Optimizing Lifestyle Behaviors in Preventing Multiple Long-Term Conditions

Optimizing Lifestyle Behaviors in Preventing Multiple Long-Term Conditions: Comparison

Please note this is a comparison between Version 2 by Vivi Li and Version 1 by Ahmad Alkhatib.

Multiple long-term conditions such as the simultaneous prevalence of obesity, diabetes and cardiovascular disease are becoming increasingly prevalent globally with major consequences of morbidity, mortality and health economy. Lifestyle preventative approaches, especially combining nutrition and physical activity behavioral components, are essential in preventing multiple long-term conditions. However, funded research programs often focus on a single disease or a condition rather than a cluster of conditions. This entry addresses how lifestyle components, especially exercise and nutrition, could target multiple risk reductions associated with preventing multiple long-term conditions, especially diabetes and cardiovascular disease. Innovative exercise prescription should include different intensity-based approaches, which may include intense forms of exercise, but one size does not fit all. Nutritional intake guidelines can also be individualized to target multiple long-term conditions, which all contribute to informing better public health preventative policies.

non-communicable disease
diabetes
cardiovascular
exercise
diet
personalized medicine
high intensity training
sedentary
public health

Lifestyle related diseases are becoming prevalent globally and non-communicable diseases (NCDs) such as cardiovascular disease (CVD), cancer, respiratory disease and diabetes are now becoming synonymous causes of mortality among adults. Type-2 diabetes (T2D) prevalence figures have almost reached one in ten adults ^[1], but this figure is on the rise due to the recent COVID-19 lockdown burdens, especially given the reduced healthcare provision and the increased sedentary lifestyle. Multiple NCDs have often been clustered together as the term multimorbidity is coined, which defines the simultaneous existence of two or more chronic conditions in the same individual, such as diabetes, CVD and hypertension ^[2]. However, lifestyle being the primary cause of such diseases could serve as the primary preventative approach of multimorbidity; hence, it should remain a priority prevention across the healthcare systems.

Interventions involving lifestyle are well established amongst several NCDs. For example, diabetes prevention programs have shown superior or similar effectiveness to medication in individuals with prediabetes [3,4,5,6]^[3][4][5][6]. Conventional components of such lifestyle interventions were primarily driven by physical activity, nutrition and education in individuals with high risks of T2D and cardiovascular disease [7,8]^[7][8]. Large prospective cohort studies have consistently demonstrated that lifestyle interventions have significant risk reduction in T2D incidence among populations with impaired glucose tolerance or those with prediabetes [3,4,5,6]^[3][4][5][6]. Both the US diabetes prevention program and the Finnish diabetes studies showed 58% reduced T2D incidence in a large cohort who followed combined physical activity and dietary lifestyle behavior changes over a 5-year period [3,4]^[3][4]. Similar benefits of lifestyle interventions have also been shown across other global regions such as those shown in the Indian Diabetes Study and the Di Qing study in China [5,6]^[5][6]. A single-component nutritional lifestyle intervention, focusing on adopting the Mediterranean diet longitudinally, has also shown CVD prevention effectiveness [9,10]^[9][10]. This intervention was retrospectively analyzed for diabetes incidence in older adults with prediabetes as a secondary outcome, and showed that the Mediterranean diet had reversed prediabetes into the remission state ^[11]. As such, longitudinal and population-based physical activity and nutritional interventions are recommended to prevent multiple long-term conditions.

However, lessons from such largescale interventions across different countries have also shown that widescale interventions require major government, societal and health care systems’ commitment, significant healthcare cost and coordinated efforts, which are not always possible across the globe ^[12]. Disparities between high-income countries (HICs) and low- and middle-income countries (LMICs), based on countries’ GDP, have been associated with a prevalence of NCDs across different age groups [13,14]^[13][14]. There is also an issue of health inequality in terms of community reach, recruitment, effectiveness and long-term adherence, even with the same country. Preventative healthcare could target a cluster of NCDs via interventions which could be appropriated across different populations. Therefore, whether and how is an important question to answer via this entry, which proposes lifestyle intervention approaches to address multiple long-term conditions, including those appropriate to reduce health disparities, and offers useful tools for public health researchers and healthcare professionals.

References

International Diabetes Federation. Diabetes Atlas, 7th ed.; 2015. Available online: http://www.diabetesatlas.org/ (accessed on 1 April 2019).
Rokas, N.; Vesna-Kerstin, P.; Andrea, F.; Martin, S. Multimorbidity: What do we know? What should we do? J. Comorbidity 2016, 6, 4–11.
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Pan, X.-R.; Li, G.-W.; Hu, Y.-H.; Wang, J.-X.; Yang, W.-Y.; An, Z.-X.; Hu, Z.-X.; Lin, J.; Xiao, J.-Z.; Cao, H.-B.; et al. Effects of Diet and Exercise in Preventing NIDDM in People With Impaired Glucose Tolerance: The Da Qing IGT and Diabetes Study. Diabetes Care 1997, 20, 537–544.
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Esposito, K.; Maiorino, M.I.; Petrizzo, M.; Bellastella, G.; Giugliano, D. The Effects of a Mediterranean Diet on the Need for Diabetes Drugs and Remission of Newly Diagnosed Type 2 Diabetes: Follow-up of a Randomized Trial. Diabetes Care 2014, 37, 1824–1830.
Estruch, R.; Ros, E.; Salas-Salvadó, J.; Covas, M.-I.; Corella, D.; Arós, F.; Gómez-Gracia, E.; Ruiz-Gutiérrez, V.; Fiol, M.; Lapetra, J.; et al. Primary Prevention of Cardiovascular Disease with a Mediterranean Diet. N. Engl. J. Med. 2013, 368, 1279–1290.
Salas-Salvadó, J.; Bulló, M.; Estruch, R.; Ros, E.; Covas, M.-I.; Ibarrola-Jurado, N.; Corella, D.; Arós, F.; Gómez-Gracia, E.; Ruiz-Gutiérrez, V.; et al. Prevention of Diabetes With Mediterranean Diets. Ann. Intern. Med. 2014, 160, 1–10.
Tuomilehto, J.; Schwarz, P.E. Preventing Diabetes: Early Versus Late Preventive Interventions. Diabetes Care 2016, 39, S115–S120.
Alkhatib, A.; Nnyanzi, L.A.; Mujuni, B.; Amanya, G.; Ibingira, C. Preventing Multimorbidity with Lifestyle Interventions in Sub-Saharan Africa: A New Challenge for Public Health in Low and Middle-Income Countries. Int. J. Environ. Res. Public Health 2021, 18, 12449.
Obita, G.; Alkhatib, A. Disparities in the Prevalence of Childhood Obesity-Related Comorbidities: A Systematic Review. Front. Public Health 2022, 10, 923744.