Cost-effectiveness of behavioural counselling intervention compared with non-intervention for adult patients with metabolic syndrome to prevent cardiovascular diseases and type 2 diabetes in Japan: a microsimulation modelling study.

OBJECTIVES: Nationwide lifestyle intervention-specific health guidance (SHG) in Japan-employs counselling and education to change unhealthy behaviours that contribute to metabolic syndrome, especially obesity or abdominal obesity. We aimed to perform a model-based economic evaluation of SHG in a low participation rate setting. DESIGN: A hypothetical population, comprised 50 000 Japanese aged 40 years who met the criteria of the SHG, used a microsimulation using the Markov model to evaluate SHG's cost-effectiveness compared with non-SHG. This hypothetical population was simulated over a 35-year time horizon. SETTING: SHG is conducted annually by all Japanese insurers. OUTCOME MEASURES: Model parameters, such as costs and health outcomes (including quality-adjusted life-years, QALYs), were based on existing literature. Incremental cost-effectiveness ratios were estimated from the healthcare payer's perspective. Deterministic and probabilistic sensitivity analyses (PSA) were conducted to evaluate the uncertainty around the model input parameters. RESULTS: The simulation revealed that the total costs per person in the SHG group decreased by JPY53 014 (US$480) compared with that in the non-SHG group, and the QALYs increased by 0.044, wherein SHG was considered the dominant strategy despite the low participation rates. PSA indicated that the credibility intervals (2.5th-97.5th percentile) of the incremental costs and the incremental QALYs with the SHG group compared with the non-SHG group were -JPY687 376 to JPY85 197 (-US$6226 to US$772) and -0.009 to 0.350 QALYs, respectively. Each scenario analysis indicated that programmes for improving both blood pressure and blood glucose levels among other risk factors for metabolic syndrome are essential for improving cost-effectiveness. CONCLUSIONS: This study suggests that even small effects of counselling and education on behavioural modification may lead to the prevention of acute life-threatening events and chronic diseases, in addition to the reduction of medication resulting from metabolic syndrome, which results in cost savings.

Understanding ethnic inequalities in the design and implementation of digital health interventions for cardiometabolic disease: a qualitative study.

BACKGROUND: The use of digital health interventions (DHIs), such as apps and wearable devices, for prevention and management of cardiometabolic disease, has been accelerated by the impact of COVID-19 on health-care services. Digital inequalities disproportionately affect those most at risk of wider health inequalities (e.g., older age, minority ethnicity, and lower household income) and might intersect with populations with higher cardiometabolic disease risk such as South Asians in the UK. We wanted to understand how those involved in DHI implementation perceive and address these inequalities, to help develop recommendations to reduce the risk of DHI implementation exacerbating existing health inequalities. METHODS: For this qualitative study we used a purposive sampling strategy, whereby focus groups and semi-structured interviews were done online between April 7 and Dec 8, 2022, with stakeholders, including health-care professionals (n=15); technology developers and digital experts (n=10); those in strategy, evaluation, or policy roles (n=15); and charities (n=4). Discussions covered barriers and facilitators to inclusive design and implementation of DHIs, with focus dependent on expertise. Findings from a qualitative study with South Asian patients have been reported separately. Audio recordings were transcribed and coded using reflexive thematic analysis. Participants provided written consent and the study received NHS Health Research Authority approval from London - Brent Research Ethics Committee (IRAS 261047). FINDINGS: Participants had a good understanding of barriers to DHI use for cardiometabolic disease faced by South Asians, highlighting the need to design for language, culture, and diet. Many emphasised the link between digital exclusion and socioeconomic deprivation, across all ethnic groups in the UK. The potential for DHIs in improving patient outcomes was recognised; however, equity concerns included unequal patient access, lack of data and resources to target support, and need for quality evidence to recommend and commission digital tools. A range of solutions for improving equity were suggested such as resourcing support for digital upskilling, community engagement, and the role of regulation in embedding improved design and evaluation of DHIs available through health-care services. INTERPRETATION: This study reflects the experiences of professionals interested in (digital) health inequalities. However, challenges to equitable digital health implementation and use are well described. Our findings present multi-sectoral responsibilities and opportunities for action. FUNDING: National Institute for Health and Care Research (NIHR).

