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Community-based lifestyle intervention improves metabolic syndrome and related markers among Kenyan adults

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Abstract

Purpose

Metabolic syndrome (MetS) is a major risk factor for cardiovascular diseases and type-2 diabetes. The study aimed to establish the efficacy of a community-based lifestyle intervention on MetS in Kenyan adults using randomized control trial involving a 15-months follow up.

Methods

A randomized controlled trial involving 352 (18–64 years old) adults with MetS spanning 15-months duration. Participants were recruited from a Nairobi based Mission-led outpatient clinic, randomly assigned equally into intervention and control groups. The intervention group was exposed to a community-based health education on lifestyle modification, while control group was subjected to hospital-led routine care involving treatment and general lifestyle advice. The study was structured into baseline, intervention and evaluation phases with inbuilt data collection in each phase. Physiologic, anthropometric, and clinical parameters as well lifestyle characteristics were measured at baseline, midline and end-line. The parameters were compared across the groups and between the time points during analyses using chi-square test, binary logistic, independent t-test and paired t-test.

Results

Proportion of participants with MetS declined significantly (p < 0.001) with marked (p < 0.05) improvement in markers of MetS (elevated BP, raised sugars, cholesterols, central obesity) in intervention compared to control group. The rates of consumption of fruits, vegetables, legumes, nuts and uptake of physical activity significantly (p < 0.05) improved in the intervention group. However, the intake of processed/fast foods, salt, sugar, and alcohol significantly (p < 0.05) declined in the intervention compared to controls by the end-line.

Conclusion

One in three adults under the community-based lifestyle intervention had improvement in physiologic, anthropometrics and clinical markers relevant to definition of MetS. Additionally, an improved adherence to the recommended dietary intake and increased uptake of physical activity in adults with MetS was observed. These findings underscore the feasibility, effectiveness and proof of concept for community-based lifestyle approach as a viable strategic intervention for addressing premorbid risk factors for cardiovascular CVDs and diabetes before evolving into full blown conditions in low-income settings.

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Data Availability

The dataset analysed for the current study is available from the corresponding author on a reasonable request.

References

  1. Grundy SM. Metabolic syndrome pandemic. Arterioscler Thromb Vasc Biol. 2008;28(4):629–36.

    Article  CAS  Google Scholar 

  2. Syed MA, Al Nuaimi AS, Latif Zainel AJA, Abdulla H. Prevalence of Metabolic Syndrome in Primary Health Settings in Qatar: A Cross Sectional Study. BMC Public Health. 2020;20(1):1–7. https://doi.org/10.1186/s12889-020-08609-5.

    Article  Google Scholar 

  3. Pitsavos C, Panagiotakos D, Weinem M, Stefanadis C. Diet, exercise and the metabolic syndrome. Rev Diabet Stud. 2006;3(3):118–118. https://doi.org/10.1900/rds.2006.3.118.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Zimmet P, Magliano D, Matsuzawa Y, Alberti G, Shaw J. The metabolic syndrome: a global public health problem and a new definition. J Atheroscler Thromb. 2005;12(6):295–300. https://doi.org/10.5551/jat.12.295.

    Article  CAS  PubMed  Google Scholar 

  5. International Diabetic Federation (IDF). Diabetes ATLAS, Seventh Edition. 2015.

  6. O’Neill S, O’Driscoll L. Metabolic syndrome: a closer look at the growing epidemic and its associated pathologies. Obes Rev. 2015;16(1):1–12 Google Scholar.

    Article  CAS  Google Scholar 

  7. Kaduka LU, Kombe Y, Kenya E, Kuria E, Bore JK, Bukania ZN, Mwangi M. Prevalence of Metabolic Syndrome Among an Urban Population in Kenya. Diabetes J Diabetes Care. 2012;2012(35):887–93.

    Article  Google Scholar 

  8. Cantiello F, et al. Association between metabolic syndrome, obesity, diabetes mellitus and oncological outcomes of bladder cancer: a systematic review. Int J Urol. 2015;22:22–32.

