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BACKGROUND: Previous small studies investigating health-related quality of life (HRQoL) following bariatric surgery have demonstrated heterogenous effects. This study aimed to use National Bariatric Surgery Registry (NBSR) records to investigate the relationship between weight and HRQoL in people undergoing bariatric surgery in the UK. MATERIALS AND METHODS: In this observational study using United Kingdom National Bariatric Surgery Registry (NBSR) records between 1st June 2017 and 23rd November 2022, patients undergoing primary bariatric surgery with one baseline and at least one follow-up visit within one year from surgery were eligible for inclusion. Models estimated the relationship between EuroQol Five Dimension 5-level (EQ-5D) and BMI at baseline and longitudinally. Further analyses stratified by type 2 diabetes, type of operation (adjustable gastric band, sleeve, or bypass) and domain of EQ-5D. RESULTS: 5,587 observations of 2,160 patients were analysed. At baseline, mean BMI was 45.7±7.8 kg/m2 and mean EQ-5D was 0.78±0.22. A 1 kg/m2 higher BMI was associated with 0.005 (95%CI[-0.006,-0.004]) lower EQ-5D. In the month following surgery, EQ-5D increased to 0.91±0.2 while BMI decreased to 39.8±7.1 kg/m2 (P<0.001 for both); subsequently EQ-5D plateaued (0.90±0.17 at 12 months) while BMI continued to decrease (31.5±6.2 kg/m2 at 12 months, P<0.001). Each 1 kg/m2 decrease in BMI was associated with a 0.006 (95%CI [-0.007,-0.005]) increase in EQ-5D. Remission of T2D was independently associated with increase in EQ-5D (0.037, 95%CI [0.015,0.059]); type of operation was not. Decreases in BMI were associated with improvements in all five domains of EQ-5D. CONCLUSIONS: In this large dataset, greater weight loss and T2D remission were independently associated with greater improvements in HRQoL following bariatric surgery. The HRQoL-BMI relationship for people undergoing bariatric surgery differs to that which has previously been estimated following behavioural interventions. Use of the estimates generated here will be important for clinical and political decision making.
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BACKGROUND: Diet-disease association studies increasingly use dietary patterns (DPs) to account for the complexity of the exposure. We assessed if a DP associated with type 2 diabetes mellitus, CVD, and all-cause mortality is also associated with colorectal cancer (CRC). METHODS: We used reduced rank regression on 24-h recall data to identify DPs explaining the maximum variation in four nutrient-response variables: energy density, saturated fatty acids, free sugars and fibre density. Cox-proportional hazards models examined prospective associations between DP adherence (coded in a continuous scale as z-scores as well as in quintiles) and incident CRC. Subgroup analyses were conducted for tumour site, age, and sex. RESULTS: Post-exclusions, 1,089 CRC cases occurred in 114,443 participants over a median follow-up of 8.0 years. DP1 was characterised by increased intake of chocolate and confectionery, butter, low-fibre bread, red and processed meats and alcohol, as well as low fruit, vegetable, and high-fibre cereal intake. After accounting for confounders, including body mass, there were positive linear associations between DP1 and incident overall CRC (HR of quintile 5 vs. 1: 1.34, 95%CI 1.16-1.53, PTrend=0.005) and rectal cancer (HR of quintile 5 vs. 1: 1.58, 95%CI 1.27-1.96, PTrend=0.009), but not for proximal or distal colon cancers. No DP2-CRC association was observed. CONCLUSION: A DP previously associated with cardio-metabolic disease is also associated with incident CRC, especially rectal cancers. IMPACT: These consistent associations of particular food groups with both cardiometabolic disease and this diet-related cancer strengthen the evidence base for holistic population dietary guidelines to prevent ill-health.