Improving physical health monitoring and interventions in a learning disabilities forensic psychiatric secure service.

BACKGROUND: Patients in psychiatric inpatient settings are at increased risk of developing physical health complications due to the structure of inpatient wards, the metabolic side-effects of antipsychotic medications and socioeconomic factors. Robust physical health monitoring and interventions are paramount in reducing this health inequality. OBJECTIVE: To improve the quality of physical health interventions in the ward environment and empower patients to follow healthy lifestyle guidance to reduce their risk of metabolic syndrome. METHODS: Patient weight and waist circumference data were collected at baseline and weekly throughout the 8-week intervention period. A questionnaire was recorded from baseline to week-5 to assess patient understanding. Two Plan-Do-Study-Act (PDSA) cycles were completed: (1) Series of weekly psychoeducation sessions and group exercise and (2) Implementation of healthy living diaries. RESULTS: Our data did not demonstrate any definitive impact upon the waist circumference and weight of participants. However, analysis of the questionnaires showed a consistent trend in knowledge improvement. CONCLUSION: Whilst our aim of reducing patient weight and waist circumference was not realised, there was a significant impact on participant's knowledge, demonstrating a subjective benefit of our interventions. Our project also highlighted inconsistencies in physical health measurements and data collection, providing vital information for further quality improvement measures.

Dietary Assessment Tools and Metabolic Syndrome: Is It Time to Change the Focus?

Metabolic syndrome (MS) is associated with a range of chronic diseases, for which lifestyle interventions are considered the cornerstone of treatment. Dietary interventions have primarily focused on weight reduction, usually via energy restricted diets. While this strategy can improve insulin sensitivity and other health markers, weight loss alone is not always effective in addressing all risk factors associated with MS. Previous studies have identified diet quality as a key factor in reducing the risk of MS independent of weight loss. Additionally, supporting evidence for the use of novel strategies such as carbohydrate restriction and modifying the frequency and timing of meals is growing. It is well established that dietary assessment tools capable of identifying dietary patterns known to increase the risk of MS are essential for the development of personalised, targeted diet and lifestyle advice. The American Heart Association (AHA) recently evaluated the latest in a variety of assessment tools, recommending three that demonstrate the highest evidence-based and clinical relevance. However, such tools may not assess and thus identify all dietary and eating patterns associated with MS development and treatment, especially those which are new and emerging. This paper offers a review of current dietary assessment tools recommended for use by the AHA to assess dietary and eating patterns associated with MS development. We discuss how these recommendations align with recent and novel evidence on the benefits of restricting ultra-processed food and refined carbohydrates and modifying timing and frequency of meals. Finally, we provide recommendations for future redevelopment of these tools to be deployed in health care settings.

Predictors of Health Promotion Behaviors Among Working Adults at Risk for Metabolic Syndrome.

