Establishment and validation of an adherence prediction system for lifestyle interventions in non-alcoholic fatty liver disease

BACKGROUND Non-alcoholic fatty liver disease(NAFLD)is the most common liver disease worldwide,affecting about 1/4th of the global population and causing a huge global economic burden.To date,no drugs have been approved for the treatment of NAFLD,making the correction of unhealthy lifestyles the principle method of treatment.Identifying patients with poor adherence to lifestyle correction and attempting to improve their adherence are therefore very important.AIM To develop and validate a scale that can rapidly assess the adherence of patients with NAFLD to lifestyle interventions.METHODS The Exercise and Diet Adherence Scale(EDAS)was designed based on com-pilation using the Delphi method,and its reliability was subsequently evaluated.Demographic and laboratory indicators were measured,and patients completed the EDAS questionnaire at baseline and after 6 months.The efficacy of the EDAS was evaluated in the initial cohort.Subsequently,the efficacy of the EDAS was internally verified in a validation cohort.RESULTS The EDAS consisted of 33 items in six dimensions,with a total of 165 points.Total EDAS score correlated significantly with daily number of exercise and daily reduction in calorie intake(P<0.05 each),but not with overall weight loss.A total score of 116 was excellent in predicting adherence to daily reduction in calorie intake(>500 kacl/d),(sensitivity/specificity was 100.0%/75.8%),while patients score below 97 could nearly rule out the possibility of daily exercise(sensitivity/specificity was 89.5%/44.4%).Total EDAS scores≥116,97-115,and<97 points were indicative of good,average,and poor adherence,respectively,to diet and exercise recommendations.CONCLUSION The EDAS can reliably assess the adherence of patients with NAFLD to lifestyle interventions and have clinical application in this population.

Scale offers the possibility of identifying adherence to lifestyle interventions in patients with non-alcoholic fatty liver disease

Nonalcoholic fatty liver disease(NAFLD)is the most common chronic liver disorder,and dietary and lifestyle interventions remain the mainstays of NAFLD therapy.Zeng et al established a prediction system to evaluate adherence to lifestyle interventions in patients with NAFLD and choose optimal management.Here,we discuss the application scenarios of the scale and the areas warranting further attention,aiming to provide a possible reference for clinical recommend-ations.

Validation of adherence prediction system for lifestyle interventions in nonalcoholic fatty liver disease

This editorial delves into the research article by Zeng et al published in the latest issue of World Journal of Gastroenterology.The manuscript contributes significantly to addressing the global health issue of nonalcoholic fatty liver disease(NAFLD)by introducing and validating the Exercise and Diet Adherence Scale(EDAS).The article effectively conveys the importance of the study,highlighting the prevalence of NAFLD,the lack of approved drugs for its treatment,and the crucial role of lifestyle correction.The use of the Delphi method for scale development and the subsequent evaluation of its reliability add scientific rigor to the methodology.The results demonstrate that the scale is correlated with key lifestyle indicators,which makes it a promising tool for assessing patient adherence to interventions.The identification of specific score thresholds for predicting adherence to daily calorie intake and exercise adds practical value to the scale.The differentiation among scores indicative of good,average,and poor adherence enhances its clinical applicability.In conclusion,the manuscript introduces EDAS,a valuable instrument that can contribute substantially to the field of NAFLD research and clinical practice.

Effect of lifestyle intervention on non-alcoholic fatty liver disease in Chinese obese children