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BACKGROUND: Randomised controlled trials have shown that total diet replacement (TDR) can lead to remission of type 2 diabetes. In 2019, the English National Health Service (NHS) committed to establishing a TDR-based interventional programme delivered at scale within real-world environments; development followed of the NHS Type 2 Diabetes Path to Remission (T2DR) programme, a 12-month behavioural intervention to support weight loss involving an initial 3-month period of TDR. We assessed remission of type 2 diabetes for programme participants. METHODS: In this national prospective service evaluation of programme implementation, people in England aged 18-65 years and diagnosed with type 2 diabetes in the last 6 years were referred to the programme between programme launch on Sept 1, 2020, and Dec 31, 2022. Programme data were linked to the National Diabetes Audit to ascertain HbA1c measurements and glucose-lowering medication prescriptions. The primary outcome was remission of type 2 diabetes at 1 year, defined as two HbA1c measurements of less than 48 mmol/mol recorded at least 3 months apart with no glucose-lowering medications prescribed from 3 months before the first HbA1c measurement, and the second HbA1c measurement recorded 11-15 months after the programme start date. Outcomes were assessed in two ways: for all participants who started TDR on the 12-month programme before January, 2022, for whom there were no missing data; and for all participants who started TDR on the 12-month programme before January, 2022, and had completed the programme (ie, had a valid weight recorded at month 12) by Dec 31, 2022, for whom there were no missing data. FINDINGS: Between Sept 1, 2020, and Dec 31, 2022, 7540 people were referred to the programme; of those, 1740 started TDR before January, 2022, and therefore had a full 12-month opportunity to undertake the programme by the time of data extraction at the end of December, 2022. Of those who started TDR before January, 2022, 960 (55%) completed the programme (defined as having a weight recorded at 12 months). The mean weight loss for the 1710 participants who started the programme before January, 2022 and had no missing data was 8·3% (95% CI 7·9-8·6) or 9·4 kg (8·9-9·8), and the mean weight loss for the 945 participants who completed the programme and had no missing data was 9·3% (8·8-9·8) or 10·3 kg (9·7-10·9). For the subgroup of 710 (42%) of 1710 participants who started the programme before January, 2022, and also had two HbA1c measurements recorded, 190 (27%) had remission, with mean weight loss of 13·4% (12·3-14·5) or 14·8 kg (13·4-16·3). Of the 945 participants who completed the programme, 450 (48%) had two HbA1c measurements recorded; of these, 145 (32%) had remission, with mean weight loss of 14·4% (13·2-15·5) or 15·9 kg (14·3-17·4). INTERPRETATION: Findings from the NHS T2DR programme show that remission of type 2 diabetes is possible outside of research settings, through at-scale service delivery. However, the rate of remission achieved is lower and the ascertainment of data is more limited with implementation in the real world than in randomised controlled trial settings. FUNDING: None.
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Diabetes Mellitus Tipo 2 , Medicina Estatal , Humanos , Diabetes Mellitus Tipo 2/terapia , Pessoa de Meia-Idade , Masculino , Feminino , Adulto , Estudos Prospectivos , Idoso , Adolescente , Adulto Jovem , Hemoglobinas Glicadas/análise , Inglaterra , Indução de Remissão , Avaliação de Programas e Projetos de Saúde , Redução de Peso , Glicemia/análiseRESUMO
BACKGROUND: On 6 April 2022, legislation came into effect in England requiring calorie labels to be applied to food items on menus of larger food businesses. This study aimed to assess the impact of calorie labelling on (a) food purchased and (b) energy content of menu options in worksite cafeterias. METHODS: Product-level sales data and energy content of available items was obtained from 142 worksite cafeterias from January 2022-October 2022. Interrupted-time-series (ITS) analysis with level and slope change evaluated daily energy (kcal) purchased per item, and ITS with level change assessed mean energy per option available on menus before and after calorie labelling. Each analysis was conducted 6 weeks and 6 months from implementation. A post-hoc ITS examined weekly energy purchased per item over a longer period (March 2021-October 2022; 135 sites). RESULTS: There was no evidence calorie labelling changed the energy content of foods purchased (6-week: + 0.60 cal/product, 95%CI:-2.54, + 3.75; 6-month: + 1.59 cal/product, 95%CI:-0.96, + 4.16). Post-hoc analyses suggested calorie labels were associated with a reduction in mean energy of items purchased over time (-0.65 kcal/week, 95%CI:-0.81,-0.49), but a significant increase (+ 3 kcal, 95%CI: + 0.43, + 5.60) at the point of implementation. There was a reduction in the mean energy content of menu options at each seasonal menu change (April 2022:-1.79 kcal, 95%CI:-3.42,-0.15; July 2022:-4.18 kcal, 95% CI:-7.65,-0.73). CONCLUSION: This large observational study in worksite cafeterias found no evidence to indicate the introduction of calorie labelling led to any immediate reduction in energy purchased by customers. There was some evidence of increasing impact over time, possibly associated with changes in menu offerings, but this effect was small and cannot be directly attributed to calorie labelling.
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BACKGROUND: The period between cancer diagnosis and surgery presents an opportunity for trials to assess the feasibility of behaviour change interventions. However, this can be a worrying time for patients and may hinder recruitment. We describe the perspectives of patients with excess weight awaiting colorectal cancer surgery about their recruitment into a randomised trial of a prehabilitation weight loss intervention. METHODS: We interviewed the first 26 participants from the 8 recruitment sites across England in the 'CARE' feasibility trial. Participants were randomised into either usual care (n = 13) or a low-energy nutritionally-replete total diet replacement programme with weekly remote behavioural support by a dietitian (n = 13). The semi-structured interviews occurred shortly after recruitment and the questions focused on participants' recollections of being recruited into the trial. We analysed data rapidly and then used a mind-mapping technique to develop descriptive themes. Themes were agreed by all co-authors, including a person with lived-experience of colorectal surgery. RESULTS: Participants had a mean body mass index (± SD) of 38 kg/m2 (± 6), age of 50 years (± 12), and 42% were female. People who participated in the trial were motivated by the offer of structured weight loss support that could potentially help them improve their surgical outcomes. However, participants also had concerns around the potential unpalatability of the intervention diet and side effects. Positive attitudes of clinicians towards the trial facilitated recruitment but participants were disappointed when they were randomised to usual care due to clinical teams' overemphasis on the benefits of losing weight. CONCLUSIONS: Patients were motivated to take part by the prospect of improved surgical outcomes. However, the strong preference to be allocated to the intervention suggests that balanced communication of equipoise is crucial to minimise disappointment from randomisation to usual care and differential dropout from the trial. CLINICAL TRIAL REGISTRATION: ISRCTN39207707, Registration date 13/03/2023.
