Riggi Emilia, Baccini Michela, Camussi Elisa, Gallo Federica, Anatrone Caterina, Pezzana Andrea, Senore Carlo, Giordano Livia, Segnan Nereo
S.S.D. Epidemiologia Screening - CPO. AOU Città della Salute e della Scienza di Torino, Turin, Italy.
Department of Statistics, Computer Science, Applications, University of Florence, Florence, Italy.
J Public Health Res. 2022 Jul 12;11(3):22799036221106542. doi: 10.1177/22799036221106542. eCollection 2022 Jul.
Unhealthy diets, physical inactivity, alcohol and tobacco consumption are among the leading risk factors for non-communicable diseases. It is estimated that around 40% of cancers could be prevented by adopting healthy lifestyles.
The Stili di Vita (Sti.Vi) study was a randomized study for assessing the impact of healthy lifestyle interventions on anthropometric measures, metabolic parameters, and health outcomes among participants of cancer screening programs in Turin (Italy). Eligible women aged 50-54 years, invited to biennial mammography screening, and 58-years-old men and women, invited to a once-only sigmoidoscopy for colorectal cancer (CRC) screening were randomly allocated to Diet group (DG), Physical Activity group (PAG), Physical Activity plus Diet group (PADG), or control group (CG). Physical and eating habits, metabolic and anthropometric measurements, repeatedly collected, were the study outcomes. The active intervention, offered to participants assigned to the DG, PAG, and PADG arms, consisted of a basic module and an advanced module. The effect of the interventions was estimated through logistic regression or a difference in differences approach. A multiple imputation procedure was implemented to deal with missing values and -values have been calculated in the presence of multiple hypothesis testing.
Out of the 8442 screened attendees, 1270 signed informed consent, while 1125 participants accomplished the baseline visit. Participants were equally distributed across the four treatments as following: 273 (24.3%) in DG, 288 (25.6%) in the PAG, 283 (25.1%) in PADG, and 281 (25%) in the CG. Participants assigned to DG or PADG increased their consumption of whole grains (OR = 1.77, 95% CI: 1.20-2.60 and OR = 1.55, 95% CI: 1.06-2.27, respectively) and legumes (OR = 1.77, 95% CI: 1.12-2.79 and OR = 2.24, 95% CI: 1.41-3.57, respectively), with respect to CG. The participants randomized to DG reduced processed meat and increased fruit consumption (OR = 2.57, 95% CI: 1.76-3.76 and OR = 2.38, 95% CI: 1.12-5.06, respectively). The effects were more evident in the CRC screening subgroup. No relevant difference was observed between PAG and CG. No impact was observed on physical activity habits.
Our findings suggest that active interventions can increase awareness and induce diet changes. However, participation rate and compliance to the courses was quite low, innovative strategies to enhance participants' retention are needed, with the ultimate goal of increasing awareness and inducing positive lifestyle changes.
不健康饮食、缺乏身体活动、饮酒和吸烟是非传染性疾病的主要危险因素。据估计，约40%的癌症可通过采用健康的生活方式来预防。
“生活方式”（Sti.Vi）研究是一项随机研究，旨在评估健康生活方式干预对意大利都灵癌症筛查项目参与者的人体测量指标、代谢参数和健康结局的影响。年龄在50 - 54岁、受邀参加两年一次乳腺钼靶筛查的符合条件女性，以及年龄在58岁、受邀参加一次性乙状结肠镜结直肠癌（CRC）筛查的男性和女性，被随机分配到饮食组（DG）、身体活动组（PAG）、身体活动加饮食组（PADG）或对照组（CG）。反复收集的身体和饮食习惯、代谢和人体测量数据为研究结局。为分配到DG、PAG和PADG组的参与者提供的积极干预包括一个基础模块和一个高级模块。通过逻辑回归或差异分析方法估计干预效果。采用多重填补程序处理缺失值，并在存在多重假设检验的情况下计算p值。
在8442名接受筛查的参与者中，1270人签署了知情同意书，1125名参与者完成了基线访视。参与者在四种治疗组中的分布如下：DG组273人（24.3%），PAG组288人（25.6%），PADG组283人（25.1%），CG组281人（25%）。与CG组相比，分配到DG组或PADG组的参与者增加了全谷物（OR = 1.77，95%CI：1.20 - 2.60和OR = 1.55，95%CI：1.06 - 2.27）和豆类（OR = 1.77，95%CI：1.12 - 2.79和OR = 2.24，95%CI：1.41 - 3.57）的摄入量。随机分配到DG组的参与者减少了加工肉类的摄入并增加了水果摄入量（OR = 2.57，95%CI：1.76 - 3.76和OR = 2.38，95%CI：1.12 - 5.06）。这些效果在CRC筛查亚组中更为明显。未观察到PAG组和CG组之间有显著差异。未观察到对身体活动习惯有影响。
我们的研究结果表明，积极干预可以提高意识并促使饮食改变。然而，参与率和课程依从性相当低，需要创新策略来提高参与者的留存率，最终目标是提高意识并促使积极的生活方式改变。
