Cited by 110Diabetes, Cardiovascular Risks, and LipoproteinsPhysical Activity and HealthCardiovascular Health and Risk Factors

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Effect of lifestyle interventions on cardiovascular risk factors among adults without impaired glucose tolerance or diabetes: A systematic review and meta-analysis

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Zhang, Xuanping, Devlin, Heather M., Smith, Bryce, Imperatore, Giuseppina, Thomas, William, Lobelo, Felipe, Ali, Mohammed K., Norris, Keri, Gruss, Stephanie, Bardenheier, Barbara, Cho, Pyone, Garcia de Quevedo, Isabel, Mudaliar, Uma, Jones, Christopher D., Durthaler, Jeffrey M., Saaddine, Jinan, Geiss, Linda S., Gregg, Edward W.·2017·PLOS ONE

DOI 10.1371/journal.pone.0176436PMC PMC5426619

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Abstract

Structured lifestyle interventions can reduce diabetes incidence and cardiovascular disease (CVD) risk among persons with impaired glucose tolerance (IGT), but it is unclear whether they should be implemented among persons without IGT. We conducted a systematic review and meta-analyses to assess the effectiveness of lifestyle interventions on CVD risk among adults without IGT or diabetes. We systematically searched MEDLINE, EMBASE, CINAHL, Web of Science, the Cochrane Library, and PsychInfo databases, from inception to May 4, 2016. We selected randomized controlled trials of lifestyle interventions, involving physical activity (PA), dietary (D), or combined strategies (PA+D) with follow-up duration ≥12 months. We excluded all studies that included individuals with IGT, confirmed by 2-hours oral glucose tolerance test (75g), but included all other studies recruiting populations with different glycemic levels. We stratified studies by baseline glycemic levels: (1) low-range group with mean fasting plasma glucose (FPG) <5.5mmol/L or glycated hemoglobin (A1C) <5.5%, and (2) high-range group with FPG ≥5.5mmol/L or A1C ≥5.5%, and synthesized data using random-effects models. Primary outcomes in this review included systolic blood pressure (SBP), diastolic blood pressure (DBP), total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), and triglycerides (TG). Totally 79 studies met inclusion criteria. Compared to usual care (UC), lifestyle interventions achieved significant improvements in SBP (-2.16mmHg[95%CI, -2.93, -1.39]), DBP (-1.83mmHg[-2.34, -1.31]), TC (-0.10mmol/L[-0.15, -0.05]), LDL-C (-0.09mmol/L[-0.13, -0.04]), HDL-C (0.03mmol/L[0.01, 0.04]), and TG (-0.08mmol/L[-0.14, -0.03]). Similar effects were observed among both low-and high-range study groups except for TC and TG. Similar effects also appeared in SBP and DBP categories regardless of follow-up duration. PA+D interventions had larger improvement effects on CVD risk factors than PA alone interventions. In adults without IGT or diabetes, lifestyle interventions resulted in significant improvements in SBP, DBP, TC, LDL-C, HDL-C, and TG, and might further reduce CVD risk.

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Authors: Zhang, X., Devlin, H. M., Smith, B., Imperatore, G., Thomas, W., Lobelo, F., Ali, M. K., Norris, K., Gruss, S., Bardenheier, B., Cho, P., Garcia de Quevedo, I., Mudaliar, U., Jones, C. D., Durthaler, J. M., Saaddine, J., Geiss, L. S., & Gregg, E. W.
Affiliations: Centers for Disease Control and Prevention (US)
Emory University (US)
Corresponding author: Zhang, Xuanping
ORCID: Zhang, Xuanping
Devlin, Heather M.
Smith, Bryce
Imperatore, Giuseppina
Lobelo, Felipe
Ali, Mohammed K.
Norris, Keri
Bardenheier, Barbara
Mudaliar, Uma
Durthaler, Jeffrey M.
Saaddine, Jinan
Geiss, Linda S.
Gregg, Edward W.
Venue: PLOS ONE
Publisher: Public Library of Science (PLoS)
Published: 2017-05-11
Volume: 12
Issue: 5
Pages: e0176436
ISSN: 1932-6203 (ISSN-L)
DOI: 10.1371/journal.pone.0176436
PMC: PMC5426619
OpenAlex: W2613978613
Cited by: 110
References: 147
Citations by year: 2026: 6 · 2025: 2 · 2024: 10 · 2023: 16 · 2022: 20 · 2021: 16 · 2020: 18 · 2019: 8 · 2018: 12 · 2017: 2
FWCI: 1.59
Type: journal article
Language: en
Open access: gold
doi.org
Licence: public-domain
creativecommons.org/publicdomain/zero/1.0/ (vor)
Locations: PLoS ONE (publishedVersion, public-domain)
Europe PMC (PubMed Central) (publishedVersion, public-domain)
PubMed Central (publishedVersion, public-domain)
PubMed (publishedVersion)
DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Spiral (Imperial College London) (submittedVersion, public-domain)
Funders: Centers for Disease Control and Prevention
Topics: Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Physical Activity and Health
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
Keywords: lifestyle intervention, cardiovascular risk factors, physical activity, dietary intervention, blood pressure, lipid profile, impaired glucose tolerance, prediabetes, glycemic status, cardiovascular disease prevention, adults without diabetes, usual care comparison, triglycerides, HDL cholesterol, LDL cholesterol, total cholesterol, systolic and diastolic blood pressure, follow-up duration
MeSH terms: Blood Glucose, Cardiovascular Diseases, Cholesterol, Diabetes Mellitus, Glycated Hemoglobin, Humans, Life Style, Cholesterol, HDL, Cholesterol, LDL, Risk Factors, Triglycerides, Exercise, Randomized Controlled Trials as Topic, Glucose Intolerance

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Effect of lifestyle interventions on cardiovascular risk factors among adults without impaired glucose tolerance or diabetes: A systematic review and meta-analysis

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