PREVIEW study—Influence of a behavior modification intervention (PREMIT) in over 2300 people with pre-diabetes : Intention, self-efficacy and outcome expectancies during the early phase of a lifestyle intervention
Huttunen-Lenz, Maija ; Hansen, Sylvia ; Christensen, Pia ; Larsen, Thomas Meinert ; Sandø-Pedersen, Finn ; Drummen, Mathijs ; Adam, Tanja C. ; Macdonald, Ian A. ; Taylor, Moira A. ; Martinez, J.A. ; Navas-Carretero, Santiago ; Handjiev, Svetoslav ; Poppitt, Sally D. ; Silvestre, Marta P. ; Fogelholm, Mikael ; Pietiläinen, Kirsi H. ; Brand-Miller, Jennie ; Berendsen, Agnes A.M. ; Raben, Anne ; Schlicht, Wolfgang - \ 2018
Psychology Research and Behavior Management 11 (2018). - ISSN 1179-1578 - p. 383 - 394.
Cognition - Diabetes mellitus - Goals - Habits - Weight loss
Purpose: Onset of type 2 diabetes (T2D) is often gradual and preceded by impaired glucose homeostasis. Lifestyle interventions including weight loss and physical activity may reduce the risk of developing T2D, but adherence to a lifestyle change is challenging. As part of an international T2D prevention trial (PREVIEW), a behavior change intervention supported participants in achieving a healthier diet and physically active lifestyle. Here, our aim was to explore the influence of this behavioral program (PREMIT) on social-cognitive variables during an 8-week weight loss phase. Methods: PREVIEW consisted of an initial weight loss, Phase I, followed by a weight-maintenance, Phase II, for those achieving the 8-week weight loss target of ≥ 8% from initial bodyweight. Overweight and obese (BMI ≥25 kg/m2) individuals aged 25 to 70 years with confirmed pre-diabetes were enrolled. Uni-and multivariate statistical methods were deployed to explore differences in intentions, self-efficacy, and outcome expectancies between those who achieved the target weight loss (“achievers”) and those who did not (“non-achievers”). Results: At the beginning of Phase I, no significant differences in intentions, self-efficacy and outcome expectancies between “achievers” (1,857) and “non-achievers” (163) were found. “Non-achievers” tended to be younger, live with child/ren, and attended the PREMIT sessions less frequently. At the end of Phase I, “achievers” reported higher intentions (healthy eating χ2 (1)=2.57; P <0.008, exercising χ2 (1)=0.66; P <0.008), self-efficacy (F(2; 1970)=10.27, P <0.005), and were more positive about the expected outcomes (F(4; 1968)=11.22, P <0.005). Conclusion: Although statistically significant, effect sizes observed between the two groups were small. Behavior change, however, is multi-determined. Over a period of time, even small differences may make a cumulative effect. Being successful in behavior change requires that the “new” behavior is implemented time after time until it becomes a habit. Therefore, having even slightly higher self-efficacy, positive outcome expectancies and intentions may over time result in considerably improved chances to achieve long-term lifestyle changes.
Demographic and Social-Cognitive Factors Associated with Weight Loss in Overweight, Pre-diabetic Participants of the PREVIEW Study
Hansen, Sylvia ; Huttunen-Lenz, Maija ; Sluik, Diewertje ; Brand-Miller, Jennie ; Drummen, Mathijs ; Fogelholm, Mikael ; Handjieva-Darlenska, Teodora ; Macdonald, Ian ; Martinez, Alfredo J. ; Larsen, Thomas Meinert ; Poppitt, Sally ; Raben, Anne ; Schlicht, Wolfgang - \ 2018
International Journal of Behavioral Medicine 25 (2018)6. - ISSN 1070-5503 - p. 682 - 692.
Behavioral determination - Lifestyle intervention - Social-cognitive factors - Weight loss
Purpose: Weight loss has been demonstrated to be a successful strategy in diabetes prevention. Although weight loss is greatly influenced by dietary behaviors, social-cognitive factors play an important role in behavioral determination. This study aimed to identify demographic and social-cognitive factors (intention, self-efficacy, outcome expectancies, social support, and motivation with regard to dietary behavior and goal adjustment) associated with weight loss in overweight and obese participants from the PREVIEW study who had pre-diabetes. Method: Prospective correlational data from 1973 adult participants were analyzed. The participants completed psychological questionnaires that assessed social-cognitive variables with regard to dietary behavior. Stepwise multiple regression analyses were performed to identify baseline demographic and social-cognitive factors associated with weight loss. Results: Overall, being male, having a higher baseline BMI, having a higher income, perceiving fewer disadvantages of a healthy diet (outcome expectancies), experiencing less discouragement for healthy eating by family and friends (social support), and lower education were independently linked to greater weight loss. When evaluating females and males separately, education was no longer associated with weight loss. Conclusion: The results indicate that a supportive environment in which family members and friends avoid discouraging healthy eating, with the application of a strategy that uses specific behavior change techniques to emphasize the benefits of outcomes, i.e., the benefits of a healthy diet, may support weight loss efforts. Weight loss programs should therefore always address the social environment of persons who try to lose body weight because family members and friends can be important supporters in reaching a weight loss goal.
