Prevention of type 2 diabetes - where is the evidence? Assessment of absolute risk of death after myocardial infarction by use of multiple-risk-factor assessment equations: GISSI-Prevenzione mortality risk chart. Cardiac rehabilitation adapted to transient ischaemic attack and stroke (CRAFTS): a randomised controlled trial Do sugar-sweetened beverages cause adverse health outcomes in children? A systematic review protocol Effectiveness of community-based comprehensive healthy lifestyle promotion on cardiovascular disease risk factors in a rural Vietnamese population: a quasi-experimental study Four years of practice-based and exercise-supported behavioural medicine in one community of the German CINDI area. Countrywide Integrated Non-Communicable Diseases Intervention. Behavioural risk factors for non communicable diseases among adults in Kerala, India. The ProActive trial protocol – a randomised controlled trial of the efficacy of a family-based, domiciliary intervention programme to increase physical activity among individuals at high risk of diabetes [ISRCTN61323766] A risk table to assist health practitioners assess and prevent the onset of depression in later life. Assessing the efficacy of the healthy eating and lifestyle programme (HELP) compared with enhanced standard care of the obese adolescent in the community: study protocol for a randomized controlled trial Is level of social support associated with health behaviours modifying cardiovascular risk? Results of the WOBASZ study. A cognitive/behavioral group intervention for weight loss in patients treated with atypical antipsychotics NHS health checks through general practice: randomised trial of population cardiovascular risk reduction Etiology of overactive bladder: a diet and lifestyle model for diabetes and obesity in older women.
Diabetes is an “ old disease ” . The first description of diabetes written on papyrus about 3500 years ago is found in the Ebers papyrus  , which was discovered in Egypt in 1873 by the German archeologist Georg Ebers . Humans , like most mammals , may develop diabetes , if sufficient environmental exposure to physical inactivity , unhealthy diet and obesity are present . Genetic effects are important for the individual risk of type 2 diabetes ( T2D ) but twin studies have shown that the genetic effects combined explain less than 50 % of the risk of T2D ( 1 ) . Today we know almost 100 susceptibility genes associated with T2D but the relative importance of each of these genes is low ( 2 ) , and together they explain only a small part of the disease risk . Thus , genetic screening can not be used for the prediction of T2D for individuals . On the other h and , healthy lifestyle can also prevent T2D in people who are genetically at high risk , e.g. those with positive family history ( 3 ) . Thus , the importance of lifestyle factors for the development and prevention of T2D is overwhelming . The strongest evidence in medicine is considered to come from r and omized controlled trials ( RCTs ) . They are also important in providing the link to causal inference that in most observational studies can not be derived . At the same time , observational studies are necessary for the identification of factors associated with an increased or decreased risk of a disease , and for generation of hypotheses on potential means for prevention based on modifiable risk factors . Observational studies have by now identified a large number of factors that are associated with the development of T2D or with the protection against it . Most of them are related to physical activity , diet and obesity . It has also been shown unequivocally that exposures ( poor nutrition , infections , smoking , etc . ) during fetal life and early infancy result ing in insufficient development ( often shown as low birth weight ) also predict T2D later in life ( 4 ) . Traditionally , T2D has been considered to be a disease of the elderly . However , with increasing obesity and sedentary lifestyle in children , there are increasing numbers of cases of T2D already occurring at a young age in many population s ( 5 ) . In the past two decades several innovative RCTs have repeatedly shown that interventions on modifiable risk factors can reduce the incidence of diabetes in high-risk groups . The evidence has been summarized in several systematic review s and meta-analyses ( 6,7 ) . There is compelling scientific evidence from RCTs that T2D can be prevented or its onset delayed . The key for prevention is a multimodal package of lifestyle changes that is a sum outcome of dietary and physical activity behaviours . The power of lifestyle was dramatically illustrated by the Finnish Diabetes Prevention Study ( DPS ) that explicitly showed that when the study participants with impaired glucose tolerance reached all five modest lifestyle intervention targets , none of