Comparative Effectiveness of Lifestyle Intervention on Fasting Plasma Glucose in Normal Weight Versus Overweight and Obese Adults With Prediabetes.

Background. It is hypothesized that normal weight individuals develop diabetes through different pathophysiological mechanisms and that methods of prevention may differ in the absence of overweight/obesity. In this study, we compared the effect of lifestyle health coaching (LHC) on fasting plasma glucose (FPG) in normal weight, overweight, and obese US adults with prediabetes. Methods. Subjects were 1358 individuals who completed baseline and follow-up evaluations as part of an LHC program (follow-up = ~6 months). Participants were stratified, based on baseline body mass index (BMI), into normal weight (n = 129), overweight (n = 345), and obese (n = 884) cohorts. LHC included counseling, predominantly via telehealth, on exercise and nutrition. Results. BMI decreased (P < .001) in the overweight and obese participants but was unchanged in the normal weight participants. FPG decreased (P < .001) in all 3 cohorts, and the magnitude of decrease did not differ significantly among cohorts. FPG decreased to <5.6 mmol/L in 58.1%, 49.3%, and 41.4% of the normal weight, overweight, and obese participants, respectively. Conclusions. To our knowledge, this study is the first outside of Asia to show that LHC is as effective in managing FPG in normal weight adults with prediabetes versus those who are overweight/obese.

Multicenter Study of Temporal Trends in the Achievement of Atherosclerotic Cardiovascular Disease Risk Factor Goals During Cardiac Rehabilitation.

PURPOSE: Secondary prevention risk factor goals have been established by the American Heart Association/American College of Cardiology, and the American Heart Association has further delineated ideal cardiovascular health metrics. We evaluated risk factor goal achievement during early-outpatient cardiac rehabilitation (CR) and temporal trends in risk factor control. METHODS: Patients completed assessments on entry into and exit from CR at 35 centers between 2000 and 2009 and were categorized into 3 cohorts: entire (N = 12 984), 2000-2004 (n = 5468), and 2005-2009 (n = 7516) cohorts. RESULTS: Improvements occurred in multiple risk factors during CR. For the entire cohort, the percentages of patients at goal at CR completion ranged from 95.5% for smoking to 21.9% for body mass index (BMI) of <25.0 kg/m. Compared with 2000-2004, the percentage of the 2005-2009 cohort at goal was higher (P < .001) for blood pressure, low-density lipoprotein cholesterol, and physical activity, lower (P = .005) for BMI, and not significantly different (P > .05) for fasting glucose and smoking. At CR completion, of those in the entire, 2000-2004, and 2005-2009 cohorts, 4.4%, 3.9%, and 4.8% (P = .219 vs 2000-2004), respectively, had all biomarkers at the goal for ideal cardiovascular health and, of those with atherosclerotic cardiovascular disease, 70.8%, 71.5%, and 70.3% (P = .165 vs 2000-2004), respectively, were receiving statins. CONCLUSIONS: The percentage of patients at goal at CR completion increased for some, but not all, risk factors during 2005-2009 versus 2000-2004. Despite the benefits of CR, risk factor profiles are often suboptimal after CR. There remains room for improvement in risk factor management during CR and a need for continued intervention thereafter.

Clinical Effectiveness of Lifestyle Health Coaching: Case Study of an Evidence-Based Program.

We have developed, tested, and successfully implemented an affordable, evidence-based, technology-enabled, data-driven, outcomes-oriented, comprehensive lifestyle health coaching (LHC) program. The LHC program has been used primarily to provide services to employees of larger employers (ie, with at least 3000 employees) but has also been implemented in a variety of other settings, including hospitals, cardiac rehabilitation centers, physician practices, and as part of multicenter clinical trials. The program is delivered mainly using the telephone and Internet. Health coaches are guided by a Web-based participant management and tracking system. Lifestyle management interventions are based on several behavior change models and strategies, especially adult learning theory, social learning theory, the stages of change model, single concept learning theory, and motivational interviewing. The program is administered by nonphysician health professionals whose services are integrated with the care provided by participants' physicians. Outcomes data from published studies, including randomized clinical trials and independent third-party conducted research, have documented the clinical effectiveness of this evidence-based approach in terms of modification of multiple risk factors in healthy persons as well as those with certain common chronic diseases.