AIM: To investigate the effect of lifestyle intervention on non-alcoholic fatty liver disease (NAFLD) in Chinese obese children. METHODS: Seventy-six obese children aged from 10 to 17 years with NAFLD were enrolled for a one-month intervention and divided randomly into three groups. Group1, consisting of 38 obese children, was an untreated control group without any intervention. Group 2, consisting of 19 obese children in summer camp, was strictly controlled only by life style intervention. Group 3, consisting of 19 obese children, received oral vitamin E therapy at a dose of 100 mg/d. The height, weight, fasting blood glucose (FBG), fasting serum insulin (FINS), plasma alanine aminotransferase (ALT), aspartate aminotransferase (AST), triglyceride (TG), total cholesterol (TCHO) and homeostasis model assent- insulin resistance (HOMA-IR) were measured at baseline and after one month. All patients were underwent to an ultrasonographic study of the liver performed by one operator who was blinded to the groups. RESULTS: The monitor indices of BMI, ALT, AST, TG, TCHO and HOMA-IR were successfully improved except in group 1. BMI and ALT in group 2 were reduced more significantly than in group 3 (2.44 ± 0.82 vs 1.45 ± 0.80, P = 0.001; 88.58 ± 39.99 vs 63.69 ± 27.05, P = 0.040, respectively).CONCLUSION: Both a short-term lifestyle intervention and vitamin E therapy have an effect on NAFLD in obese children. Compared with vitamin E, lifestyle intervention is more effective. Therefore, lifestyle intervention should represent the first step in the management of children with NAFLD.

Effects of lifestyle interventions on rural patients with type 2 diabetes mellitus

BACKGROUND The prevalence of type 2 diabetes mellitus(T2DM)is rising rapidly in rural areas,and lifestyle interventions can effectively reduce the blood glucose levels of patients with T2DM.However,current dietary and exercise guidelines are still at experimental stages and are difficult for subjects to understand and implement.The Human Metabolism Analyzer provides real life interventions for the prevention and treatment of T2DM,and our pilot research has demonstrated its effectiveness and good compliance.AIM To investigate the effect of and compliance with lifestyle interventions in rural patients with T2DM.METHODS A total of ten rural villages were randomly selected in Chaoshui Township,Penglai City,Shandong Province,China,to conduct health screening among residents aged 50 years or older.Each rural village represented a group,and 12 patients with T2DM were randomly selected from each group(total:120)to participate in this study and receive real life lifestyle interventions and medication guidance.Lifestyle interventions included changing the meal order(A),postprandial activities(B),resistance exercise(C),and reverse abdominal breathing(D).Diabetes education was conducted at least once a month with a weekly phone follow-up to monitor exercise and diet.Waist circumference,blood pressure,body mass index(BMI),motor function,body composition,fasting blood glucose,and glycated hemoglobin(HbA1c)were analyzed before and 3 mo after the intervention.Moreover,patient compliance and adjustments of hypoglycemic drugs were evaluated.RESULTS A total of 109 subjects completed the study.The compliance rates for lifestyle interventions A,B,C,and D were 57.79%,60.55%,64.22%,and 75.23%,respectively.Among the subjects who received hypoglycemic drugs,the dose was reduced 2 to 3 times based on blood glucose in 54(67.50%)subjects and was tapered and discontinued in 5(6.25%)subjects within 3 mo,with no significant fluctuations in blood glucose after dose reduction and withdrawal.After lifestyle interventions,waist circumference,BMI,fasting blood glucose,and HbA1c significantly decreased(P<0.001);motor function and body composition also significantly improved(P<0.001).CONCLUSION For patients with T2DM,compliance to real-life lifestyle interventions is good,and the interventions significantly improve metabolic indicators such as waist circumference,BMI,blood pressure,HbA1c,body composition,and motor function.Some patients are able to taper or discontinue hypoglycemic drugs.