    Article  Google Scholar 

  9. Mendonça FM, de Sousa FR, Barbosa AL, Martins SC, Araújo RL, Soares R, et al. Metabolic syndrome and risk of cancer: which link? Metabolism. 2015;64:182–9.

    Article  Google Scholar 

  10. Mensah GA, et al. Mortality from cardiovascular diseases in sub-Saharan Africa, 1990–2013: a systematic analysis of data from the Global Burden of Disease Study 2013. Cardiovasc J Afr. 2015;26(2 Suppl 1):S6-10. https://doi.org/10.5830/CVJA-2015-036.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Roth GA, et al. Demographic and epidemiologic drivers of global cardiovascular mortality. N Engl J Med. 2015;372(14):1333–41. https://doi.org/10.1056/NEJMoa1406656.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Popkin BM, Adair LS, Ng SW. Global nutrition transition and the pandemic of obesity in developing countries. Nutr Rev. 2012;70(1):3–21.

    Article  Google Scholar 

  13. Ricci G, Pirillo I, Tomassoni D, Sirignano A, Grappasonni I. Metabolic syndrome, hypertension, and nervous system injury: Epidemiological correlates. Clin Exp Hypertens. 2017. https://doi.org/10.1080/10641963.2016.1210629.

    Article  PubMed  Google Scholar 

  14. Okube OT, Kimani S, Waithira M. Association of dietary patterns and practices on metabolic syndrome in adults with central obesity attending a mission hospital in Kenya: a cross-sectional study. BMJ Open. 2020;10: e039131. https://doi.org/10.1136/bmjopen-2020-039131.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Samuel K, Mirie W, Chege M, Okube OT, Muniu S. Association of lifestyle modification and pharmacological adherence on blood pressure control among patients with hypertension at Kenyatta National Hospital, Kenya: a cross-sectional study. BMJ Open. 2019;9:e023995. https://doi.org/10.1136/bmjopen-2018-023995.

  16. Annelieke H, van de Vijver S, Oti SO, Egondi T, Kyobutung C. Profile of people with hypertension in Nairobi’s slums: a descriptive study. Glob Health. 2015;11:26. https://doi.org/10.1186/s12992-015-0112-1.

    Article  Google Scholar 

  17. Boateng D, Wekesah F, Browne JL, Agyemang C, Agyei-Baffour P, Aikins A-G, et al. Knowledge and awareness of and perception towards cardiovascular disease risk in sub-Saharan Africa: a systematic review. PLoS ONE. 2017;12(12): e0189264. https://doi.org/10.1371/journal.pone.0189264.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. World health organization. Kenya faces rising burden of diabetes. Geneva: Switzerland; 2014.

    Google Scholar 

  19. Mohamed SF, Mutua MK, Wamai R, Wekesah F, Haregu T, Juma P, Nyanjau L, Kyobutungi C, Ogola E. Prevalence, awareness, treatment and control of hypertension and their determinants: results from a national survey in Kenya. BMC Public Health. 2018;18(Suppl 3):1219. https://doi.org/10.1186/s12889-018-6052-y.

    Article  PubMed  PubMed Central  Google Scholar 

  20. World Health Organization. Global status report on non-communicable diseases. Geneva: Switzerland; 2014.

    Google Scholar 

  21. Al-Thani MH, Al-Thani AAM, Cheema S, Sheikh J, Mamtani R, Lowenfels AB, et al. Prevalence and determinants of metabolic syndrome in Qatar: results from a National Health Survey. BMJ Open. 2016;6:e009514.

    Article  Google Scholar 

  22. Mohamed SA. Effect of lifestyle intervention on health behaviors, weight and blood glucose level among patients with diabetes mellitus. J Nurs Educ. 2014; Pract. 4

  23. Yamaoka K, Tango T. Effects of lifestyle modification on metabolic syndrome: a systematic review and meta-analysis. BMC Med.2012; 10.

