2013 International Conference on Diabetes & Metabolism Seoul, Korea, 9 th November 2013

Transcription

1 2013 International Conference on Diabetes & Metabolism Seoul, Korea, 9 th November 2013 Effect of Yoga on Metabolic Abnormalities Outcomes in Middle-Aged and Older Adults with Metabolic Syndrome Parco Siu, PhD, FACSM, FECSS

2 Prevalence of Diabetes Mellitus (DM) Worldwide 153 million in million in 2008 (WHO) 439 million in 2030 (Danaei et al., 2011 Lancet) Asia-Pacific 2007 estimated, DM prevalence in adults aged yr 8.6% in South Korea, 7.2% in Thailand, 9.9% in Malaysia, 5.7% in Taiwan, and 4.3% in China (Chan et al., 2009 JAMA) China: Recent estimated 11.6% (114 million) DM & 50.1% (493.4 million) Prediabetes (Xu et al., 2013 JAMA) Hong Kong DM 2% (<35 yr) to 20% (>65 yr) (Chan et al., 2009 JAMA)

3 Metabolic Syndrome (MetS) A cluster of cardiovascular risk factors: Hyperglycemia Fasting glucose Hypertension Metabolic Syndrome Central obesity Waist circumference Dyslipidemia High triglyceride Low HDL-cholesterol Identify individuals with high risk developing diabetes

4 Importance of Prevention MetS DM

5 Body-mind exercise Yoga Alleviate stress, improve balance, increase flexibility & muscular strength /PHD/PHD539/AA jpg

6 MetS & Yoga Cohen et al. (2008) Restorative Yoga in Adults with Metabolic Syndrome: A Randomized, Controlled Pilot Trial. Metabolic Syndrome and Related Disorders 2.5-month Yoga Intervention vs. Waitlist Control (N = 13 per group) Significantly Energy level Trend to: Blood pressure Well-being Stress Larger RCT is needed

7 Research Question Does Yoga Training Have Beneficial Effects on the Metabolic Abnormalities Outcomes in Middle-Aged and Older Adults with MetS? A Randomized Controlled Trial Investigation

8 Inclusion Criteria 1) Age and Hong Kong Chinese Adults 2) With MetS (>= 3 of the followings) according to US National Cholesterol Education Program (NCEP) criteria Central obesity Waist circumference >= 90 cm (Asian M); 80 cm (Asian F) High blood pressure SBP/DBP >= 130/85 mmhg or use of hypertension drug Elevated blood glucose Fasting blood glucose >= 100 mg/dl or use of hyperglycemia drug Elevated blood triglyceride Triglyceride >= 150 mg/dl Reduced HDL-cholesterol HDL-C <= 40 mg/dl (M); <= 50 mg/dl (F)

9 Dementia or mental disorders Severe or acute cardiovascular illnesses Post-stroke Neuromusculoskeletal illnesses Severe rheumatoid arthritis or osteoarthritis Pulmonary illnesses Immobile or wheelchair users Undertaking drug therapy treating metabolic abnormalities Other physical conditions not suitable for exercise training Tobacco users Exclusion Criteria

10 3967 Individuals were screened from

11 Subject Recruitment Blood Screening in the Community years of age (N = 3967) MetS and not fell into exclusion criteria years of age (Young) Randomized Yoga (N = 65) Control (N = 53) years of age (Aged) Randomized Yoga (N = 33) Control (N = 31) Outcome Measures (Pre, 0-month) Outcome Measures (Mid, 6-month) Outcome Measures (Post, 12-month)

12 3 x 1-hour session a week Yoga Intervention Instructor-led standard yoga class Small group (~10 participants in each class) Hatha yoga postures include centering (in cross-legged position), finger and toe weaving, virasana (hero pose), vajrasana (thunderbolt pose), tadasana (mountain pose), table pose (e.g., leg lifts), salabasana (locust pose), padangusthasana (big toe pose), sputa padangusthana (big toe lying down pose), uttitha hasta padangustasana (extended big toe pose), sputa baddha konasana (lying down bound angle pose), eka pada bhekasana (1-leg frog pose) and shavasana (corpse pose) (DiBenedetto et al., 2005)

13 Outcome Measures Systolic and diastolic blood pressure Waist circumference Fasting blood glucose Blood triglyceride High-density lipoprotein cholesterol Self-reported health survey, stress and depression levels Physical activity level by IPAQ (as covariate) Caloric intake by food diary record (as covariate)

