A community-based lifestyle and weight loss intervention promoting a Mediterranean-style diet pattern evaluated in the stroke belt of North Carolina: the Heart Healthy Lenoir Project

Thomas C Keyserling, Carmen D Samuel-Hodge, Stephanie Jilcott Pitts, Beverly A Garcia, Larry F Johnston, Ziya Gizlice, Cassandra L Miller, Danielle F Braxton, Kelly R Evenson, Janice C Smith, Gwen B Davis, Emmanuelle L Quenum, Nadya T Majette Elliott, Myron D Gross, Katrina E Donahue, Jacqueline R Halladay, Alice S Ammerman, Thomas C Keyserling, Carmen D Samuel-Hodge, Stephanie Jilcott Pitts, Beverly A Garcia, Larry F Johnston, Ziya Gizlice, Cassandra L Miller, Danielle F Braxton, Kelly R Evenson, Janice C Smith, Gwen B Davis, Emmanuelle L Quenum, Nadya T Majette Elliott, Myron D Gross, Katrina E Donahue, Jacqueline R Halladay, Alice S Ammerman

Abstract

Background: Because residents of the southeastern United States experience disproportionally high rates of cardiovascular disease (CVD), it is important to develop effective lifestyle interventions for this population.

Methods: The primary objective was to develop and evaluate a dietary, physical activity (PA) and weight loss intervention for residents of the southeastern US. The intervention, given in eastern North Carolina, was evaluated in a 2 year prospective cohort study with an embedded randomized controlled trial (RCT) of a weight loss maintenance intervention. The intervention included: Phase I (months 1-6), individually-tailored intervention promoting a Mediterranean-style dietary pattern and increased walking; Phase II (months 7-12), option of a 16-week weight loss intervention for those with BMI ≥ 25 kg/m(2) offered in 2 formats (16 weekly group sessions or 5 group sessions and 10 phone calls) or a lifestyle maintenance intervention; and Phase III (months 13-24), weight loss maintenance RCT for those losing ≥ 8 lb with all other participants receiving a lifestyle maintenance intervention. Change in diet and PA behaviors, CVD risk factors, and weight were assessed at 6, 12, and 24 month follow-up.

Results: Baseline characteristics (N = 339) were: 260 (77 %) females, 219 (65 %) African Americans, mean age 56 years, and mean body mass index 36 kg/m(2). In Phase I, among 251 (74 %) that returned for 6 month follow-up, there were substantial improvements in diet score (4.3 units [95 % CI 3.7 to 5.0]), walking (64 min/week [19 to 109]), and systolic blood pressure (-6.4 mmHg [-8.7 to -4.1]) that were generally maintained through 24 month follow-up. In Phase II, 138 (57 group only, 81 group/phone) chose the weight loss intervention and at 12 months, weight change was: -3.1 kg (-4.9 to -1.3) for group (N = 50) and -2.1 kg (-3.2 to -1.0) for group/phone combination (N = 75). In Phase III, 27 participants took part in the RCT. At 24 months, weight loss was -2.1 kg (-4.3 to 0.0) for group (N = 51) and -1.1 kg (-2.7 to 0.4) for combination (N = 72). Outcomes for African American and whites were similar.

Conclusions: The intervention yielded substantial improvement in diet, PA, and blood pressure, but weight loss was modest.

Trial registration: clinicaltrials.gov Identifier: NCT01433484.

Keywords: Cardiovascular disease; Dietary intervention; Disparities; Lifestyle intervention; Low-income participants; Mediterranean diet; Prevention; Weight loss intervention.

Figures

Fig. 1
Fig. 1
Study overview
Fig. 2
Fig. 2
Study flow diagram, part 1
Fig. 3
Fig. 3
Study flow diagram, part 2

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