A simple dietary message to improve dietary quality for metabolic syndrome

改善代谢综合征饮食质量的简单饮食信息

• 批准号: 7799040
• 负责人: YUNSHENG MA
• 金额: $ 69.06万
• 依托单位: UNIV OF MASSACHUSETTS MED SCH WORCESTER
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-04-10 至 2013-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7799040
• 关键词: Adherence; Adult; Affect; American; American Heart Association; Area; Attitude; Blood Glucose; Blood Pressure; Body Weight; Body Weight decreased; Carbohydrates; Cardiovascular Diseases; Cholesterol; Clinical; Complex; Diabetes Mellitus; Diagnostic; Diet; Dietary Component; Dietary Fiber; Dietary Intervention; Dietary intake; Dietitian; Education; Energy Intake; Exhibits; Fasting; Fatty acid glycerol esters; Fiber; Food; Glucose; Glycosylated Hemoglobin; Glycosylated hemoglobin A; Goals; Guidelines; Health; Health Campaign; High Density Lipoprotein Cholesterol; Homeostasis; Individual; Instruction; Insulin; Intake; Intervention; Knowledge; LDL Cholesterol Lipoproteins; Lead; Lipids; Macronutrients Nutrition; Maintenance; Measures; Mediating; Medical center; Mental Depression; Metabolic; Metabolic syndrome; Micronutrients; Minerals; Mono-S; National Heart, Lung, and Blood Institute; Obesity; Omega-3 Fatty Acids; One-Step dentin bonding system; Outcome; Overweight; Participant; Patients; Persons; Pharmaceutical Preparations; Phase; Physical activity; Physicians; Prevention; Proteins; Public Health; Quality of life; Randomized; Randomized Clinical Trials; Randomized Controlled Trials; Recommendation; Recruitment Activity; Relative (related person); Risk; Self Efficacy; Social support; Testing; Trans Fats; Triglycerides; United States; United States Department of Agriculture; Vitamins; Weight; Work; arm; base; blood lipid; comparative efficacy; diaries; fasting glucose; follow-up; good diet; improved; inflammatory marker; meetings; primary care setting; primary outcome; programs; public health relevance; randomized trial; saturated fat; waist circumference

DESCRIPTION (provided by applicant): The overall goal is to compare the efficacy of two intervention approaches to dietary change among patients with the metabolic syndrome. Metabolic syndrome, which affects nearly 27% of US adults, is a national priority for prevention of CHD as described by the National Cholesterol Education Program's Adult Treatment Panel III. Weight loss is paramount in recommendations for metabolic syndrome. Results from three recent review articles agreed that adding dietary fiber can aid weight loss and weight loss maintenance; dietary fiber also exerts clinical benefits on several components of the metabolic syndrome, including waist circumference, glucose and lipid homeostasis, and insulin control. Despite this, the average fiber intake of adults in the United States is less than half recommended levels. In addition, interventions that target dietary change have typically not been successful with adherence to all recommendations in the short term, and with maintaining changes in diet over the longer term. A contributing factor to poor dietary adherence is likely of the complexity of dietary guidelines. We propose that a simplified dietary intervention strategy that focuses on a key aspect of dietary quality, fiber intake, will overcome the poor adherence typically associated with dietary interventions and improve overall diet quality. We will recruit 240 overweight and obese adults from a primary care setting who meet diagnostic criteria for metabolic syndrome. The efficacy of the two dietary change interventions will be compared in a randomized controlled trial, with 120 patients per group. The two approaches are 1) the American Heart Association (AHA) Dietary Guidelines; and 2) a simple dietary change condition that focuses on increasing fiber. Patients in both conditions will receive intensive dietary instruction for 3 months, followed by a 9 month maintenance phase. Both conditions will receive dietary instructions via individual and group sessions led by registered dietitians. Assessments, including diet, anthropometrics, blood pressure, fasting blood glucose, glycosylated hemoglobin (HbA1c), blood lipids, insulin, inflammatory markers, medication use, depression, quality of life, and physical activity will be conducted at baseline and at 6-, and 12-months after randomization. A 3-month post-intensive intervention assessment will measure short-term changes in body weight, diet, and metabolic syndrome indicators. We hypothesize that participants randomized to the higher fiber condition will have significantly greater weight loss, improvements in metabolic health, and dietary quality at follow-up, compared to those randomized to the AHA diet condition. Such a simple message, if found efficacious for weight loss, metabolic health, dietary quality and adherence in a clinical setting might then be ideal for testing as a public health message. PUBLIC HEALTH RELEVANCE: Identifying a simple dietary recommendation for weight loss and metabolic health may demonstrate potential for a simple public health message to impact CHD prevention and metabolic syndrome. In a randomized clinical trial, we propose to compare the efficacy of two intervention approaches to dietary change for CHD prevention among persons with metabolic syndrome. The two approaches are 1) the AHA Dietary Guidelines; and 2) a simple dietary change condition that focuses on increasing fiber. We hypothesize that a message promoting high fiber intake may be the simple message that has potential to produce broad impact.

描述（由申请人提供）：总体目标是比较两种干预方法在代谢综合征患者中饮食变化的疗效。如《国家胆固醇教育计划》的成人治疗小组III所述，影响了近27％的美国成年人的代谢综合征是预防CHD的国家优先事项。对于代谢综合征的建议，体重减轻至关重要。最近的三篇评论文章的结果同意，增加饮食纤维可以帮助减肥和减肥。饮食纤维还对代谢综合征的几个组成部分（包括腰围，葡萄糖和脂质稳态以及胰岛素控制）具有临床益处。尽管如此，美国成年人的平均纤维摄入量不到建议水平的一半。此外，针对饮食变化的干预措施通常在短期内遵守所有建议，并且在长期内保持饮食变化。导致饮食不良的促成因素可能是饮食指南的复杂性。我们建议，一种简化的饮食干预策略，重点是饮食质量的关键方面，纤维摄入量将克服通常与饮食干预措施相关的不良依从性并提高整体饮食质量。我们将从初级保健环境中招募240名超重和肥胖的成年人，他们符合代谢综合征的诊断标准。在一项随机对照试验中，将比较两种饮食干预措施的功效，每组120例患者。这两种方法是1）美国心脏协会（AHA）饮食指南； 2）一种简单的饮食变化条件，重点是增加纤维。两种情况下的患者将接受3个月的密集饮食指导，然后进行9个月的维护阶段。两种情况都将通过注册营养师领导的个人和小组会议接受饮食指示。评估，包括饮食，拟人化，血压，空腹血糖，糖基化血红蛋白（HBA1C），血脂，胰岛素，炎症标志物，药物使用，抑郁症，生活质量，生活质量和体育活动将在基础上进行，在6--和12个月后进行。 3个月的强化后干预评估将衡量体重，饮食和代谢综合征指标的短期变化。我们假设与随机的AHA饮食状况相比，参与者随机分配到更高的纤维状况将显着更大的体重减轻，代谢健康的改善以及随访时的饮食质量。这样一个简单的信息，如果发现减肥，代谢健康，饮食质量和依从性有效，则可能是测试作为公共卫生信息的理想选择。公共卫生相关性：确定减肥和代谢健康的简单饮食建议可能表明，简单的公共卫生信息可能会影响预防CHD和代谢综合征。在一项随机临床试验中，我们建议将两种干预方法的饮食变化方法比较代谢综合征患者预防CHD的功效。两种方法是1）AHA饮食指南； 2）一种简单的饮食变化条件，重点是增加纤维。我们假设促进高纤维摄入的消息可能是具有产生广泛影响的简单信息。