This article introduces a systematic process-based approach which focuses on the 4C's, Clarity, Commitment, Compassion, and Consistency. It is essential for individuals to have Clarity before they begin their health journey. Clarity must address, what do I want to change, why, and how am I going to make the change. Commitment highlights the importance of following a process-based approach that focuses on small incremental changes which over time can lead to remarkable results. Compassion is the necessary ingredient which allows individuals to continue the journey despite setbacks. By staying committed to the process, by practicing self-compassion, and by finding a healthy community, the individual is slowly able to achieve Consistency in achieving and then maintaining a healthier diet and lifestyle.

Medical Education Column, Creating a High-Yield Guide to Lifestyle Medicine for Medical Students and Healthcare Professionals.

Despite their inclusion as first-line therapy for many chronic diseases, lifestyle interventions are often de-emphasized in medical education and fail to make it into the repertoire of non-lifestyle medicine trained clinicians. We sought to address this gap in medical education by creating a concise pocket guide to lifestyle medicine that lends itself to use in the face-to-face clinical setting. With input from lifestyle medicine experts, the guide was created by medical students for medical students as well as other healthcare professionals for use in a variety of clinical settings. In this article we share our process of creating the guide, initial feedback, and future directions.

The Effect of an AI-Based, Autonomous, Digital Health Intervention Using Precise Lifestyle Guidance on Blood Pressure in Adults With Hypertension: Single-Arm Nonrandomized Trial.

BACKGROUND: Home blood pressure (BP) monitoring with lifestyle coaching is effective in managing hypertension and reducing cardiovascular risk. However, traditional manual lifestyle coaching models significantly limit availability due to high operating costs and personnel requirements. Furthermore, the lack of patient lifestyle monitoring and clinician time constraints can prevent personalized coaching on lifestyle modifications. OBJECTIVE: This study assesses the effectiveness of a fully digital, autonomous, and artificial intelligence (AI)-based lifestyle coaching program on achieving BP control among adults with hypertension. METHODS: Participants were enrolled in a single-arm nonrandomized trial in which they received a BP monitor and wearable activity tracker. Data were collected from these devices and a questionnaire mobile app, which were used to train personalized machine learning models that enabled precision lifestyle coaching delivered to participants via SMS text messaging and a mobile app. The primary outcomes included (1) the changes in systolic and diastolic BP from baseline to 12 and 24 weeks and (2) the percentage change of participants in the controlled, stage-1, and stage-2 hypertension categories from baseline to 12 and 24 weeks. Secondary outcomes included (1) the participant engagement rate as measured by data collection consistency and (2) the number of manual clinician outreaches. RESULTS: In total, 141 participants were monitored over 24 weeks. At 12 weeks, systolic and diastolic BP decreased by 5.6 mm Hg (95% CI -7.1 to -4.2; P<.001) and 3.8 mm Hg (95% CI -4.7 to -2.8; P<.001), respectively. Particularly, for participants starting with stage-2 hypertension, systolic and diastolic BP decreased by 9.6 mm Hg (95% CI -12.2 to -6.9; P<.001) and 5.7 mm Hg (95% CI -7.6 to -3.9; P<.001), respectively. At 24 weeks, systolic and diastolic BP decreased by 8.1 mm Hg (95% CI -10.1 to -6.1; P<.001) and 5.1 mm Hg (95% CI -6.2 to -3.9; P<.001), respectively. For participants starting with stage-2 hypertension, systolic and diastolic BP decreased by 14.2 mm Hg (95% CI -17.7 to -10.7; P<.001) and 8.1 mm Hg (95% CI -10.4 to -5.7; P<.001), respectively, at 24 weeks. The percentage of participants with controlled BP increased by 17.2% (22/128; P<.001) and 26.5% (27/102; P<.001) from baseline to 12 and 24 weeks, respectively. The percentage of participants with stage-2 hypertension decreased by 25% (32/128; P<.001) and 26.5% (27/102; P<.001) from baseline to 12 and 24 weeks, respectively. The average weekly participant engagement rate was 92% (SD 3.9%), and only 5.9% (6/102) of the participants required manual outreach over 24 weeks. CONCLUSIONS: The study demonstrates the potential of fully digital, autonomous, and AI-based lifestyle coaching to achieve meaningful BP improvements and high engagement for patients with hypertension while substantially reducing clinician workloads. TRIAL REGISTRATION: ClinicalTrials.gov NCT06337734; https://clinicaltrials.gov/study/NCT06337734.

Effect of a Low-Calorie Dietary Intervention on Liver Health and Body Weight in Adults with Metabolic-Dysfunction Associated Steatotic Liver Disease (MASLD) and Overweight/Obesity: A Systematic Review and Meta-Analysis.

INTRODUCTION: Metabolic-dysfunction Associated Steatotic Liver Disease (MASLD) is a common cause of chronic liver disease. This review assessed the efficacy of a Low-Calorie Diet (LCD) on liver health and body weight in people living with MASLD and obesity. METHODS: The study was registered with PROSPERO (CRD42021296501), and a literature search was conducted using multiple databases. The key inclusion criteria were randomised controlled trials or cohort studies, obesity/overweight and MASLD. Two authors screened abstracts, reviewed full texts and performed data extraction and quality assessment. The primary outcome was the change in the serum ALT, and secondary outcomes included the changes in the serum AST, intrahepatic lipid content (IHL), quantified non-invasively via MRI/MRS, and body weight. RESULTS: Fifteen studies were included. The LCD reduced body weight by 9.1 kg versus the control (95%CI: -12.4, -5.8) but not serum ALT (-5.9 IU/L, -13.9, 2.0). Total Dietary Replacement (TDR) reduced IHL by -9.1% vs. the control (-15.6%, -2.6%). The Mediterranean-LCD for ≥12 months reduced ALT (-4.1 IU/L, -7.6, -0.5) and for 24 months reduced liver stiffness versus other LCDs. The Green-Mediterranean-LCD reduced IHL, independent of body weight. Limited studies assessed those of Black or Asian ethnicity, and there was heterogeneity in the methods assessing the liver fat content and fibrosis. CONCLUSIONS: In people with MASLD and obesity, an LCD intervention reduces IHL and body weight. Trials should focus on the recruitment of Black and Asian ethnicity participants.