Efficacy of early lifestyle intervention on metabolic syndrome

Objective Intensive lifestyle intervention significantly reduces the progression to diabetes in high-risk individuals. This study aimed to investigate the efficacy of early lifestyle intervention on high-risk groups of metabolic syndrome. Methods In a two-arm randomized controlled 1-year trial, we compared the effectiveness of a general recommendation-based program of lifestyle intervention carded out by wained professionals versus standard unstructured information given by physicians at reducing the prevalence of multiple metabolic and inflammatory abnormalities in 306 adults aged 45-64 years in Xiaogan city, China. Results At baseline, clinical/ anthropometric/laboratory and lifestyle characteristics of the intervention （n= 153 ） and control （n= 153） 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 （OR=0.28; 95% CI 0.18-0.44）, with a 31% （95% C121-41） absolute risk reduction, corresponding to 3.2 （95% CI, 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; 95% CI, 0.20-0.56）, and hypertriglyceridemia （OR=0.48; 95% CI, 0.31-0.75） and the incidence of diabetes （OR=0.23; 95% CI, 0.06-0.85）. Conclusions A lifestyle intervention based on general recommendations was effective in reducing multiple metabolic/inflammatory abnormalities. The usual care by clinical physicians was ineffective at modifying progressive metabolic deterioration in high-risk individuals （J Geriatr Cardio12010; 7：10-16）.

Effects of Lifestyle Intervention Performed by Community Pharmacists on Glycemic Control in Patients with Type 2 Diabetes: The Community Pharmacists Assist (Compass) Project, a Pragmatic Cluster Randomized Trial

Background: Community pharmacists should be involved in diabetes care, while there has been less evidence about whether a brief lifestyle intervention is effective for diabetes care in community pharmacies. Objectives: To examine the effects of brief lifestyle intervention on glycemic control in patients with type 2 diabetes mellitus (T2D) by using a coaching style, provided by community pharmacists. Methods: A prospective, cluster-randomized, controlled trial was conducted in 50 groups of community pharmacies in Japan. In all, 132 patients with T2D (age, 20 - 75 years, ≥8.0% of hemoglobin A1c (HbA1c)) were assigned to the intervention group (n = 90) or the usual care group (n = 42). The intervention group (IG) underwent brief lifestyle coaching for self-care of T2D for 6 months. The standard care group (CG) received usual care by pharmacists and was given a general newsletter. The primary outcome was changes in HbA1c levels. Results: After 6 months, the IG had significantly improved HbA1c (IG: -0.6 ± 0.9 vs. CG: -0.2% ± 0.9%;p = 0.021 using the last observation carried forward analysis). Although the number of drugs reduced from 2.3 ± 0.8 to 2.0 ± 1.2 in the IG, the number increased from 2.3 ± 1.1 to 2.5 ± 1.1 in the CG (-0.2 ± 0.9 in IG vs. 0.2 ± 0.6 in CG;p = 0.023). Conclusions: The brief lifestyle intervention by community pharmacists improved glycemic control in patients with T2D. Community pharmacists may more positively participate as lifestyle coaches for diabetes care.

Dance Movement Therapy: A Promising Lifestyle Intervention in the Management of Chronic Obstructive Pulmonary Disease

Chronic Obstructive Pulmonary Disease(COPD),a progressive multicomponent malady with high morbidity and mortality,is an important public health challenge,throughout the world.Despite remarkable progress in its diagnostic and therapeutic modalities,significant number of patients,especially the elderly,continue to suffer from distressing dyspnoea and harrowing extra-pulmonary manifestations limiting their daily activities,with resultant exercise intolerance.Dance Movement Therapy(DMT),a pleasurable and feasible exercise,has been found to be equally efficacious when compared to routinely prescribed physical exercises.Moreover,it has aesthetic expression,attractive to both genders irrespective of age,tempting to those with disabilities,and a fruitful tool in developing self-confidence.During the current stressful situation,caused by COVID-19 pandemic,the COPD patients,notably those over 70 years,are particularly vulnerable to intensification of symptoms and some of them may experience serious disorders of mental illness.Home isolation,social distancing,limiting outdoor activities and prohibiting participation in group exercises,though being appropriate prophylactic measures,are likely to add to already existing physical inactivity and heighten stress and depression,with deleterious effects on overall well-being.Solo dancing,while restricted to home,is a highly accessible,doable,sustainable and well rewarding alternative.