  24. Makrilakis K, Grammatikou S, Liatis S, Kontogianni M, Perrea D, Dimosthenopoulos C, et al. The effect of a non-intensive community- based lifestyle intervention on the prevalence of Metabolic Syndrome. The DEPLAN study in Greece. Hormones (Athens). 2012;11:316–24.

    Article  Google Scholar 

  25. Orchard TJ, Temprosa M, Goldberg R, Haffner S, Ratner R, Marcovina S, et al. The effect of metformin and intensive lifestyle intervention on the metabolic syndrome: the Diabetes Prevention Program randomized trial. Ann Intern Med. 2005;142(8):611–9.

    Article  CAS  Google Scholar 

  26. Schwalm JD, McCready T, Lopez-Jaramillo P, et al. A community-based comprehensive intervention to reduce cardiovascular risk in hypertension (HOPE 4): a cluster-randomized controlled trial. Lancet. 2019;394:1231–42.

    Article  Google Scholar 

  27. Cargo M, Mercer SL. The value and challenges of participatory research: Strengthening its practice. Ann Rev Public Health. 2008;29:325–50 PubMed.

    Article  Google Scholar 

  28. S Amir, Chowdhury R, Anchala R, Stevens S, Blanco P, Han T, Niessen L, Franco OH. Cost effective interventions for the prevention of cardiovascular disease in low- and middle-income countries: a systematic review. BMC Public Health. 2013, 13:285 http://www.biomedcentral.com/1471-2458/13/285.

  29. Alberti KG, Eckel RH, Grundy SM, et al. International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; International Association for the Study of Obesity. Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation. 2009;120:1640–5.

    Article  CAS  Google Scholar 

  30. World Health Organization. Global Status Report on Non-communicable diseases. Geneva: Switzerland; 2011.

    Google Scholar 

  31. World Health Organization. Global Recommendations on Physical Activity for Health 18–64 years old. Geneva: Switzerland; 2011.

    Google Scholar 

  32. World Health Organization. The WHO STEP-wise approach to non-communicable disease risk factor surveillance (STEPS). 2017. Geneva, Switzerland.

  33. Onvani Sh, Haghighatdoost F, Azadbakht L. Dietary approach to stop hypertension (DASH): diet components may be related to lower prevalence of different kinds of cancer: a review on the related documents. J Res Med Sci. 2015;20:708–13.

    CAS  Google Scholar 

  34. World Health Organization. Global health risks: mortality and burden of disease attributable to selected major risks.2009. Geneva, Switzerland.

  35. World Health Organization. Global Physical Activity Questionnaire (GPAQ) Analysis Guide. Surveillance and Population-Based Prevention of Noncommunicable Diseases. 2002. Geneva, Switzerland

  36. World Health Organization Western Pacific Region. International Association for the Study of Obesity, International Obesity Task Force: The Asia-Pacific Perspective: Redefining Obesity and its Treatment. Sydney: Health Communications Australia; 2000.

    Google Scholar 

  37. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr, et al. The seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA. 2003;289:2560–72.

    Article  CAS  Google Scholar 

  38. World Medical Association Declaration of Helsinki. Ethical Principles for Medical Research Involving Human Subjects. 2013.

  39. Gerstel E, Pataky Z, Busnel C, Rutschmann O, Guessous I, Zumwald C, et al. Impact of lifestyle intervention on body weight and the metabolic syndrome in home-care providers. Diabetes Metab. 2013;2013(39):78–84.

    Article  Google Scholar 

  40. Shehu A, Toti F, Carcani M, Lapardhaja A, Tare R. The prevalence of metabolic syndrome and its relation to metabolic control in patient with diagnosed type 2 Diabetes. 2017

  41. Muchiri JW, Gericke GJ, Rheeder P. Effect of a nutrition education programme on clinical status and dietary behaviours of adults with type 2 diabetes in a resource-limited setting in South Africa: a randomised controlled trial. Public Health Nutr. 2015;19:1–14.

    Google Scholar 

  42. Askari F, Rabiei S, Rastmanesh R. The Effects of Nutrition Education and Diet Therapy on Glycemic and Lipidemic Control in Iranian Patients with Type 2 Diabetes.2013; 3.

