MNT: Disorders of Lipid Metabolism (2015)
Citation:
Study Design:
Class:
- Click here for explanation of classification scheme.
Quality Rating:
Research Purpose:
To determine the extent to which 2 types of counseling (Individual vs. Group) can improve physical profiles and metabolic disorders in patients with metabolic syndrome.
Inclusion Criteria:
Metabolic syndrome diagnosis.
Exclusion Criteria:
- Malignant diseases
- Inflammatory diseases
- History of CVD
- Virus or autoimmune hepatitis
- Cirrhosis
- Renal diseases
- Thyroid diseases
- Arthropathy
- Other physical problems
- Medication-treated diabetes mellitus
- Dyslipidemia
- Primary or secondary hypertension.
Description of Study Protocol:
- Recruitment: Employee health checkup at the workplace
- Design: Those with metabolic syndrome diagnoses were randomized into one of two groups; Individual Couseling or Group Counseling
- Intervention
- Individual Counseling (IC): Three-day diet record analyzed by RDs; patients given personalized counseling sessions (one hour) plus four one-hour general counsultations with healthcare workers (MDs and RNs)
- Group Counseling (GC): One-hour group session on fundamental dietary advice by RDs plus four one-hour general consultations with healthcare workers.
- Statistical analysis: Student's T-test, Peason's chi-square; P<0.05 as significant.
Data Collection Summary:
Timing of Measurements
Group session or individual session by RD at baseline only.
Dependent Variables
- Body weight, body fat percentage, waist circumference measured at baseline and monthly
- Blood sampling (glucose, insulin, Hgb A1C, TG, cholesterol) measured at baseline and three months.
Independent Variables
RD Counseling Group.
Control Variables
- Timing of measurements
- Health worker contact.
Description of Actual Data Sample:
Initial N
- 161 males recruited
- 37 randomized to individual counseling (IC) and 54 to group counseling (GC).
Attrition (Final N)
- IC: 37
- GC: 54
- 0% attrition rate.
Age
- IC: 51.1±6.4 years
- GC: 49.6±5.0 years.
Ethnicity
Japanese.
Anthropometrics
BMI
- IC: 27.3±2.1kg/m2
- GC: 27.6±2.3kg/m2.
Location
Kobe, Japan.
Summary of Results:
Key Findings
Change in parameters (from baseline to three months) between IC and GC were each significantly greater in the IC than in GC.
- Change in BMI: -0.6kg/m2
- Body fat percentage: -2.5%
- Waist circumference: -2.2cm
- Systolic BP: -3.3mmHg
- LDL-cholesterol: -7.9mg/dL
- HbA1c: -0.7%.
Author Conclusion:
Lifestyle diet and exercise counseling, especially individually, may improve physical profiles and metabolic disorders in patients with metabolic syndrome.
Funding Source:
Other: | No Funding Disclosed. |
Reviewer Comments:
Only one visit with RD in both IC and GC Groups: It is questionable whether this represents enough exposure.
Quality Criteria Checklist: Primary Research
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Relevance Questions | |||
1. | Would implementing the studied intervention or procedure (if found successful) result in improved outcomes for the patients/clients/population group? (Not Applicable for some epidemiological studies) | Yes | |
2. | Did the authors study an outcome (dependent variable) or topic that the patients/clients/population group would care about? | Yes | |
3. | Is the focus of the intervention or procedure (independent variable) or topic of study a common issue of concern to dieteticspractice? | Yes | |
4. | Is the intervention or procedure feasible? (NA for some epidemiological studies) | Yes | |
Validity Questions | |||
1. | Was the research question clearly stated? | Yes | |
1.1. | Was (were) the specific intervention(s) or procedure(s) [independent variable(s)] identified? | Yes | |
1.2. | Was (were) the outcome(s) [dependent variable(s)] clearly indicated? | Yes | |
1.3. | Were the target population and setting specified? | Yes | |
2. | Was the selection of study subjects/patients free from bias? | Yes | |
2.1. | Were inclusion/exclusion criteria specified (e.g., risk, point in disease progression, diagnostic or prognosis criteria), and with sufficient detail and without omitting criteria critical to the study? | N/A | |
2.2. | Were criteria applied equally to all study groups? | Yes | |
2.3. | Were health, demographics, and other characteristics of subjects described? | Yes | |
2.4. | Were the subjects/patients a representative sample of the relevant population? | Yes | |
3. | Were study groups comparable? | Yes | |
3.1. | Was the method of assigning subjects/patients to groups described and unbiased? (Method of randomization identified if RCT) | No | |
3.2. | Were distribution of disease status, prognostic factors, and other factors (e.g., demographics) similar across study groups at baseline? | Yes | |
3.3. | Were concurrent controls or comparisons used? (Concurrent preferred over historical control or comparison groups.) | Yes | |
