Introduction
Chronic diseases, such as heart disease, diabetes, and hypertension, are long-lasting conditions that have become a significant health concern globally. These diseases not only decrease the quality of life for millions but also contribute to high healthcare costs and increased mortality rates. Despite their prevalence, many chronic diseases are preventable and manageable through lifestyle modifications.
The importance of lifestyle changes in the treatment and reversal of chronic diseases cannot be overstated. Adopting a healthy diet, engaging in regular physical activity, managing stress, and ensuring adequate sleep are foundational steps in combating chronic illnesses. These lifestyle improvements can significantly reduce the risk factors associated with chronic diseases, leading to better health outcomes and enhanced quality of life.
In addition to lifestyle changes, regular monitoring of specific biomarkers plays a crucial role in the effective prevention and reversal of chronic diseases. Biomarkers, such as blood glucose levels, inflammation markers, and cholesterol levels, provide critical insights into an individual’s health status. By regularly tracking these biomarkers, individuals and healthcare practitioners can identify early warning signs of chronic diseases, make informed decisions about treatment plans, and assess the effectiveness of lifestyle interventions.
By combining lifestyle modifications with regular biomarker monitoring, individuals can take proactive steps towards preventing and reversing chronic diseases. This integrated approach empowers individuals to take control of their health and work collaboratively with healthcare practitioners to achieve optimal health outcomes. In the following sections, we will explore the power of lifestyle changes, key biomarkers to monitor, and practical strategies for prevention and reversal of chronic diseases.
1. The Power of Lifestyle Changes
How Lifestyle Improvements Can Treat Chronic Diseases
Chronic diseases, such as type 2 diabetes, cardiovascular disease, and hypertension, are often influenced by lifestyle factors. Making significant lifestyle improvements can help manage, treat, and even reverse these conditions. By focusing on a holistic approach to health; encompassing proper nutrition, regular physical activity, stress management, and sufficient sleep; individuals can drastically improve their health outcomes. As the WHO constitution states, “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”
Importance of Diet, Exercise, Stress Management, and Sleep
Diet: A balanced diet rich in whole foods, such as fruits, vegetables, whole grains, lean proteins, and healthy fats, is essential for managing chronic diseases. Diets high in processed foods, sugar, and unhealthy fats contribute to inflammation and metabolic imbalances, exacerbating chronic conditions. Nutritional improvements can lower blood pressure, reduce cholesterol levels, and stabilize blood sugar, making it easier to manage diseases like diabetes and heart disease.
Exercise: Regular physical activity is crucial for overall health and particularly beneficial for those with chronic diseases. Exercise helps control weight, improve cardiovascular health, increase insulin sensitivity, and reduce inflammation. Even moderate activities, such as walking, swimming, or cycling, can make a significant difference. The key is consistency and finding enjoyable activities that can be sustained long-term.
Stress Management: Chronic stress negatively impacts physical health, contributing to conditions like hypertension, heart disease, and diabetes. Effective stress management techniques, such as mindfulness, meditation, yoga, and deep-breathing exercises, can reduce stress hormones and promote relaxation. Reducing stress not only helps manage chronic diseases but also improves mental health and overall well-being.
Sleep: Adequate sleep is essential for the body’s repair and regeneration processes. Poor sleep quality or insufficient sleep can lead to hormonal imbalances, increased inflammation, and higher risk of chronic diseases. Prioritizing good sleep hygiene, such as maintaining a regular sleep schedule, creating a restful environment, and avoiding stimulants before bedtime, is crucial for managing chronic conditions.
Case Studies and Testimonials Showcasing Successful Lifestyle Interventions
Case Study 1: Reversing Type 2 Diabetes through Diet and Exercise
John, a 50-year-old man diagnosed with type 2 diabetes, struggled with managing his blood sugar levels despite medication. After consulting with a nutritionist and adopting a whole-food, plant-based diet, combined with a daily exercise routine, John experienced remarkable improvements. Within six months, he lost 10 kilograms, his HbA1c levels dropped to normal ranges, and he reduced his dependency on medication. John’s commitment to lifestyle changes not only helped him reverse his diabetes but also improved his overall health and energy levels.