them progressed to T2D ( 8) . Importantly , lifestyle intervention lasting for 3–6 years has been shown to have a carry-over effect on T2D incidence that lasts for several years ; up to 15 in the Finnish Diabetes Prevention Study ( 9 ) and 20 years in the China Da Qing Diabetes Prevention Study ( 10 ) . The observed sustained risk reduction seems to be a result of sustained lifestyle changes , but the legacy effect of improved glycaemia during the early intervention may also have contributed to the long-term effect . The follow-up data from the Chinese study indicate moreover that vascular risks are also reduced by lifestyle management . Several prognostic question naires exist for detecting people at risk of T2D ( 11 ) . One of the screening tools with an adequately high sensitivity and specificity is the Finnish Diabetes Risk Score ( FINDRISC ) developed in Finl and ( 12 ) . The FINDRISC has been successfully implemented in the Finnish primary health care system and used also in many other countries . The FINDRISC was also tested in the Omani population and as a result a slightly modified Omani Diabetes Risk Score was developed ( 13 ) which may be a suitable screening tool for the Arab population s in the Middle East . Lifestyle interventions aim ing at translating evidence from efficacy RCTs on T2D prevention into “ real world ” intervention programmes have also been carried out in various population s. Such data were recently combined in a meta- analysis considering the relationship between intervention effectiveness and adherence to guidelines ( 14 ) . The primary meta- analysis included 22 studies with outcome data for weight loss at 12 months . The pooled result of the direct pairwise meta- analysis shows that AIMS To present and discuss a comprehensive and ready to use prediction model of risk of death after myocardial infa rct ion based on the very recently concluded follow-up of the large GISSI-Prevenzione cohort and on the integrated evaluation of different categories of risk factors : those that are non-modifiable , and those related to lifestyles , co-morbidity , background , and other conventional clinical complications produced by the index myocardial infa rct ion . METHODS The 11 - 324 men and women recruited in the study within 3 months from their index myocardial infa rct ion have been followed-up to 4 years . The following risk factors have been used in a Cox proportional hazards model : non-modifiable risk factors : age and sex ; complications after myocardial infa rct ion : indicators of left ventricular dysfunction ( signs or symptoms of acute left ventricular failure during hospitalization , ejection fraction , NYHA class and extent of ventricular asynergy at echocardiography ) , indicators of electrical instability ( number of premature ventricular beats per hour , sustained or repetitive arrhythmias during 24-h Holter monitoring ) , indicators of residual ischaemia ( spontaneous angina pectoris after myocardial infa rct ion , Canadian Angina Classification class , and exercise testing results ) ; cardiovascular risk factors : smoking habits , history of diabetes mellitus and arterial hypertension , systolic and diastolic blood pressure , blood total and HDL cholesterol , triglycerides , fibrinogen , leukocytes count , intermittent claudication , and heart rate . Multiple regression modelling was assessed by receiver operating characteristic ( ROC ) analysis . Generalizability of the models was assessed through cross validation and bootstrapping techniques . POPULATION AND RESULTS During the 4 years of follow-up , a total of 1071 patients died . Age and left ventricular dysfunction were the most relevant predictors of death . Because of pharmacological treatments , total blood cholesterol , triglycerides , and blood pressure values were not significantly associated with prognosis . Sex-specific prediction equations were formulated to predict risk of death according to age , simple indicators of left ventricular dysfunction , electrical instability , and residual ischaemia along with the following cardiovascular risk factors : smoking habits , history of diabetes mellitus and arterial hypertension , blood HDL cholesterol , fibrinogen , leukocyte count , intermittent claudication , and heart rate . The predictive models produced on the basis of information available in the routine conditions of clinical care after myocardial infa rct ion provide ready to use and highly discriminant criteria to guide secondary prevention strategies . CONCLUSIONS AND IMPLICATION S Besides documenting what should be the preferred and practicable focus of clinical attention for today 's patients , the experience of GISSI-Prevenzione suggests that periodically and prospect ively collected data bases on naturalistic ' cohorts could be an important option for updating and verifying the impact of