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Neoplasias Colorretais , Pesquisa Qualitativa , Humanos , Feminino , Neoplasias Colorretais/cirurgia , Neoplasias Colorretais/psicologia , Masculino , Pessoa de Meia-Idade , Redução de Peso , Seleção de Pacientes , Programas de Redução de Peso/métodos , Adulto , Inglaterra , Estudos de Viabilidade , Índice de Massa CorporalRESUMO
BACKGROUND: Digitally delivered weight loss programmes can provide a convenient, potentially cheaper, and scalable treatment option for people who may need to lose weight. However, outcomes are often inferior to in-person interventions in the long-term. This trial will use principles from the Multiphase Optimisation Strategy (MOST) framework to test whether it can enhance the effectiveness of a commercial digital behavioural weight loss programme. This trial aims to identify an optimised combination of four intervention components to enhance weight loss over a 24-week period. We will also explore which components contribute to improvements in participant retention and engagement with the programme. METHODS: Approximately 1400 adults with a BMI > 21 kg/m2 will be enrolled and randomised to one of 16 experimental conditions in a 24 factorial cluster design. The trial will test four intervention components: an introductory video call with the health coach, drop-in webchat sessions with the health coach, goal setting statements, and food diary review and feedback. All participants will receive the core digital behavioural weight loss programme and up to four new intervention components. Participation in the trial will last for 24 weeks. The primary outcome will be weight change at 16 weeks. Other outcomes, measured at 4, 16, and 24 weeks, include programme drop-out and engagement (number of interactions with the three main app functions). Fidelity and acceptability will be assessed using data on component adherence and self-report questionnaires. Decision-making for the enhanced programme will be based on components that contribute to at least a minimal improvement in weight loss, defined as ≥ 0.75kg, alone or in combination with other components. DISCUSSION: The factorial design is an efficient way to test the efficacy of behavioural components alone, or in combination, to improve the effectiveness of digital weight loss programmes. This trial will test the implementation of the MOST framework in an industry setting, using routinely collected data, which may provide a better way to refine and evaluate these types of interventions in a model of continuous service improvement. TRIAL REGISTRATION: Trial registration: ISRCTN, ISRCTN14407868. Registered 5 January 2024, 10.1186/ISRCTN14407868.
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Terapia Comportamental , Ensaios Clínicos Controlados Aleatórios como Assunto , Redução de Peso , Programas de Redução de Peso , Humanos , Programas de Redução de Peso/métodos , Terapia Comportamental/métodos , Obesidade/terapia , Resultado do Tratamento , Adulto , Fatores de Tempo , Feminino , Comportamentos Relacionados com a SaúdeRESUMO
OBJECTIVE: To evaluate the effectiveness of behavioural interventions that include motivational interviewing on physical activity outcomes in adults. DESIGN: Systematic review and meta-analysis. STUDY SELECTION: A search of seven databases for randomised controlled trials published from inception to 1 March 2023 comparing a behavioural intervention including motivational interviewing with a comparator without motivational interviewing on physical activity outcomes in adults. Outcomes of interest were differences in change in quantitative measures of total physical activity, moderate to vigorous physical activity (MVPA), and sedentary time. DATA EXTRACTION AND SYNTHESIS: Two reviewers extracted data and assessed risk of bias. Population characteristics, intervention components, comparison groups, and outcomes of studies were summarised. For overall main effects, random effects meta-analyses were used to report standardised mean differences (SMDs) and 95% confidence intervals (CIs). Differential effects based on duration of follow-up, comparator type, intervention duration, and disease or health condition of participants were also examined. RESULTS: 129 papers reporting 97 randomised controlled trials totalling 27 811 participants and 105 comparisons were included. Interventions including motivational interviewing were superior to comparators for increases in total physical activity (SMD 0.45, 95% CI 0.33 to 0.65, equivalent to 1323 extra steps/day; low certainty evidence) and MVPA (0.45, 0.19 to 0.71, equivalent to 95 extra min/week; very low certainty evidence) and for reductions in sedentary time (-0.58, -1.03 to -0.14, equivalent to -51 min/day; very low certainty evidence). Evidence for a difference in any outcome compared with comparators of similar intensity was lacking. The magnitude of effect diminished over time, and evidence of an effect of motivational interviewing beyond one year was lacking. Most interventions involved patients with a specific health condition, and evidence of an effect of motivational interviewing to increase MVPA or decrease sedentary time was lacking in general population samples. CONCLUSIONS: Certainty of the evidence using motivational interviewing as part of complex behavioural interventions for promoting total physical activity in adults was low, and for MVPA and sedentary time was very low. The totality of evidence suggests that although interventions with motivational interviewing increase physical activity and decrease sedentary behaviour, no difference was found in studies where the effect of motivational interviewing could be isolated. Effectiveness waned over time, with no evidence of a benefit of motivational interviewing to increase physical activity beyond one year. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42020219881.
