Full Title Multifactorial lifestyle interventions in the primary and secondary prevention of cardiovascular disease and type 2 diabetes mellitus--a systematic review of randomized controlled trials.

This systematic review aims to summarize the available randomized trials of multifactorial lifestyle interventions in the primary and secondary prevention of coronary heart disease and type 2 diabetes mellitus. Randomized trials investigating the effects of lifestyle interventions including the elements of diet, physical activity, and stress management in people at increased risk for or with manifest coronary heart disease or type 2 diabetes mellitus were searched for in five electronic database and by citation tracking. Quality was assessed using the Cochrane Collaboration's risk of bias tool. Exploratory effect size calculations were performed for a variety of laboratory and clinical outcome measures. Twenty-five trials including a total of 7,703 participants met the inclusion criteria. Fifteen trials were in patients with coronary heart disease, seven in patients with type 2 diabetes mellitus, and three on primary prevention. The interventions varied greatly regarding concept, intensity, and providers. Compared to participants in "usual care" control groups, there were no consistent effects on lipid levels and blood pressure and small effects on body mass index and glycated hemoglobin (HbA1c). Composite cardiac event rates were significantly less in the intervention groups of the few trials reporting these outcomes. Mortality was also lower in the intervention groups, but the difference was not statistically significant, and confidence intervals were wide. The evidence base for multifactorial lifestyle interventions is weak. Effects on surrogate measures seem minor, but there may be clinically relevant effects on major clinical endpoints.

Angermayr L, Melchart D, Linde K. Ann Behav Med. 2010 Aug;40(1):49-64. Competence Centre of Complementary Medicine and Naturopathy, Technische Universität München, Kaiserstr 9, 80801, Munich, Germany. Lucia.Angermayr@mnet-online.de

In 2 studies, children ages 3 to 7 years were asked to recall a series of touches that occurred during a previous staged event. The recall interview took place 1 week after the event in Study 1 and immediately after the event in Study 2. Each recall interview had 2 sections: In 1 section, children were given human figure drawings (HFDs) and were asked to show where the touching took place; in the other section, the same questions were asked without the HFDs (verbal condition). Children were randomly assigned to 2 different conditions: HFD 1st/verbal 2nd or verbal 1st/HFD 2nd. There were 2 major findings. First, HFDs elicited more errors than the verbal condition when used to probe for information that the child had already been asked. Second, regardless of interview method, children had poor recall of the touches even when these occurred minutes before the interview. It is suggested that cognitive mechanisms involving memory and semantics underlie children's poor recall of touching in both verbal and HFD conditions.

J Exp Psychol Appl. 2009 Dec;15(4):361-74. Bruck M. Division of Child and Adolescent Psychiatry, Johns Hopkins University, Baltimore, MD 21205, USA. mbruck1@jhmi.edu