BACKGROUND: Metabolic syndrome has a high global prevalence, affecting 26% of South Koreans. Lifestyle modifications have shown benefits in studies involving health behavior enhancement, specifically through workplace eating and exercise interventions. However, workplace interventions focusing on health behaviors have been inadequately explored. OBJECTIVES: This study examined factors affecting health promotion behaviors of workers at high risk of metabolic syndrome by applying Theory of Planned Behavior constructs (attitude, subjective norm, perceived behavioral control, and intention). METHODS: This correlational cross-sectional study collected survey data from 164 hotel workers in South Korea. The study applied factor analysis and structural equation modeling for the data analysis. RESULTS: Analysis revealed five health promotion behaviors: exercise, making healthy food choices, avoiding fatty foods, eating a nutritious and balanced diet, and eating regular moderate meals. Participants were grouped as total participants, those with one risk factor, and those with two risk factors. In the "total" group, four behaviors were influenced by perceived behavioral control: exercise, making healthy food choices, eating a nutritious and balanced diet, and eating regular moderate meals. In the "one risk factor" group, intention and attitude influenced the eating regular moderate meals behavior, and two other behaviors were influenced by perceived behavioral control: exercise and eating a nutritious and balanced diet; in the "two risk factor" group, only perceived behavioral control directly affected exercise. DISCUSSION: Perceived behavioral control was a key predictor of health behaviors, and theory constructs partially explained behaviors. Perceived behavioral control influenced four behaviors and influenced exercise in all three groups. Also, theory constructs showed a greater effect on behaviors in the one risk factor group than in the two risk factor group, indicating that participants with one risk factor more effectively managed their behaviors on their own and with healthcare providers' support. Occupational health providers should conduct early assessments of workers showing metabolic syndrome risk factors to identify their particular risks, intention, and behaviors. As the number of risk factors affects behaviors and perceived behavioral control primarily influences exercise, these findings should be incorporated in metabolic syndrome interventions.

Cost-effectiveness of a stepwise cardiometabolic disease prevention program: results of a randomized controlled trial in primary care.

BACKGROUND: Cardiometabolic diseases (CMD) are the major cause of death worldwide and are associated with a lower quality of life and high healthcare costs. To prevent a further rise in CMD and related healthcare costs, early detection and adequate management of individuals at risk could be an effective preventive strategy. The objective of this study was to determine long-term cost-effectiveness of stepwise CMD risk assessment followed by individualized treatment if indicated compared to care as usual. A computer-based simulation model was used to project long-term health benefits and cost-effectiveness, assuming the prevention program was implemented in Dutch primary care. METHODS: A randomized controlled trial in a primary care setting in which 1934 participants aged 45-70 years without recorded CMD or CMD risk factors participated. The intervention group was invited for stepwise CMD risk assessment through a risk score (step 1), additional risk assessment at the practice in case of increased risk (step 2) and individualized follow-up treatment if indicated (step 3). The control group was not invited for risk assessment, but completed a health questionnaire. Results of the effectiveness analysis on systolic blood pressure (- 2.26 mmHg; 95% CI - 4.01: - 0.51) and total cholesterol (- 0.15 mmol/l; 95% CI - 0.23: - 0.07) were used in this analysis. Outcome measures were the costs and benefits after 1-year follow-up and long-term (60 years) cost-effectiveness of stepwise CMD risk assessment compared to no assessment. A computer-based simulation model was used that included data on disability weights associated with age and disease outcomes related to CMD. Analyses were performed taking a healthcare perspective. RESULTS: After 1 year, the average costs in the intervention group were 260 Euro higher than in the control group and differences were mainly driven by healthcare costs. No meaningful change was found in EQ 5D-based quality of life between the intervention and control groups after 1-year follow-up (- 0.0154; 95% CI - 0.029: 0.004). After 60 years, cumulative costs of the intervention were 41.4 million Euro and 135 quality-adjusted life years (QALY) were gained. Despite improvements in blood pressure and cholesterol, the intervention was not cost-effective (ICER of 306,000 Euro/QALY after 60 years). Scenario analyses did not allow for a change in conclusions with regard to cost-effectiveness of the intervention. CONCLUSIONS: Implementation of this primary care-based CMD prevention program is not cost-effective in the long term. Implementation of this program in primary care cannot be recommended. TRIAL REGISTRATION: Dutch Trial Register NTR4277 , registered on 26 November 2013.

The CASSIOPEA Study (Economic Crisis and Adherence to the Mediterranean diet: poSSIble impact on biOmarkers of inflammation and metabolic PhEnotypes in the cohort of the Moli-sAni Study): Rationale, design and characteristics of participants.

