Abstract:Cardiometabolic risk factors, and the chronic cardiovascular diseases (CVDs) that result from them, are highly prevalent in the US and amenable to clinical nutrition interventions. This creates an urgency to develop comprehensive care models that incorporate prevention-based actions by improving lifestyle routines. Such care models should account for social determinants of health, ethnocultural variables, and challenges to sustainability. The relevance of these newly designed chronic care models is to inform a… Show more
“…Our subgroup analyses confirm that significant effects on ccIMT may be more easily demonstrated in individuals with higher baseline ccIMT (21) , and such higher ccIMT values are more likely to be present in study samples of individuals with confirmed CVD risk factors such as hypercholesterolaemia (31) or diabetes (23,35) . Nevertheless, it is of high public health relevance to develop tools (such as our intervention programme) which already initiate CVD prevention measures in individuals who are still at low to moderate CVD risk (37) . Consequently, it appears justifiable to conduct further lifestyle/dietary interventions assessing ccIMT change in generally healthy participants.…”
Common carotid intima-media thickness (ccIMT) progression is a risk marker for cardiovascular disease (CVD), whereas healthy lifestyle habits are associated with lower ccIMT. The objective of the present study was to test whether a healthy lifestyle intervention can beneficially affect ccIMT progression. A community-based non-randomised, controlled lifestyle intervention was conducted, focusing on a predominantly plant-based diet (strongest emphasis), physical activity, stress management and social health. Assessments of ccIMT were made at baseline, 6 months and 1 year. Participants had an average age of 57 years and were recruited from the general population in rural northwest Germany (intervention: n 114; control: n 87). From baseline to 1 year, mean ccIMT significantly increased in both the intervention (0⋅026 [95 % CI 0⋅012, 0⋅039] mm) and control group (0⋅045 [95 % CI 0⋅033, 0⋅056] mm). The 1-year trajectory of mean ccIMT was lower in the intervention group (P = 0⋅022; adjusted for baseline). In a subgroup analysis with participants with high baseline mean ccIMT (≥0⋅800 mm), mean ccIMT non-significantly decreased in the intervention group (−0⋅016 [95 % CI −0⋅050, 0⋅017] mm; n 18) and significantly increased in the control group (0⋅065 [95 % CI 0⋅033, 0⋅096] mm; n 12). In the subgroup, the 1-year trajectory of mean ccIMT was significantly lower in the intervention group (between-group difference: −0⋅051 [95 % CI −0⋅075, −0⋅027] mm; P < 0⋅001; adjusted for baseline). The results indicate that healthy lifestyle changes may beneficially affect ccIMT within 1 year, particularly if baseline ccIMT is high.
“…Our subgroup analyses confirm that significant effects on ccIMT may be more easily demonstrated in individuals with higher baseline ccIMT (21) , and such higher ccIMT values are more likely to be present in study samples of individuals with confirmed CVD risk factors such as hypercholesterolaemia (31) or diabetes (23,35) . Nevertheless, it is of high public health relevance to develop tools (such as our intervention programme) which already initiate CVD prevention measures in individuals who are still at low to moderate CVD risk (37) . Consequently, it appears justifiable to conduct further lifestyle/dietary interventions assessing ccIMT change in generally healthy participants.…”
Common carotid intima-media thickness (ccIMT) progression is a risk marker for cardiovascular disease (CVD), whereas healthy lifestyle habits are associated with lower ccIMT. The objective of the present study was to test whether a healthy lifestyle intervention can beneficially affect ccIMT progression. A community-based non-randomised, controlled lifestyle intervention was conducted, focusing on a predominantly plant-based diet (strongest emphasis), physical activity, stress management and social health. Assessments of ccIMT were made at baseline, 6 months and 1 year. Participants had an average age of 57 years and were recruited from the general population in rural northwest Germany (intervention: n 114; control: n 87). From baseline to 1 year, mean ccIMT significantly increased in both the intervention (0⋅026 [95 % CI 0⋅012, 0⋅039] mm) and control group (0⋅045 [95 % CI 0⋅033, 0⋅056] mm). The 1-year trajectory of mean ccIMT was lower in the intervention group (P = 0⋅022; adjusted for baseline). In a subgroup analysis with participants with high baseline mean ccIMT (≥0⋅800 mm), mean ccIMT non-significantly decreased in the intervention group (−0⋅016 [95 % CI −0⋅050, 0⋅017] mm; n 18) and significantly increased in the control group (0⋅065 [95 % CI 0⋅033, 0⋅096] mm; n 12). In the subgroup, the 1-year trajectory of mean ccIMT was significantly lower in the intervention group (between-group difference: −0⋅051 [95 % CI −0⋅075, −0⋅027] mm; P < 0⋅001; adjusted for baseline). The results indicate that healthy lifestyle changes may beneficially affect ccIMT within 1 year, particularly if baseline ccIMT is high.
