Personalisation of the Dutch combined lifestyle intervention SLIMMER improves participant retention and weight loss in people at risk for cardiometabolic disease

Figures

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  Fig. 1. Study design including an overview of study procedures of the intervention and control group. T = 0 is referred to as baseline, t = 6 is end of study.

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  Fig. 2. Study flow diagram. Dropouts are defined as participants discontinuing the study or were lost to follow-up. Number of participants analysed is based on the modified intention-to-treat (mITT) principle in which participants are included in the analysis of whom > 80% of baseline data was available. CLI; combined lifestyle intervention.

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  Fig. 3. Self-reported adherence to combined lifestyle program. Self-reported adherence to physical activity guidelines (A, left) and dietary guidelines (A, right) of intervention (blue) and control (red) participants over the course of the program on pre-defined scores from 1–5 with score 1 meaning “no and I have no intention” and score 5 meaning “yes regularly”. Adherence to lifestyle advice was assessed at months 0, 3 and 6 by the questions ” Do you practice physical activity regularly at the moment” and “do you currently have a healthy diet” from the subjective compliance and effort questionnaire. Grey circles represent the fraction size expressed as percentage. Total Dutch Healthy Diet Index (DHDI) score (B) for intervention (blue) and control (red) participants. X-axis: months after start intervention. Y-axis: mean DHDI score (0–160, higher score is better diet quality) ± SE. *p < = 0.05; **p < = 0.01; ***p < = 0.001; a: interaction effect p < = 0.05.

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  Fig. 4. Self-efficacy for combined lifestyle program. Self-efficacy for physical activity (left) and self-efficacy for diet (right) of intervention (blue) and control (red) over the course of the program. Self-efficacy for implementing lifestyle advice was assessed with the subjective compliance and effort questionnaire evaluated on months 0, 3 and 6 on a 7 points Likert scale. X-axis: months after start intervention. Y-axis: mean score on 7-points Likert scale ± SE.

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  Fig. 5. Maintenance of lifestyle behaviour change. Maintenance of lifestyle behaviour change was determined by rating difficulty of maintaining the dietary and physical activity advice and the participant’s own goals on months 0, 3 and 6 on a 7 points Likert scale. Level of difficulty of conforming to advice about physical activity (left); about diet (middle); maintaining participants own goal for a longer period of time (right) between intervention (blue) and control group (red). Grey circles represent the fraction size expressed as percentage, X-axis: months after start intervention. Y-as: mean score on 7-points Likert scale.

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  Fig. 6. Quality of life during study. Quality of life scored using the EQ-5D questionnaire for the intervention (blue) and control group (red). X-axis: months after start of intervention. Y-axis: box plots based on first quartile (q25) and third quartile (q75) with median quality of life score (scale 0–100) and minimum and maximum values represented. Dots indicate outliers (q25-1.5*(q75-q25) or q75 + 1.5*(q75-q25). Blue box plots represent intervention and red box plots represent control. *p < = 0.05; **p < = 0.01; ***p < = 0.001; a: interaction effect p < = 0.05.

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  Fig. 7. Plasma inflammatory biomarkers. comparison of inflammatory biomarkers between intervention (blue) and control group (red) over 6 months intervention. CRP; C-reactive Protein, IFNg; Interferon- γ, Il; Interleukin, IP10; IFN-γ-induced protein 10, MPO; myeloperoxidase, SAA; serum amyloid A1, TNFa; tumor necrosis factor α, *p < = 0.05; **p < = 0.01; ***p < = 0.001.