Effectivenesss of the Feel4Diabetes lifestyle intervention in adults

Dietary and physical activity interventions are considered the cornerstone in obesity management, however their efficacy at community settings has not been established. To delineate the impact (changes in diet quality and physical activity) and outcome evaluation (changes in BMI and cardiovascular risk markers) among families at risk for type 2 diabetes mellitus (based on the Finnish Diabetes Risk score) of the Feel4Diabetes, a two-years community intervention on healthy and active living, implemented in 6 European countries. Participants were adults at risk of developing diabetes. The intervention included counseling group sessions during year 1 and text messages during year 2. Diet was assessed through food frequency questionnaires and physical activity by daily steps. The intervention led to a significant increase in diet quality and physical activity, compared to controls. Although no change in BMI was observed, the intervention, compared to control, had beneficial impact on waist circumference (-1.1 ± 0.4 vs. +1.1 ± 0.4 cm), blood glucose (+ 1.1 ± 0.35 vs. +2.6 ± 0.5 mg/dL), total cholesterol (-6.7 ± 1.7 vs. -1.0 ± 1.4 mg/dL), LDL-cholesterol (-4.8 ± 1.4 vs. +0.4 ± 1.1 mg/dL) and diastolic blood pressure (-0.8 ± 0.4 vs. +0.7 ± 0.4 mmHg). Both an increase in diet quality or physical activity were associated with a favorable effect on waist circumference, but only an increase in diet quality was furtherly associated with favorable outcome on total and LDL-cholesterol. A community-based intervention may increase diet quality and physical activity levels and may improve cardiovascular markers, without weight loss, in individuals at risk. An increase in diet quality was a prerequisite for improving lipid profile. The Feel4Diabetes may serve as a paradigm of cost-effective and scalable interventions for enhancing public health. Diet and physical activity have been considered as the basic components of any intervention for the prevention or treatment of obesity and cardiovascular diseases. However, their efficacy at the community level has not been firmly tested. In addition, there is scarce of information regarding adherence to diet and physical activity in such interventions. The Feel4Diabetes study was a community intervention focusing on active living and improvements of diet in individuals at high risk for developing type II diabetes in six European countries. Here we show that an improvement in cardiovascular risk markers is achievable in such interventions, without a concomitant weight loss. Improvements in diet quality and increases in physical activity were observed at similar proportions in the intervention group. Both an improvement in diet and physical activity were associated with a favorable outcome on waist circumference. An improvement in diet, but not in physical activity, was furtherly associated with an improvement in lipidemic profile. Interventions on diet and physical activity may improve cardiovascular risk markers at the community settings, without a concomitant weight loss. A diet component in such interventions may be necessary for improving lipidemic profile. The Feel4Diabetes may serve as a paradigm on how individuals at risk may be reached at the community settings and on what components such interventions should include.