“…Importantly, malnutrition has been shown to persist 30 days post-COVID-19 discharge ( 86 ). As such, patients with COVID-19, especially those with diabetes, may require tailored medical nutrition therapy to improve short- and long-term COVID-19 outcomes ( 71 , 72 , 87 , 88 ).…”
Section: Edge 2: Covid-19 and Malnutritionmentioning
The coronavirus disease 2019 (COVID-19) pandemic challenges our collective understanding of transmission, prevention, complications, and clinical management of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Risk factors for severe infection, morbidity, and mortality are associated with age, environment, socioeconomic status, comorbidities, and interventional timing. Clinical investigations report an intriguing association of COVID-19 with diabetes mellitus and malnutrition but incompletely describe the triphasic relationship, its mechanistic pathways, and potential therapeutic approaches to address each malady and their underlying metabolic disorders. This narrative review highlights common chronic disease states that interact epidemiologically and mechanistically with the COVID-19 to create a syndromic phenotype—the COVID-Related Cardiometabolic Syndrome—linking cardiometabolic-based chronic disease drivers with pre-, acute, and chronic/post-COVID-19 disease stages. Since the association of nutritional disorders with COVID-19 and cardiometabolic risk factors is well established, a syndromic triad of COVID-19, type 2 diabetes, and malnutrition is hypothesized that can direct, inform, and optimize care. In this review, each of the three edges of this network is uniquely summarized, nutritional therapies discussed, and a structure for early preventive care proposed. Concerted efforts to identify malnutrition in patients with COVID-19 and elevated metabolic risks are needed and can be followed by improved dietary management while simultaneously addressing dysglycemia-based chronic disease and malnutrition-based chronic disease.
“…When other metabolic drivers (e.g., abnormal adiposity [adiposity-based chronic disease; ABCD], hypertension [hypertension-based chronic disease; HBCD], and dyslipidemia [lipid-based chronic disease; LBCD] are configured along the 4 stages, a 2 × 2 matrix arises and depicts the 2-dimensional CMBCD framework. 29,32 In the third dimension, each stage and driver (represented by each cell of the 2 × 2 CMBCD matrix) is populated by SDOH and other ethnocultural factors to improve precision of preventive actions and optimize outcomes (Figure 3). Implementing this model in the daily routine clinical practice implies the staging of the patient’s individual risk for each biological driver (adiposity, dysglycemia, hypertension, dyslipidemia) and the incorporation of social determinants to specify the lifestyle recommendations.Figure 3.The transcultural Cardiometabolic-Based Chronic Disease (tCMBCD) model.…”
Section: Lifestyle Medicine At Ldhmentioning
confidence: 99%
“…In the first dimension, the 4 stages are mapped to specific prevention modalities: 1 (Risk-primordial prevention of risk development and progression), 2 (Predisease-primary prevention of disease), 3 (Disease-secondary prevention of complications), and 4 (Complications-tertiary prevention of suffering and mortality); each stage is also subject to quaternary prevention (the avoidance of overmedicalization and unethical behavior). 29,31,32 In the second dimension, individual metabolic drivers are considered as progressing along these 4 stages. For example, the dysglycemia-based chronic disease (DBCD) model constitutes a new way to approach diabetes prevention and management: stage 1 is insulin resistance, stage 2 prediabetes, stage 3 T2D, and stage 4 cardiovascular complications.…”
Section: Codification Of These Various Sequential Processes Facilitat...mentioning
Introduction The relevance of lifestyle medicine in diabetes treatment is now incorporated in clinical practice guidelines but finding an exemplar for the creation of a Lifestyle Medicine Program (LMP) is a difficult task. Aim To use Lifedoc Health (LDH) as a LMP exemplar by describing their multidisciplinary team (MDT) approach to diabetes care along with tactics to address sustainability challenges. Results The LDH model facilitates early activation of patients with diabetes and other cardiometabolic risk factors, MDT approaches, and protocols/policies that are able to overcome barriers to equitable healthcare in the community. Specific programmatic targets are clinical outcomes, effective dissemination, economic viability, and sustainability. Infrastructure centers on patient-driven problem-based visits, shared medical appointments, telemedicine, and patient tracking. Further discussions on program conceptualization and operationalization are provided. Conclusion Even though strategic plans for LMPs that specialize in diabetes care are well represented in the literature, implementation protocols, and performance metrics are lacking. The LDH experience provides a starting point for those healthcare professionals interested in translating ideas into action.
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