Effectiveness of a lifestyle intervention on metabolic syndrome. A randomized controlled trial

Abstract

Background: Intensive lifestyle intervention significantly reduces the progression to diabetes in high-risk individuals.

Objective: It is not known whether a program of moderate intervention might effectively reduce metabolic abnormalities in the general population.

Design: Two-arm randomized controlled 1-year trial.

Patients: Three hundred and thirty-five patients participated from a dysmetabolic population-based cohort of 375 adults aged 45-64 years in northwestern Italy.

Measurements: We compared the effectiveness of a general recommendation-based program of lifestyle intervention carried out by trained professionals versus standard unstructured information given by family physicians at reducing the prevalence of multiple metabolic and inflammatory abnormalities.

Results: At baseline, clinical/anthropometric/laboratory and lifestyle characteristics of the intervention (n = 169) and control (n = 166) groups were not significantly different. The former significantly reduced total/saturated fat intake and increased polyunsaturated fat/fiber intake and exercise level compared to the controls. Weight, waist circumference, high-sensitivity C-reactive protein, and most of the metabolic syndrome components decreased in the intervention group and increased in the controls after 12 months. Lifestyle intervention significantly reduced metabolic syndrome (odds ratio [OR] = 0.28; 95% CI 0.18-0.44), with a 31% (21-41) absolute risk reduction, corresponding to 3.2 (2-5) patients needing to be treated to prevent 1 case after 12 months. The intervention significantly reduced the prevalence of central obesity (OR = 0.33; 0.20-0.56), and hypertriglyceridemia (OR = 0.48; 0.31-0.75) and the incidence of diabetes (OR = 0.23; 0.06-0.85).

Conclusion: A lifestyle intervention based on general recommendations was effective in reducing multiple metabolic/inflammatory abnormalities. The usual care by family physicians was ineffective at modifying progressive metabolic deterioration in high-risk individuals.

Figures

Figure 1

Flow of participants. MS= metabolic syndrome; hs-CRP= high-sensitivity C-reactive protein. All the 45- to 64-year-old residents in the province of Asti (n = 1,877) from 6 family physicians, whose patients were representative of the local sanitary districts, were contacted. Of these, 1,658 subjects (88.3%) participated in the metabolic screening.