title: Effects of a culturally adapted lifestyle intervention on cardio-metabolic outcomes: a randomized controlled trial in Iraqi immigrants to Sweden at high risk for Type 2 diabetes.
abstract: OBJECTIVE
  Middle-Eastern immigrants constitute a growing proportion of the Swedish population and are at high risk for Type 2 diabetes. This calls for a more proactive preventive approach for dealing with diabetes risk in this target group. The aim was to test the effect of a culturally adapted lifestyle intervention programme on changes in lifestyle habits and cardio-metabolic outcomes comparing an intervention group with a control group receiving usual care.
  
  
  METHODS
  Citizens of Malmö, Sweden born in Iraq and at high risk for Type 2 diabetes (n=636) were invited. Participation rate was 15.1%. In all, 96 participants were randomized to the intervention group (n=50) or to the control group (n=46). The intervention group was offered seven group sessions addressing healthy diet and physical activity including one cooking class. Changes in body weight, physical activity levels and cardio-metabolic outcomes were evaluated using linear mixed-effects models.
  
  
  RESULTS
  The mean follow-up time was 3.9 and 3.5months in the intervention and control groups, respectively. The drop-out rate from baseline to the last visit was 30.0% in the intervention group (n=15) and 30.4% in the control group (n=14). The mean insulin sensitivity index increased significantly at follow-up in the intervention group compared to the control group (10.9% per month, p=0.005). The intervention group also reached a significant reduction in body weight (0.4% per month, p=0.004), body mass index (0.4% per month, p=0.004) and LDL-cholesterol (2.1% per month, p=0.036) compared to the control group. In total, 14.3% in the intervention group reached the goal to lose ≥5% of body weight versus none in the control group.
  
  
  CONCLUSIONS
  This culturally adapted lifestyle intervention programme shows a beneficial effect on insulin action, body weight reduction, as well as LDL-cholesterol reduction, in Middle-Eastern immigrants. The programme adapted to resources in primary health care provides tools for improved primary prevention and reduced cardio-metabolic risk in this high-risk group for Type 2 diabetes.
authors.affiliation: Department of Clinical Sciences, Lund University, Malmö, Sweden.
authors.forename: Faiza
authors.initials: F
authors.lastname: Siddiqui
authors.affiliation: Genetic and molecular epidemiology unit, Lund University, Malmö, Sweden.
authors.forename: Azra
authors.initials: A
authors.lastname: Kurbasic
authors.affiliation: Department of Community Medicine/Primary Health Care, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
authors.forename: Ulf
authors.initials: U
authors.lastname: Lindblad
authors.affiliation: Department of Clinical Sciences, Lund University, Malmö, Sweden.
authors.forename: Peter M
authors.initials: PM
authors.lastname: Nilsson
authors.affiliation: Department of Clinical Sciences, Lund University, Malmö, Sweden; Center for Primary Health Care Research, Region Skåne and Lund University, Malmö, Sweden. Electronic address: Louise.bennet@med.lu.se.
authors.forename: Louise
authors.initials: L
authors.lastname: Bennet
mesh_terms: D000069:Acculturation; D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000032:analysis; D002319:Cardiovascular System / Q000503:physiopathology*; D003924:Diabetes Mellitus, Type 2 / Q000517:prevention & control*; D054242:Emigrants and Immigrants; D015444:Exercise; D005260:Female; D006801:Humans; D007493:Iraq; D008019:Life Style; D008297:Male; D008875:Middle Aged; D011236:Prediabetic State / Q000378:metabolism* / Q000503:physiopathology / Q000628:therapy*; D040242:Risk Reduction Behavior; D013548:Sweden; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose
keywords: Body weight; Immigrants; Insulin sensitivity; Lifestyle; Randomized controlled trial