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Exercício Físico , Entrevista Motivacional , Humanos , Entrevista Motivacional/métodos , Exercício Físico/psicologia , Adulto , Comportamento Sedentário , Terapia Comportamental/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto , Promoção da Saúde/métodosRESUMO
BACKGROUND: Excess weight is a major risk factor for severe disease after infection with SARS-CoV-2. However, the effect of BMI on COVID-19 hospital resource use has not been fully quantified. This study aimed to identify the association between BMI and hospital resource use for COVID-19 admissions with the intention of informing future national hospital resource allocation. METHODS: In this community-based cohort study, we analysed patient-level data from 57 415 patients admitted to hospital in England with COVID-19 between April 1, 2020, and Dec 31, 2021. Patients who were aged 20-99 years, had been registered with a general practitioner (GP) surgery that contributed to the QResearch database for the whole preceding year (2019) with at least one BMI value measured before April 1, 2020, available in their GP record, and were admitted to hospital for COVID-19 were included. Outcomes of interest were duration of hospital stay, transfer to an intensive care unit (ICU), and duration of ICU stay. Costs of hospitalisation were estimated from these outcomes. Generalised linear and logit models were used to estimate associations between BMI and hospital resource use outcomes. FINDINGS: Patients living with obesity (BMI >30·0 kg/m2) had longer hospital stays relative to patients in the reference BMI group (18·5-25·0 kg/m2; IRR 1·07, 95% CI 1·03-1·10); the reference group had a mean length of stay of 8·82 days (95% CI 8·62-9·01). Patients living with obesity were more likely to be admitted to ICU than the reference group (OR 2·02, 95% CI 1·86-2·19); the reference group had a mean probability of ICU admission of 5·9% (95% CI 5·5-6·3). No association was found between BMI and duration of ICU stay. The mean cost of COVID-19 hospitalisation was £19 877 (SD 17 918) in the reference BMI group. Hospital costs were estimated to be £2736 (95% CI 2224-3248) higher for patients living with obesity. INTERPRETATION: Patients admitted to hospital with COVID-19 with a BMI above the healthy range had longer stays, were more likely to be admitted to ICU, and had higher health-care costs associated with hospital treatment of COVID-19 infection as a result. This information can inform national resource allocation to match hospital capacity to areas where BMI profiles indicate higher demand. FUNDING: National Institute for Health Research.
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Índice de Massa Corporal , COVID-19 , Hospitalização , Tempo de Internação , Obesidade , Humanos , COVID-19/epidemiologia , COVID-19/economia , COVID-19/terapia , Pessoa de Meia-Idade , Masculino , Feminino , Idoso , Inglaterra/epidemiologia , Adulto , Hospitalização/economia , Hospitalização/estatística & dados numéricos , Idoso de 80 Anos ou mais , Obesidade/epidemiologia , Obesidade/economia , Obesidade/terapia , Estudos de Coortes , Tempo de Internação/estatística & dados numéricos , Tempo de Internação/economia , Unidades de Terapia Intensiva/economia , Unidades de Terapia Intensiva/estatística & dados numéricos , Adulto Jovem , SARS-CoV-2 , Recursos em Saúde/economia , Recursos em Saúde/estatística & dados numéricosRESUMO
Food purchasing behaviours are shaped by the choices available to shoppers and the way they are offered for sale. This study tested whether prominent positioning of more sustainable food items online and increasing their relative availability might reduce the environmental impact of foods selected in a 2x2 (availability x position) factorial randomised controlled trial. Participants (n = 1179) selected items in a shopping task in an experimental online supermarket. The availability intervention added lower-impact products to the regular range. The positioning intervention biased product order to give prominence to lower-impact products. The primary outcome was the environmental impact score (ranging from 1 "least impact" to 5 "most impact", of each item in shopping baskets) analysed using Welch's ANOVA. Secondary outcomes included interactions (analysed via linear regression) by gender, age group, education, income and meat consumption and we assessed intervention acceptability (using different frames) in a post-experiment questionnaire. Compared to control (mean = 21.6), mean eco quintile score was significantly reduced when availability & order was altered (-2.30; 95%CI: 3.04; -1.56) and when order only was changed (-1.67; 95%CI: 2.42; -0.92). No significant difference between availability only (-0.02; 95%CI: 0.73; 0.69) and control was found. There were no significant interactions between interventions or by demographic characteristics. Both interventions were acceptable under certain frames (positioning emphasising lower-impact products: 70.3% support; increasing lower-impact items: 74.3% support). Prominent positioning of more sustainable products may be an effective strategy to encourage more sustainable food purchasing. Increasing availability of more sustainable products alone did not significantly alter the environment impact of products selected.
