key: cord-1013705-yw0utfsp authors: Suazo, Elvia Maricela Hernandez; Chagoya, Luis Alberto Mendez; Gutierrez, Lujhon Guillermo Florez title: Improvement on Biometrics in Individuals Undergoing a 10 and 21-Day Lifestyle Intervention in a Lifestyle Medicine Clinic in Mexico date: 2021-07-31 journal: J Lifestyle Med DOI: 10.15280/jlm.2021.11.2.66 sha: 783016d8ab0ec08bf49d2ae80b42afbc3338430a doc_id: 1013705 cord_uid: yw0utfsp BACKGROUND: The intervention in the Lifestyle Medicine Clinic from La Carlota Hospital gives an opportunity to assess the clinical effect of a healthy lifestyle in an inpatient setting with emphasis in a plant-based diet, supervised daily exercise, sleep hygiene, psychological and optional spiritual therapies. This work evaluated the effect of short-term therapy on biometrics and blood profiles’ risk factors for non-communicable diseases (NCDs). METHODS: Twenty-five patients were enrolled in the intervention, 12 for the 10-day intervention and 13 for the 21-day intervention. RESULTS: The intervention improved most of the NCDs risk factors for the 10-day intervention weight decreased by -4.3% (p < .001), BMI -4.1% (p < .001), SBP -16.3% (p = .002), DBP -11.8% (p = .004), fasting glucose -31.3% (p = .041), total cholesterol -12.8% (p < .001), LDL -13.9 (p = .017), triglycerides and HDL lack statistical significance, however, there was a reduction of -7.7% and -9% respectively. For the 21-day intervention weight decreased by -8.3% (p = .016), SBP -11.2% (p = .005), DBP -11.4% (p = .022), triglycerides -39.5% (p = .034), total cholesterol -23.6% (p < .000), HDL -14.7% (p = .038), LDL -27.3% p < .000), BMI and fasting glucose presented a -15.2% and -21.2% reduction respectively without statistical significance. CONCLUSION: The present study confirms that short-term lifestyle interventions effectively reduce the risk factors associated with NCD’s. Of the 56.9 million global deaths in 2016, 40.5 million, or 71%, were due to non-communicable diseases (NCDs) [1] . In 2015, 80% of all deaths were attributed to NCDs in Mexico. Cardiovascular diseases and diabetes mellitus cause half of these deaths and in recent years, Mexico has experienced a rise in the prevalence of NCDs [2] . The increment in this prevalence is due to unhealthy lifestyle challenges such as a great number of low cost fast food choices with high salt, fat and sugar; reduction of time for preparing food, increase of the industrialized food publicity, and sedentary work and reduction in the physical activity [3, 4] . Obesity, diabetes mellitus, hypertension and dyslipidemia among other chronic diseases are one of the biggest chal- Fig. 1 . The paradigm of lifestyle medicine. Physical activity, nutrition, mental health (e.g., stress management), sleep behavior, circadian patterning, and substance use (e.g., tobacco), all contribute to the discipline of lifestyle medicine. lenges for the health care system [5] . Mexico is currently the second most obese country and recent research predicts that in 2030, 39% of the population will be obese, affecting all economic groups, low-income and high-income populations. Obesity is comorbid with heart conditions, diabetes mellitus, hypertension, cancer or sleep apnea [6, 7] . In 2016, the government of Mexico declared the epidemic of diabetes a national emergency and is seeking to improve the quality of care for some 13 million people with the disease [8] . One estimate determines that the cost of managing diabetes in Mexico ranges from $700 to $3,200 a year, being the total annual expenditure of people with diabetes 6.027 billion dollars (78 billion pesos) [7, 9] [17] . LALMA is the scientific medical professional association that represents physicians and health professionals in the countries of Latin America and the Caribbean dedicated to the advancement and practice of Lifestyle Medicine [18] . Applying lifestyle medicine into daily practice of medicine, encouraging patients to adopt and maintain change will improve outcomes and also cost of care [19] . Intensive lifestyle interventions have demonstrated shortterm and long-term benefits for the management of chronic diseases and the improvement of their associated risk factors within weeks; these interventions has been applied in corporate, clinical and community settings [20, 21] . CHIP (Com- A vegetarian diet is conducted during the intervention with a plant-based, low-fat, and whole food approach; this includes fruits, vegetables, legumes, seeds, and nuts. Health benefits have been shown for vegetarian diets in regard to NCDs such as hypertension, cardiovascular disease and metabolic syndrome, as well as a reduction in all-cause mortality [33] . Three meals a day are served (breakfast, lunch and supper) based on My Vegetarian Plate [34] , which is a is an adaptation of the USDA MyPlate that displays balanced nutrition meeting nutrient needs for those who choose to follow a vegetarian meal pattern (Fig. 2) . Consumption of tobacco products, alcohol, soda, sugary fruit drinks and caf-feine were not permitted. As for hydration, patients were encouraged to drink 1.5-2.0 L of water daily, sometimes increasing this amount due to dehydration during optional hydrotherapy sessions. Three to five cooking workshops were offered during the intervention where patients learn how to prepare healthy and balanced dishes, sauces, dairy, and meat substitutes; workshops were directed by the physician and dietitian. Every three days patients met individually with the dietitian in a one-hour session where personalized nutrition plans were structured according to each patient's needs. Every morning patients engaged a 30 minutes' walk and stretching session as well as a 10 minutes' walk after each meal. 60 minutes of a daily supervised exercise program included aerobic exercise (outdoors and indoors) and strength training in the gym. Patients had the opportunity to meet with a fitness coach for consultation and elaboration of exercise programs at home, for those who are unable to go to the gym after the intervention. Principals of sleep hygiene were applied during the intervention. Establishment of a bedtime routine was essential, patients went to bed at 9:00 pm, keeping the bedroom dark and at a cool temperature. They were encouraged to avoid electronic screens