Effects of a behavioural approach on lifestyle habits in a healthy Italian population: a before-after interventional study.

Background: The study aimed to assess the effectiveness of an educational intervention promoting adherence to healthy diet and physical activity. Study design: Before-after interventional study. Methods: Participants were healthy volunteers, 18-70 y old, from Bologna. They followed a training course consisting of seven meetings and signed a contract to comply with the promoted habits, verified through questionnaires at the engagement phase (T0), three months later (T1) and one year later (T2). Results: One hundred, fifty-three subjects were involved, 75.8% were evaluated at T1 and 41.2% at T2. More than 80% of the subjects involved at T1 achieved an improvement of planned goals. Moreover, 77% of T1 compliants retained healthy eating and physical activity at T2. Conclusions: The proposed pathway of empowerment positively affected nutrition and promotion of physical activity at 3 months after the intervention (T1) and were maintained even after a year. The results appear to be promising for primary prevention across the spectrum of a healthy lifestyle educational approach.

A controlled, class-based multicomponent intervention to promote healthy lifestyle and to reduce the burden of childhood obesity.

BACKGROUND: Overweight and obesity prevention in childhood and adolescence represent a priority for public health; school is a privileged place for health promotion interventions. OBJECTIVES: The study aimed to test the effectiveness of a multicomponent 5-month intervention on the habits of primary school children, making the families aware of the importance of healthy choices. METHODS: Two hundred nine children attending the fourth class of primary school, divided into interventional (n = 103) and control arm (n = 106) were included in the study. In the intervention group, parents and teachers received more intense lifestyle counseling, associated with weekly motivational telephone calls to families to motivate further their lifestyle changes. Standard deviation score (SDS) body mass index (BMI) was the primary outcome measure; on open-air games and TV watching were secondary outcomes. RESULTS: At baseline, no differences were observed between groups. At 8-month follow-up, mean SDS BMI had decreased by 0.06 units in the intervention arm and increased by 0.12 in controls (time × treatment anova, P < 0.002). Outdoor activities increased from 6.23 h week(-1) to 9.93 in the intervention group (P < 0.001), not in controls. This change was associated differences in TV watching from baseline (intervention, -0.96 h week(-1); P = 0.037; controls, +1.33 h week(-1); P = 0.031). CONCLUSION: A multicomponent school-based intervention addressing the needs of children, teachers and families produced a significant and favourable short-term effect on overweight/obese schoolchildren.

Which treatment for nonalcoholic fatty liver disease?

Subjects with nonalcoholic fatty liver disease are at risk of progressive liver failure. Lifestyle changes including weight-loss strategies and increased physical activity remain the first-line approach, but a few pharmacological treatments have also been successfully tested. Several drugs improve biochemistry, only a few improve histology; in all cases, the results were not sustained after treatment stop. Pharmacological treatment is not so far indicated outside controlled clinical trials with histological outcomes.

Non-alcoholic fatty liver and insulin resistance: a cause-effect relationship?

The role of insulin resistance in non-alcoholic fatty liver disease is suggested by laboratory data (hyperinsulinemia and decreased sensitivity to endogenous and exogenous insulin). The clinical association with features of the metabolic syndrome, particularly in the most aggressive stages of the disease, further confirms a causative role. Fat accumulation in the liver may stem either from genetic defects, primarily responsible for insulin resistance, or excessive calorie intake and visceral obesity, and is mediated by adipocytokines (leptin, adiponectin, tumour necrosis factor-alpha). Progression of fatty liver to steatohepatitis may be the result of an imbalance between pro-inflammatory and anti-inflammatory cytokines, triggering the formation of reactive oxygen species and intrahepatic lipid peroxidation. This process may also be promoted or accelerated by pro-oxidant xenobiotics or environmental factors. Insulin resistance provides a target for specific treatment of non-alcoholic fatty liver, and insulin-sensitising agents (metformin or thiazolidinediones) as well as lifestyle changes to reduce visceral adiposity are the most promising therapeutic options. Future trials need to be performed in order to test the long-term effectiveness of these treatments on the basis of clinically relevant histological outcomes.