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Comportamento do Consumidor , Preferências Alimentares , Supermercados , Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Preferências Alimentares/psicologia , Comportamento de Escolha , Abastecimento de Alimentos/métodos , Adulto Jovem , Inquéritos e Questionários , Meio Ambiente , Conservação dos Recursos Naturais/métodos , Internet , AdolescenteRESUMO
BACKGROUND: Dietary changes are necessary to improve population health and meet environmental sustainability targets. Here we analyse the impact of promotional activities implemented in UK supermarkets on purchases of healthier and more sustainable foods. METHODS: Three natural experiments examined the impact of promotional activities on sales of a) no-added-sugar (NAS) plant-based milk (in 199 stores), b) products promoted during 'Veganuary' (in 96 stores), and c) seasonal fruit (in 100 non-randomised intervention and 100 matched control stores). Data were provided on store-level product sales, in units sold and monetary value (£), aggregated weekly. Predominant socioeconomic position (SEP) of the store population was provided by the retailer. Analyses used interrupted time series and multivariable hierarchical mixed-effects models. RESULTS: Sales of both promoted and total NAS plant-based milks increased significantly during the promotional period (Promoted:+126 units, 95%CI: 105-148; Overall:+307 units, 95%CI: 264-349). The increase was greater in stores with predominately low SEP shoppers. During Veganuary, sales increased significantly for plant-based foods on promotion (+60 units, 95%CI: 37-84), but not for sales of plant-based foods overall (dairy alternatives: -1131 units, 95%CI: -5821-3559; meat alternatives: 1403 units, 95%CI: -749-3554). There was no evidence of a change in weekly sales of promoted seasonal fruit products (assessed via ratio change in units sold: 0.01, 95%CI: 0.00-0.02), and overall fruit category sales slightly decreased in intervention stores relative to control (ratio change in units sold: -0.01, 95%CI: -0.01-0.00). CONCLUSION: During promotional campaigns there was evidence that sales of plant-based products increased, but not seasonal fruits. There was no evidence for any sustained change beyond the intervention period.
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Comércio , Supermercados , Reino Unido , Humanos , Comércio/estatística & dados numéricos , Promoção da Saúde/métodos , Frutas , Dieta Saudável/estatística & dados numéricos , Dieta Saudável/economia , Leite/economiaRESUMO
BACKGROUND: Physical activity (PA) interventions have an encouraging role in gestational diabetes mellitus (GDM) management. Digital technologies can potentially be used at scale to support PA. The aim of this study was to assess the feasibility and acceptability of + Stay-Active: a complex intervention which combines motivational interviewing with a smartphone application to promote PA levels in women with GDM. METHODS: This non-randomised feasibility study used a mixed methods approach. Participants were recruited from the GDM antenatal clinic at Oxford University Hospitals. Following baseline assessments (visit 1) including self-reported and device determined PA measurements (wrist worn accelerometer), women participated in an online motivational interview, and then downloaded (visit 2) and used the Stay-Active app (Android or iOS). Women had access to Stay-Active until 36 weeks' gestation, when acceptability and PA levels were reassessed (visit 3). The primary outcome measures were recruitment and retention rates, participant engagement, and acceptability and fidelity of the intervention. Secondary outcome measures included PA levels, app usage, blood glucose and perinatal outcomes. Descriptive statistics were performed for assessments at study visits. Statistics software package Stata 14 and R were used. RESULTS: Over the recruitment period (46 weeks), 114 of 285 women met inclusion criteria and 67 (58%) enrolled in the study. Mean recruitment rate of 1.5 participants/clinic with 2.5 women/clinic meeting inclusion criteria. Fifty-six (83%) received the intervention at visit 2 and 53 (79%) completed the study. Compliance to accelerometer measurement protocols were sufficient in 78% of participants (52/67); wearing the device for more than 10 h on 5 or more days at baseline and 61% (41/67) at 36 weeks. There was high engagement with Stay-Active; 82% (55/67) of participants set goals on Stay-Active. Sustained engagement was evident, participants regularly accessed and logged multiples activities on Stay-Active. The intervention was deemed acceptable; 85% of women rated their care was satisfactory or above, supported by written feedback. CONCLUSIONS: This combined intervention was feasible and accepted. Recruitment rates were lower than expected. However, retention rates remained satisfactory and participant compliance with PA measurements and engagement was a high. Future work will explore the intervention's efficacy to increase PA and impact on clinical outcomes. TRIAL REGISTRATION: The study has received a favourable opinion from South Central-Hampshire B Research Ethics Committee; REC reference: 20/SC/0342. ISRCTN11366562.
