Postgraduate Course Stress Management and Health Promotion, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
First Department of Propaedeutic Internal Medicine, Medical School, Diabetes Center, Laiko General Hospital, National and Kapodistrian University of Athens, Athens, Greece.
Eur J Clin Invest. 2019 Oct;49(10):e13164. doi: 10.1111/eci.13164. Epub 2019 Sep 16.
Over the past decades, the prevalence of obesity has markedly increased worldwide. Stress is recognized as a substantial contributor to increased body weight; therefore, stress management interventions, especially cognitive behavioural, are becoming increasingly popular. The impact of stress management on stress- and obesity-related biomarkers (eg blood lipid profile, HBA1c, inflammatory biomarkers, such as CRP) has been scarcely studied. The aim of this study was to assess the effect of a novel cognitive behavioural stress management intervention, called 'Pythagorean Self-Awareness Intervention' (PSAI), in overweight/obese adults.
This was a two-armed 1:1 randomized, nonblind controlled study including overweight/obese individuals. The control group followed a personalized Mediterranean low-calorie diet, and the intervention group followed the same diet in addition to the PSAI intervention for 8 weeks. Measurements included demographic, anthropometric (ie BMI, waist-to-hip ratio), stress (ie perceived stress, salivary cortisol), dietary behaviour (ie emotional eating) and metabolic parameters (ie blood lipid profile, HBA1c, CRP, body composition in fat and water). Outcome per-protocol analysis was performed using mixed linear models adjusted for age and gender.
A total of 49 of 62 eligible adults were analysed in the study (there were three dropouts in the intervention group and 10 dropouts in the control group); 28 were assigned to the intervention group (mean age 54.7 ± 11.9 years) and 21 to the control group (mean age 51.8 ± 11.9 years). The intervention group showed a statistically significant decrease in perceived stress, cortisol concentrations 30 minutes after awakening, cortisol's area under the curve, BMI, waist-to-hip ratio, restrained, emotional and external eating behaviour, fasting glucose, LDL, triglycerides, HbA1c and body and trunk fat, compared with the control group. Based on the observed effect sizes, clinically meaningful changes may be more evident in stress perception, restrained and external eating behaviour, Hb1ac and trunk fat. The compliance to the PSAI intervention reached 100%, and there were no adverse effects.
The PSAI technique may be an effective stress management method for overweight/obese adults. Future and larger randomized controlled studies are needed to allow generalization of these findings.
在过去的几十年中，肥胖的流行率在全球范围内显著增加。压力被认为是体重增加的一个重要因素；因此，压力管理干预措施，特别是认知行为疗法，越来越受欢迎。压力管理对与压力和肥胖相关的生物标志物（如血脂谱、HbA1c、炎症标志物如 CRP）的影响尚未得到充分研究。本研究旨在评估一种新的认知行为压力管理干预措施，称为“毕达哥拉斯自我意识干预”（PSAI），对超重/肥胖成年人的影响。
这是一项为期 8 周的、1:1 随机、非盲对照研究，纳入了超重/肥胖个体。对照组遵循个性化的地中海低热量饮食，干预组在遵循相同饮食的基础上，还进行了 PSAI 干预。测量包括人口统计学、人体测量学（即 BMI、腰臀比）、压力（即感知压力、唾液皮质醇）、饮食行为（即情绪性进食）和代谢参数（即血脂谱、HbA1c、CRP、脂肪和水的身体成分）。使用混合线性模型进行意向治疗分析，模型调整了年龄和性别。
在研究中，共有 62 名符合条件的成年人中的 49 名进行了分析（干预组有 3 名脱落，对照组有 10 名脱落）；28 名被分配到干预组（平均年龄 54.7±11.9 岁），21 名被分配到对照组（平均年龄 51.8±11.9 岁）。与对照组相比，干预组的感知压力、觉醒后 30 分钟皮质醇浓度、皮质醇的曲线下面积、BMI、腰臀比、抑制、情绪和外在进食行为、空腹血糖、LDL、甘油三酯、HbA1c 以及身体和躯干脂肪均有统计学显著降低。根据观察到的效应大小，在压力感知、抑制和外在进食行为、Hb1ac 和躯干脂肪方面，可能会出现更明显的临床意义变化。对 PSAI 干预的依从性达到 100%，且无不良反应。
PSAI 技术可能是一种有效的超重/肥胖成年人的压力管理方法。需要进一步进行更大规模的随机对照研究，以推广这些发现。
