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Meta-Analysis
. 2017 May 11;12(5):e0176436.
doi: 10.1371/journal.pone.0176436. eCollection 2017.

Effect of lifestyle interventions on cardiovascular risk factors among adults without impaired glucose tolerance or diabetes: A systematic review and meta-analysis

Xuanping Zhang  1 , Heather M Devlin  1 , Bryce Smith  1 , Giuseppina Imperatore  1 , William Thomas  2 , Felipe Lobelo  3 , Mohammed K Ali  3 , Keri Norris  4 , Stephanie Gruss  1 , Barbara Bardenheier  1 , Pyone Cho  1 , Isabel Garcia de Quevedo  5 , Uma Mudaliar  3 , Christopher D Jones  6 , Jeffrey M Durthaler  6 , Jinan Saaddine  1 , Linda S Geiss  1 , Edward W Gregg  1
Affiliations
Meta-Analysis

Effect of lifestyle interventions on cardiovascular risk factors among adults without impaired glucose tolerance or diabetes: A systematic review and meta-analysis

Xuanping Zhang et al. PLoS One. .

Abstract

Structured lifestyle interventions can reduce diabetes incidence and cardiovascular disease (CVD) risk among persons with impaired glucose tolerance (IGT), but it is unclear whether they should be implemented among persons without IGT. We conducted a systematic review and meta-analyses to assess the effectiveness of lifestyle interventions on CVD risk among adults without IGT or diabetes. We systematically searched MEDLINE, EMBASE, CINAHL, Web of Science, the Cochrane Library, and PsychInfo databases, from inception to May 4, 2016. We selected randomized controlled trials of lifestyle interventions, involving physical activity (PA), dietary (D), or combined strategies (PA+D) with follow-up duration ≥12 months. We excluded all studies that included individuals with IGT, confirmed by 2-hours oral glucose tolerance test (75g), but included all other studies recruiting populations with different glycemic levels. We stratified studies by baseline glycemic levels: (1) low-range group with mean fasting plasma glucose (FPG) <5.5mmol/L or glycated hemoglobin (A1C) <5.5%, and (2) high-range group with FPG ≥5.5mmol/L or A1C ≥5.5%, and synthesized data using random-effects models. Primary outcomes in this review included systolic blood pressure (SBP), diastolic blood pressure (DBP), total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), and triglycerides (TG). Totally 79 studies met inclusion criteria. Compared to usual care (UC), lifestyle interventions achieved significant improvements in SBP (-2.16mmHg[95%CI, -2.93, -1.39]), DBP (-1.83mmHg[-2.34, -1.31]), TC (-0.10mmol/L[-0.15, -0.05]), LDL-C (-0.09mmol/L[-0.13, -0.04]), HDL-C (0.03mmol/L[0.01, 0.04]), and TG (-0.08mmol/L[-0.14, -0.03]). Similar effects were observed among both low-and high-range study groups except for TC and TG. Similar effects also appeared in SBP and DBP categories regardless of follow-up duration. PA+D interventions had larger improvement effects on CVD risk factors than PA alone interventions. In adults without IGT or diabetes, lifestyle interventions resulted in significant improvements in SBP, DBP, TC, LDL-C, HDL-C, and TG, and might further reduce CVD risk.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Study flow diagram.
CINAHL, Cumulative Index to Nursing and Allied Health Literature EMBASE, Excerpta Medica Database MEDLINE, Medical Literature Analysis and Retrieval System Online PsycInfo, Psychological Information Database WOS, Web of Science.
Fig 2
Fig 2. changes in systolic blood pressure in the intervention versus usual care groups (mmHg).
Group 1: low-range glycemic group (FPG<5.5mmol/L or A1C <5.5%). Group 2: high-range glycemic group (FPG ≥5.5mmol/L or A1C ≥5.5%). D, diet, PA, physical activity, UC, usual care, vs, versus.
Fig 3
Fig 3. changes in diastolic blood pressure in the intervention versus usual care groups (mmHg).
Group 1: low-range glycemic group (FPG<5.5mmol/L or A1C <5.5%). Group 2: high-range glycemic group (FPG ≥5.5mmol/L or A1C ≥5.5%). D, diet, PA, physical activity, UC, usual care, vs, versus.
Fig 4
Fig 4. changes in total cholesterol in the intervention versus usual care groups (mmol/L).
Group 1: low-range glycemic group (FPG<5.5mmol/L or A1C <5.5%). Group 2: high-range glycemic group (FPG ≥5.5mmol/L or A1C ≥5.5%). D, diet, PA, physical activity, UC, usual care, vs, versus.
Fig 5
Fig 5. changes in low density lipoprotein cholesterol in the intervention versus usual care groups (mmol/L).
Group 1: low-range glycemic group (FPG<5.5mmol/L or A1C <5.5%). Group 2: high-range glycemic group (FPG ≥5.5mmol/L or A1C ≥5.5%). D, diet, PA, physical activity, UC, usual care, vs, versus.
Fig 6
Fig 6. changes in high density lipoprotein cholesterol in the intervention versus usual care groups (mmol/L).
Group 1: low-range glycemic group (FPG<5.5mmol/L or A1C <5.5%). Group 2: high-range glycemic group (FPG ≥5.5mmol/L or A1C ≥5.5%). D, diet, PA, physical activity. UC, usual care, vs, versus.
Fig 7
Fig 7. Changes in triglycerides in the intervention versus usual care groups (mmol/L).
Group 1: low-range glycemic group (FPG<5.5mmol/L or A1C <5.5%). Group 2: high-range glycemic group (FPG ≥5.5mmol/L or A1C ≥5.5%). D, diet, PA, physical activity, UC, usual care, vs, versus.
See this image and copyright information in PMC

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