Elsevier

Public Health

Volume 139, October 2016, Pages 178-182
Public Health

Original Research
The preventive effects of lifestyle intervention on the occurrence of diabetes mellitus and acute myocardial infarction in metabolic syndrome

https://doi.org/10.1016/j.puhe.2016.06.012Get rights and content

Highlights

  • The lifestyle intervention was administered to subjects with metabolic syndrome (MS) participating in a lifestyle intervention program.

  • The same number of non-participating age- and sex-matched subjects with MS were randomly extracted from national health examination data.

  • The occurrence of diabetes mellitus and acute myocardial infarction was lower in the intervention group than in the control group.

  • The lifestyle intervention is effective in lowering the occurrence of diabetes mellitus and acute myocardial infarction in metabolic syndrome.

Abstract

Objectives

Metabolic syndrome (MS), as a precursor of diabetes mellitus (DM) and cardiovascular disease, is increasing steadily worldwide. We examined the preventive effects of lifestyle intervention on the occurrence of DM and acute myocardial infarction (AMI) in MS.

Study design

Observational study on disease occurrence after lifestyle intervention.

Methods

The lifestyle intervention was administered to subjects with MS participating in a metropolitan lifestyle intervention program for 1 year. The same numbers of non-participating age- and sex-matched subjects with MS were randomly extracted from national health examination data. After intervention or examination, new occurrences of hypertension, DM, and AMI were identified through the national health insurance claims data during 1 year. For DM and AMI, multivariate logistic regression analysis for the factors affecting each disease was performed.

Results

In the intervention group and the control group (14,918 in each group), the occurrence of hypertension was 555 (6.07%) and 751 (8.33%), the occurrence of DM was 324 (2.55%) and 488 (3.89%), the occurrence of dyslipidemia was 321 (2.59%) and 373 (2.72%), and the occurrence of AMI was 13 (0.09%) and 26 (0.17%), respectively. In multivariate logistic regression analysis, adjusted odds ratios for intervention were 0.752 (95% confidence interval [CI]: 0.644–0.879) and 0.499 (95% CI: 0.251–0.992) for DM and AMI, respectively, indicating that lifestyle intervention has a preventive effect.

Conclusions

Lifestyle intervention in MS has preventive effects on the occurrence of DM and AMI, and long-term follow-up is needed to evaluate these preventive effects in more detail.

Introduction

Metabolic syndrome (MS) is a comprehensive term encompassing diabetes mellitus (DM), hypertension, obesity, and dyslipidemia. The prevalence of MS is increasing steadily worldwide, and Korea is not an exception.1 MS is a precursor of DM2 and cardiovascular disease (CVD) and increases the risk of incident cardiovascular events and death.3 As the burden of disease due to acute myocardial infarction (AMI) and the resulting economic burden have increased,4, 5 comprehensive management of MS is necessary.

Lifestyle intervention aims to improve the metabolic parameters through diet, exercise, and education, and many studies regarding the effects of lifestyle intervention on MS have been reported. A recent meta-analysis further strengthens the evidence that long-term regular lifestyle intervention reduces the prevalence of MS and abnormalities associated with MS and may be a useful tool in reducing the future occurrence of MS.6

Of course, these positive results mean that the intervention improve the metabolic parameters but more important than that is whether these interventions are effective in the prevention of complications of MS such as DM, hypertension, and ischaemic heart disease.

In subjects with impaired glucose tolerance (IGT), several studies have reported the prevention of MS7, 8 or DM9, 10 as well as improvement in the risk factors of CVD11 through lifestyle intervention, but there is little research on the prevention of DM or AMI in MS.

In South Korea, the MS management projects are underway in many local health centres under the awareness of the importance of MS, and the design and preliminary results have been announced previously.12

Therefore, we evaluated the preventive effects of lifestyle intervention on the occurrence of DM and AMI in MS by a metropolitan lifestyle intervention program.

Section snippets

Study population

Korean adults aged 30 years and older with MS were enrolled among the subjects participating in a metropolitan lifestyle intervention program for city residents aimed at decreasing the risk of MS from January 2009 to December 2012.

MS was defined with the widely used National Cholesterol Education Program – Adult Treatment Panel III guidelines.13 However, for the waist circumference in consideration of the characteristics of the Korean, it was applied with the recommendations of the Korean

Baseline characteristics

Among the 38,424 subjects participating in the intervention program and receiving follow-up examination after 12 months, 14,918 (38.8%) had MS. Of the 196,470 Seoul citizens aged 30 years and older with national health examination data and not participating in the intervention program, 50,283 (25.6%) had MS. From these non-participants, 14,918 for the control group were randomly extracted matched for age and sex to the intervention group. The clinical and laboratory characteristics of these

Discussion

There have been many lifestyle intervention programs for MS or IGT in several communities. For the effect of these programs, previous studies evaluated the reduced number of metabolic factors, the decreased rate of MS, and the changes in such indicators related to cardiovascular complications before and after the intervention. In this study, we found that the metabolic factors were improved and the average number of retained risk factors decreased.

Although IGT is one of the components of the

Ethical approval

The study protocol was approved by the institutional review board of Korea University (1040548-KU-IRB-13-118-A-1).

Funding

This study was supported by a grant from the National R&D Program for Cancer Control, Ministry of Health and Welfare, Korea (grant no. 1320310).

Competing interests

The authors have not declared any conflicts of interest.

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