Sarrafzadegan Nizal, Kelishadi Roya, Esmaillzadeh Ahmad, Mohammadifard Noushin, Rabiei Katayoun, Roohafza Hamidreza, Azadbakht Leila, Bahonar Ahmad, Sadri Gholamhossein, Amani Ahmad, Heidari Saeid, Malekafzali Hossein
Cardiovascular Research Center, Isfahan University of Medical Sciences, Isfahan, Islamic Republic of Iran.
Bull World Health Organ. 2009 Jan;87(1):39-50. doi: 10.2471/blt.07.049841.
To assess the effects of a comprehensive, integrated community-based lifestyle intervention on diet, physical activity and smoking in two Iranian communities.
Within the framework of the Isfahan Healthy Heart Program, a community trial was conducted in two intervention counties (Isfahan and Najaf-Abad) and a control area (Arak). Lifestyle interventions targeted the urban and rural populations in the intervention counties but were not implemented in Arak. In each community, a random sample of adults was selected yearly by multi-stage cluster sampling. Food consumption, physical exercise and smoking behaviours were quantified and scored as 1 (low-risk) or 0 (other) at baseline (year 2000) and annually for 4 years in the intervention areas and for 3 years in the control area. The scores for all behaviours were then added to derive an overall lifestyle score.
After 4 years, changes from baseline in mean dietary score differed significantly between the intervention and control areas (+2.1 points versus -1.2 points, respectively; P < 0.01), as did the change in the percentage of individuals following a healthy diet (+14.9% versus -2.0%, respectively; P < 0.001). Daily smoking had decreased by 0.9% in the intervention areas and by 2.6% in the control area at the end of the third year, but the difference was not significant. Analysis by gender revealed a significant decreasing trend in smoking among men (P < 0.05) but not among women. Energy expenditure for total daily physical activities showed a decreasing trend in all areas, but the mean drop from baseline was significantly smaller in the intervention areas than in the control area (-68 metabolic equivalent task (MET) minutes per week versus -114 MET minutes per week, respectively; P < 0.05). Leisure time devoted to physical activities showed an increasing trend in all areas. A significantly different change from baseline was found between the intervention areas and the control area in mean lifestyle score, even after controlling for age, sex and baseline values.
The results suggest that community-based lifestyle intervention programmes can be effective in a developing country setting.
评估一项基于社区的综合、一体化生活方式干预措施对伊朗两个社区的饮食、身体活动和吸烟情况的影响。
在伊斯法罕健康心脏项目的框架内，在两个干预县（伊斯法罕和纳贾法巴德）和一个对照地区（阿拉克）开展了一项社区试验。生活方式干预针对干预县的城乡人口，但未在阿拉克实施。在每个社区，每年通过多阶段整群抽样选取成年随机样本。在基线期（2000年）以及干预地区的4年和对照地区的3年中，对食物消费、体育锻炼和吸烟行为进行量化，并评分为1（低风险）或0（其他）。然后将所有行为的得分相加得出总体生活方式得分。
4年后，干预地区和对照地区的平均饮食得分相对于基线的变化存在显著差异（分别为+2.1分和-1.2分；P<0.01），遵循健康饮食的个体百分比变化也存在显著差异（分别为+14.9%和-2.0%；P<0.001）。在第三年末，干预地区的每日吸烟率下降了0.9%，对照地区下降了2.6%，但差异不显著。按性别分析显示，男性吸烟率呈显著下降趋势（P<0.05），而女性则不然。所有地区每日总身体活动的能量消耗均呈下降趋势，但干预地区相对于基线的平均下降幅度明显小于对照地区（分别为每周-68代谢当量任务（MET）分钟和-114 MET分钟；P<0.05）。用于体育活动的休闲时间在所有地区均呈增加趋势。即使在控制了年龄、性别和基线值之后，干预地区和对照地区的平均生活方式得分相对于基线仍存在显著不同的变化。
结果表明，基于社区的生活方式干预项目在发展中国家环境中可能有效。
