BACKGROUND Lifestyle interventions improve the metabolic control of individuals with hyperglycemia. PURPOSE We aimed to determine the effect of lifestyle interventions on cardiovascular and all-cause mortality in this population. DATA SOURCES Searches were made through MEDLINE, Cochrane CENTRAL, Embase, and Web of Science (no date/language restriction, until 15 May 2022). STUDY SELECTION We included randomized clinical trials (RCTs) of subjects with prediabetes and type 2 diabetes, comparing intensive lifestyle interventions with usual care, with a minimum of 2 years of active intervention. DATA EXTRACTION Data from the 11 RCTs selected were extracted in duplicate. A frequentist and arm-based meta-analysis was performed with random-effects models to estimate relative risk (RR) for mortality, and heterogeneity was assessed through I2 metrics. A generalized linear mixed model (GLMM) was used to confirm the findings. DATA SYNTHESIS Lifestyle interventions were not superior to usual care in reducing cardiovascular (RR 0.99; 95% CI 0.79–1.23) or all-cause (RR 0.93; 95% CI 0.85–1.03) mortality. Subgroup, sensitivity, and meta-regression analyses showed no influence of type of intervention, mean follow-up, age, glycemic status, geographical location, risk of bias, or weight change. All of these results were confirmed with the GLMM. Most studies had a low risk of bias according to the RoB 2.0 tool and the certainty of evidence was moderate for both outcomes. LIMITATIONS Most studies had a low risk of bias according to the RoB 2.0 tool, and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach resulted in moderate certainty of evidence for both outcomes. Differences in lifestyle programs and in usual care between the studies should be considered in the interpretation of our results. CONCLUSIONS Intensive lifestyle interventions implemented so far did not show superiority to usual care in reducing cardiovascular or all-cause mortality for subjects with prediabetes and type 2 diabetes.

Maternal consumption of polyphenol-rich foods has been associated with fetal ductus arteriosus constriction (DAC), but safety of chocolate exposure in fetal life has not been studied. This experimental study tested the hypothesis that maternal cocoa consumption in late pregnancy causes fetal DAC, with possible associated antioxidant effects. Pregnant Wistar rats, at the 21st gestational day, received by orogastric tube cocoa (720 mg/Kg) for 12 h, indomethacin (10 mg/Kg), for 8 h, or only water, before cesaren section. Immediately after withdrawal, every thorax was obtained and tissues were fixed and stained for histological analysis. The ratio of the narrowest part of the pulmonary artery to the fetal ductus inner diameter and increased ductal inner wall thickness characterized ductal constriction. Substances reactive to thiobarbituric acid were quantified. Statistical analysis used ANOVA and Tukey test. Cocoa (n = 33) and indomethacin (n = 7) reduced fetal internal ductus diameter when compared to control (water, n = 25) (p < 0.001) and cocoa alone increased ductus wall thickness (p < 0.001), but no change was noted in enzymes activity. This pharmacological study shows supporting evidences that there is a cause and effect relationship between maternal consumption of cocoa and fetal ductus arteriosus constriction. Habitual widespread use of chocolate during gestation could account for undetected ductus constriction and its potentially severe consequences, such as perinatal pulmonary hypertension, cardiac failure and even death. For this reason, dietary guidance in late pregnancy to avoid high chocolate intake, to prevent fetal ductal constriction, may represent the main translational aspect of this study.

Background People with type 2 diabetes (T2D) have higher risks of cancer incidence and death. We aimed to evaluate the relationship between dietary and physical activity-based lifestyle intervention and cancer outcomes among prediabetes and T2D populations. Methods We searched for randomized control trials with at least 24 months of lifestyle interventions in prediabetes or T2D populations. Data was extracted by pairs of reviewers and discrepancies were resolved by consensus. Descriptive syntheses were performed, and the risk of bias was assessed. Relative risks (RRs) and 95% confidence intervals (CI) were estimated using a pairwise meta-analysis with both random effects model and general linear mixed model (GLMM). Certainty of evidence was evaluated using the GRADE framework and trial sequential analysis (TSA) was conducted to assess if current information is enough for definitive conclusions. Subgroup analysis was performed by glycemic status. Results Six clinical trials were included. Among 12,841 participants, the combined RR for cancer mortality comparing lifestyle interventions with usual care was 0.94 (95% CI 0.81 to 1.10 using GLMM and 0.82 to 1.09 using random effects model). Most studies had a low risk of bias, and the certainty of evidence was moderate. TSA showed that cumulative Z-curve reached futility boundary while total number did not reach detection boundary. Conclusion Based on the limited data available, dietary and physical activity-based lifestyle interventions had no superiority to usual care on reducing cancer risk in populations with pre-diabetes and T2D. Lifestyle interventions focused on cancer outcomes should be tested to better explore their effects.

<p>  </p> <p><strong>Background: </strong>Lifestyle interventions improve the metabolic control of individuals with hyperglycemia. We aimed to determine the effect of lifestyle interventions on cardiovascular and all-cause mortality in this population.</p> <p><strong>Methods: </strong>Searches were made through MEDLINE, Cochrane CENTRAL, Embase, and Web of Science (no date/language restriction, until May 15, 2022). Were included randomized clinical trials (RCTs) of subjects with prediabetes and type 2 diabetes, comparing intensive lifestyle interventions to usual care, and a minimum of 2 years of active intervention. Data from the 11 RCTs selected were extracted in duplicate. A frequentist and arm-based meta-analysis was performed using random effects models to estimate relative risk (RR) for mortality, and heterogeneity was assessed through I2 metrics. A generalized linear mixed model (GLMM) was performed to confirm the findings.</p> <p><strong>Results: </strong>Lifestyle interventions were not superior to usual care in reducing cardiovascular (RR, 0.99; 95% CI, 0.79 to 1.23) and all-cause mortality (RR, 0.93; 95% CI, 0.85 to 1.03). Subgroup, sensitivity and meta-regression analyses showed no influence of type of intervention, mean follow-up, age, glycemic status, geographical location, risk of bias, and weight change. All these results were confirmed with the GLMM.  Most studies had a low risk of bias according to the RoB 2.0 tool, and the GRADE approach resulted in moderate certainty of evidence for both outcomes.</p> <p><strong>Conclusion:</strong> Intensive lifestyle interventions implemented so far did not show superiority to usual care in reducing cardiovascular and all-cause mortality in subjects with prediabetes and type 2 diabetes.</p>

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