guidelines , which should incorporate the different components of the complex profile of cardiovascular risk . The GISSI Prevenzione risk function is a simple tool to predict risk of death and to improve clinical management of subjects with recent myocardial infa rct ion . The use of predictive risk algorithms can favour the shift from medical logic , based on the treatment of single risk factors , to one centred on the patient as a whole as well as the tailoring of medical interventions according to patients ' overall risk Background Coronary Heart Disease and Cerebrovascular Disease share many predisposing , modifiable risk factors ( hypertension , abnormal blood lipids and lipoproteins , cigarette smoking , physical inactivity , obesity and diabetes mellitus ) . Lifestyle interventions and pharmacological therapy are recognised as the cornerstones of secondary prevention . Cochrane review has proven the benefits of programmes incorporating exercise and lifestyle counselling in the cardiac disease population . A Cochrane review highlighted as priority , the need to establish feasibility and efficacy of exercise based interventions for Cerebrovascular Disease . Methods A single blind r and omised controlled trial is proposed to examine a primary care cardiac rehabilitation programme for adults post transient ischemic attack ( TIA ) and stroke in effecting a positive change in the primary outcome measures of cardiac risk scores derived from Blood Pressure , lipid profile , smoking and diabetic status and lifestyle factors of habitual smoking , exercise and healthy eating participation . Secondary outcomes of interest include health related quality of life as measured by the Hospital Anxiety and Depression Scale , the Stroke Specific Quality of Life scale and WONCA COOP Functional Health Status charts and cardiovascular fitness as measured by a sub-maximal fitness test .  A total of 144 patients , over 18 years of age with confirmed diagnosis of ischaemic stroke or TIA , will be recruited from Dublin community stroke services and two tertiary T.I.A clinics . Exclusion criteria will include oxygen dependence , unstable cardiac conditions , uncontrolled diabetes , major medical conditions , claudication , febrile illness , pregnancy or cognitive impairment . Participants will be block-statified , r and omly allocated to one of two groups using a pre-prepared computer generated r and omisation schedule . Both groups will receive a two hour education class on  risk reduction  post stroke  .  The intervention group will receive a 10 week programme of supervised aerobic exercises ( twice weekly ) and individually tailored brief intervention lifestyle counselling . Both groups will be tested on week one and week ten of the programme . Follow-up at 1 year will assess longer term benefits . Analysis will test for significant changes in the key variables indicated . Discussion Application of the Cardiac Rehabilitation paradigm to patients with ischaemic stroke or TIA has not been explored despite the obvious overlap in aetiology . It is hoped the anticipated improvement in vascular risk factors and fitness result ing from such a programme will enhance health and social gain in this population .Trial Registration Current Controlled Trials ISCTRN90272638 Background Cardiovascular disease and type 2 diabetes are examples of chronic diseases that impose significant morbidity and mortality in the general population worldwide . Most chronic diseases are associated with underlying preventable risk factors , such as elevated blood pressure , high blood glucose or glucose intolerance , high lipid levels , physical inactivity , excessive sedentary behaviours , and overweight/obesity . The occurrence of intermediate outcomes during childhood increases the risk of disease in adulthood . Sugar-sweetened beverages are known to be significant sources of additional caloric intake , and given recent attention to their contribution in the development of chronic diseases , a systematic review is warranted . We will assess whether the consumption of sugar-sweetened beverages in children is associated with adverse health outcomes and what the potential moderating factors are . Methods / Design Of interest are studies addressing sugar-sweetened beverage consumption , taking a broad perspective . Both direct consumption studies as well as those evaluating interventions that influence consumption ( e.g. school policy , educational ) will be relevant . Non-specific or multi-faceted behavioural , educational , or policy interventions may also be included subject to the level of evidence that exists for the other interventions /exposures . Comparisons of interest and endpoints of interest are pre-specified . We will include r and omized controlled trials , controlled clinical trials , interrupted time series studies , controlled before-after