Quarterly Lifestyle Modification Reduces CVD Risk in Young Asians

Kristin Jenkins

September 06, 2017

A one-to-one lifestyle-modification program delivered quarterly by peer educators can significantly reduce the incidence of cardiometabolic disease predictors in young people at high risk for type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD), particularly when they're under the age of 18, says an international research team.

Results from a median 3-year follow-up of the randomized, controlled DIABRISK-SL trial show the cumulative incidence of cardiometabolic disease predictors such as T2DM and hypertension was 11% lower in South Asian participants 5 to 40 years of age receiving a "pragmatic" lifestyle-modification program compared with controls given annual lifestyle modification, according to Mahen Wijesuriya, MD, of the Diabetes Association of Sri Lanka, in Colombo, and colleagues (Trials. 2011;DOI:10.1186/1745-6215-12-209).

The incidence of new-onset dysglycemia — including new-onset T2DM, impaired fasting glycemia (IFG), and impaired glucose tolerance (IGT) — was significantly reduced in the pragmatic-lifestyle-modification group compared with those in the control group (incident rate ratio [IRR], 0.9; P = .01), the authors say in their online report, published August 29 in BMC Medicine.

And the impact of learning how to eat better, exercise more, manage stress, and achieve and maintain a healthy weight was even more dramatic in participants younger than 18 years of age. The incidence of composite cardiometabolic predictors such as new-onset T2DM, hypertension, IGT, IFG, CVD, and renal disease was 17% lower in participants who received pragmatic lifestyle modification compared with controls (IRR, 0.83; = .004), the findings demonstrate. Pragmatic-lifestyle-modification participants were also more likely to increase their physical activity than their control counterparts.

"Our study highlights the importance of early intervention and establishes the proof of concept and rationale for further pragmatic-lifestyle-modification-intervention studies in young South Asian participants at risk of cardiometabolic disease," Dr Wijesuriya and colleagues write.

Although lifestyle modification has been shown to prevent the onset of T2DM in adults with IGT who are older than 40 years of age, this is the first time that the impact of such a program on cardiometabolic disease risk factors has been studied in a younger, healthy population, the study authors say.

It is estimated that 40% of Sri Lankans are younger than 40 years and 25% are 18 years of age and younger.

"This study highlights that even small changes in lifestyle could lead to changes in health," co–lead author Janaka Karalliedde, MD, senior lecturer at King's College London, United Kingdom, said in a statement. 'We suggest that early and regular interventions can have a significant impact in delaying or preventing the onset of type 2 diabetes and other cardiovascular disease."

Asia at the Epicenter of the Global Diabetes Epidemic

By the year 2035, it is estimated that 592 million people worldwide will have type 2 diabetes, with the vast majority living in low- and middle-income countries. Asia currently sits at the epicenter of the global epidemic, with 60% of cases.

"South Asians are predisposed to early onset of T2DM, with almost a third of future T2DM cases predicted to occur in those aged below 45 years," Dr Wijesuriya and colleagues point out.

"The impact of this research could hold huge benefits for young South Asians at risk of type 2 diabetes and other cardiovascular disease," Dr Wijesuriya adds in the statement.

"Importantly, it is a low-cost intervention that could be translated into parts of the community in Sri Lanka and other low- to middle-income countries. The use of peer educators to deliver interventions could be a more pragmatic, cost-effective approach than registered dietitians or counselors."

In the DIABRISK-SL trial, 23,298 healthy participants were recruited from Columbo between January 1, 2008, and June 30, 2009. A total of 3539 were identified as having two risk factors for cardiometabolic disease; 1726 were randomized to pragmatic lifestyle medication and 1813 to the control group.

At baseline, all had similar clinical and biochemical characteristics, and 92% had a normal glucose tolerance. Mean age was 23 years, and 48% were male.

Both lifestyle-modification programs lasted for up to 3 years and were essentially identical except for frequency. Peer educators 18 to 40 years of age were trained by experts. For participants younger than 16, parents were also given the goal-oriented advice.

The study authors acknowledge that the cumulative incidence of T2DM observed in this trial is much lower than that observed in previous seminal studies of lifestyle modification. However, the Diabetes Prevention Program, Finnish Diabetes Prevention study, the Indian Diabetes Prevention Program, and the Da Qing Diabetes Prevention study focused on older adults with a baseline IGT, they point out.

The fact that both lifestyle-modification groups in the current study received the same counseling with the same targets may explain why the relative risk reductions and incident rates of T2DM were smaller compared with previous studies, the investigators suggest. The true value of pragmatic lifestyle modification in reducing risk may have been underestimated by the current study, they add.

More studies in younger populations are needed to confirm whether reducing risk of dysglycemia and hypertension would result in fewer cardiovascular events, Dr Wijesuriya and colleagues say. However, they note, 23 years of follow-up data from the Da Qing study support this premise (Lancet Diabetes Endocrinol. 2014;2:474-480).

Funding for this study was provided by the International Diabetes Federation and the Diabetes Association of Sri Lanka. The authors declare no relevant financial relationships.  

BMC Med. Published online on August 29, 2017. Article

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