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Diabetes Gestacional , Exercício Físico , Estudos de Viabilidade , Aplicativos Móveis , Entrevista Motivacional , Smartphone , Humanos , Feminino , Gravidez , Diabetes Gestacional/terapia , Diabetes Gestacional/psicologia , Entrevista Motivacional/métodos , Exercício Físico/psicologia , Adulto , Promoção da Saúde/métodos , Cuidado Pré-Natal/métodosRESUMO
AIM: To investigate the association of gestational diabetes mellitus (GDM) with premature mortality and cardiovascular (CVD) outcomes and risk factors. MATERIALS AND METHODS: Parous women recruited to the UK Biobank cohort during 2006-2010 were followed up from their first delivery until 31 October 2021. The data were linked to Hospital Episode Statistics and mortality registries. Multivariate Cox proportional hazard models investigated associations of GDM with all-cause mortality, CVD, diabetes, hypertension and dyslipidaemia. RESULTS: The maximum total analysis time at risk and under observation was 9 694 090 person-years. Among 220 726 women, 1225 self-reported or had a recorded diagnosis of GDM. After adjusting for confounders and behavioural factors, GDM was associated with increased risk for premature mortality [hazard ratio (HR): 1.44, 95% confidence interval (CI): 1.12-1.86], particularly CVD-related death (HR: 2.38, 95% CI: 1.63-3.48), as well as incident total CVD (HR: 1.50, 95% CI: 1.30-1.74), non-fatal CVD (HR: 1.41, 95% CI: 1.20-1.65), diabetes (HR: 14.37, 95% CI: 13.51-15.27), hypertension (HR: 1.49, 95% CI: 1.38-1.60), and dyslipidaemia (HR: 1.30, 95% CI: 1.22-1.39). The total CVD risk was greater in women with GDM who did not later develop diabetes than in those with GDM and diabetes. CONCLUSIONS: Women with GDM are at increased risk of premature death and have increased CV risk, emphasizing the importance of interventions to prevent GDM. If GDM develops, the diagnosis represents an opportunity for future surveillance and intervention to reduce CVD risk factors, prevent CVD and improve long-term health.
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Doenças Cardiovasculares , Diabetes Gestacional , Mortalidade Prematura , Adulto , Idoso , Feminino , Humanos , Pessoa de Meia-Idade , Gravidez , Doenças Cardiovasculares/mortalidade , Doenças Cardiovasculares/epidemiologia , Estudos de Coortes , Diabetes Gestacional/epidemiologia , Diabetes Gestacional/mortalidade , Estudos Retrospectivos , Fatores de Risco , Biobanco do Reino Unido , Reino Unido/epidemiologiaRESUMO
A reduction in meat consumption is necessary to mitigate negative impacts of climate change and adverse health outcomes. The UK has an increasingly multi-ethnic population, yet there is little research on meat consumption habits and attitudes among ethnic groups in the UK. We ran a survey (N = 1014) with quota samples for ethnic groups and analyzed attitudes, behaviors and norm perceptions of White, South Asian and Black British respondents. Most respondents believe overconsumption of red and processed meat has negative impacts on health (73.3%) and the environment (64.3%).South Asian respondents were statistically significantly less likely to be meat eaters than White respondents (OR = 0.44, 95% CIs: 0.30-0.65, t = -4.15, p = 0.000), while there was no significant difference between White and Black respondents (OR = 1.06, 95% CIs: 0.63-1.76, t = 0.21, p = 0.834). Both South Asian (OR = 2.76, 95% CIs: 1.89-4.03 t = 5.25, p = 0.000) and Black respondents (OR = 2.09, 95% CIs: 0.1.30-3.35, t = 3.06, p = 0.002) were significantly more likely to express being influenced by friends and family in their food choices than White respondents. South Asian (OR = 3.24,95% CIs: 2.17-4.84, t = 5.74, p = 0.000) and Black (OR = 2.02,95% CIs: 1.21-3.39, t = 2.69, p = 0.007) respondents were also both significantly more likely to report they would want to eat similarly to their friends and family than White respondents. Statistical analyses suggested some gender and socioeconomic differences across and among ethnic groups, which are reported and discussed. The differences in meat consumption behaviors and norm conformity between ethnic groups raises the prospect that interventions that leverage social norms may be more effective in South Asian groups than Black and White groups in the UK.