Lifestyle intervention by group-based rehabilitation versus individual counseling in type 2 diabetes: 1-year follow-up of the Copenhagen type 2 diabetes rehabilitation project

Background: Today most guidelines on the management of type 2 diabetes incorporate lifestyle intervention including patient education, physical activity and dietary modification. However, the content and organization of lifestyle intervention programs are still debatable. Aims: To compare the longer term effectiveness of a group-based rehabilitation program with an individual counseling program at improving glycemic control, cardiovascular risk factors and quality of life among type 2 diabetes patients. Methods: We randomized 143 type 2 diabetes patients to either a 6-month group-based rehabilitation program, including patient education, supervised exercise, and diet intervention, or a 6-month individual counseling program. Follow-up time was 12 months after baseline. Outcome measures were glycated hemoglobin (HbA1c), cardiovascular risk factors, quality-of-life and self-rated health. Results: In the rehabilitation group, HbA1c decreased 0.2%-point (95% confidence interval [CI] = -0.4, -0.03), systolic blood pressure decreased 6 mmHg (95% CI = -9.3, -2.5), diastolic blood pressure decreased 4 mmHg (95% CI = -6.3, -2.4), weight decreased 2.2 kg (95% CI = -3.2, -1.3), and waist circumference decreased 2.0 cm (95% CI = -2.9, -1.1). In the individual group, HbA1c decreased 0.4% (95% CI = -0.6, -0.1), systolic blood pressure decreased 3 mmHg (95% CI = -6.3, -0.7), diastolic blood pressure decreased 3 mmHg (95% CI = -4.7, -0.7), weight decreased 1.6 kg (95% CI = -2.6, -.7]), and waist circumference decreased 1.6 cm (95% CI = -2.5, -0.6). Vitality, fatigue distress, physical functioning and cardiovascular distress improved over time (P < 0.05) in the two groups combined. Repeated measurement analysis did not result in significant differences between the groups of any outcome. Conclusions: This study demonstrates that group-based rehabilitation in a primary healthcare center is a comparable alternative to individual counseling in an outpatient clinic. However, the resource use of the rehabilitation program was twice as much as the individual program.

The Experience and Impact of a Fitbit-Based Physical Activity and Sleep Hygiene Intervention for Older Adults Experiencing Cognitive Decline

Objectives: This study aimed to understand the experience and impact of a physical activity and sleep wrist-worn tracker (Fitbit)-based healthy lifestyle intervention for older patients attending a memory assessment service, who are experiencing cognitive impairment but do not receive a dementia diagnosis. Methods: A qualitative design was employed. Semi-structured interviews were conducted with a purposeful sample of thirteen participants recruited from a memory assessment service. Thematic analysis, that was data driven and inductive, was undertaken to analyse the data. Results: Two global themes were developed. “Understanding exercise and sleep as part of my lifestyle” was made up of themes representing how participants viewed exercise and sleep as part of their lifestyles in terms of acknowledging the positive impacts and the barriers to exercise and sleep. The second global theme “Understanding my experience of the healthy lifestyle intervention” was made up of themes that identified the positive impact of the intervention regarding improving health and wellbeing, enabling validation of proactive behaviours and motivation to engage in healthy lifestyle behaviours, so promoting positive behaviour change. Conclusion: Patients experiencing age-related cognitive impairment, applied and benefited from a healthy lifestyle Fitbit-based intervention to facilitate and promote physical activity, better sleep hygiene and healthy lifestyles.

Lifestyle intervention for gestational diabetes mellitus prevention: A cluster-randomized controlled study

