The effect of lifestyle intervention on cardiometabolic risk factors in mental health rehabilitation hostel residents at-risk: a cluster-randomized controlled 15-month trial

Faina Tsodikov, Meir Schechter, Rebecca Goldsmith, Lilach Peleg, Vered Baloush-Kleinman, Aliza Rozenberg, Ilan Yanuv, Yuri Gimelfarb, Ofri Mosenzon, Ronit Endevelt

Research output: Contribution to journalArticlepeer-review

Abstract

Objective: Cardiometabolic disorders contribute to morbidity and mortality in people with severe mental illnesses (SMI), yet lifestyle-intervention efficacy in patients with SMI is unclear. Israel’s unique mental-health rehabilitation hostels (MHRHs) provide housing to subjects with SMI. We tested how multi-component lifestyle intervention affects cardiometabolic risk-factors in at-risk SMI populations residing in MHRHs. Methods: In a prospective, cluster-randomized, controlled study, six MHRHs, paired by residents’ functioning level, were randomized to lifestyle intervention (nutrition education, physical education), or usual care. Subjects recruited included those with ≥1 of: BMI > 25 kg/m2; plasma triglycerides ≥150 mg/dL; HbA1c ≥ 5.7%; fasting plasma glucose ≥ 100 mg/dL and plasma HDL < 40(men)/ 50(women) mg/dL. Primary outcome was BMI change after 15 months; other outcomes were plasma lipids levels and glycemic control. Low cooperation in one MHRH pair led to their exclusion, the others were assigned to intervention or control. Results: Eighty residents were enrolled to intervention groups and 74 to control. Compared to baseline, intervention-arm participants experienced improvements in BMI (–0.83 kg/m2 [–1.36, –0.29] 95%CI), triglycerides (–30.60 mg/dL [–49.39, –11.82]95%CI) and LDL (–15.51 mg/dL [–24.53, –6.50]95%CI) (all P ≤ 0.003). BMI improvement correlated with number of dietitian consultations (r = –0.30; P = 0.001). No significant differences were found between treatment arms in BMI (–0.46 kg/m2 [–1.11, 0.18]95%CI;P = 0.189), triglycerides (–24.70 mg/dL [–57.66, 8.25]95%CI), LDL (–9.24 mg/dL [–20.50, 2.03]95%CI), HDL and glycemic control. Conclusions: Lifestyle intervention significantly improved BMI, LDL and triglycerides compared to baseline in at-risk MHRHs residents with SMI, yet compared to usual care the differences did not reach statistical significance. The association between the number of dietitian’s consultations and BMI improvement suggests that programs should highlight participants’ adherence.

Original languageEnglish
Pages (from-to)926-934
Number of pages9
JournalInternational Journal of Obesity
Volume46
Issue number5
DOIs
StatePublished - May 2022

Bibliographical note

Funding Information:
This study was funded by the Israeli Otzma Authority in 2015, grant number 3-12181. This paper was presented in part at the annual conference of Otzma Authority for the presentation of studies in diabetes (2018, October), Tel-HaShomer, Israel.

Funding Information:
OM declares Advisory Board from Novo Nordisk, Eli Lilly, Sanofi, Merck Sharp & Dohme, Boehringer Ingelheim, Novartis, AstraZeneca, BOL Pharma; Research grant support through Hadassah Hebrew University Hospital from Novo Nordisk, AstraZeneca; Speaker’s Bureau from AstraZeneca, Novo Nordisk, Eli Lilly, Sanofi, Merck Sharp & Dohme, Boehringer Ingelheim, Jansen. All other authors declare no conflict of interest.

Publisher Copyright:
© 2022, The Author(s), under exclusive licence to Springer Nature Limited.

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Endocrinology, Diabetes and Metabolism
  • Nutrition and Dietetics

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