BACKGROUND AND AIMS: The CASSIOPEA Study was designed to evaluate whether the economic downturn during the late 2000s was a contributing factor to the observed decrease in adherence to Mediterranean diet (MD). METHODS AND RESULTS: The study protocol consists of two steps: A) recall of 7406 men and women who, between 2005 and 2006, had been randomly recruited in the Moli-sani Study from the general population of Molise, to assess possible economic hardship (EH) related to the economic crisis initiated in 2007; B) re-examination, between 2017 and 2020, of available subjects identified in Step 1 as poorly or harder hit by EH to test the hypothesis that EH is associated with a decrease in MD adherence, possibly resulting in increased inflammation. The results of Step 1 are reported here. From the initial sample of individuals re-examined after 12.6 years (median; IQR = 12.1-13.0 y), 3646 were finally analysed. An Economic Hardship Score (EHS; range 0-14) was obtained by scoring three domains: 1) change in employment status; 2) financial hardship and 3) financial hardship for health expenditures. Overall, 37.8% of the sample reported high EHS (≥3), whilst 32% scored 0 (no EH). Those with high EHS were prevalently women and younger, with low socioeconomic status. CONCLUSIONS: High economic hardship was prevalently reported by weaker socioeconomic groups. Longitudinal analysis (step 2) will examine whether the economic crisis had an effect on adherence to Mediterranean diet with consequent potential impact on inflammation, one of the main biological pathways linking MD to health outcomes. CLINICALTRIALS. GOV IDENTIFIER: NCT03119142.

A cross sectional study on beliefs and roles of community pharmacy professionals in preventing and managing metabolic syndrome in an Ethiopian setting.

INTRODUCTION: Metabolic syndrome (MetS) is a group of cardiovascular risk factors, and its prevalence is becoming alarmingly high in Ethiopia. Studies uncovered as community pharmacy professionals (CPPs) have not yet well integrated into public health programs and priorities. In low income setting like Ethiopia, evidence regarding the roles CPPs in preventing and management of MetS is dearth. OBJECTIVE: The study was aimed to assess community pharmacy professionals'(CPPs) opinions about metabolic syndrome, describe their perception level towards the effectiveness of the main interventions and explore their extent of involvement in counseling patients with the metabolic syndrome in Gondar town, Northwestern Ethiopia. METHOD: A descriptive, cross-sectional study was conducted among pharmacists and druggists working in community medication retail outlets (CMROs) in Gondar town, northwestern Ethiopia from April 1 to May 31, 2019. Data were collected using a self-administered pre-tested questionnaire. Descriptive statistics was used to summarize different variables, and presented in tables and figure. An independent t-test and one way ANOVA (Analysis of Variance) were used to compare mean scores. A 5% level of significance was used. RESULT: Out of the 75 CPPs approached, 65(40 pharmacists and 25 druggists) completed the survey giving a response rate of 86.7%. Smoking cessation practice was identified to be low. There were a statistically significant difference (t = 2.144, P = 0.036) in the involvement towards counseling patients between CPPs who claimed to work in pharmacy (mean = 3.96 out of 5 points Likert scale) and drug stores (mean = 3.80 out of 5 points Likert scale). CONCLUSION: The study concluded that the overall involvement of professionals in counseling patients, opinion about metabolic syndrome, and perception towards the effectiveness of the intervention was found to be more or less positive. However, the provision of services, such as monitoring therapy, selling equipment for home blood pressure and glucose monitoring and documenting patient care services needs to be encouraged. Given proper education and training, the current study hope that community pharmacists could be an important front-line contributors to contain this emerging epidemic in Gondar town as well as in the entire nation.

A systematic review of pharmacist input to metabolic syndrome screening, management and prevention.