studies , prospect i ve and retrospective comparative cohort studies , case – control studies , and nested case – control design s. The MEDLINE ® , Embase , The Cochrane Library , CINAHL , ERIC , and PsycINFO ® data bases and grey literature sources will be search ed . The processes for selecting studies , abstract ing data , and resolving conflicts are described . We will assess risk of bias using design -specific tools . To determine sets of confounding variables that should be adjusted for , we have developed causal directed acyclic graphs and will use those to inform our risk of bias assessment s. Meta- analysis will be conducted where appropriate ; parameters for exploring statistical heterogeneity and effect modifiers are pre-specified . The Grading of Recommendations Assessment , Development and Evaluation ( GRADE ) approach will be used to determine the quality of evidence for outcomes . Systematic review registration PROSPERO CRD42014009641 Background Health promotion is a key component for primary prevention of cardiovascular disease ( CVD ) . This study evaluated the impact of healthy lifestyle promotion campaigns on CVD risk factors ( CVDRF )  in the general population in the context of a community-based programme on hypertension management . Methods A quasi-experimental intervention study was carried out in two rural communes of Vietnam from 2006 to 2009 . In the intervention commune , a hypertensive-targeted management programme integrated with a community-targeted health promotion was initiated , while no new programme , apart from conventional healthcare services , was provided in the reference commune . Health promotion campaigns focused on smoking cessation , reducing alcohol consumption , encouraging physical activity and reducing salty diets . Repeated cross-sectional surveys in local adult population aged 25 years and over were undertaken to assess changes in blood pressure ( BP ) and behavioural CVDRFs ( smoking , alcohol consumption , physical inactivity and salty diet ) in both communes before and after the 3-year intervention . Results Overall 4,650 adults above 25 years old were surveyed , in four r and omly independent sample s covering both communes at baseline and after the 3-year intervention . Although physical inactivity and obesity increased over time in the intervention commune , there was a significant reduction in systolic and diastolic BP ( 3.3 and 4.7 mmHg in women versus 3.0 and 4.6 mmHg in men respectively ) in the general population at the intervention commune . Health promotion reduced levels of salty diets but had insignificant impact on the prevalence of daily smoking or heavy alcohol consumption . Conclusion Community-targeted healthy lifestyle promotion can significantly improve some CVDRFs in the general population in a rural area over a relatively short time span . Limited effects on a context -bound CVDRF like smoking suggested that higher intensity of intervention , a supportive environment or a gender approach are required to maximize the effectiveness and maintain the sustainability of the health intervention The main goal of the preventive intervention study in one community of the German CINDI ( Countrywide Integrated Non-Communicable Diseases Intervention programme of the WHO ) area was to improve cardiovascular health by reducing the risk factors smoking , hypertension , obesity , hypercholesterolaemia , and by changing sedentary lifestyle . The intervention was performed by using the special " Three-Level- Strategy " , which is characterised by activities of primary care physicians in the usual consulting hour ( 1st level ) , with patient groups in their practice s ( 2nd level ) , and at community level ( 3rd level ) where a special work group and a co-ordinating general practice are co-operating . To evaluate the occurrence of the risk factors in practice and the local population , four cross-sectional r and om sample s ( N(total ) = 4881 ) were carried out in seven practice s from 1992 to 1995 . On the community level , 23 special exercise-based health groups ( N(total ) = 600 ) were established and were investigated by means of a question naire , related to behaviour and health beliefs . A " Local Health Information System " facilitated the evaluation , the management of the data , and the organisation of the health programme . The results of the practice sample s showed a significant reduction of smoking ( -17.8 % ) and hypertension ( -31.5 % ) ( p < 0.01 ) . The exercise-based groups were combined with nutritional counselling or relaxation and were accepted very well by the participants ( 83.8 % ) . The participants considerably improved their health behaviour : 82 % discussed health in their family , 37.3 % stated an increase of healthy nutrition , 52 % of relaxation ; 86.2 % intended to regularly increase physical activity in leisure time