title: A community-based lifestyle and weight loss intervention promoting a Mediterranean-style diet pattern evaluated in the stroke belt of North Carolina: the Heart Healthy Lenoir Project.
abstract: Because residents of the southeastern United States experience disproportionally high rates of cardiovascular disease (CVD), it is important to develop effective lifestyle interventions for this population.
  
  
  
  The primary objective was to develop and evaluate a dietary, physical activity (PA) and weight loss intervention for residents of the southeastern US. The intervention, given in eastern North Carolina, was evaluated in a 2 year prospective cohort study with an embedded randomized controlled trial (RCT) of a weight loss maintenance intervention. The intervention included: Phase I (months 1-6), individually-tailored intervention promoting a Mediterranean-style dietary pattern and increased walking; Phase II (months 7-12), option of a 16-week weight loss intervention for those with BMI ≥ 25 kg/m(2) offered in 2 formats (16 weekly group sessions or 5 group sessions and 10 phone calls) or a lifestyle maintenance intervention; and Phase III (months 13-24), weight loss maintenance RCT for those losing ≥ 8 lb with all other participants receiving a lifestyle maintenance intervention. Change in diet and PA behaviors, CVD risk factors, and weight were assessed at 6, 12, and 24 month follow-up.
  
  
  
  Baseline characteristics (N = 339) were: 260 (77 %) females, 219 (65 %) African Americans, mean age 56 years, and mean body mass index 36 kg/m(2). In Phase I, among 251 (74 %) that returned for 6 month follow-up, there were substantial improvements in diet score (4.3 units [95 % CI 3.7 to 5.0]), walking (64 min/week [19 to 109]), and systolic blood pressure (-6.4 mmHg [-8.7 to -4.1]) that were generally maintained through 24 month follow-up. In Phase II, 138 (57 group only, 81 group/phone) chose the weight loss intervention and at 12 months, weight change was: -3.1 kg (-4.9 to -1.3) for group (N = 50) and -2.1 kg (-3.2 to -1.0) for group/phone combination (N = 75). In Phase III, 27 participants took part in the RCT. At 24 months, weight loss was -2.1 kg (-4.3 to 0.0) for group (N = 51) and -1.1 kg (-2.7 to 0.4) for combination (N = 72). Outcomes for African American and whites were similar.
  
  
  
  The intervention yielded substantial improvement in diet, PA, and blood pressure, but weight loss was modest.
  
  
  
  clinicaltrials.gov Identifier: NCT01433484.
authors: Division of General Medicine and Clinical Epidemiology, Department of Medicine, School of Medicine, CB 7110, University of North Carolina, 5039 Old Clinic Building, Chapel Hill, NC, 27599, USA. jato@med.unc.edu.|Center for Health Promotion and Disease Prevention (a CDC Prevention Research Center), CB 7426, University of North Carolina, Chapel Hill, NC, 27599, USA. jato@med.unc.edu.
authors: Thomas C
authors: TC
authors: Keyserling
authors: Center for Health Promotion and Disease Prevention (a CDC Prevention Research Center), CB 7426, University of North Carolina, Chapel Hill, NC, 27599, USA.|Department of Nutrition, Gillings School of Global Public Health, CB 7461, University of North Carolina, Chapel Hill, NC, 27599, USA.
authors: Carmen D
authors: CD
authors: Samuel-Hodge
authors: Department of Public Health, Brody School of Medicine, East Carolina University, Lakeside Annex 8, 600 Moye Blvd, MS 660, Greenville, NC, 27834, USA.
authors: Stephanie Jilcott
authors: SJ
authors: Pitts
authors: Center for Health Promotion and Disease Prevention (a CDC Prevention Research Center), CB 7426, University of North Carolina, Chapel Hill, NC, 27599, USA.
authors: Beverly A
authors: BA
authors: Garcia
authors: Center for Health Promotion and Disease Prevention (a CDC Prevention Research Center), CB 7426, University of North Carolina, Chapel Hill, NC, 27599, USA.
authors: Larry F
authors: LF
authors: Johnston
authors: Center for Health Promotion and Disease Prevention (a CDC Prevention Research Center), CB 7426, University of North Carolina, Chapel Hill, NC, 27599, USA.
authors: Ziya
authors: Z
authors: Gizlice
authors: Center for Health Promotion and Disease Prevention (a CDC Prevention Research Center), CB 7426, University of North Carolina, Chapel Hill, NC, 27599, USA.
authors: Cassandra L
authors: CL
authors: Miller
authors: Center for Health Promotion and Disease Prevention (a CDC Prevention Research Center), CB 7426, University of North Carolina, Chapel Hill, NC, 27599, USA.|Department of Nutrition, Gillings School of Global Public Health, CB 7461, University of North Carolina, Chapel Hill, NC, 27599, USA.
authors: Danielle F
authors: DF
authors: Braxton
authors: Department of Epidemiology, Gillings School of Global Public Health, CB 8050, University of North Carolina, Chapel Hill, NC, 27599, USA.
authors: Kelly R
authors: KR
authors: Evenson
authors: Center for Health Promotion and Disease Prevention (a CDC Prevention Research Center), CB 7426, University of North Carolina, Chapel Hill, NC, 27599, USA.
authors: Janice C
authors: JC
authors: Smith
authors: Center for Health Promotion and Disease Prevention (a CDC Prevention Research Center), CB 7426, University of North Carolina, Chapel Hill, NC, 27599, USA.
authors: Gwen B
authors: GB
authors: Davis
authors: Greene County Health Department, 225 Kingold Blvd, Suite B, Snow Hill, North Carolina, 28580, USA.
authors: Emmanuelle L
authors: EL
authors: Quenum
authors: Student Health Services, East Carolina University, 1000 East 5th St, MS 408, Greenville, NC, 27858, USA.
authors: Nadya T Majette
authors: NT
authors: Elliott
authors: Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, 55455, USA.
authors: Myron D
authors: MD
authors: Gross
authors: Department of Family Medicine, School of Medicine, CB 7595, University of North Carolina, Chapel Hill, NC, 27599, USA.
authors: Katrina E
authors: KE
authors: Donahue
authors: Department of Family Medicine, School of Medicine, CB 7595, University of North Carolina, Chapel Hill, NC, 27599, USA.|Cecil G. Sheps Center for Health Services Research, School of Medicine, CB 7590, University of North Carolina, Chapel Hill, NC, 27599, USA.
authors: Jacqueline R
authors: JR
authors: Halladay
authors: Center for Health Promotion and Disease Prevention (a CDC Prevention Research Center), CB 7426, University of North Carolina, Chapel Hill, NC, 27599, USA.|Department of Nutrition, Gillings School of Global Public Health, CB 7461, University of North Carolina, Chapel Hill, NC, 27599, USA.
authors: Alice S
authors: AS
authors: Ammerman
mesh_terms: D000293:Adolescent; D000328:Adult; D001741:Black or African American; D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000208:ethnology / Q000209:etiology / Q000517:prevention & control*; D038441:Diet, Mediterranean; D005247:Feeding Behavior; D005260:Female; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009657:North Carolina; D009765:Obesity / Q000150:complications / Q000208:ethnology / Q000628:therapy*; D015397:Program Evaluation; D011446:Prospective Studies; D012111:Residence Characteristics; D016138:Walking; D015431:Weight Loss; D061217:Weight Reduction Programs; D055815:Young Adult
keywords: Cardiovascular disease; Dietary intervention; Disparities; Lifestyle intervention; Low-income participants; Mediterranean diet; Prevention; Weight loss intervention