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Tailored lifestyle intervention improves cardiometabolic profile in Middle Eastern immigrants
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Middle Eastern immigrants living in Sweden who are at high risk for developing type 2 diabetes saw improvements in insulin sensitivity, body weight, BMI and LDL cholesterol when assigned to a culturally tailored lifestyle intervention program vs. those assigned to usual care, according to study findings.
In a randomized controlled trial, Faiza Siddiqui, MBBS, MPH, a PhD student in the department of clinical sciences at Lund University in Malmö, Sweden, and colleagues analyzed data from 96 Iraqi immigrants living in Malmö at high risk for type 2 diabetes, defined as having prediabetes or a BMI of at least 28 kg/m² or a waist circumference of at least 80 cm (women) or 94 cm (men). Researchers assigned 50 participants to an intervention modeled on the Diabetes Prevention Program but tailored to Middle Eastern lifestyle, culture and food habits, including sex-specific groups led by Arabic-speaking health coaches. Intervention included seven group sessions, including one cooking class, with intervals of 1 to 4 weeks over 4 months. Sessions addressed self-empowerment, with a special emphasis on cultural and social barriers and negative perceptions of lifestyle change, according to researchers. Participants assigned to the control group (n = 46) received usual care, including written advice at three points during the study on increasing physical activity levels and healthy eating habits. Mean follow-up time for the intervention and control groups was 3.9 and 3.5 months, respectively.
After adjustment for age, sex, BMI, family history of diabetes, physical activity and education, participants assigned to the intervention saw a mean decrease of 0.4% per month in both body weight and BMI vs. the control group (beta = –0.004; 95% CI, –0.007 to –0.001); 14.3% of intervention participants lost at least 5% of their body weight (P = .054).
Intervention participants also saw a 10.9% increase in mean insulin sensitivity index per month vs. controls (beta = 0.096; 95% CI, 0.025-0.167), whereas BMI, waist circumference and physical activity were all associated with mean insulin sensitivity index. Those assigned to intervention also saw a mean 2.1% monthly decrease in LDL level vs. controls; there were no between-group differences over time in HDL, triglycerides or mean caloric intake. The drop-out rate was similar between groups (30% in intervention group vs. 30.4% in control group).
“The study provides insight into the effects and the challenges of implementing a lifestyle intervention for diabetes prevention in this immigrant group at high risk for type 2 diabetes,” the researchers wrote. “We conclude that adopting a similar culturally sensitive approach in [primary health care] settings may improve metabolic profile and reduce future cardiometabolic risk in this diabetes-prone target group.” – by Regina Schaffer
Disclosure: This study was funded by grants from Lund University, the Swedish Society of Medicine, the Crafoord Foundation and a donation from Novo Nordisk Scandinavia AB.
AUTHORS: Siddiqui F, Kurbasic A, Lindblad U, Nilsson PM, Bennet L
BACKGROUND: Middle-Eastern immigrants constitute a growing proportion of the Swedish population and are at high risk of type 2 diabetes. This calls for a more proactive preventive approach for dealing with diabetes risk in this target group. The aim was to test the effect of a culturally adapted lifestyle intervention programme on changes in lifestyle habits and cardio-metabolic outcomes comparing an intervention group with a control group receiving usual care ...
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