Objective: The study was to examine whether gestational diabetes mellitus (GDM) can be prevented by early trimester lifestyle counseling in a high-risk population.Methods: From September 2012 to January 2013, 1664 pregnancies in the Department of Obstetrics and Gynecology of First Hospital of Peking University were enrolled in the study during their first prenatal care visit before the 8 gestational weeks visit and asked to fill out a questionnaire on GDM risk evaluation.According to the questionnaire and medical records, those with at least one risk factor of GDM were included in the intervention study and randomly allocated to two groups, intervention group and control group.Routine prenatal care was offered, while standardized two-step lifestyle intervention was provided to the intervention group during 6-8 gestational weeks, and at 12-13 gestational weeks, enforcement intervention based on maternal anthropometrics were offered.Both groups were followed until 75 g oral glucose tolerance test (OGTT) testing at 24-28 gestational weeks.The weight gain after intervention and the prevalence of GDM were used to evaluate the effect.Results: (1) According to the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria, the positive rate of GDM for the intervention group was 17.16％ (23/134), lower than the control group which was 23.91％ (33/138), P =0.168.(2) The weight gain during the first and second trimester for the intervention group was (1.38 ± 2.34) kg and (5.51 ± 2.18) kg, lower than in the control group which was (1.41 ± 2.58) kg and (5.66 ± 2.25) kg, (P =0.905, P =0.567).(3) Positive rate of GDM for those fasting plasma glucose (FPG) ≥5.1 mmol/L during early pregnancy was 11/36 (30.55％) for the intervention group that was lower than 17/37 (45.95％) for the control group, but the statistical difference was not significant (P =0.076).Conclusion: The positive rate of GDM could be reduced by a certain amount lifestyle intervention from the beginning of pregnancy.More validated effective intervention should be explored in the high-risk pregnant women.Copyright 2015, Chinese Medical Association Production.Production and hosting by Elsevier B.V.on behalf of KeAi Communications Co., Ltd.This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/ by-nc-nd/4.0/).

Screening and interventions to prevent nonalcoholic fatty liver disease/nonalcoholic steatohepatitis-associated hepatocellular carcinoma

Liver cancer is the sixth most commonly diagnosed cancer worldwide,with hepatocellular carcinoma(HCC)comprising most cases.Besides hepatitis B and C viral infections,heavy alcohol use,and nonalcoholic steatohepatitis(NASH)-associated advanced fibrosis/cirrhosis,several other risk factors for HCC have been identified(i.e.old age,obesity,insulin resistance,type 2 diabetes).These might in fact partially explain the occurrence of HCC in non-cirrhotic patients without viral infection.HCC surveillance through effective screening programs is still an unmet need for many nonalcoholic fatty liver disease(NAFLD)patients,and identification of pre-cirrhotic individuals who progress to HCC represents a substantial challenge in clinical practice at the moment.Patients with NASHcirrhosis should undergo systematic HCC surveillance,while this might be considered in patients with advanced fibrosis based on individual risk assessment.In this context,interventions that potentially prevent NAFLD/NASH-associated HCC are needed.This paper provided an overview of evidence related to lifestyle changes(i.e.weight loss,physical exercise,adherence to healthy dietary patterns,intake of certain dietary components,etc.)and pharmacological interventions that might play a protective role by targeting the underlying causative factors and pathogenetic mechanisms.However,well-designed prospective studies specifically dedicated to NAFLD/NASH patients are still needed to clarify the relationship with HCC risk.

Remission of type 2 diabetes mellitus

The surge in type 2 diabetes mellitus(T2DM)is tightly linked to obesity,leading to ectopic fat accumulation in internal organs.Weight management has become a cornerstone of T2DM treatment,with evidence suggesting that significant weight loss can induce remission.Remission,defined as sustained hemoglobin(HbA1c)below 6.5% for at least 3 months without medication,can be achieved through various approaches,including lifestyle,medical,and surgical interventions.Metabolic bariatric surgery offers significant remission rates,particularly for patients with severe obesity.Intensive lifestyle modifications,including lowcalorie diets and exercise,have also demonstrated significant potential.Medications like incretin-based agents show robust results in improving beta-cell function,achieving glycemic control,and promoting weight loss.While complete remission without medication may not be attainable for everyone,especially those with severe insulin resistance or deficiency,early and aggressive glycemic control remains a crucial strategy.Maintaining HbA1c below 6.5%from the time of diagnosis reduces the risk of long-term complications and mortality.Moreover,considering a broader definition of remission,encompassing individuals with sustained control on medication,could offer a more comprehensive and inclusive approach to managing this chronic disease.