Background Metabolic syndrome is a cluster of factors that increase the risk of cardiovascular disease and include: diabetes and prediabetes, abdominal obesity, elevated triglycerides, low high-density lipoprotein cholesterol and high blood-pressure. However, the role of the pharmacist in the metabolic syndrome has not yet been fully explored. Aim of the review This systematic review aimed to critically appraise, synthesise, and present the available evidence on pharmacists' input to the screening, prevention and management of metabolic syndrome. Method The final protocol was based on the "Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P)". Studies published in English from January 2008 to March 2020 reporting any pharmacist activities in the screening, prevention or management of metabolic syndrome were included. Databases searched were Medline, Cumulative Index to Nursing and Allied Health Literature, International Pharmaceutical Abstracts, Cochrane and Google Scholar. Studies were assessed for quality by two researchers, data extracted and findings synthesised using a narrative approach. Results Of the 39,430 titles reviewed, ten studies were included (four were randomised controlled trials). Most studies focused on pharmacist input to metabolic syndrome screening and management. Screening largely involved communicating metabolic parameters to physicians. Management of metabolic syndrome described pharmacists collaborating with members of the multidisciplinary team. A positive impact was reported in all studies, including achieving metabolic syndrome parameter goals, reverting to a non-metabolic syndrome status and, improved medication adherence. The populations studied were paediatrics with risk factors, adults with comorbidities and psychiatric patients. Integration of the pharmacist within the multidisciplinary team, an easy referral process and accessibility of service were potential facilitators. Inadequate funding was the key barrier. Conclusion The studies describing pharmacist input in metabolic syndrome provide limited evidence of positive outcomes from screening and management as part of collaborative practice. Further work is required to provide more robust evidence of effectiveness and cost-effectiveness while considering key barriers.

Does the association between patterns of fruit and vegetables and metabolic syndrome incidence vary according to lifestyle factors and socioeconomic status?

BACKGROUND AND AIMS: The aim of this study is to investigate the association between the identified patterns of fruits and vegetables and metabolic syndrome (MetS) incidence, and to investigate whether lifestyle factors and socioeconomic status modify the effect of the patterns on MetS risk. METHODS AND RESULTS: We prospectively studied 1915 participants of the Tehran Lipid and Glucose Study, who were aged 19-74 years and followed up for dietary assessment using a validated, semi-quantitative food frequency questionnaire. After adjustment for confounding factors, total vegetable intake was inversely related to the risk of MetS. Total fruit and total fruit and vegetable were not associated with MetS risk. We identified four major patterns of fruits and vegetables by factor analysis: "fresh fruit pattern", "vegetable pattern", "dried fruit and cruciferous vegetable pattern", and "potatoes and fruit juice pattern". "Vegetable pattern" was negatively associated with MetS risk, and "potatoes and fruit juice pattern" increased the risk of MetS. Among participants with weight gain <7% during follow-up, all four identified patterns reduced MetS risk. When stratified by smoking, "vegetable pattern" and "dried Fruit and cruciferous vegetable pattern" lowered MetS risk among non-smokers. Stratification based on education resulted in MetS risk reduction across tertiles of "fresh fruit pattern" and "vegetable pattern". First and second tertiles of "dried fruit and cruciferous vegetable pattern" lowered MetS risk among educated participants, compared to the reference. CONCLUSIONS: The reduction in MetS risk caused by fruits and vegetables intake depends on the modifying effect of lifestyle and socioeconomic factors.

Metabolic syndrome: physical inactivity and socioeconomic inequalities among non-institutionalized Brazilian elderly. / Síndrome metabólica: inatividade física e desigualdades socioeconômicas entre idosos brasileiros não institucionalizados.

OBJECTIVE: Evaluate the association between Metabolic Syndrome (MetS), physical activity and socioeconomic conditions among non-institutionalized elderly individuals. METHODOLOGY: Cross-sectional study with, elderly individuals (≥ 60) living in the city of São Paulo. MetS was evaluated by means of the National Cholesterol Education Program criteria, the Adult Treatment Panel III. Descriptive and bivariate analyses were performed, followed by multiple logistic regression with a 5% significance level. An attributable fraction (AF) and a proportional attributable fraction (PAF) were calculated in relation to physical activity. The magnitude of the socioeconomic inequalities was evaluated using the Slope Index of Inequality (SII) and the Relative Index of Inequality (RII). RESULTS: The prevalence of MetS was 40.1%, and 23.3% of the individuals had at least one MetS' component. Physically inactive elderly had higher chances of having MetS. The prevalence of MetS was higher among those with lower education levels in both absolute and relative terms. AF and PAF were significant among the inactive individuals and for the total population. CONCLUSION: This study demonstrated that physical activity and schooling are significantly associated with MetS, highlighting the importance of these factors for the control of this syndrome.