  43. Nazaimoon W, Mohamud W, Ismail A, Sharifuddin A. Prevalence of metabolic syndrome and its risk factors in adult Malaysians: Results of a nationwide survey. Diabetes Res Clin Pract. 2011;96:91–7.

    Google Scholar 

  44. Chang S-H, Chien N-H, Ching-Yi Yu. Long-term lifestyle intervention in elderly with metabolic syndrome. J Clin Nurs. 2019;28(6):658–75.

    Article  Google Scholar 

  45. Chang S-H, Chen M-C, Chien N-H, Lin H-F. Effectiveness of community-based exercise intervention programme in obese adults with metabolic syndrome. J Clin Nurs. 2016;25(17–18):2579–89.

    Article  Google Scholar 

  46. Azizi F, Mirmiran P, Momenan AA, Hadaegh F, Members of Tehran Lipid and Glucose Study Group. The Effect of Community-Based Education for Lifestyle Intervention on the Prevalence of Metabolic Syndrome and Its Components: Tehran Lipid and Glucose Study. Int J Endocrinol Metab. 2013;11(3):145–53.

    Article  Google Scholar 

  47. Watetu TA, Kiage BN, Onyango AN, Makokha AO. Effect of a nutrition education programme on the metabolic syndrome in type 2 diabetes mellitus patients at a level 5 Hospital in Kenya: a randomized controlled trial. BMC Nutr. 2020;6:30. https://doi.org/10.1186/s40795-020-00355-6.

    Article  Google Scholar 

  48. Dabou S, Telefo PB, Leonard SF. Evaluation of dietary habits and lifestyle on the prevalence of metabolic syndrome and obesity in undergraduate university students in cameroon: a cross sectional study. J Metab Syndr. 2018;7:236. https://doi.org/10.4172/2167-0943.1000236.

    Article  Google Scholar 

  49. Choi J-H, Woo HD, Lee J-H, Kim J. Dietary patterns and risk for metabolic syndrome in Korean women: a cross-sectional study. Medicine. 2015;94(34):e1424.

    Article  Google Scholar 

  50. Firouzeh Sajjadi, Mojgan Gharipour, Noushin Mohammadifard, Fatemeh Nouri, Maryam Maghroun, Hasan Alikhasi. Relationship between legumes consumption and metabolic syndrome: Findings of the Isfahan Healthy Heart Program. ARYA Atheroscler. 2014; 10 (1).

  51. Li H, Li X, Yuan S, Jin Y, Jinping Lu. Nut consumption and risk of metabolic syndrome and overweight/obesity: a meta-analysis of prospective cohort studies and randomized trials. Nutr Metab. 2018;15:46.

    Article  Google Scholar 

  52. Jayalath VH, de Souza RJ, Sievenpiper JL, et al. Effect of dietary pulses on blood pressure: a systematic review and meta-analysis of controlled feeding trials. Am J Hypertens. 2014;27:56–64.

    Article  Google Scholar 

  53. Lee J, Kim Y, Jeon JY. Association between physical activity and the prevalence of metabolic syndrome: from the Korean National Health and Nutrition Examination Survey, 1999–2012. Springerplus. 2016;5:1870. https://doi.org/10.1186/s40064-016-3514-5.

    Article  PubMed  PubMed Central  Google Scholar 

  54. Shirinzadeh M, Afshin-Pour B, Angeles R, Gaber J, Agarwal G. The effect of community-based programs on diabetes prevention in low- and middle-income countries: a systematic review and meta-analysis. Glob Health. 2019;15:10. https://doi.org/10.1186/s12992-019-0451-4.

    Article  Google Scholar 

  55. Liu Y, Han Y, Shi J, Li R, Li S, Jin N, et al. Effect of peer education on self-management and psychological status in type-2 diabetes patients with emotional disorders. 2015; 6: 479–86.