Case Study 2: Managing Hypertension through Stress Reduction and Diet
Maria, a 45-year-old woman with hypertension, found it challenging to control her blood pressure with medication alone. She decided to incorporate stress reduction techniques, such as yoga and meditation, into her daily routine. Additionally, Maria switched to a DASH (Dietary Approaches to Stop Hypertension) diet, rich in fruits, vegetables, and low-fat dairy products. Over a year, Maria’s blood pressure stabilized within a healthy range, allowing her to reduce her medication dosage. The combination of stress management and dietary changes significantly improved her condition and overall quality of life.
Testimonial: Improving Cardiovascular Health through Comprehensive Lifestyle Changes
David, a 60-year-old man with a family history of heart disease, adopted a comprehensive lifestyle change approach after a heart attack scare. He embraced a Mediterranean diet, focusing on healthy fats, lean proteins, and abundant vegetables. David incorporated regular physical activities, such as brisk walking and swimming, and practiced mindfulness meditation to manage stress. Within a year, David’s cholesterol levels improved, his weight decreased, and he felt more energetic and healthier than ever. David’s story highlights the profound impact that holistic lifestyle changes can have on cardiovascular health.
These case studies and testimonials underscore the transformative power of lifestyle changes in managing and reversing chronic diseases. By focusing on diet, exercise, stress management, and sleep, individuals can take proactive steps towards better health and improved quality of life. Remember, true health encompasses not just the absence of disease, but a holistic state of well-being.
2. Key Biomarkers for Monitoring Health
Biomarkers are biological indicators that provide valuable insights into an individual’s health status. They are measurable substances in the body that can reflect physiological or pathological processes. Monitoring biomarkers is essential in chronic disease management as they help assess disease risk, progression, and response to treatment. Regularly tracking these biomarkers enables healthcare providers and individuals to make informed decisions about health strategies and interventions.
Key Biomarkers
- Homeostasis Model Assessment (HOMA) Insulin Resistance
The Homeostasis Model Assessment (HOMA) is a method used to quantify insulin resistance and beta-cell function. It involves measuring fasting blood glucose and insulin levels. Insulin resistance is a condition where the body’s cells become less responsive to insulin, leading to higher blood sugar levels. This is a precursor to type 2 diabetes and is associated with various metabolic disorders.
Significance: Assessing insulin sensitivity is crucial for identifying individuals at risk of developing type 2 diabetes and other metabolic diseases. Early detection allows for interventions that can improve insulin sensitivity through diet, exercise, and medication. - Glycated Hemoglobin (HbA1c)
Glycated hemoglobin (HbA1c) is a biomarker that reflects the average blood sugar levels over the past two to three months. It measures the percentage of hemoglobin in the blood that has glucose attached to it.
Significance: Monitoring HbA1c is essential for managing diabetes. It provides a long-term view of blood sugar control, helping to assess how well diabetes is being managed and whether treatment plans need adjustment. Keeping HbA1c levels within a target range reduces the risk of diabetes-related complications. - High-Sensitivity C-Reactive Protein (hsCRP)
High-sensitivity C-reactive protein (hsCRP) is a protein produced by the liver in response to inflammation, measured through blood tests.
Significance: Elevated levels of hsCRP indicate systemic inflammation, which is linked to various chronic diseases, including cardiovascular disease, diabetes, and autoimmune disorders. It serves as a valuable marker for assessing overall health risks. - F2-isoprostanes (Oxidative Stress Indicator)
F2-isoprostanes are compounds formed by the free radical-catalyzed peroxidation of arachidonic acid, a type of fatty acid. They are considered one of the most reliable biomarkers for assessing oxidative stress.
Significance: Oxidative stress occurs when there is an imbalance between free radicals and antioxidants in the body, leading to cellular damage. This is implicated in the development of many chronic diseases, including cardiovascular disease, neurodegenerative diseases, and cancer. Measuring F2-isoprostanes helps assess the level of oxidative damage and the body’s antioxidant status. - Vitamin D 25 OH
Vitamin D, often referred to as the “sunshine vitamin,” is crucial for maintaining overall health. The 25-hydroxyvitamin D (25 OH) test is the most accurate way to measure how much vitamin D is in the body. Vitamin D plays a vital role in calcium absorption, bone health, immune function, and reducing inflammation.