Key challenges of post-liver transplant weight management

Liver transplantation serves as a life-saving intervention for patients with endstage liver disease,yet long-term survival remains a challenge.Post-liver transplant obesity seems to have a significant contribution to this challenge and it emerges as a significant risk factor for graft steatosis,metabolic syndrome and denovo malignancy development.This review synthesizes current literature on prevalence,risk factors and management strategies for post-liver transplant obesity,emphasizing its impact on graft and patient survival.Literature review consultation was conducted in Medline/PubMed,SciELO and EMBASE,with the combination of the following keywords:Weight management,liver transplantation,immunosuppressive therapy,lifestyle interventions,bariatric surgery.Immunosuppressive therapy has a significant influence on long-term survival of liver transplant patients,yet it seems to have lesser effect on post-transplant obesity development than previously thought.However,it significantly contributes to the development of other components of metabolic syndrome.Key predisposing factors for post-transplant obesity development encompass elevated recipient and donor body mass index,a history of alcoholic liver disease,hepatocellular carcinoma,male gender,the absence of cellular rejection and the marital status of the recipient.Tailored immunosuppressive regimens,pharmacotherapy,lifestyle interventions and bariatric surgery represent key components in mitigating post-transplant obesity and improving long-term survival and quality of life in this group of patients.Timely identification and intervention thus hold paramount importance.Further research is warranted to refine optimal management strategies and enhance outcomes in this patient population.

Obesity: Impact and Outcome on Infertility—A Literature Review

Background: The health risks of obesity are a forever growing concern for societies worldwide. With the advent of Assisted reproductive technology more couples can achieve fertility which includes overweight and obese men and women. The review intends to explore the impact of overweight and obesity on human reproductive potential and explores ways of optimising outcome and minimising risk through development of sound recommendations. Aim: To determine the impact of obesity on infertility in men and women and recommendations to optimise reproductive outcome. Method: Relevant published reviews on the subject were searched on the PubMed, Google scholar, Medline, and Cochrane library within the past 10 years, from 2011 to 2021. Results: Thirty-six articles met the criteria. Twenty-six of these were qualitative studies and ten were quantitative. The main themes were increasing prevalence and burden of disease, impact on male and female obesity and assisted reproductive outcomes. Conclusion: Overall, it is evident that overweight and obesity negatively effects reproductive health of both men and women. It has numerous sequalae in men and women of reproductive age group with lasting impact on following progeny. These risks are minimised both in short and long term by weight loss strategies and there is need for more literature on the subject.

Nonalcoholic fatty liver disease in lean subjects:Prognosis,outcomes and management

Nonalcoholic fatty liver disease(NAFLD)accounts for most cases of chronic liver disease worldwide,with an estimated global prevalence of approximately 25%and ranges from simple steatosis to nonalcoholic steatohepatitis and cirrhosis.NAFLD is strongly connected to metabolic syndrome,and for many years,fatty liver was considered to be an exclusive feature of obese patients.However,recent studies have highlighted the presence of NAFLD in non-obese subjects,with or without increased visceral fat or even in lean subjects without increased waist circumference.“Lean NAFLD”is a relatively new concept and there is significant scientific interest in understanding the differences in pathophysiology,prognosis and management compared with NAFLD in overweight/obese patients.In the present editorial,we discuss the clinical and metabolic profiles and outcomes of lean NAFLD compared with both obese NAFLD and lean healthy individuals from Asian and Western countries.Moreover,we shed light to the challenging topic of management of NAFLD in lean subjects since there are no specific guidelines for this population.Finally,we discuss open questions and issues to be addressed in the future in order to categorize NAFLD patients into lean and nonlean cohorts.