  56. Muchiri JW, Gericke GJ, Rheeder P. Effect of nutrition education on diabetes knowledge and attitudes of adults with type 2 diabetes living in a resource limited setting in South Africa: a randomised controlled trial Impact of nutrition education on diabetes knowledge and attitudes of adul. J Endocrinol Metab Diabetes South Africa. 2016;21:26–34.

    Article  Google Scholar 

  57. Gyawali B, Bloch J, Vaidya A, Kallestrup P. Community-based interventions for prevention of Type 2 diabetes in low- and middle-income countries: a systematic review. Health Promot Int. 2019;34(6):1218–30. https://doi.org/10.1093/heapro/day081.

    Article  PubMed  Google Scholar 

  58. Stone NJ, Bilek S, Rosenbaum S. Recent National Cholesterol Education Program Adult Treatment Panel III update: adjustments and options. Am J Cardiol. 2005;96(4A):53E-59E.

    Article  Google Scholar 

  59. Visioli, F. Nutritional support in the pharmacological treatment of metabolic syndrome. Eur J Pharmacol. 2011; 668: S43-S49.

  60. Wang Y, Danyan Xu. Effects of aerobic exercise on lipids and lipoproteins. Lipids Health Dis. 2017;16:132. https://doi.org/10.1186/s12944-017-0515-5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  61. Hu FB. Physical Activity, Sedentary Behaviors, and Obesity. In: Hu FB, editor. Obesity Epidemiology. New York: Oxford University Press; 2008. p. 301–19.

    Chapter  Google Scholar 

  62. Wennberg M, Gustafsson PE, Wennberg P, et al. Poor breakfast habits in adolescence predict the metabolic syndrome in adulthood. Public Health Nutr. 2015;18(1):122–9.

    Article  Google Scholar 

  63. Després JP, Lemieux I, Bergeron J, et al. Abdominal obesity and the metabolic syndrome: contribution to global cardiometabolic risk. Arterioscler Thromb Vasc Biol. 2008;28(6):1039–49.

    Article  Google Scholar 

  64. Guzman M, Zbella E, Shah Alvarez S, Nguyen JL, Imperial E, Troncale FJ, Holub C, Mallhi AK, Van Wyk S. Effect of an intensive lifestyle intervention on the prevalence of metabolic syndrome and its components among overweight and obese adults. J Public Health. 2019;42(4):828–38. https://doi.org/10.1093/pubmed/fdz170.

    Article  Google Scholar 

  65. Sabate J, Oda K, Ros E. Nut consumption and blood lipid levels: a pooled analysis of 25 intervention trials. Arch Intern Med. 2010;170:821–7.

    Article  Google Scholar 

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Acknowledgements

The authors thank for the laboratory staff of St. Mary’s Mission Hospital for their assistance during the biochemical collection and analysis period. We also thank the administration of St. Mary’s Mission Hospital for allowing us to carry out this research in their institution.

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Authors and Affiliations

  1. School of Nursing Sciences, University of Nairobi, P.O Box 19676-00202, Nairobi, Kenya

    Okubatsion Tekeste Okube, Samuel Kimani & Waithira Mirie

  2. School of Nursing, The Catholic University of Eastern Africa, P.O Box 62157-00200, Nairobi, Kenya

    Okubatsion Tekeste Okube

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  1. Okubatsion Tekeste Okube
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  2. Samuel Kimani
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Contributions

OT and SK both conceptualized the study. OT, SK and WM participated in the study design and contributed to the writing of the study protocol, drafting and editing of this manuscript. All authors read and approved the final manuscript.

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Correspondence to Okubatsion Tekeste Okube.

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Ethics approval

The study was approved by the Kenyatta National Hospital-University of Nairobi Ethical Review Committee (KNH-UoN ERC) (Approval number: P430/07/2017).

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Consent was obtained from the study participants prior to data collection.

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The authors state no conflict of interest.

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Okube, O.T., Kimani, S. & Mirie, W. Community-based lifestyle intervention improves metabolic syndrome and related markers among Kenyan adults. J Diabetes Metab Disord 21, 607–621 (2022). https://doi.org/10.1007/s40200-022-01023-1

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