Effect of exercise-based cardiac rehabilitation on multiple atherosclerotic risk factors in patients taking antidepressant medication.

Antidepressants might increase compliance with cardiovascular disease risk reduction interventions. However, antidepressants have been linked to deleterious metabolic effects. In the present multicenter study, we sought to determine whether patients who take antidepressants derive the expected benefits from cardiac rehabilitation in terms of improvements in multiple atherosclerotic risk factors. A cohort of 26,957 patients who had completed a baseline assessment before participating in an exercise-based cardiac rehabilitation program constituted the study population. The patients were stratified into 3 cohorts (i.e., nondepressed, depressed unmedicated, and depressed medicated) at baseline according to a self-reported history of depression and the current use of antidepressants. Risk factors were assessed at baseline and after ∼12 weeks of program participation. A self-reported history of depression was present at baseline in 5,172 patients (19.2%). Of these patients, 2,147 (41.5%) were taking antidepressants. Patients in the nondepressed cohort (49.4% completion) were more likely (p <0.001) to complete the exit assessment than patients in the depressed unmedicated (44.5% completion) or depressed medicated (43.5% completion) cohorts. Patients in all 3 cohorts who completed the exit assessment showed significant improvement in multiple risk factors. Moreover, the magnitude of improvement in blood pressure, serum lipids and lipoproteins, fasting glucose, weight, and body mass index was similar (p >0.05) in patients taking antidepressants and those who were not. In conclusion, our study is the first to show that antidepressants do not offset the average magnitude of improvement in multiple atherosclerotic risk factors that occurs with completion of a cardiac rehabilitation program.

Seasonal variation and bioactivity in the leaf oil of Liriodendron tulipifera growing in Huntsville, Alabama.

The seasonal variation in the chemical composition of the leaf essential oil of Liriodendron tulipifera has been analyzed by GC-MS. Two individual trees were sampled five times during the course of the growing season. Twenty components were identified in the leaf oils, which were dominated by sesquiterpene hydrocarbons, principally germacrene D and beta-elemene, in the early part of the season (42-44% and 18-23%, respectively,) but monoterpene hydrocarbons, largely (Z)-beta-ocimene, dominated the later season leaf oils (40-60%). The leaf oils exhibited in-vitro antibacterial activity against Bacillus cereus and Staphylococcus aureus as well as cytotoxic activity on MDA-MB-231 and Hs 578T human breast tumor cells.

Essential oil compositions and cytotoxic activities of Dendropanax capillaris, Oreopanax nubigenus, and Schefflera rodrigueziana from Monteverde, Costa Rica.

The leaf essential oils of Dendropanax capillaris, Oreopanax nubigenus and Schefflera rodrigueziana (Araliaceae) were isolated by hydrodistillation and analyzed by GC-MS. The leaf oil of Dendropanax capillaris was composed of only four compounds, beta-pinene (25.3%), 6-3-carene (44.7%), daucene (17.1%), and dauca-5,8-diene (12.9%). Oreopanax nubigenus leaf oil was dominated by the sesquiterpene hydrocarbons germacrene D (70.1%) and beta-caryophyllene (11.8%), while Schefflera rodrigueziana leaf oil was made up entirely of sesquiterpene hydrocarbons, mostly germacrene D (27.6%), beta-cubebene (27.2%), beta-caryophyllene (12.2%), beta-cubebene (11.1%), and alpha-copaene (10.8%). Both O. nubigenus and S. rodrigueziana leaf oils showed notable in-vitro cytotoxicity on MDA-MB-231 cells, which may be attributable to the relatively high concentrations of germacrene D and beta-caryophyllene in those oils.