Glymphatic imaging and modulation of the optic nerve

Optic nerve health is essential for proper function of the visual system.However,the pathophysiology of certain neurodegenerative disease processes affecting the optic nerve,such as glaucoma,is not fully understood.Recently,it was hypothesized that a lack of proper clearance of neurotoxins contributes to neurodegenerative diseases.The ability to clear metabolic waste is essential for tissue homeostasis in mammals,including humans.While the brain lacks the traditional lymphatic drainage system identified in other anatomical regions,there is growing evidence of a glymphatic system in the central nervous system,which structurally includes the optic nerve.Named to acknowledge the supportive role of astroglial cells,this perivascular fluid drainage system is essential to remove toxic metabolites from the central nervous system.Herein,we review existing literature describing the physiology and dysfunction of the glymphatic system specifically as it relates to the optic nerve.We summarize key imaging studies demonstrating the existence of a glymphatic system in the optic nerves of wild-type rodents,aquaporin 4-null rodents,and humans;glymphatic imaging studies in diseases where the optic nerve is impaired;and current evidence regarding pharmacological and lifestyle interventions that may help promote glymphatic function to improve optic nerve health.We conclude by highlighting future research directions that could be applied to improve imaging detection and guide therapeutic interventions for diseases affecting the optic nerve.

Interpretation on Daily Diet and Exercise Management for Hypertension

Hypertension is a major health problem with great consequences for public health,characterized by persistently-elevated blood pressure.In recent years,more and more studies have shown that unhealthy lifestyles play decisive roles in the development of hypertension,such as psychosocial stress,obesity,excessive intake of salt,smoking,excessive drinking,and lack of physical activity.Therefore,interventions to lifestyles are very important in decrease of blood pressure and cardiovascular risk.In this article,the prevention measures of hypertension were analyzed and summarized through lifestyle interventions,mainly in the aspects of daily diet and exercise management.

Interpretation on Daily Diet and Exercise Management for Diabetes Mellitus

Diabetes mellitus is an increasing health problem worldwide.With the increased prevalence,the diabetes-related complications,including neuropathy,retinopathy,nephropathy as well as cardiovascular and cerebrovascular diseases,become much more common,and has gradually increased the burden on the individuals and healthcare systems.For the patients with type 2 diabetes mellitus,the prevention and management measures mainly include glucose control and lifestyle interventions.It has been confirmed that lifestyle interventions seem to be at least as effective as pharmacological interventions in people with impaired glucose tolerance.Therefore,interventions to lifestyle are very important for preventing diabetes mellitus.In this article,the prevention measures of diabetes mellitus were analyzed and summarized through lifestyle interventions,mainly in the aspects of daily diet and exercise management.

Physical Exercise as Treatment for Type 2 Diabetes Distal Symmetric Polyneuropathy: A Systematic Review of Randomized and Controlled Studies

Pharmaceuticals targeting the pathogenesis of diabetic distal symmetric polyneuropathy have all failed in clinical trials, limiting recourse to palliative treatments. The American Diabetes Association regards the effectiveness of glycemic control and lifestyle modification therapies on diabetic neuropathies as inconclusive. The objective of this research was to determine if and how physical exercise influences distal symmetric polyneuropathic severity in type 2 diabetes patients. Embase, MEDLINE, and Google Scholar were searched to collect randomized and controlled studies published between January 1, 2012 and April 20, 2020. Titles had to mention diabetes, physical exercise of any type or lifestyle interventions in general, and neuropathy. Abstracts had to indicate satisfaction of PICOS criteria, whereas full-text reviews had to be fully confirmatory. Extracted data was thematically synthesized based primarily on relationships between exercise interventions and effects on distal symmetric polyneuropathic severity outcomes in type 2 diabetes patients. Qualitative analysis scoring criteria objectively mirrored PICO except for the bias and limitation score component, which assessed common markers of validity for randomized trials (as specified in the PRISMA statement). Database searches yielded 379 unique records, 15 of which passed eligibility screening. Thematic synthesis supported exercise as an ameliorative treatment of type 2 diabetes distal symmetric polyneuropathy through improved Michigan Diabetic Neuropathy Scores and increased sural sensory nerve conduction velocity, though efficacy may be limited by neuropathic severity. This is the first systematic review to acquire these results, and to do so within the context of neuropathic severity. This review protocol is registered on PROSPERO (CRD42020181211) at https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020181211