Significance: Adequate levels of vitamin D are essential for maintaining strong bones and teeth, supporting the immune system, brain, and nervous system, and regulating insulin levels. Deficiency in vitamin D can lead to bone disorders such as rickets in children and osteomalacia or osteoporosis in adults. It has also been linked to an increased risk of chronic diseases such as cardiovascular disease, diabetes, and certain cancers. - Apolipoprotein B (ApoB)
Apolipoprotein B (ApoB) is a primary protein component of low-density lipoprotein (LDL), often referred to as “bad cholesterol.” It plays a crucial role in lipid metabolism and is a key indicator of cardiovascular health.
Significance: High levels of ApoB are associated with an increased risk of atherosclerosis, where arteries become clogged with fatty substances, leading to cardiovascular diseases such as heart attack and stroke. Measuring ApoB provides a more accurate risk assessment for cardiovascular disease than traditional LDL cholesterol measurements alone. - Homocysteine
Homocysteine is an amino acid in the blood, and its levels are influenced by diet and genetic factors. Elevated homocysteine levels are a known risk factor for cardiovascular diseases.
Significance: High homocysteine levels can damage the lining of the arteries, promote blood clot formation, and lead to arterial blockages, increasing the risk of heart attack, stroke, and other cardiovascular conditions. Monitoring homocysteine levels helps in assessing cardiovascular risk and guiding dietary and lifestyle interventions. - Cystatin C
Cystatin C is a protein that is produced by all nucleated cells and is filtered out of the blood by the kidneys. It serves as a marker for estimating the glomerular filtration rate (GFR), a key indicator of kidney function.
Significance: Measuring cystatin C levels provides a reliable assessment of kidney function, often more accurately than traditional creatinine-based tests, especially in individuals with normal or mildly impaired kidney function. Early detection of kidney dysfunction through cystatin C measurement allows for timely intervention to prevent further deterioration. - Waist Circumference
Waist circumference is a simple and effective measure of central obesity, which is the accumulation of excess fat around the abdomen. It is a strong predictor of metabolic risk and chronic diseases.
Significance: Excess abdominal fat is associated with a higher risk of metabolic syndrome, type 2 diabetes, cardiovascular disease, and certain cancers. Measuring waist circumference helps in identifying individuals at higher risk of these conditions. A waist circumference above 102 cm (40 inches) in men and 88 cm (35 inches) in women indicates central obesity.
Monitoring these key biomarkers is vital for proactive health management and chronic disease prevention. Regular assessments can help individuals and healthcare providers identify potential health risks, track progress, and adjust lifestyle interventions accordingly. By staying informed about these biomarkers, individuals can take meaningful steps toward improving their health and overall well-being.
3. Importance of Regular Monitoring
Regular monitoring of biomarkers is essential in the management and prevention of chronic diseases. By consistently assessing key health indicators, individuals and healthcare practitioners can gain valuable insights into the body’s physiological state. This proactive approach allows for timely interventions, adjustments in treatment plans, and the ability to track progress over time. Regular monitoring empowers individuals to take control of their health and fosters a collaborative relationship with their healthcare providers.
Recommended Frequency for Testing Biomarkers
To maximize the benefits of monitoring, it is generally recommended that key biomarkers be tested every six months. This frequency allows for timely detection of any significant changes in health status, facilitating early intervention before conditions progress. For individuals with existing chronic diseases or those at high risk, more frequent testing may be necessary based on individual circumstances and medical advice.
How Regular Monitoring Helps in Early Detection of Potential Issues and Timely Interventions
Regular biomarker assessments play a crucial role in early detection of potential health issues. For instance, consistent tracking of HbA1c levels can reveal trends in blood sugar control, enabling healthcare providers to adjust diabetes management plans proactively. Similarly, monitoring hsCRP levels can signal rising inflammation, prompting timely interventions that could prevent the onset of cardiovascular diseases.
