Intervention factors associated with reduction in metabolic syndrome score during a lifestyle intervention program
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Background: Metabolic syndrome (MetSyn) is a cluster of risk factors associated with increased incidence of diabetes and cardiovascular disease. Personalized lifestyle interventions using diet and exercise are effective approaches to reverse metabolic syndrome, but have not been well adopted by Canadians. The Canadian Health Advanced By Nutrition and Graded Exercise (CHANGE) demonstration project focused on implementing a physician-led lifestyle intervention program in the primary care setting. Understanding how dietitian and kinesiologists sessions impact patient outcomes may help the implementation of other lifestyle intervention programs. Methods: A retrospective pre-post cohort study was conducted using data collected prospectively as part of the CHANGE demonstration project. Patients in the CHANGE demonstration project were adults diagnosed with metabolic syndrome in one of three Canadian primary care clinics. All 305 patients were provided a one year intensive personalized diet and exercise program through a multidisciplinary approach involving their family physician, a dietitian and a kinesiologist. Metabolic syndrome severity was measured using a continuous metabolic syndrome score standardized to have a standard deviation of one. Half a standard deviation change in metabolic syndrome score represents a moderate effect size. Robust multiple linear regression with multiple imputation was the method used to model the association between the exposures and outcomes while controlling for potential confounders and precision variables. A mediation analysis was also conducted where warranted and the statistical significance was tested by bootstrapping of the imputed sample. Results: The mean decrease in metabolic syndrome score was 0.5 after three months of intervention. The number of kinesiologist visits was not significantly associated with change in metabolic syndrome score but each dietitian visit was associated with a -0.048 [CI -0.09, -0.01] change in metabolic syndrome score. Although statistically significant, only 12.5% of the improvement in the metabolic syndrome score associated with dietitian contacts was partially mediated by the Healthy Eating Index. Conclusion: In the context of a multi-modal primary care-based lifestyle intervention program, increasing dietitian contacts appears to be associated with an improvement in metabolic syndrome score. More research is needed to understand what mediates the treatment effect of dietitian visits.