at least one hour before bedtime and noise was markedly reduced in hallways and rooms. The waking up time was at 6:00 am each morning, allowing the patients to obtain enough sleep to feel rested. To establish baseline biometrics, during admission of each patient, biometric readings were taken for weight, height, body mass index (BMI), and blood pressure. Fasting (12 h) blood samples were collected and analyzed by the laboratory of La Carlota Hospital, they were analyzed for fasting plasma glucose, total cholesterol, triglycerides, low-density lipoprotein (LDL) and high-density lipoprotein (HDL). Diabetic and hypertensive patients were monitored daily for fasting glucose and blood pressure to maintain control in their health. All patients had fasting blood drawn samples and biometric readings at the departure of the intervention to review changes in values. Statistical analysis was performed using SPSS (version 24). Mean ± SD is the format presenting the data. Values before and after the intervention were analyzed by means of student t-test, significance was set at p ＜ 0.05. Notable improvements in biometrics were observed over 10-day (Table 1 ) and 21-day (Table 2) [36] , therefore the importance of these studies that approach the cause and not merely the disease. The prevention and control of NCDs should be considered as a priority for the health care system due to the growth in its incidence and lethality, in addition to the high cost of care and late attention with little satisfactory outcomes in many cases. COVID-19 is a pandemic that must highlight the high burden that NCDs place on health resources [37] . States the consequences of NCDs over COVID-19 are just as real and over 5 times as prevalent [39] . Katie Dain, chief executive of NCD Alliance, states that COVID-19 has been unforgiving on people living with NCDs and has laid bare the failure of the vast majority of governments worldwide to adequately guarantee the health of its citizens [40] . This study is subject to some limitations such as the small sample size and absence of a control group. Lack of follow-up for measurement of long-term changes in lifestyle behaviors after the interventions is a challenge to overcome on further research. A community-based intervention model would be a very innovative and cost-effective initiative to determine if we can mimic the same results. The 10 and 21-day lifestyle intervention provides valuable information of health behaviors that will impact positively the biological risk factors for NCDs. This study also gives evidence that a multidisciplinary approach is the best strategy to intervene NCDs and obtain a satisfactory outcome. NCD Countdown 2030: Worldwide trends in non-communicable disease mortality and progress towards Non-communicable disease prevention in Mexico: Policies, programs and regulations Recomendaciones para una política de Estado. Dirección General de Publicaciones y Fomento Editorial -UNAM Physical inactivity prevalence and trends among Mexican adults: Results from the National Health and Nutrition Survey (ENSANUT) México y el reto de las enfermedades crónicas no transmisibles. El laboratorio también juega un papel importante Childhood obesity in Mexico: A critical analysis of the environmental factors, behaviours and discourses contributing to the epidemic The complex scenario of obesity, diabetes and hypertension in the area of influence of primary healthcare facilities in Mexico World Health Organization. Quality of care is key to tackling Mexico's diabetes emergency Per capita expenditures in health, nursery coverage and diabetes in Mexico Hypertension in Mexican adults: prevalence, diagnosis and type of treatment Cost-effectiveness and budget impact analysis of a pharmaceutical care program for patients with hypertension of a third-level care hospital in Mexico Enfermedades No Transmisibles: Situación y Propuestas de Acción: Una Perspectiva desde la Experiencia de México. Secretaría de Salud Octubre What Is Lifestyle Medicine? Personalized Lifestyle Medicine [Figure 2.1 The paradigm of lifestyle medicine Genomic and precision medicine The Advent of Lifestyle Medicine Medicina del Estilo de Vida: Trabajando juntos para revertir la epidemia de las enfermedades crónicas en Latinoamérica Quiénes somos [Internet] Latin American Lifestyle Medicine Association Are We Ready to Practice Lifestyle Medicine? The Complete Health Improvement Program (CHIP): History, Evaluation, and Outcomes Body Mass Index Change as a Predictor of Biometric Changes following an Intensive Lifestyle Modification Program Long-term effectiveness of the community-based Complete Health Improvement Program (CHIP) lifestyle intervention: A cohort study Effect of short-term Pritikin diet therapy on the metabolic syndrome A four week residential program for primary health care patients to control obesity and related heart risk factors: Effective application of principles of learning and lifestyle change A Prospective Study of Short-term Outcomes of a Residential Programme for the Morbidly Obese in Malta Long-term cost reduction of routine medications following a residential programme combining physical activity and nutrition in the treatment of type 2 diabetes: A prospective cohort study Intensive Lifestyle Interventions Improve Isolated Systolic Hypertension Structure-size me:" weight and health changes in a four week residential program Life Expectancy, and Chronic Disease: Studies of Seventh-Day Adventists and Other Vegetarians Ten years of life: Is it a matter of choice? Living life to the fullest. (1st ed) Review and Herald publisher; Silver Spring (MD) Physician competencies for prescribing lifestyle medicine Vegetarian dietary patterns and mortality in Adventist Health Study 2 My Vegetarian Plate. General Conference of Seventh-day Adventists Nutrition Council Health Ministries publications, Silver Spring (MD) Quality of Life: The Primary Goal of Lifestyle Intervention Geneva: World Health Organization COVID-19: a new lens for non-communicable diseases Secretaría de Salud; c2020 Lifestyle Medicine in the COVID-19 Era Statement by Katie Dain on WHO rapid assessment of service delivery for NCDs during COVID-19 We would like to thank Professor Victor Monarrez Perez for his assistance with the statistical analysis.