and 82 % could not imagine regular health training without exercise meetings . We conclude that the practice -based " Three-Level- Strategy " provides a strong support for successful long-term prevention of cardiovascular risk , particularly , when exercise-based health training sessions are performed in order to change sedentary lifestyle . When organised on community level , they might have a positive impact on the health behaviour of the whole community . Physical activity can be used as a " prodrug " for health promotion in a holistic way BACKGROUND & OBJECTIVE Cardiovascular and other chronic diseases are becoming the major causes of morbidity and mortality in most of the third world countries including India , especially in the southern Indian States , like Kerala , where most of the health indicators match closely with those of any developed country . Various behavioural risk factors ( BRF ) namely smoking , unhealthy diet , stress at home and work place , consumption of alcohol , sedentary life style , etc . , are known to be risk factors for many such diseases . The present study was carried out to estimate the prevalence of various behavioural risk factors for chronic diseases , and to identify their biosocial correlates . METHODS A cross-sectional study was done in which the data were collected from a sample of 6579 individuals of age 30 to 74 yr , r and omly selected following a stratified multi-stage cluster sampling design covering Kerala State . The important factors investigated include various behavioural risk factors , presenting chronic diseases and family histories among close relatives . The data were analysed using both univariate and multivariate analyses . RESULTS The two major risk factors observed among males were smoking and alcohol consumption . About two fifths ( 40 % ) of them were current smokers as well as current users of alcohol ( 41 % ) . The median age at initiation was 21 yr for both smoking habits and for alcohol consumption . Nearly a quarter of the target population were inactive ( 23 % males and 22 % females ) based on work and leisure time activities . More than one-fifth of them ( 23 % ) reported stress . Obesity was found more among females ( 33 % ) than males ( 17 % ) . Low socio-economic background was found to be a high predictor ( high risk group ) for habit of smoking , alcohol consumption , stress and unhealthy diet . INTERPRETATION & CONCLUSION Substantially high levels of the various behavioural risk factors among adults in Kerala suggests an urgent need for adopting healthy life style modifications among the population in general . The increased risk observed among the younger generation for behavioural risk factors such as smoking and alcohol consumption calls for urgent corrective steps and measures for long-term monitoring of all major risk factors as well as the major chronic disease conditions Background Increasing prevalence of obesity and disorders associated with sedentary living constitute a major global public health problem . While previous evaluations of interventions to increase  physical activity  have involved communities or individuals with established disease , less attention has been given to interventions for individuals at risk of disease . Methods / design ProActive aims to evaluate the efficacy of a theoretical , evidence - and family-based intervention programme to increase physical activity  in a sedentary population , defined as being at-risk through having a parental family history of diabetes . Primary care diabetes or family history registers were used to recruit 365 individuals aged 30–50 years , screened for activity level . Participants were assigned by central r and omisation to three intervention programmes : brief written advice ( comparison group ) , or a psychologically based behavioural change programme , delivered either by telephone ( distance group ) or face-to-face in the family home over one year . The protocol -driven intervention programme is delivered by trained facilitators , and aims to support increases in physical activity through the introduction and facilitation of a range of self-regulatory skills ( e.g. goal setting ) . The primary outcome is daytime energy expenditure and its ratio to resting energy expenditure , measured at baseline and one year using individually calibrated heart rate monitoring . Secondary measures include self-report of individual and family activity , psychological mediators of behaviour change , physiological and biochemical correlates , acceptability , and costs , measured at baseline , six months and one year . The primary intention to treat analysis will compare groups at one-year post r and omisation . Estimation of the impact on diabetes incidence will be modelled using data from a parallel ten-year cohort study using similar measures . Discussion ProActiveis the first