Dietary Habits and Dietary Antioxidant Intake Are Related to Socioeconomic Status in Polish Adults: A Nationwide Study.

The aim of this study was to estimate dietary habits and dietary antioxidant intake in a Polish adult population in relation to socioeconomic status. The subjects (4774) were participants in the Polish National Multi-Centre Health Examination Survey (the WOBASZ II study) performed in 2013-2014. Socioeconomic status (SES) scores were calculated by multiplying ordinal numerical values assigned to consecutive categories of education level and monthly income per capita in a family. In the Polish adult population, a higher socioeconomic status was significantly associated with a better lifestyle (more physical activity and less smoking), a better health status (lower occurrence of overweight individuals and metabolic syndrome in both genders, and lower occurrence of central obesity, hypertension, and diabetes in women), and better dietary habits, including a higher intake of dietary antioxidants.

A cross-sectional study of the public health response to non-alcoholic fatty liver disease in Europe.

BACKGROUND & AIMS: Non-alcoholic fatty liver disease (NAFLD) is a growing public health problem worldwide and has become an important field of biomedical inquiry. We aimed to determine whether European countries have mounted an adequate public health response to NAFLD and non-alcoholic steatohepatitis (NASH). METHODS: In 2018 and 2019, NAFLD experts in 29 European countries completed an English-language survey on policies, guidelines, awareness, monitoring, diagnosis and clinical assessment in their country. The data were compiled, quality checked against existing official documents and reported descriptively. RESULTS: None of the 29 participating countries had written strategies or action plans for NAFLD. Two countries (7%) had mentions of NAFLD or NASH in related existing strategies (obesity and alcohol). Ten (34%) reported having national clinical guidelines specifically addressing NAFLD and, upon diagnosis, all included recommendations for the assessment of diabetes and liver cirrhosis. Eleven countries (38%) recommended screening for NAFLD in all patients with either diabetes, obesity and/or metabolic syndrome. Five countries (17%) had referral algorithms for follow-up and specialist referral in primary care, and 7 (24%) reported structured lifestyle programmes aimed at NAFLD. Seven (24%) had funded awareness campaigns that specifically included prevention of liver disease. Four countries (14%) reported having civil society groups which address NAFLD and 3 countries (10%) had national registries that include NAFLD. CONCLUSIONS: We found that a comprehensive public health response to NAFLD is lacking in the surveyed European countries. This includes policy in the form of a strategy, clinical guidelines, awareness campaigns, civil society involvement, and health systems organisation, including registries. LAY SUMMARY: We conducted a survey on non-alcoholic fatty liver disease with experts in European countries, coupled with data extracted from official documents on policies, clinical guidelines, awareness, and monitoring. We found a general lack of national policies, awareness campaigns and civil society involvement, and few epidemiological registries.

Development and Assessment of a Social Network Service-Based Lifestyle-Modification Program for Workers at High Risk of Developing Cardiovascular Disease.

Cardiovascular disease is a leading cause of mortality in the United States. This study examined the cardiovascular disease risk factors and health beliefs of workers for the purpose of developing a social network service (SNS)-based (e.g., Facebook and KakaoTalk) lifestyle-modification program for workers. Participants included 68 hospital workers (aged 25-60 years), with more than two metabolic syndrome or cardiovascular disease risk factors. Participants were randomly assigned to one of three groups: SNS intervention group (n = 23), education-only intervention group (n = 19), or nonintervention group (n = 26). Data were collected to compare changes in risk indicators according to the intervention method and time and analyzed using repeated-measures analyses of variance. Compared to the education and nonintervention groups, the SNS intervention group demonstrated significant improvements in waist circumference, body mass index, total cholesterol, low-density lipoprotein cholesterol, health promotion behaviors, and self-efficacy. This type of program has potential for allowing occupational health professionals to work with workers to improve lifestyle behaviors that promote health and reduce the risk of cardiovascular disease.