3.4. | If cohort study or cross-sectional study, were groups comparable on important confounding factors and/or were preexisting differences accounted for by using appropriate adjustments in statistical analysis? | N/A | |
3.5. | If case control study, were potential confounding factors comparable for cases and controls? (If case series or trial with subjects serving as own control, this criterion is not applicable.) | N/A | |
3.6. | If diagnostic test, was there an independent blind comparison with an appropriate reference standard (e.g., "gold standard")? | N/A | |
4. | Was method of handling withdrawals described? | Yes | |
4.1. | Were follow-up methods described and the same for all groups? | Yes | |
4.2. | Was the number, characteristics of withdrawals (i.e., dropouts, lost to follow up, attrition rate) and/or response rate (cross-sectional studies) described for each group? (Follow up goal for a strong study is 80%.) | Yes | |
4.3. | Were all enrolled subjects/patients (in the original sample) accounted for? | Yes | |
4.4. | Were reasons for withdrawals similar across groups? | Yes | |
4.5. | If diagnostic test, was decision to perform reference test not dependent on results of test under study? | N/A | |
5. | Was blinding used to prevent introduction of bias? | N/A | |
5.1. | In intervention study, were subjects, clinicians/practitioners, and investigators blinded to treatment group, as appropriate? | N/A | |
5.2. | Were data collectors blinded for outcomes assessment? (If outcome is measured using an objective test, such as a lab value, this criterion is assumed to be met.) | N/A | |
5.3. | In cohort study or cross-sectional study, were measurements of outcomes and risk factors blinded? | N/A | |
5.4. | In case control study, was case definition explicit and case ascertainment not influenced by exposure status? | N/A | |
5.5. | In diagnostic study, were test results blinded to patient history and other test results? | N/A | |
6. | Were intervention/therapeutic regimens/exposure factor or procedure and any comparison(s) described in detail? Were interveningfactors described? | Yes | |
6.1. | In RCT or other intervention trial, were protocols described for all regimens studied? | Yes | |
6.2. | In observational study, were interventions, study settings, and clinicians/provider described? | Yes | |
6.3. | Was the intensity and duration of the intervention or exposure factor sufficient to produce a meaningful effect? | ??? | |
6.4. | Was the amount of exposure and, if relevant, subject/patient compliance measured? | No | |
6.5. | Were co-interventions (e.g., ancillary treatments, other therapies) described? | Yes | |
6.6. | Were extra or unplanned treatments described? | N/A | |
6.7. | Was the information for 6.4, 6.5, and 6.6 assessed the same way for all groups? | Yes | |
6.8. | In diagnostic study, were details of test administration and replication sufficient? | N/A | |
7. | Were outcomes clearly defined and the measurements valid and reliable? | Yes | |
7.1. | Were primary and secondary endpoints described and relevant to the question? | Yes | |
7.2. | Were nutrition measures appropriate to question and outcomes of concern? | Yes | |
7.3. | Was the period of follow-up long enough for important outcome(s) to occur? | Yes | |
7.4. | Were the observations and measurements based on standard, valid, and reliable data collection instruments/tests/procedures? | Yes | |
7.5. | Was the measurement of effect at an appropriate level of precision? | Yes | |
7.6. | Were other factors accounted for (measured) that could affect outcomes? | N/A | |
7.7. | Were the measurements conducted consistently across groups? | N/A | |
8. | Was the statistical analysis appropriate for the study design and type of outcome indicators? | Yes | |
8.1. | Were statistical analyses adequately described and the results reported appropriately? | Yes | |
8.2. | Were correct statistical tests used and assumptions of test not violated? | Yes | |
8.3. | Were statistics reported with levels of significance and/or confidence intervals? | Yes | |
8.4. | Was "intent to treat" analysis of outcomes done (and as appropriate, was there an analysis of outcomes for those maximally exposed or a dose-response analysis)? | N/A | |
8.5. | Were adequate adjustments made for effects of confounding factors that might have affected the outcomes (e.g., multivariate analyses)? | No | |
8.6. | Was clinical significance as well as statistical significance reported? | No | |
8.7. | If negative findings, was a power calculation reported to address type 2 error? | N/A | |
9. | Are conclusions supported by results with biases and limitations taken into consideration? | Yes | |
9.1. | Is there a discussion of findings? | Yes | |
9.2. | Are biases and study limitations identified and discussed? | Yes | |
10. | Is bias due to study's funding or sponsorship unlikely? | Yes | |
10.1. | Were sources of funding and investigators' affiliations described? | Yes | |
10.2. | Was the study free from apparent conflict of interest? | Yes | |