Culturally adapted lifestyle intervention no better than written materials for CVD risk reduction

Among South Asian adults, a culturally adapted, group-based lifestyle intervention does not appear to result in greater improvements in cardiovascular disease (CVD) risk factors as compared with written health education materials, according to the SAHELI study.

SAHELI included 549 South Asian adults (mean age 49.2 years, 57.9 percent women) who were overweight or obese, had no history of CVD events, and had at least one additional CVD risk factor (hypertension, dyslipidemia, prediabetes, or diabetes).

The participants were randomly assigned to undergo a 16-week, culturally adapted, group-based lifestyle intervention led by community health coaches (intervention group) or to receive written health education materials delivered weekly (control group). Lifestyle modification counselling was conducted in English, Gujarati, Hindi, and Urdu, delivered in person prior to the onset of COVID-19 pandemic and virtually thereafter.

The primary outcomes were changes in CVD risk factors from baseline to 12 months—including weight, systolic blood pressure (SBP), diastolic blood pressure (DBP), glycated haemoglobin (HbA1c), and total cholesterol—as compared between the intervention and control groups using using multivariate mixed-effects regression models. Secondary outcomes included self-reported diet quality, physical activity, and self-efficacy.

At 12 months, the mean differences in the change in CVD risk factors between the intervention and control groups were −0.07 kg (95 percent confidence interval [CI], −0.55 to 0.42) for weight, 0.47 mm Hg (95 percent CI, −1.85 to 2.79) for SBP, 0.44 mm Hg (95 percent CI, −1.06 to 1.95) for DBP, −2.47 mg/dL (95 percent CI, −8.51 to 3.57) for cholesterol, and −0.07 percent (95 percent CI −0.20 to 0.07) for HbA1c.

An overall test of between-group difference in any CVD risk factor change at the 12-month assessment was not significant.

Finally, participants in the intervention group reported greater improvements in dietary quality, physical activity, and self-efficacy than those in the control group.