Sage Journals: Discover world-class research

Abstract

Background

Cardiovascular disease is a major cause of morbidity/mortality in non-developed countries. Reports of the effects of non-pharmacological interventions on global cardiovascular risk in Latin American adults, however, are scarce.

Objective

To compare the change in global cardiovascular risk induced by a tailored, Adult Treatment Panel-III compliant nutrition program versus the same program with addition of supervised, regular physical activity in Colombian adults.

Design

The study was a randomized, controlled trial.

Methods

Seventy-five Colombian patients aged 40–70 years and with Framingham-estimated global cardiovascular risk of 1% or higher were randomly assigned to a nutritional intervention program or a combined nutritional intervention-physical exercise program for 16 weeks. Patients underwent medical and anthropometric evaluation, bioelectrical impedance, lipid profile and Framingham global cardiovascular risk determination at baseline and at the end of follow-up.

Results

The groups were comparable at baseline; 21 persons in the nutritional intervention program group and 27 in the nutritional intervention-physical exercise program group completed the follow-up. Global cardiovascular risk modification (mean ± SE) was −2.04 ± 1.1 absolute percentage points (relative reduction 19.6%) in the nutritional intervention-physical exercise program group, compared with 0.23 ± 0.9 (relative increase 2.8%) in the nutritional intervention program group. Mean difference in global cardiovascular risk modification between groups reached borderline statistical significance in ANCOVA (P = 0.054). Reductions in systolic and diastolic blood pressure, waist circumference and low-density lipoprotein cholesterol were similar, but the nutritional intervention-physical exercise program group achieved significantly greater improvements in body weight, body mass index, percentage body fat and high-density lipoprotein cholesterol.

Conclusions

Our data suggest that a structured nutritional intervention-physical exercise program is more efficacious than a nutritional intervention program in the reduction of global cardiovascular risk and cardiovascular risk factors, in only 16 weeks.

Keywords

lifestyle risk reduction hyperlipidemia atherosclerosis exercise diet therapy nutrition

Get full access to this article

View all access options for this article.

References

1 World Health Organization. Deaths by cause, sex and mortality stratum in WHO Regions, estimates for 2001. In: The World Health Report 2002: reducing risks, promoting healthy life. Geneva: WHO; 2002.

2 Mahley

Weisgraber

Farese

. Disorders of lipid metabolism. In: Larsen

Kronenberg

Melmed

Polonsky

, editors. Williams textbook of endocrinology. Philadelphia: Saunders; 2003. pp. 1682–1683.

3 Kris-Etherton

Eckel

Howard

St. Jeor

Bazzarre

. Lyon Diet Heart Study: Benefits of a mediterranean-style, National Cholesterol Education Program/American Heart Association Step I dietary pattern on cardiovascular disease. Circulation 2001; 103:1823–1825.

4 National Ministry of Health of Colombia. Situación de Salud en Colombia, Indicadores Básicos 2001. Bogotá: National Ministry of Health of Colombia; 2002.

5 Mendivil

Sierra

Pérez

. Global cardiovascular risk assessment and prevalence of dyslipidemias according to NCEP-ATP III criteria in an adult population from Bogotá, Colombia [in Spanish]. Clin Inv Arteriosclerosis 2004; 16:99–107.

6 Wittes

. Sample size calculations for randomised controlled trials. Epidemiol Rev 2002; 24:39–43.

7 Anderson

Wilson

Odell

Kannel

. An updated coronary risk profile. A statement for health professionals. Circulation 1991; 83:356–362.

8 Lukasky

. Methods for the assessment of human body composition: traditional and new. Am J Clin Nutr 1987; 46:537–556.

9 United States Department of Food and Agriculture. Table of Food Composition, 14th Release; 2001. Available at: http://www.nal.usda.gov/fnic/foodcomp. [Accessed 14 September 2005].

10.

10 Metropolitan Life Insurance Co. New weight standards for men and women. Statist Bull 1959; 40:1.

11.

11 Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults. Executive summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III). JAMA 2001; 285:2486–2497.

12.

Lichtenstein

Ausman

Jalbert

Vilella-Bach

Jauhiainen

McGladdery

Efficacy of a therapeutic lifestyle change/Step 2 diet in moderately hypercholesterolemic middle-aged and elderly female and male subjects. J Lipid Res 2002; 43:264–273.

13.

Yu-Poth

Etherton

Reddy

Pearson

Reed

Zhao

Lowering dietary saturated fat and total fat reduces the oxidative susceptibility of LDL in healthy men and women. J Nutr 2000; 130:2228–2237.

14.

14 Pelkman

Fishell

Maddox

Pearson

Mauger

Kris-Etherton

. Effects of moderate-fat (from monounsaturated fat) and low-fat weight-loss diets on the serum lipid profile in overweight and obese men and women. Am J Clin Nutr 2004; 79:204–212.

15.

15 Eilat-Adar

Eldar

Goldbourt

. Association of intentional changes in body weight with coronary heart disease event rates in overweight subjects who have an additional coronary risk factor. Am J Epidemiol 2005; 161:352–358.

16.

16 Gregg

Gerzoff

Thompson

Williamson

. Intentional weight loss and death in overweight and obese US adults 35 years of age and older. Ann Intern Med 2003; 138:383–389.

17.

17 Wannamethee

Shaper

Lennon

. Reasons for intentional weight loss, unintentional weight loss, and mortality in older men. Arch Intern Med 2005; 165:1035–1040.

18.

18 Tsai

Sandretto

Chung

. Dieting is more effective in reducing weight but exercise is more effective in reducing fat during the early phase of a weight-reducing program in healthy humans. J Nutr Biochem 2003; 14:541–549.

19.

Ross

Janssen

Dawson

Kungl

Kuk

Wong

Exercise-induced reduction in obesity and insulin resistance in women: a randomized controlled trial. Obes Res 2004; 12:789–798.

20.

20 Lee

Blair

Jackson

. Cardiorespiratory fitness, body composition and all-cause and cardiovascular disease mortality in men. Am J Clin Nutr 1999; 69:373–380.

21.

21 Rock

Flatt

Thomson

Stefanick

Newman

Jones

. Plasma triacylglycerol and HDL cholesterol concentrations confirm self-reported changes in carbohydrate and fat intakes in women in a diet intervention trial. J Nutr 2004; 134:342–347.

22.

22 Jannsen

Hudson

Fortier

Ross

. Effects of an energy-restrictive diet with or without exercise on abdominal fat, intermuscular fat, and metabolic risk factors in obese women. Diabetes Care 2002; 25:431–438.

23.

23 Nieman

Brock

Butterworth

Utter

Nieman

. Reducing diet and/or exercise training decreases the lipid and lipoprotein risk factors of moderately obese women. J Am Coll Nutr 2002; 21:344–350.

24.

24 Fox

Thompson

Butterfield

Gylfadottir

Moynihan

Spiller

. Effects of diet and exercise on common cardiovascular disease risk factors in moderately obese older women. Am J Clin Nutr 1996; 63:225–233.