Biologic Treatment in Combination with Lifestyle Intervention in Moderate to Severe Plaque Psoriasis and Concomitant Metabolic Syndrome: Rationale and Methodology of the METABOLyx Randomized Controlled Clinical Trial

Inflammatory diseases including psoriasis are associated with metabolic and cardiovascular comorbidities, including obesity and metabolic syndrome. Obesity is associated with greater psoriasis disease severity and reduced response to treatment. Therefore, targeting metabolic comorbidities could improve patients’ health status and psoriasis-specific outcomes. METABOLyx is a randomized controlled trial evaluating the combination of a lifestyle intervention program with secukinumab treatment in psoriasis. Here, the rationale, methodology and baseline patient characteristics of METABOLyx are presented. A total of 768 patients with concomitant moderate to severe plaque psoriasis and metabolic syndrome were randomized to secukinumab 300 mg, or secukinumab 300 mg plus a tailored lifestyle intervention program, over 24 weeks. A substudy of immunologic and metabolic biomarkers is ongoing. The primary endpoint of METABOLyx is PASI90 response at week 24. Other endpoints include patient-reported outcomes and safety. METABOLyx represents the first large scale clinical trial of an immunomodulatory biologic in combination with a standardized lifestyle intervention.

A Comprehensive, Multidisciplinary, Personalized, Lifestyle Intervention Program is Associated with Increased Leukocyte Telomere Length in Children and Adolescents with Overweight and Obesity

Leucocyte telomere length (LTL) is a robust marker of biological aging and is associated with obesity and cardiometabolic risk factors in childhood and adolescence. We investigated the effect of a structured, comprehensive, multidisciplinary, personalized, lifestyle intervention program of healthy diet and physical exercise on LTL in 508 children and adolescents (239 males, 269 females; 282 prepubertal, 226 pubertal), aged 10.14 ± 0.13 years. Participants were classified as obese (n = 267, 52.6%), overweight (n = 174, 34.2%), or of normal BMI (n = 67, 13.2%) according to the International Obesity Task Force (IOTF) cutoff points and were studied prospectively for one year. We demonstrated that LTL increased significantly after 1 year of the lifestyle interventions, irrespective of gender, pubertal status, or body mass index (BMI). Waist circumference was the best negative predictor of LTL at initial assessment. The implementation of the lifestyle interventions also resulted in a significant improvement in clinical (BMI, BMI z-score and waist to height ratio) and body composition indices of obesity, inflammatory markers, hepatic enzymes, glycated hemoglobin (HbA1C), quantitative insulin sensitivity check index (QUICKI), and lipid profile in all participants. These findings indicate that the increased LTL may be associated with a more favorable metabolic profile and decreased morbidity later in life.

Lifestyle Medicine for Treatment–Resistant Depression

The authors recommend that time, resources, and funding be allocated to support the cost–effective lifestyle medicine interventions for mental illness (and, in fact, all chronic illnesses, pain management, etc.). These interventions have positive results and seem to support true health and healing. In November 2020, Navarro et al10 published a paper regarding their promising on–going clinical trial. The main aim of their study is to “evaluate the effectiveness of an Internet–based adjuvant lifestyle–based intervention for patients with TRD.”10 Since TRD can be exacerbated by stressors that have become more common due to the COVID–19 pandemic, such as poor physical health and economic struggles, their study is an important one. Information and communications technologies and video conferencing will be used. The authors hypothesize that by the time of their 1–year follow–up, the lifestyle program group will show greater adherence and therefore benefits of the intervention. They said, “If this Internet–based multimodal lifestyle intervention program is useful as an adjunct to the pharmacological treatment of depression, this approach should be considered for the management of patients with TRD in similar emergency situations.”10 This study is not only promising because of its novel approach to treating TRD, but also because this intervention may be duplicated and used almost anywhere in the world and at any time, even times of emergency. The idea that TRD could be successfully treated by combining lifestyle medicine with modern–day technology rather than by administering drugs is hopeful.

Participants’ Views on Lifestyle Intervention Program Enhancing Long-Term Health-Related Behaviors Improvement among Prehypertension and/or Prediabetes Mellitus Older Adults: A Qualitative Study Examined in Thailand at Health Promoting Hospitals

This study aimed to investigate the view of prediabetes and prehypertension elderly patients living around temple on long-term self-management in proficient way underneath the lifestyle intervention program based on both focus-group discussion and In-depth interview methods to fill the gap in partially successful intervention. 62 participants were selected from 220 participants of the quantitative published study by 2 researchers. The triangulation method was used to put great emphasis on the consistency and the credibility of the results. Almost all of the participants had benefited from the program regarding proper foods, suitable exercise and an inspiration of lifestyle modification. They made changes of eating behavior and exercise behavior during program attendance, however, after the program had finished, they had minimal concern to take care of themselves. Nonetheless, more than half of them demonstrated some health-related behaviors changes due to they gave the value of the suggestion in different aspects. Moreover, high-frequency program attendance was not related to blood results improvement. The knowledge obtained from program intervention together with adequate contact between the patient and the program staff, personal problems solving, personal attitude, practice and acceptable played a key role for long-term lifestyle modification and completely successful intervention.

Use of a mobile lifestyle intervention application as a waitlist intervention for adolescents with obesity: single arm feasibility study (Preprint)

BACKGROUND Use of a mobile health tool as a waitlist intervention combined with in-person weight management clinic visits may increase participant engagement and be an effective treatment strategy for adolescent obesity. OBJECTIVE The aim of this study was to assess the effectiveness of and adolescent engagement with a mobile application-based lifestyle intervention program as a waitlist intervention prior to their engagement with a multidisciplinary weight management clinic METHODS This single-arm feasibility study recruited adolescents with obesity, aged 10-16 year old, to a waitlist intervention using a mobile app-based lifestyle intervention program with routine clinical care. Primary outcomes were adolescents’ engagement with the mobile application and BMI z-score at 6 months. Secondary outcomes included health behaviours, physical activity levels , quality of life and disordered eating behaviours. RESULTS We enrolled 40 adolescents with mean age of 13.8 ± 1.7 years and BMI z-score of 2.07 ± 0.30. Participants were ethnically diverse with 45% Chinese, 33% Malay, 15% Indians and 10% of other ethnicity. 83% of the participants had a household income level that was below the national median levels. 83% of the participants engaged with the mobile app-based lifestyle intervention program. There was no significant differences in the BMI z-score and disordered eating behaviours of the participants at 6 months. Participants had significant improvement in quality of life (P=0.044) and physical activity level (P=0.026) with reduction of total caloric intake (P=0.018) and fat percentage (P=0.018) at 6 months. CONCLUSIONS Use of a mobile app-based lifestyle intervention program combined with multidisciplinary clinical care is feasible strategy to provide obesity management services to a low-income and racially diverse Asian population and improves quality of life, physical activity levels and reduces fat percentage and total caloric intake. CLINICALTRIAL ClinicalTrials.gov NCT03561597