Effectiveness of a community-based intervention in improving cardio-metabolic risk factors in adults with Metabolic Syndrome: A Randomized Controlled Trial.

Abstract

Background Cardiovascular diseases (CVDs) are disproportionately burdened the low- and middle-income countries (LMICs), where awareness and detection rates remain low. Community-based approaches addressing health behaviors including diet, regular physical activity and not smoking cigarettes have all been proved to substantially reduce the risk of CVDs in the high-income countries. However, their effects in improving cardio-metabolic risk factors in adults with Metabolic Syndrome in the LMICs remains unknown. Objective This study aimed to evaluate the effectiveness of community-based lifestyle intervention in improving cardio-metabolic risk factors among adults with MetS. Methods This was a randomized controlled trial study conducted for a period of 15-months among adults with MetS. Eligible individuals (n = 352) were randomly allocated to either the control or the intervention group on 1:1 ratio. The treatment arm received World Health Organization recommended lifestyle intervention that encouraged physical activity and healthy diet through face-to-face contacts. The control group received usual medical care involved drug treatment and general medical advice. Anthropometric, clinical and biochemical measurements as well as lifestyle characteristics were assessed before and 12-months after the intervention. The measurements were compared between and within the groups during analyses using chi-square test, independent t-test and paired t-test. Results The changes in lifestyle characteristics have been reported elsewhere [31]. Relative to the baseline values and the control group, the intervention group experienced significant average reductions in body weight (-4.6 vs -0.4 kgs, p = 0.027), body mass index (-1.6 vs -0.14, p = 0.012), waist circumference (-2.29 vs -0.12 cm, p = 0.019), waist hip ratio (-0.02 vs -0.0, P = 0.003), waist height ratio (-0.01 vs 0.0, p = 0.015), systolic BP (-4.06 vs + 0.24 mmHg, p = 0.025), diastolic BP (-2.4 vs – 0.23 mmHg, p = 0.033), fasting blood glucose (− 0.5 vs + 0.08 mmol/L; p < 0.001), Triglycerides (-0.33 vs -0.01 mmol/L, p = 0.006), and an increase in high-density lipoprotein cholesterol (+ 0.25 vs + 0.02 mmol/L; p < 0.001) at the end-line. Conclusion Community-based lifestyle intervention comprised diet and physical activity significantly improved cardio-metabolic risk factors in adults with MetS. Population-based screening and adoption of a healthy lifestyle should be considered for the prevention, reduction, and treatment of cardio-metabolic risk factors in the LMICs. The strategy could be implemented through nurses and community health workers.