American Journal of Lifestyle Medicine最新文献

Chronic kidney disease (CKD) is a major public health problem and the prevalence of CKD is substantially higher in older adults. Similarly insufficient sleep and abnormal sleep duration is more common among older adults. However, the relation between sleep duration and CKD has not been widely examined in older adults. We examined the association between long and short sleep duration and CKD in a large, multiethnic sample of older US adults aged ≥60 years (N = 178 268) who participated in the 2022 Behavioral Risk Factor Surveillance System. Sleep duration was categorized into 5 groups: ≤5, 6, 7, 8, and ≥9 h. Main outcome-of-interest was CKD (prevalence = 7.3%). We found both short and long sleep duration to be associated with higher prevalence of CKD. Compared to 7 hours of sleep (referent), the multivariable-adjusted odds ratio (95% confidence interval) of CKD was 1.32 (1.16-1.51) for 6 h of sleep, 1.55 (1.33-1.81) for ≤5 h of sleep, 1.27 (1.12-1.43) for 8 h of sleep, and 1.41 (1.23-1.62) for ≥9 h of sleep. The association was consistently present in subgroup analyses by gender, age, race/ethnicity, and body mass index. In conclusion, both short and long sleep durations are associated with CKD in older adults.

Fibromyalgia is a complex, chronic disorder characterized by widespread musculoskeletal pain, fatigue, sleep disturbances, and cognitive dysfunction. While pharmacologic treatments remain the mainstay of symptom management, their long-term efficacy is limited and often accompanied by undesirable side effects. As a result, there is growing interest in non-pharmacologic interventions, particularly dietary therapies. Emerging literature suggests that whole food plant-based (WFPB) diets, which emphasize fresh fruits, vegetables, legumes, and whole grains while eliminating animal products and processed foods, may reduce systemic inflammation, improve pain thresholds, and enhance overall quality of life in chronic pain populations. Preliminary studies have shown promising associations between plant-based eating patterns and reductions in pain, fatigue, and depressive symptoms in fibromyalgia patients; however, evidence remains limited by small sample sizes, heterogeneous dietary definitions, and varying outcome measures. This literature review synthesizes current evidence on the potential role of WFPB diets in fibromyalgia management, highlights biological mechanisms underlying dietary influence on pain and inflammation, and identifies methodological gaps in the literature. By synthesizing and critically evaluating existing literatures, this review is both an exploratory commentary and a call for further research on the role of WFPB diets in fibromyalgia.

The United States continues to face rising healthcare costs, with Federally Qualified Health Centers (FQHCs) disproportionately affected by the complexity of the populations they serve. Traditional payment models often fail to reflect these realities, limiting value-based care. This article describes a 4-year value-based care pilot at Waianae Coast Comprehensive Health Center, developed with a nonprofit Medicaid health plan and supported by artificial intelligence (AI) and natural language processing (NLP) analytics. The pilot aligned payment with population complexity and total cost of care management using predictive risk and impactability analytics embedded in clinical workflows. By integrating claims data with NLP-derived insights from unstructured clinical notes, the model identified high-risk patients and delivered targeted lifestyle and enabling services, including food-as-medicine interventions. In the first year, services delivered to 884 patients reduced total costs by $806,208 while maintaining access and quality. A produce prescription program generated net savings of $118 per patient per month alongside improvements in hemoglobin A1c. Over 4 years, the approach served more than 3000 patients, generating approximately $4 million in sustained savings. These findings demonstrate that value-based care can succeed in FQHCs when supported by accurate risk adjustment, advanced analytics, and payer-provider collaboration, positioning lifestyle medicine as a cost-effective strategy.

Stroke is a leading cause of mortality and disability, affecting approximately 13.7 million individuals globally each year. It is broadly classified as ischemic or hemorrhagic and often results in cognitive, motor, and emotional impairments. Lifestyle interventions are associated with lower stroke risk and recurrent events, and are core to guideline-based prevention; effect sizes vary by risk factor, adherence, and setting. This review begins with the pathophysiology of stroke, focusing on the roles of sex hormones, genetics, environment, and lifestyle. We then outline how lifestyle interventions can aid in primary and secondary prevention of stroke by targeting modifiable risk factors responsible for approximately 90% of stroke risk, including hypertension, diabetes, high cholesterol, poor diet, sedentary behavior, abdominal obesity, psychological stress, smoking, cardiac causes, and alcohol use. We also discuss clinical implementation, policy strategies, health equity, cost-effectiveness, and future directions. These insights highlight the critical role of lifestyle medicine in stroke prevention, aimed at reducing the global stroke burden.

Dietary interventions for disease prevention have been well studied, yet standard American diets often fall short. Limited culinary skills and nutritional literacy are key contributors. Shared medical appointments (SMAs) with culinary education offer one solution to enhance culinary and nutrition literacy. In our model, patients were recruited from the University of Texas Southwestern Culinary Medicine Clinic to participate in a culinary medicine-focused SMA program located in local church kitchens in Dallas, TX including 6 classes over 2 months. Classes, led by a physician and culinary dietitian, included goal-setting, culinary skill demonstration, and supervised cooking. Classes were billed as primary care visits through patients' insurance. Health records and patient reported data were collected to assess feasibility. Sixty patients from four cohorts of SMAs had a 75% average attendance. Patients were predominantly Black (55%) and female (87%). Hypertension, diabetes, and obesity were the most common referral diagnoses. Qualitative telephone interviews (n = 18) reveal that co-learning new skills with peers is an important contributor to patient engagement. In conclusion, culinary medicine-focused SMAs are a feasible approach to deliver culinary nutrition education, demonstrate high levels of engagement and retention, and lay the foundation for a financially sustainable model.

This transdisciplinary, evidence-based viewpoint draws attention to literature suggesting that formalized plant-based lifestyle interventions have the potential to reduce the risk of COVID-19 and non-communicable diseases. Such interventions also offer the health sector a way to contribute to mitigating the risk of new zoonotic diseases and reducing carbon emissions (and, consequently, climate-change-induced diseases), all of which would help lower the overall disease burden. However, several challenges must be addressed to incorporate plant-based lifestyle interventions into clinical medicine. These include generating more methodologically robust and convincing evidence on the COVID-19-diet link, enhancing physicians' understanding of plant-based diets, and ensuring equitable access to affordable, culturally inclusive, nutritionally adequate, and appealing plant-based foods. Contextual barriers, such as counteraction from profit-driven industries, and personal barriers, such as psychological resistance, must also be acknowledged and mitigated. While not without obstacles, plant-based lifestyle interventions merit consideration given their multifaceted potential to enhance both human and planetary health.