Exchange experiences with Canada on lifestyle intervention programs for prevention of chronic diseases: considering Brazilian's behavioural and psychosocial factors

Abstract

Lifestyle-related chronic diseases are major causes of mortality worldwide and psychosocial factors may aggravate the risk for these diseases. Depression is currently associated with unhealthy behaviors (inappropriate diet and physical inactivity), resulting in increased risk for T2DM. A mechanism proposed to explain the frequent association between depression and metabolic diseases is the activation of the hypothalamic-pituitary-adrenal axis, contributing to accumulate fat and generate a pro-inflammatory state. By impairing the compliance to lifestyle interventions, psychological disturbances reduce their cardiometabolic benefits. There is evidence that interdisciplinary approaches improve participation in lifestyle intervention. A Canadian experience has shown that the Health Foods North Program - HFN with a multilevel support network (including schools, store owners, government and community members) represents a good strategy to improve adherence to healthy habits aiming at the prevention of chronic diseases. A Brazilian program for T2DM prevention (PDM) has suggested that psychological problems may limit the participation and the response to intervention programs. Preliminary analysis indicates that interdisciplinary approach - considering psychosocial aspects - may enhance quality of life (QOL). Objectives: 1) Conduct a comprehensive literature review on the interdisciplinary strategies used in Canada and in Brazil to prevent obesity and T2DM in high-risk individuals, considering the role of behavioural and psychosocial aspects; 2) determine predictors of successful lifestyle intervention in terms of cardiometabolic responses, with emphasis on behavioural factors, depression, and inflammatory markers in the PDM; 3) assess the residual effects of PDM after the completion of the intervention, with more emphasis on cardiometabolic risk factors and depressive symptomatology; 4) discuss the similarities and contrasts between the interventions conducted in a developed (HFN study in Canada) and a developing country (PDM study in Brazil). Methods: Literature will be reviewed in co-operation with the Canadian team for the development of manuscripts for publication in peer reviewed journals. The Brazilian PDM included 183 individuals with pre-diabetes or with metabolic syndrome attending a public healthcare unit. They were allocated to a traditional or intensive 18-month intervention based on diet, physical activity, and stress management. Clinical, psychological, and laboratory data were collected at baseline, at the end of the 18-month intervention period, and 9 months post intervention. Statistical analyzes will be performed using SPSS 17.0. (AU)