Principal investigator

Dr. Ofra Kalter-Leibovici

Subinvestigators

Gertner Institute:

Dr. Flora Lubin (Cardiovascular Epidemiology Unit), Information and Computerization Unit

Clalit Health Services, Samaria District:

Dr. Ahmed Atamna, Dr. Gershon Alpert, Ms Nuha Zaidan-Younis

Background

The level of morbidity and mortality from diabetes and cardiovascular disease is high among Arab women in Israel. Findings from the Hadera District Study conducted by the unit showed that many Arab women suffer from metabolic syndrome. The syndrome is a risk factor for diabetes and cardiovascular disease.

Findings from the Hadera District Study showed that Arab women rarely engage in leisure-time physical activity and they have a high degree of obesity. In more than 50% of cases, intervention programs for weight loss and moderate, regular physical activity reduce the chance of developing diabetes. However, lifestyle intervention programs developed for western populations are likely to fail in other populations.

Objectives

To develop, implement and test the effectiveness of an adapted intervention program designed to make lifestyle (dietary habits and physical activity) changes among Arab women with a high risk of developing diabetes and cardiovascular disease.

Practical importance

If the evaluation finds the program effective, it will be possible to implement the program on a national level in order to significantly reduce morbidity caused by obesity, lack of physical activity, diabetes and cardiovascular disease among Arab women in Israel.

Type of research

Controlled clinical trial with random allocation of participants in one of two research groups:

• Intensive lifestyle intervention
• Moderate lifestyle intervention

Method

Research population

Arab women, ages 35-54, living in Wadi Ara, who do not have diabetes, but are obese and have one of more symptoms of metabolic syndrome.

Intensive intervention includes:

• Personal meetings with a dietician, once/month
• Group meetings with a dietician, once/month
• Group meetings with a fitness coach, once every two weeks

Moderate intervention includes:

• Two group meetings with a dietician
• Personal meetings with a dietician, once every six months
• Distribution of written explanatory material

Objectives of the intervention

To achieve:

• Minimum 7% reduction of initial body weight
• Moderate physical activity at least 2.5 hours/week

Outcome variables:

• Improvement in metabolic syndrome characteristics  
• Improvement in lifestyle characteristics
• Meet intervention objectives (weight loss and physical activity)

Evaluation:

Upon entry and every six months thereafter, including:

• Anthropometric data and blood pressure
• Biochemical and hormonal characteristics of metabolic syndrome
• Lifestyle questionnaire (SF-36)

Cultural adaptation

• The staff who implemented the program (dieticians, fitness coaches and secretary) were women who live in the region
• The intervention program related to the population's beliefs and traditions; the dietary intervention included adaptation to Arab cuisine.  

Principles of the dietary intervention

• The dietary intervention was based on quantitative evaluation of dietary consumption using software that was developed for purposes of the program.
• The intervention included an educational discussion, supported by the software, with the participant to identify components of the diet that contribute most of the calories and/or undesirable fat, and replacing them with other items.

Commencement date and duration

Commencement: November 2004

Conclusion of the study: June 2008

Status

Of the 740 women who were tested for the threshold criteria for inclusion in the study, 204 were allocated randomly into two intervention groups. In April 2008, the last participant completed the evaluation conducted 12 months after entering the intervention program. Some participants were evaluated six months after completing the intervention program, in order to measure its long-term impact.

Results

• The culturally-adapted, intensive intervention program led to modest weight loss and improved sensitivity to insulin and glucose metabolism.
• It is necessary to invest substantial effort and resources to overcome cultural and social obstacles, and achieve long-lasting change in body weight and physical activity of Arab women.
• Considering the high frequency of diabetes and cardiovascular disease among Arab women, this investment is justified.

Financing organization

1. The Russell Barrie Foundation, through D-Cure
2. The Ministry of Science, through the Research and Development Center in Kefar Qara, Al-Zahrawi Foundation

Publications

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