Department of Food Science and Technology, Kyambogo University, Kampala, Uganda; Clinical and Experimental Endocrinology, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium; Mildmay Research Centre Uganda, Kampala, Uganda.
Clinical and Experimental Endocrinology, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium; Department of Endocrinology, University Hospitals Leuven, Leuven, Belgium.
Am J Clin Nutr. 2023 Feb;117(2):436-443. doi: 10.1016/j.ajcnut.2022.12.005. Epub 2022 Dec 23.
The metabolic health of urban Ugandans, mostly females, is increasingly becoming sub-optimal.
We assessed the effect of a complex lifestyle intervention, based on a small change approach, on metabolic health among females of reproductive age in urban Uganda.
A cluster randomized controlled two-arm trial with a 1:1 allocation involving church communities in Kampala (Uganda) was undertaken. The intervention arm received infographics and face-to-face group sessions, whereas the comparison arm received infographics only. Eligible participants were aged 18 to 45 years with a waist circumference of ≥80 cm and without cardiometabolic diseases. The study included a 3-month intervention and a 3-month postintervention follow-up. The primary outcome was a reduction in waist circumference. Secondary outcomes included optimization of cardiometabolic health, physical activity, and fruit and vegetable intake. Intention to treat analyses were performed using linear mixed models. This trial was registered at clinicaltrials.gov as NCT04635332.
The study was conducted between 21 November 2020 and 8 May 2021. Six church communities were randomly selected, 3 (n = 66) per study arm. At 3 months and postintervention follow-up, 118 and 100 participants were analyzed, respectively. At 3 months, waist circumference tended to be lower in the intervention arm (-1.48 cm (95% CI: -3.05, 0.10) P = 0.06). The intervention showed an effect on fasting blood glucose concentrations (-6.95 mg/dL (95% CI: -13.37, -0.53) P = 0.034). Participants in the intervention arm consumed more fruits (62.6 g (95% CI: 1.9, 123.3) P = 0.046) and vegetables (66.2 g (95% CI: 25.5, 106.8) P = 0.002), whereas physical activity increased with no notable differences across the study arms. At 6 months, we found an intervention effect on waist circumference (-1.87 cm (95% CI: -3.32, -0.44) P = 0.011), fasting blood glucose concentration (-6.48 mg/dL (95% CI: -12.76, -0.21) P = 0.043), fruit consumption (29.7 g (95% CI: 5.8, 53.7) P = 0.015), and physical activity (2675.1 MET-mins/wk (95% CI: 1045.7, 4304.4) P = 0.001).
The intervention improved and sustained physical activity and fruit and vegetable intake, but these changes were accompanied by minimal cardiometabolic health improvements. If maintained over time, the attained lifestyle improvements may result in substantial cardiometabolic health improvements.
大多数为女性的乌干达城市居民的代谢健康状况正在逐渐变得不佳。
我们评估了一种基于小改变方法的复杂生活方式干预对乌干达城市育龄女性代谢健康的影响。
采用了一项 1:1 随机分组、涉及坎帕拉（乌干达）教堂社区的两臂对照临床试验。干预组接受信息图和面对面小组会议，而对照组仅接受信息图。符合条件的参与者年龄在 18 至 45 岁之间，腰围≥80cm，且没有心血管代谢疾病。该研究包括 3 个月的干预和 3 个月的干预后随访。主要结局是腰围减少。次要结局包括心血管代谢健康、身体活动和水果与蔬菜摄入的优化。使用线性混合模型进行意向治疗分析。这项试验在 clinicaltrials.gov 上注册为 NCT04635332。
该研究于 2020 年 11 月 21 日至 2021 年 5 月 8 日进行。随机选择了 6 个教堂社区，每个研究组 3 个（n=66）。在 3 个月和干预后随访时，分别分析了 118 名和 100 名参与者。在 3 个月时，干预组的腰围趋于较低（-1.48cm（95%CI：-3.05，0.10）P=0.06）。该干预措施对空腹血糖浓度有影响（-6.95mg/dL（95%CI：-13.37，-0.53）P=0.034）。干预组参与者摄入更多的水果（62.6g（95%CI：1.9，123.3）P=0.046）和蔬菜（66.2g（95%CI：25.5，106.8）P=0.002），而身体活动则有所增加，但在两组之间没有明显差异。在 6 个月时，我们发现干预对腰围（-1.87cm（95%CI：-3.32，-0.44）P=0.011）、空腹血糖浓度（-6.48mg/dL（95%CI：-12.76，-0.21）P=0.043）、水果摄入量（29.7g（95%CI：5.8，53.7）P=0.015）和身体活动（2675.1MET-min/wk（95%CI：1045.7，4304.4）P=0.001）有干预效应。
该干预措施改善并维持了身体活动和水果与蔬菜的摄入，但这些变化伴随着心血管代谢健康的轻微改善。如果随着时间的推移保持下去，所获得的生活方式的改善可能会导致心血管代谢健康的显著改善。
