BackgroundThere is evidence of an association between pulmonary function and various nutrients, although no association has been observed in our setting between the Mediterranean Diet (MD) eating pattern and improved lung function. The objective of this study is to evaluate the effect of an intervention designed to increase MD adherence on lung function in smokers with no previous respiratory disease.Methods/designRandomized, controlled, parallel clinical trial. Setting: primary health care centers in Catalonia (Spain). Participants: Current smokers (cumulative > 10 pack-years) aged 35–70 years, with Internet access, who provide signed informed consent to participate. Intervention: A nutritionist will conduct a 2-year multicomponent intervention to increase MD adherence, based on: 1) a personalized dietary-nutritional education intervention, 2) a Web 2.0 approach, the DIET Blog of nutritional information, and 3) group sessions to increase motivation to increase MD adherence and motivation to make changes in eating habits. Annually, an office visit and one group session will reinforce the nutritional intervention. The control group will follow their usual diet, with general nutritional counselling. In both groups, a 14-item questionnaire will evaluate individual MD dietary patterns and forced spirometry will assess lung function. Analysis: Intention to treat. The unit of analysis will be the individual smoker. Primary outcome is lung function indicated by spirometry, FVC, FEV1 and FEV1/FVC %. Lung function parameters in both groups will be compared by adherence to the MD pattern.DiscussionThe DIET study could contribute data on a protective action of the MD pattern on lung function in smokers. If so, this population may benefit from a nutritional intervention, along with the fundamental recommendation to stop smoking.Trial registrationClinicalTrials.gov: NCT02151669. Registered 26 May 2014.
BackgroundThe DE-PLAN-CAT project (Diabetes in Europe–Prevention using lifestyle, physical activity and nutritional intervention–Catalonia) has shown that an intensive lifestyle intervention is feasible in the primary care setting and substantially reduces the incidence of diabetes among high-risk Mediterranean participants. The DP-TRANSFERS project (Diabetes Prevention–Transferring findings from European research to society) is a large-scale national programme aimed at implementing this intervention in primary care centres whenever feasible.MethodsA multidisciplinary committee first evaluated the programme in health professionals and then participants without diabetes aged 45–75 years identified as being at risk of developing diabetes: FINDRISC (Finnish Diabetes Risk Score)>11 and/or pre-diabetes diagnosis. Implementation was supported by a 4-channel transfer approach (institutional relationships, facilitator workshops, collaborative groupware, programme website) and built upon a 3-step (screening, intervention, follow-up) real-life strategy. The 2-year lifestyle intervention included a 9-hour basic module (6 sessions) and a subsequent 15-hour continuity module (10 sessions) delivered by trained primary healthcare professionals. A 3-level (centre, professionals and participants) descriptive analysis was conducted using cluster sampling to assess results and barriers identified one year after implementation.ResultsThe programme was started in June-2016 and evaluated in July-2017. In all, 103 centres covering all the primary care services for 1.4 million inhabitants (27.9% of all centres in Catalonia) and 506 professionals agreed to develop the programme. At the end of the first year, 83 centres (80.6%) remained active and 305 professionals (60.3%) maintained regular web-based activities. Implementation was not feasible in 20 centres (19.4%), and 5 main barriers were prioritized: lack of healthcare manager commitment; discontinuity of the initial effort; substantial increase in staff workload; shift in professional status and lack of acceptance. Overall, 1819 people were screened and 1458 (80.1%) followed the lifestyle intervention, with 1190 (81.6% or 65.4% of those screened) participating in the basic module and 912 in the continuity module (62.5% or 50.1%, respectively).ConclusionsA large-scale lifestyle intervention in primary care can be properly implemented within a reasonably short time using existing public healthcare resources. Regrettably, one fifth of the centres and more than one third of the professionals showed substantial resistance to performing these additional activities.
Overweight and obesity have been reported to be more prevalent in populations with autism spectrum disorder than in children with typical development. The aim of this study was to compare the anthropometric status of children with autism spectrum disorder (diagnosed and subclinical) and children with typical development and analyse which variables can affect the anthropometric and health status of children with autism spectrum disorder. We present a two-phase epidemiological study in a school population of two age groups which assesses autism spectrum disorder diagnosis, anthropometric data and bioelectrical impedance analysis. From an initial sample of 3,713 children, 79 with autism spectrum disorder, 42 with subclinical autism spectrum disorder and 350 with typical development participated in the study. Pre-schoolers with autism spectrum disorder were taller than pre-schoolers with typical development. School-age children with autism spectrum disorder showed a significantly higher body mass index and rate of overweight/obesity than children with typical development (63.4% vs 46.3%). No significant differences were found for bioelectrical impedance analysis, but school-age children with autism spectrum disorder showed a significantly higher waist circumference, waist/height ratio and cardiovascular risk than children with typical development. The quality of the diet was lower in children with autism spectrum disorder than in children with typical development. Multiple regression analyses showed that having autism spectrum disorder and internalizing psychological problems were associated with waist/height ratio and high cardiovascular risk in school-age children. Lay abstract This study makes a comparison between the growth status of pre-school and school-age children with autism spectrum disorder and typical development children. Pre-schoolers with autism spectrum disorder were taller than children with typical development. School-age children with autism spectrum disorder were more overweight/obese, had more body fat and a greater waist circumference and waist/height ratio than children with typical development. The presence of autism spectrum disorder and internalizing problems was associated with cardiovascular risk in school-age children.
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