Síndrome metabólica: inatividade física e desigualdades socioeconômicas entre idosos brasileiros não institucionalizados / Metabolic syndrome: physical inactivity and socioeconomic inequalities among non-institutionalized Brazilian elderly

RESUMO: Objetivo: Avaliar a associação da síndrome metabólica (SM) com a atividade física e as condições socioeconômicas entre idosos não institucionalizados. Metodologia: Estudo transversal com idosos (≥ 60) não institucionalizados e residentes na cidade de São Paulo (SP). A SM foi classificada com base nos critérios da National Cholesterol Education Program Adult Treatment Panel III. Realizou-se analise descritiva e bivariada seguida por regressão logística múltipla com nível de significância de 5%. Calcularam-se a fração atribuível (FA) e a fração atribuível proporcional (FAP) e determinou-se a magnitude das desigualdades por meio do índice absoluto de desigualdade e pelo índice relativo de desigualdade. Resultados: A prevalência de SM foi de 40,1%, e 23,3% dos idosos apresentavam pelo menos um componente da síndrome. A chance de SM foi maior entre os idosos fisicamente inativos. Idosos menos escolarizados apresentaram prevalências de SM significativamente maiores em termos absolutos e relativos. As FA e FAP entre os inativos e na população foram significativos. Conclusão: Este estudo demonstrou que a prática de atividade física e a escolaridade são fatores significativamente associados à SM, reforçando a importância desses fatores para o controle dessa síndrome.

ABSTRACT: Objective: Evaluate the association between Metabolic Syndrome (MetS), physical activity and socioeconomic conditions among non-institutionalized elderly individuals. Methodology: Cross-sectional study with, elderly individuals (≥ 60) living in the city of São Paulo. MetS was evaluated by means of the National Cholesterol Education Program criteria, the Adult Treatment Panel III. Descriptive and bivariate analyses were performed, followed by multiple logistic regression with a 5% significance level. An attributable fraction (AF) and a proportional attributable fraction (PAF) were calculated in relation to physical activity. The magnitude of the socioeconomic inequalities was evaluated using the Slope Index of Inequality (SII) and the Relative Index of Inequality (RII). Results: The prevalence of MetS was 40.1%, and 23.3% of the individuals had at least one MetS' component. Physically inactive elderly had higher chances of having MetS. The prevalence of MetS was higher among those with lower education levels in both absolute and relative terms. AF and PAF were significant among the inactive individuals and for the total population. Conclusion: This study demonstrated that physical activity and schooling are significantly associated with MetS, highlighting the importance of these factors for the control of this syndrome.

Ethnicity and Metabolic Syndrome: Implications for Assessment, Management and Prevention.

The metabolic syndrome (MetS) is a constellation of cardiometabolic risk factors that identifies people at increased risk for type 2 diabetes and cardiovascular disease. While the global prevalence is 20%-25% of the adult population, the prevalence varies across different racial/ethnic populations. In this narrative review, evidence is reviewed regarding the assessment, management and prevention of MetS among people of different racial/ethnic groups. The most popular definition of MetS considers race/ethnicity for assessing waist circumference given differences in visceral adipose tissue and cardiometabolic risk. However, defining race/ethnicity may pose challenges in the clinical setting. Despite 80% of the world's population being of non-European descent, the majority of research on management and prevention has focused on European-derived populations. In these studies, lifestyle management has proven an effective therapy for reversal of MetS, and randomised studies are underway in specific racial/ethnic groups. Given the large number of people at risk for MetS, prevention efforts need to focus at community and population levels. Community-based interventions have begun to show promise, and efforts to improve lifestyle behaviours through alterations in the built environment may be another avenue. However, careful consideration needs to be given to take into account the unique cultural context of the target race/ethnic group.