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Povo Asiático , População Negra , Carne , População Branca , Humanos , Reino Unido , Masculino , Feminino , Adulto , População Branca/psicologia , População Branca/estatística & dados numéricos , Povo Asiático/psicologia , Pessoa de Meia-Idade , População Negra/psicologia , População Negra/estatística & dados numéricos , Adulto Jovem , Comportamento Alimentar/psicologia , Comportamento Alimentar/etnologia , Dieta/etnologia , Dieta/psicologia , Conhecimentos, Atitudes e Prática em Saúde/etnologia , Etnicidade/psicologia , Etnicidade/estatística & dados numéricos , Idoso , Adolescente , Inquéritos e Questionários , Preferências Alimentares/etnologia , Preferências Alimentares/psicologia , Normas Sociais/etnologiaRESUMO
BACKGROUND: One-third of people with depression do not respond to antidepressants, and, after two adequate courses of antidepressants, are classified as having treatment-resistant depression (TRD). Some case reports suggest that ketogenic diets (KDs) may improve some mental illnesses, and preclinical data indicate that KDs can influence brain reward signalling, anhedonia, cortisol, and gut microbiome which are associated with depression. To date, no trials have examined the clinical effect of a KD on TRD. METHODS: This is a proof-of-concept randomised controlled trial to investigate the efficacy of a six-week programme of weekly dietitian counselling plus provision of KD meals, compared with an intervention involving similar dietetic contact time and promoting a healthy diet with increased vegetable consumption and reduction in saturated fat, plus food vouchers to purchase healthier items. At 12 weeks we will assess whether participants have continued to follow the assigned diet. The primary outcome is the difference between groups in the change in Patient Health Questionnaire-9 (PHQ-9) score from baseline to 6 weeks. PHQ-9 will be measured at weeks 2, 4, 6 and 12. The secondary outcomes are the differences between groups in the change in remission of depression, change in anxiety score, functioning ability, quality of life, cognitive performance, reward sensitivity, and anhedonia from baseline to 6 and 12 weeks. We will also assess whether changes in reward sensitivity, anhedonia, cortisol awakening response and gut microbiome may explain any changes in depression severity. DISCUSSION: This study will test whether a ketogenic diet is an effective intervention to reduce the severity of depression, anxiety and improve quality of life and functioning ability for people with treatment-resistant depression.
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Transtorno Depressivo Resistente a Tratamento , Dieta Cetogênica , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Terapia Combinada , Transtorno Depressivo Resistente a Tratamento/dietoterapia , Transtorno Depressivo Resistente a Tratamento/terapia , Avaliação de Resultados em Cuidados de Saúde , Estudo de Prova de Conceito , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
OBJECTIVE: The study objective was to assess participant weight change for the English National Health Service (NHS) Digital Weight Management Programme, the first such digital intervention to achieve population coverage. METHODS: A service evaluation was used to assess intervention effectiveness for adults with obesity and a diagnosis of hypertension and/or diabetes, between April 2021 and March 2022, using prospectively collected, national service-level data in England. RESULTS: Of the 63,937 referrals made from general practices, within the time period, 31,861 (50%) chose to take up the 12-week Programme. There were 31,718 participants who had time to finish the Programme; of those, 14,268 completed the Programme (defined as attending ≥60%), a 45% completion rate. The mean weight change for those who had time to finish the Programme was -2.2 kg (95% CI: -2.25 to -2.16), for those who completed it was -3.9 kg (95% CI: -3.99 to -3.84), and for those who had time to finish the Programme but did not complete it was -0.74 kg (95% CI: -0.79 to -0.70). CONCLUSIONS: The NHS Digital Weight Management Programme is effective at achieving clinically meaningful weight loss. The outcomes compare favorably to web-based weight management interventions tested in randomized trials and those delivered as face-to-face interventions, and results suggest that the approach may, with increased participation, bring population-level benefits.
Assuntos
Obesidade , Encaminhamento e Consulta , Medicina Estatal , Programas de Redução de Peso , Humanos , Programas de Redução de Peso/métodos , Masculino , Feminino , Pessoa de Meia-Idade , Inglaterra , Obesidade/terapia , Encaminhamento e Consulta/estatística & dados numéricos , Adulto , Idoso , Redução de Peso , Hipertensão/terapia , Estudos Prospectivos , Avaliação de Programas e Projetos de Saúde , Diabetes Mellitus/terapiaRESUMO
OBJECTIVE: To understand preferences for features of weight loss programs among adults with or at risk of type 2 diabetes in the U.K. RESEARCH DESIGN AND METHODS: We conducted a discrete choice experiment with 3,960 U.K. adults living with overweight (n = 675 with type 2 diabetes). Preferences for seven characteristics of weight loss programs were analyzed. Simulations from choice models using the experimental data predicted uptake of available weight loss programs. Patient groups comprising those who have experience with weight loss programs, including from minority communities, informed the experimental design. RESULTS: Preferences did not differ between individuals with and without type 2 diabetes. Preferences were strongest for type of diet. Healthy eating was most preferred relative to total diet replacement (odds ratio [OR] 2.24; 95% CI 2.04-2.44). Individual interventions were more popular than group interventions (OR 1.40; 95% CI 1.34-1.47). Participants preferred programs offering weight loss of 10-15 kg (OR 1.37; 95% CI 1.28-1.47) to those offering loss of 2-4 kg. Online content was preferred over in-person contact (OR 1.24; 95% CI 1.18-1.30). There were few differences in preferences by gender or ethnicity, although weight loss was more important to women than to men, and individuals from ethnic minority populations identified more with programs where others shared their characteristics. Modeling suggested that tailoring programs to individual preferences could increase participation by â¼17 percentage points (68% in relative terms). CONCLUSIONS: Offering a range of weight loss programs targeting the preferred attributes of different patient groups could potentially encourage more people to participate in weight loss programs and support those living with overweight to reduce their weight.