efficacy trial of an intervention programme to promote physical activity in a defined high-risk group accessible through primary care . The intervention programme is based on psychological theory and evidence ; it introduces and facilitates the use of self-regulatory skills to support behaviour change and maintenance . The trial addresses a range of method ological weaknesses in the field by careful specification and quality assurance of the intervention programme , precise characterisation of participants , year-long follow-up and objective measurement of physical activity . Due to report in 2005 , ProActivewill provide estimates of the extent to which this approach could assist at-risk groups who could benefit from changes in behaviours affecting health , and inform future pragmatic trials OBJECTIVE This study aim ed to develop a simple risk table of modifiable factors prospect ively associated with  depression in later life that could be used to guide the assessment , management and introduction of preventive strategies in clinical practice . METHODS This retrospective cohort study included 4636 men aged 65 to 83 years living in the community who denied history of past diagnosis or treatment for depression . They self-reported information about their physical activity , weight and height , smoking history , alcohol consumption and dietary habits , as well as history of hypertension , diabetes , coronary heart disease and stroke . We calculated the body mass index ( BMI ) in kg/m(2 ) . Three to 8 years later they were assessed with the Geriatric Depression Scale 15 ( GDS-15 ) and those with a total score of 7 or greater were considered to display clinical ly significant symptoms of depression . We used binomial exponentiated log-linked general linear models to estimate the risk ratio ( RR ) and 95 % confidence interval ( 95 % CI ) of incident depression after adjusting for age , education , marital status and prevalent medical illnesses . We calculated the probability of depression for each individual combination of risk factors and displayed the results in a risk table . RESULTS Two hundred and twenty-nine men ( 4.5 % ) showed evidence of incident depression 5.7±0.9 ( mean±st and ard deviation ) years later . Measured dietary factors showed no association with incident depression . The probability of depression was the highest for older men who were underweight , overweight or obese , physically inactive , risk drinkers and smokers ( 12.0 % , 95 % CI=7.0 % , 17.1 % ) , and the lowest for those who had all 4 healthy lifestyle markers : physically active , normal body mass , non-risk drinking and non-smoking ( 1.6 % , 95 % CI=0.6 % , 2.5 % ) . The probability of incident depression fell between these two extremes for different combinations of lifestyle practice s. CONCLUSION Four modifiable lifestyle factors can be used in combination to produce a risk table that predicts the probability of incident depression over a period of 3 to 8 years . The risk table is simple , informative and can be easily incorporated into clinical practice to guide assessment and risk reduction interventions Background The childhood obesity epidemic is one of the foremost UK health priorities . Childhood obesity tracks into adult life and places individuals at considerable risk for diabetes , cardiovascular disease , liver disease and other morbidities . There is widespread need for paediatric lifestyle programmes as change may be easier to accomplish in childhood than later in life . Study Design / Method The study will evaluate the management of adolescent obesity by conducting a Medical Research Council complex intervention phase III efficacy r and omised clinical trial of the Healthy Eating Lifestyle Programme within primary care . The study tests a community delivered multi-component intervention design ed for adolescents developed from best practice as identified by National Institute for Health and Clinical Excellence . The hospital based pilot reduced body mass index and improved health-related quality of life . Subjects will be individually r and omised to receiving either the Healthy Eating Lifestyle Programme ( 12 fortnightly family sessions ) or enhanced st and ard care . Baseline and follow up assessment s will be undertaken blind to allocation status . A health economic evaluation is also being conducted.200 obese young people ( 13 - 17 years , body mass index > 98th centile for age and sex ) will be recruited from primary care within the greater London area . The primary hypothesis is that a motivational and solution-focused family-based weight management programme delivered over 6 months is more efficacious in reducing body mass index in obese adolescents identified in the community than enhanced st and ard care . The primary outcome will be body mass index at the end of the intervention , adjusted for