Quality of life and metabolic control in type 2 diabetes mellitus diagnosed individuals.

AIMS: Determine the correlation of quality of life (QoL) and the impact on the metabolic control of patients with type 2 diabetes mellitus (T2DM). METHODS: An observational study was conducted at the outpatient consulting service in a specialized hospital in Santo Domingo, DR. We used a non-probabilistic, convenience sampling strategy, and the World Health Organization Quality of Life (WHOQOL-BREF) short form questionnaire was applied. RESULTS: The patients presented lower impact in QoL domains was: pain (x¯=29.07, SD = 3.04) and negative feelings (x¯=28.70, SD = 3.33). We found there is a negative correlation between the psychological domains and the fasting glycemia (rho = -0.192, p < 0.05), also between the summary of all domains of QoL and metabolic control, HbA1C (rho = -0.205, p < 0.05), and fasting glycaemia (rho = -0.214, p < 0.05). There was a significant difference in the physical domains F (1, 131) = 9.73, p = 0.002, η2 = 0.069, indicating that men (M = 14.81) have a higher physical QoL than women (M = 13.72). CONCLUSION: Given the evidence of the impact of metabolic control and the different domains to QoL, it is necessary to consider these aspects in the treatment plan of patients with diabetes, to ensure adequate management and control of future complications.

Metabolic syndrome in rural Australia: An opportunity for primary health care.

OBJECTIVE: To measure the impact of a 6-month home-based behaviour change intervention on reducing the risk of chronic disease as determined by metabolic syndrome status and cardiovascular risk score, and discuss implications for primary care in rural areas. DESIGN: A two-arm randomised controlled trial of rural adults. SETTING: The rural town of Albany in the Great Southern region of Western Australia. PARTICIPANTS: Participants (n = 401) aged 50-69 years who were classified with or at risk of metabolic syndrome and randomly assigned to intervention (n = 201) or waitlisted control (n = 200) group. INTERVENTIONS: A 6-month intervention program incorporating goal setting, self-monitoring and feedback, with motivational interviewing was conducted. MAIN OUTCOME MEASURES: Change in metabolic syndrome status and cardiovascular risk. RESULTS: Significant improvements in metabolic syndrome status and cardiovascular disease risk score (-0.82) were observed for the intervention group relative to control group from baseline to post-test. CONCLUSION: This home-based physical activity and nutrition intervention reduced participants' risk of experiencing a cardiovascular event in the next 5 years by 1%. Incorporating such prevention orientated approaches in primary care might assist in reducing the burden of long-term chronic diseases. However, for realistic application in this setting, hurdles such as current national health billing system and availability of resources will need to be considered.

Targeting lifestyle energy expenditure in the management of obesity and health: from biology to built environment.

Increasing lifestyle energy expenditure has long been advocated in the prevention and treatment of obesity, as embodied in the ancient prescription of Hippocrates (the 'father of modern medicine') that people with obesity should eat less and exercise more. However, the long-term outcome of exercise alone or in combination with dieting in obesity management is poor. To understand the reasons underlying these failures and to develop novel strategies that target lifestyle energy expenditure in both prevention and treatment of obesity, research over the past decades has focused on (i) the interactions between physical activity and body weight (and its composition) throughout the lifespan; (ii) the influence of biology and potential compensatory changes in energy expenditure, food intake and food assimilation in response to energy deficits; and (iii) the impact of the built environment (outdoor and indoor) and smart technology on physical activity behaviours, thermoregulatory thermogenesis and metabolic health. It is against this background that recent advances relevant to the theme of 'Targeting Lifestyle Energy Expenditure in the Management of Obesity and Health: From Biology to Built Environment' are addressed in this overview and the nine review articles in this supplement, reporting the proceedings of the 9th Fribourg Obesity Research Conference.