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
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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 xviii 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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General Medicine
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