baseline body mass index , age and sex . The secondary hypothesis is that the Healthy Eating Lifestyle Programme is more efficacious in improving quality of life and psychological function and reducing waist circumference and cardiovascular risk factors in obese adolescents than enhanced st and ard care assessed at 6 and 12 months post baseline assessment .Improvement in quality of life predicts on-going lifestyle change and maximises the chances of long-term weight reduction . We will explore whether improvement in QOL may be intermediate on the pathway between the intervention and body mass index change . Trial registration IS RCT N : IS RCT BACKGROUND Psychosocial risk factors affected the human health both by autonomic , neuroendocrine and immunological mechanisms and by the influence on human lifestyle . Lack of social support can reflect the person 's lifestyle to more unhealthy . AIM To assess if low , compared to high social support level ( SSL ) , contributes to the unhealthy lifestyle in Polish general population . METHODS The r and om sample of Polish population of 6164 men and 6915 women , aged 20 - 74 , filled-in the  Berkman and Syme question naire  in 2003 - 2005 in the frame of National Multicenter Health Survey ( WOBASZ ) . RESULTS 31 % of men and 39 % of women had low SSL and they more often had high cardiovascular risk , depressive symptoms and cardiovascular disease risk factors , especially women . Men and women with low SSL more often smoked cigarettes than those with high SSL , rarely try to quit smoking , made regular physical activity , and rarely self-measured their blood pressure . Additionally men more often drank alcohol ≥ 30.0 g/day . They also more often did not take the prescribed medication , although they bought them . Out of unhealthy elements , lack of regular physical activity and blood pressure self-measuring were significantly and independently associated with SSL in both genders and additionally smoking habit and lack of quit smoking in the past in women . CONCLUSIONS Persons with low SSL had more unhealthy lifestyle than those without . In Polish population the low SSL played a greater role in creating the cardiovascular risk in women than in men Obesity and diabetes have caused problems for individuals with schizophrenia long before atypical antipsychotic agents . The prevalence of obesity , insulin resistance , impaired glucose tolerance , type 2 diabetes mellitus , dyslipidemia , and the Metabolic Syndrome has increased in people with schizophrenia as compared to the general population . Risk reduction studies for persons with obesity , diabetes , and cardiovascular disease indicate that cognitive/behavioral interventions that promote motivation and provide strategies to overcome the barriers in adherence to diet and activity modification are effective interventions for weight management and risk reduction . In the l and mark multi-center r and omized-controlled trial study , the Diabetes Prevention Project ( DPP ) , a cognitive/behavioral intervention , was more successful in producing weight loss and preventing diabetes than the drugs metformin , troglitazone or placebo . This pilot study examined the effectiveness of a cognitive/behavioral group intervention , modified after the DPP program , in individuals with schizophrenia or schizoaffective disorder taking atypical antipsychotics in a large urban public mental health system . Outcome measures included body weight , body mass index , waist-hip ratios , and fasting glucose levels . Both groups demonstrated elevated fasting glucose levels and were obese with a mean BMI of 33 . The group that received the cognitive/behavioral group intervention  lost more weight than the treatment as usual group . The CB group participants lost an average of 5.4 lb or 2.9 % of body weight , and those in the control group lost 1.3 lb or 0.6 % body weight . The range of weight loss for the treatment group was from 1 to 20 lb . This pilot study has demonstrated that weight loss is possible with cognitive/behavioral interventions in a population with a psychotic disorder Background The global burden of the major vascular diseases is projected to rise and to remain the dominant non-communicable disease cluster well into the twenty first century . The Department of Health in Engl and has developed the NHS Health Check service as a policy initiative to reduce population vascular disease risk . The aims of this study were to monitor population changes in cardiovascular disease ( CVD ) risk factors over the first year of the new service and to assess the value of tailored lifestyle support , including motivational interview with ongoing support and referral to other services . Methods R and omised trial comparing NHS Health Check service only with NHS Health Check service plus additional lifestyle support in Stoke on Trent , Engl and . Thirty eight general practice s and 601 ( 365 usual care , 236 additional lifestyle support ) patients were recruited and r and omised independently between September 2009 and February 2010 . Changes in population CVD risk between baseline and one year follow-up were compared , using intention-to-treat analysis . The primary outcome was the Framingham 10 year CVD risk score . Secondary outcomes included individual modifiable risk measures and prevalence of individual risk categories . Additional lifestyle support included referral to a lifestyle coach and free sessions as needed for : weight management , physical activity , cook and eat and positive thinking . Results Average population CVD risk decreased from 32.9 % to 29.4 % ( p < 0.001 ) in the NHS Health Check only group and from 31.9 % to 29.2 % ( p < 0.001 ) in the NHS Health Check plus additional lifestyle support group . There was no significant difference between the two groups at either measurement point . Prevalence of high blood pressure , high cholesterol and smoking were reduced significantly ( p < 0.01 ) in both groups . Prevalence of central obesity was reduced significantly ( p < 0.01 ) in the group receiving additional lifestyle support but not in the NHS Health Check only group . Conclusions The NHS Health Check service in Stoke on Trent result ed in significant reduction in estimated population CVD risk . There was no evidence of further benefit of the additional lifestyle support services in terms of absolute CVD risk reduction OBJECTIVE To evaluate a coherent , evidence -based hypothesis that specific modifiable lifestyle factors implicated in the development of diabetes and associated obesity are related to the onset of OAB . METHODS A hypothetical causative model for OAB involving modifiable lifestyle factors implicated in the development of diabetes and obesity was constructed , based on a systematic literature review . Secondary analysis of data was undertaken in a prospect i ve cohort of women aged 40 and over , living in Leicestershire , UK . Subjects included 3,411 women free from OAB at baseline and 277 incident cases of OAB . Reported diet , lifestyle , morbid , and social factors were measured at baseline and incident cases at 1-year follow-up . Graphical chain modeling was used to estimate the associations between variables and identify likely pathways involved . RESULTS All hypothesized lifestyle factors ( physical activity , high glycemic index , and high energy intake ) plus diabetes and obesity were retained within the graph as potential contributors . However , low physical activity was the only direct risk factor linked prospect ively to the onset of OAB ( RR 2.47 ; 95 % CI 1.82 , 3.36 ) , in addition to older age . CONCLUSIONS Poor lifestyle factors causally linked to diabetes and obesity may contribute to the onset of OAB ; low physical activity appears to be an important modifiable causal factor for OAB operating directly as well as indirectly via pathways involving obesity or diabetes . Further research is needed to demonstrate a causal link between lifestyle and OAB
Results The results of the meta- analysis show an effect toward the experimental group .
Notably , prevention studies with individual psychoeducational programmes that include diet and /or physical activity seem to have the highest impact .
Conclusions When compared with treatment as usual in psychotic patients , preventive and individual lifestyle interventions that include diet and physical activity generally prove to be effective in reducing weight .
This percentage is below the 5 % to 10 % weight loss deemed sufficient to improve weight-related complications such as hypertension , type II diabetes , and dyslipidemia .
However , it is reported that outcomes associated with metabolic risk factors may have greater health implication s than weight changes alone .
Background Psychiatric patients have more physical health problems and much shorter life expectancies compared to the general population , due primarily to premature cardiovascular disease .
A multi-causal model which includes a higher prevalence of risk factors has provided a valid explanation .
It takes into consideration not only risks such as gender , age , and family history that are inherently non-modifiable , but also those such as obesity , smoking , diabetes , hypertension , and dyslipidemia that are modifiable through behavioural changes and improved care .
Thus , it is crucial to focus on factors that increase cardiovascular risk .
Obesity in particular has been associated with both the lifestyle habits and the side effects of antipsychotic medications .
The present systematic review and meta- analysis aims at collecting and updating available evidence on the efficacy of non-pharmacological health promotion programmes for psychotic patients in r and omised clinical trials .