Objectively measured physical activity and sedentary time are associated with cardiometabolic risk factors in adults with prediabetes : The PREVIEW study
Swindell, Nils ; Mackintosh, Kelly ; Mcnarry, Melitta ; Stephens, Jeffrey W. ; Sluik, Diewertje ; Fogelholm, Mikael ; Drummen, Mathijs ; Macdonald, Ian ; Martinez, J.A. ; Handjieva-Darlenska, Teodora ; Poppitt, Sally D. ; Brand-Miller, Jennie ; Larsen, Thomas M. ; Raben, Anne ; Stratton, Gareth - \ 2018
Diabetes Care 41 (2018)3. - ISSN 0149-5992 - p. 562 - 569.
OBJECTIVE The aim of the present cross-sectional study was to examine the association among physical activity (PA), sedentary time (ST), and cardiometabolic risk in adults with prediabetes. RESEARCH DESIGN AND METHODS Participants (n = 2,326; 25-70 years old, 67% female) from eight countries, with a BMI >25 kg · m22 and impaired fasting glucose (5.6-6.9 mmol · L21) or impaired glucose tolerance (7.8-11.0 mmol · L21 at 2 h), participated. Seven-day accelerometry objectively assessed PA levels and ST. RESULTS Multiple linear regression revealed that moderate-To-vigorous PA (MVPA) was negatively associated withHOMAof insulin resistance (HOMA-IR) (standardizedb =20.078 [95% CI20.128,20.027]), waist circumference (WC) (b =20.177 [20.122,20.134]), fasting insulin (b = 20.115 [20.158, 20.072]), 2-h glucose (b = 20.069 [20.112, 20.025]), triglycerides (b = 20.091 [20.138, 20.044]), and CRP (b = 20.086 [20.127, 20.045]). ST was positively associated with HOMA-IR (b = 0.175 [0.114, 0.236]), WC (b = 0.215 [0.026, 0.131]), fasting insulin (b = 0.155 [0.092, 0.219]), triglycerides (b = 0.106 [0.052, 0.16]), CRP (b = 0.106 [0.39, 0.172]), systolic blood pressure (BP) (b = 0.078 [0.026, 0.131]), and diastolic BP (b = 0.106 [0.39, 20.172]). Associations reported between total PA (counts · min21), and all risk factors were comparable or stronger than for MVPA: HOMA-IR (b = 20.151 [20.194, 20.107]), WC (b = 20.179 [20.224, 20.134]), fasting insulin (b = 20.139 [20.183, 20.096]), 2-h glucose (b = 20.088 [20.131, 20.045]), triglycerides (b = 20.117 [20.162, 20.071]), and CRP (b = 20.104 [20.146, 20.062]). CONCLUSIONS In adults with prediabetes, objectively measured PA and ST were associated with cardiometabolic risk markers. Total PA was at least as strongly associated with cardiometabolic risk markers as MVPA, which may imply that the accumulation of total PA over the day is as important as achieving the intensity of MVPA.
Prevalence and effects of functional vitamin K insufficiency : The PREVEND study
Riphagen, Ineke J. ; Keyzer, Charlotte A. ; Drummen, Nadja E.A. ; Borst, Martin H. de; Beulens, Joline W.J. ; Gansevoort, Ron T. ; Geleijnse, Johanna M. ; Muskiet, Frits A.J. ; Navis, Gerjan ; Visser, Sipke T. ; Vermeer, Cees ; Kema, Ido P. ; Bakker, Stephan J.L. - \ 2017
Nutrients 9 (2017)12. - ISSN 2072-6643
All-cause mortality - Cardiovascular mortality - Matrix Gla protein - Vitamin K
Matrix Gla Protein (MGP) is a strong vitamin K-dependent inhibitor of soft tissue calcification. We assessed the prevalence of functional vitamin K insufficiency, as derived from plasma desphospho-uncarboxylated MGP (dp-ucMGP), and investigated whether plasma dp-ucMGP is associated with all-cause and cardiovascular mortality in a large general population-based cohort. We included 4275 subjects (aged 53 ± 12 years, 46.0% male) participating in the prospective general population-based Prevention of Renal and Vascular End-Stage Disease (PREVEND) study. The prevalence of functional vitamin K insufficiency (i.e., dp-ucMGP > 500 pmol/L) was 31% in the total study population. This prevalence was significantly higher among elderly and subjects with comorbidities like hypertension, type 2 diabetes, chronic kidney disease, and cardiovascular disease (~50%). After 10 years of follow-up, 279 subjects had died, with 74 deaths attributable to cardiovascular causes. We found significant J-shaped associations of plasma dp-ucMGP with all-cause (linear term: hazard ratio (HR) (95% confidence interval (CI)) = 0.20 (0.12–0.33), p < 0.001; squared term: 1.14 (1.10–1.17), p < 0.001) and cardiovascular mortality (linear term: 0.12 (0.05–0.27), p < 0.001; squared term: 1.17 (1.11–1.23), p < 0.001). These associations remained significant after adjustment for potential confounders. Whether the correction of vitamin K insufficiency improves health outcomes needs to be addressed in future prospective intervention studies.