THE EFFECTS OF COMBINATION OF BEHAVIOURAL INTERVENTION, NUTRITIONAL EDUCATION AND EXERCISE (COMBINE) PROGRAM ON HAEMOSTATIC MARKERS AMONG OBESE SUBJECTS
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Date
2012-06
Authors
NORSUHANA, OMAR
Journal Title
Journal ISSN
Volume Title
Publisher
Pusat Pengajian Sains Perubatan Universiti Sains Malaysia
Abstract
Obesity is a condition of excess body fat and it significantly increases the risk of
coronary heart disease. Studies have shown that impaired haemostatic in obesity
were found to predict future development of coronary heart disease and numbers of
coronary events. The purpose of this study was to determine the effects of
COMBINE program on the changes of anthropometry parameters, biochemical
profile and haemostatic markers in obese subjects. The assessment was carried out on
28 obese subjects for 12-week duration. All subjects were required to give an
informed consent before enrolling into the study. Anthropometric data were
measured from the subjects selected before intervention (baseline) and after
completing the program (post-intervention). About 15 ml of blood specimen was
drawn from all subjects and tested for biochemical profile (e.g. fasting blood glucose
and lipid profile) and haemostatic markers, such as fibrinogen, factor VII, thrombin
activatable fibrinolytic inhibitors (TAFI), tissue plasminogen activators (t-PA),
plasminogen activator inhibitors-1(PAI-1), plasminogen and Heparin Cofactor II at
baseline and at post intervention. During this intervention period, the subjects were
involved in a weekly program from 8.00 am until 1.00 pm on every Thursday at
Hospital Universiti Sains Malaysia. The package of weight loss program consisted of
brisk walking, dumb bell and easy-style of aerobic dance accompanied with nutrition
education modules. Their food intake and physical activity were recorded in diary
and they act as important tools in the behaviour modification method. Data analysis
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for this study was carried out using paired t-test, SPSS 18.0. In order to correlate the
haemostatic markers with other parameters, Spearman`s rho correlation analysis was
used. The significant level, p< 0.05 was used. The results showed that there was a
significant reduction in the BMI at post intervention (33.22 ± 0.67 kg/m²) when
compared to pre intervention (35.78 ± 0.82 kg/m²). Similarly, there was a significant
reduction (p<0.05) for other anthropometric data such as waist circumference and
body composition analysis. Besides that there was also significant reduction in five
haemostatic markers such as fibrinogen, factor VII, TAFI, t-PA and PAI-1 at postintervention
when compared to baseline. Similarly, there was a significant reduction
in triglyceride level at the baseline (1.73 ± 0.18 mmol/L) compared to postintervention,
(1.24 ± 0.07mmol/L) (p< 0.05). Meanwhile there was a significant
increased level of Heparin Cofactor II after the intervention (119.89 ± 3.58%)
compared to baseline (105.22 ± 4.42%) (p< 0.05). But, there was no significant
difference seen in plasminogen level as well as in cholesterol, high density
lipoprotein, low density lipoprotein and fasting blood glucose levels. In conclusion,
the non-pharmacologic approach as an intervention is considered a successful
program based on the positive findings such as reduced haemostatic hazard markers
and improved other parameters such as physical parameters and biochemical
markers. These markers should be further explored to be utilised as predictors to
determine the effectiveness of a weight loss program and to predict the risk to
develop cardiovascular disease in obese subjects.
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Keywords
General Medicine