Assuntos
Diabetes Mellitus Tipo 2 , Programas de Redução de Peso , Masculino , Adulto , Humanos , Feminino , Diabetes Mellitus Tipo 2/terapia , Sobrepeso/terapia , Etnicidade , Grupos MinoritáriosRESUMO
AIM: To test the feasibility and acceptability of a reduced-carbohydrate dietary program, intended to reduce the risk of gestational diabetes. MATERIALS AND METHODS: Fifty-one pregnant women at <20 weeks' gestation, with body mass index ≥30 kg/m2 , and a normal baseline oral glucose tolerance test (OGTT), were randomized 2:1 to an intervention or control group and followed-up until delivery. The dietary intervention aimed at providing 130-150 g carbohydrate/day. Feasibility outcomes assessed at 24-28 weeks' gestation, included adoption of the reduced-carbohydrate diet by the intervention group, and retention of all participants, assessed by completion of a second OGTT. Changes in glycemia, weight gain and dietary intake, and the maternal and neonatal outcomes were also assessed. Participants were interviewed about their experience of the intervention and the study. RESULTS: Forty-nine of 51 participants attended the follow-up OGTT, a retention rate of 96% (95% confidence interval [CI] 86.8%-98.9%). In the intervention group, carbohydrate intake at follow-up was 190.4 (95% CI 162.5-215.6) g/day, a reduction of -24.6 (95% CI -51.5-2.4) g/day from baseline. Potentially favourable effects of the intervention on glucose control, weight gain and blood pressure were observed, but the study was not powered to detect significant differences in these. Participants found the intervention acceptable, and were content with the study processes, but some reported barriers to sustained adherence, mainly pertaining to competing priorities. CONCLUSIONS: Retention was high, suggesting the study processes are feasible, but the carbohydrate reduction in the intervention group was small, and did not meet progression criteria, limiting the likelihood of achieving the desired goal to prevent gestational diabetes. TRIAL REGISTRATION NUMBER: ISRCTN16235884.
Assuntos
Diabetes Gestacional , Recém-Nascido , Gravidez , Feminino , Humanos , Diabetes Gestacional/prevenção & controle , Estudos de Viabilidade , Obesidade/complicações , Obesidade/terapia , Aumento de Peso , Carboidratos , Dieta com Restrição de CarboidratosRESUMO
BACKGROUND: Interventions targeting the nutritional quality of grocery shopping have the potential to help improve diet and health outcomes. OBJECTIVE: This study aims to assess the feasibility and acceptability of receiving advice on healthier food purchases through SwapSHOP, a behaviorally informed smartphone app that allows users to scan barcodes of grocery products from the United Kingdom, providing nutritional information and personalized swap suggestions to encourage healthier purchases. METHODS: We randomized adult volunteers in a 6-arm parallel-group controlled feasibility trial. Participants used the SwapSHOP app to record their grocery shopping during a 2-week run-in period and were individually randomized in a 3:1 ratio to either intervention or control arms within 3 strata related to a nutrient of concern of their choice: saturated fat (SFA), sugar, or salt. Participants randomized to the intervention received the SwapSHOP app with a healthier swap function, goal setting, and personalized feedback. Participants in the control group were instructed to use a simpler version of the app to log all their food purchases without receiving any guidance or advice. The primary outcome was the feasibility of progression to a full trial, including app use and follow-up rates at 6 weeks. The secondary outcomes included other feasibility outcomes, process and qualitative measures, and exploratory effectiveness outcomes to assess changes in the nutrient content of the purchased foods. RESULTS: A total of 112 participants were randomized into 3 groups: SFA (n=38 intervention and n=13 control), sugar (n=40 intervention and n=15 control), and salt (n=5 intervention and n=1 control, not analyzed). The 2 progression criteria were met for SFA and sugar: 81% (30/37) and 87% (34/39) of intervention participants in the SFA and sugar groups, respectively, used the app to obtain healthier swaps, and 89% (68/76) of intervention participants and 96% (23/24) of control participants completed follow-up by scanning all purchases over the follow-up period. The process and qualitative outcomes suggested that the intervention was acceptable and has the potential to influence shopping behaviors. There were reductions of -0.56 g per 100 g (95% CI -1.02 to -0.19) in SFA and -1 g per 100 g (95% CI -1.97 to -0.03) in total sugars across all food purchases in the intervention groups. CONCLUSIONS: People were willing to use the SwapSHOP app to help reduce sugar and SFA (but not salt) in their grocery shopping. Adherence and follow-up rates suggest that a full trial is feasible. Given the suggestive evidence indicating that the intervention resulted in reductions in sugars and SFA, a definitive trial is necessary to target improvements in health outcomes. TRIAL REGISTRATION: International Standard Randomised Controlled Trial Number ISRCTN13022312; https://doi.org/10.1186/ISRCTN13022312.