14 MetS Summary in the Screened 3967 Hong Kong Chinese (mean age±sd: 55.3±10.7 years, 957 male and 3,010 female) Number of subjects diagnosed with MetS according to NCEP Criteria: 1081 out of 1,487 (27.2%) Number of subjects having different numbers of MetS components Number of subjects had 0 MetS component: 891 (22.5%) Number of subjects had 1 MetS component: 1084 (27.3%) Number of subjects had 2 MetS components: 911 (23.0%) Number of subjects had 3 MetS components: 627 (15.8%) Number of subjects had 4 MetS components: 355 (8.9%) Number of subjects had 5 MetS components: 99 (2.5%) 3967 (100%) Number of subjects in each of MetS components Number of subjects had abdominal obesity: 1888 (47.6%) Number of subjects had high systolic blood pressure: 1983 (50.0%) Number of subjects had high diastolic blood pressure: 891 (22.5%) Number of subjects had elevated blood glucose: 891 (22.5%) Number of subjects had elevated blood triglyceride: 956 (24.1%) Number of subjects had reduced HDL-cholesterol: 947 (23.9%) These numbers do not add up to 3967 because subjects had multiple MetS components

15 Number of Subjects with Diagnosed MetS

16 Young Aged

17 Improved (Decreased), Unchanged or Worsen (Increase) Number of MetS Component 2 x 2 Contingency Table - χ 2 Analysis P=0.037, χ 2 analysis N.S. P=0.529, χ 2 analysis Young Aged

18 Number of Subjects with Each of MetS Components

19 P=0.034, χ 2 analysis Young Aged

20 Young Aged

21 Young Aged

22 Young Aged

23 Young Aged

24 Changes in Each of MetS Components

25 P=0.007, Intervention x Time Interaction Effect by 2 x 2 x 3 mixed ANCOVA Young Aged

26 P=0.03, Intervention x Time Interaction Effect by 2 x 2 x 3 mixed ANCOVA Young Aged

27 Young Aged

28 Young Aged

29 Young Aged

30 Young Aged

31 Conclusions Systolic blood pressure & waist circumference were significantly improved in participants following yoga intervention Yoga intervention provides beneficial effects on parameters of metabolic syndrome including blood pressure and central obesity talog/comps/9/930f929f-81fc-4e21-82eedccc0b6a3c23.jpg 07/diabetes-prevention-improves-quality-of-life/

32 Acknowledgements Mr. Douglas So Ms. Imelda Chan Prof. Jean Woo Prof. Robert Kane Prof. Rosalie Kane Dr. Terry Lum CADENZA Fellows Mr. Ray Lin Ms. Farica Lo Mr. Henry Chuang Ms. Bee Tang Mr. Jeffrey Yip Mr. Samuel Hui Dr. Alan Lai Mr. Angus Yu Ms. Ingrid Lam Ms. Sophia Kwok Ms. Grace Tang Ms. Melody Poon Ms. Janet Wu Ms. Winnie Kong Funded by Special Thanks to All Participants

33 Key References: Chan JC, Malik V, Jia W, Kadowaki T, Yajnik CS, Yoon KH, et al. Diabetes in Asia: epidemiology, risk factors, and pathophysiology. JAMA. 2009; 301: Danaei G, Finucane MM, Lu Y, Singh GM, Cowan MJ, Paciorek CJ et al. National, regional, and global trends in fasting plasma glucose and diabetes prevalence since 1980: systematic analysis of health examination surveys and epidemiological studies with 370 country-years and 2.7 million participants. Lancet 2011; 378(9785): DiBenedetto M, Innes KE, Taylor AG, Rodeheaver PF, Boxer JA, Wright HJ, & Kerrigan DC (2005). Effect of a gentle Iyengar yoga program on gait in the elderly: an exploratory study. Arch Phys Med Rehabil 86, Xu Y, Wang L, He J, Bi Y, Li M, Wang T, Wang L, Jiang Y, Dai M, Lu J, Xu M, Li Y, Hu N, Li J, Mi S, Chen CS, Li G, Mu Y, Zhao J, Kong L, Chen J, Lai S, Wang W, Zhao W, Ning G; 2010 China Noncommunicable Disease Surveillance Group. Prevalence and control of diabetes in Chinese adults. JAMA Sep 4;310(9):

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36 Change in Number of MetS Components P=0.053, χ 2 analysis Young Control Young Yoga

37 Change in Number of MetS Components Aged Control Aged Yoga

38 Young Aged

39 Young Aged

40 Young Aged

41 ITT Subject Number Per protocol analysis ITT with 1 missing data ITT with 2 missing data Young Control Young Yoga Aged Control Aged Yoga Total

42 MetS & Yoga Khatri et al. (2007) Effects of Yoga and Meditation on Clinical and Biochemical Parameters of Metabolic Syndrome. Diabetes Research and Clinical Practice 3-month Yoga Intervention Randomized Case Control Study Total patient = 101? Significant improvements in middle-aged individuals: Waist circumference SBP/DBP Fasting blood sugar HbA1c Serum triglyceride Serum HDL-C 9/930f929f-81fc-4e21-82ee-dccc0b6a3c23.jpg