Early detection through regular monitoring can lead to improved outcomes, as it allows for more personalized and responsive healthcare strategies. By identifying issues before they escalate, individuals can avoid complications and enhance their overall quality of life.
Where Regular Monitoring Made a Significant Difference
Case Study 1: Early Intervention in Diabetes Management
Sarah, a 48-year-old woman with a family history of diabetes, began regular monitoring of her biomarkers every six months. During one of her routine checks, her HbA1c level was found to be rising, indicating a decline in her blood sugar control. With this early detection, her healthcare team implemented dietary changes and increased her physical activity. Over the next few months, her HbA1c levels improved significantly, preventing the onset of full-blown diabetes.
Case Study 2: Cardiovascular Health Monitoring
Mark, a 55-year-old man, had a history of high cholesterol and elevated hsCRP levels. By regularly monitoring these biomarkers, his healthcare provider noted a troubling increase in hsCRP, signaling rising inflammation. This prompted a comprehensive review of Mark’s lifestyle, leading to changes in diet and an increase in physical activity. Within a year, his hsCRP levels decreased, significantly lowering his risk for cardiovascular events.
Case Study 3: Kidney Function Assessment
Lisa, a 62-year-old woman, had been monitored for cystatin C levels due to her chronic hypertension. Regular testing revealed a gradual increase in her cystatin C levels, indicating declining kidney function. This early detection allowed her doctor to adjust her medication and implement dietary modifications to protect her kidney health, ultimately preventing more severe complications.
Regular monitoring of biomarkers is a fundamental aspect of effective chronic disease management and prevention. By testing key indicators every six months, individuals can ensure timely interventions and stay on top of their health. Through consistent monitoring, individuals can achieve better health outcomes and live healthier, more fulfilling lives.
4. Prevention Strategies
Preventing chronic diseases involves maintaining healthy levels of key biomarkers through lifestyle modifications. Here are some strategies to help maintain optimal health:
Tips for Maintaining Healthy Levels of Each Biomarker
- HOMA: Maintain a balanced diet low in refined sugars and high in fiber, engage in regular physical activity, and manage stress levels.
- HbA1c: Follow a low-glycemic index diet, monitor carbohydrate intake, and maintain regular exercise.
- hsCRP: Adopt an anti-inflammatory diet rich in fruits, vegetables, and omega-3 fatty acids, and manage stress through mindfulness practices.
- F2-isoprostanes: Increase intake of antioxidant-rich foods, reduce exposure to environmental toxins, and practice regular physical activity.
- Vitamin D 25 OH: Ensure adequate sun exposure, consume vitamin D-rich foods, and consider supplementation if necessary.
- Apolipoprotein B: Follow a heart-healthy diet, engage in regular cardiovascular exercise, and manage cholesterol levels.
- Homocysteine: Include foods rich in folate, vitamin B6, and B12, such as leafy greens, legumes, and lean meats.
- Cystatin C: Maintain blood pressure and blood sugar levels, stay hydrated, and avoid nephrotoxic substances.
- Waist Circumference: Focus on overall weight management through a balanced diet and regular exercise.
Dietary Recommendations, Including Specific Foods to Include and Avoid
Include: Leafy greens, whole grains, lean proteins, nuts, seeds, fruits, and vegetables.
Avoid: Processed foods, sugary beverages, trans fats, and high-sodium foods.
Exercise Guidelines
Cardiovascular Exercise: Aim for at least 150 minutes of moderate-intensity aerobic activity per week.
Strength Training: Include muscle-strengthening activities on two or more days a week.
Flexibility and Balance: Incorporate stretching and balance exercises to enhance overall fitness.
Stress Management Techniques and Their Impact on Chronic Disease Prevention
Chronic stress negatively impacts biomarkers such as hsCRP and insulin resistance. Implementing stress management techniques like mindfulness meditation, deep breathing exercises, yoga, and adequate sleep can significantly improve overall health and reduce chronic disease risk.
Importance of Regular Monitoring and Follow-ups with Healthcare Providers
Regular monitoring and follow-ups with healthcare providers ensure that health strategies are effective and adjusted as necessary. Healthcare providers can offer personalized advice, monitor progress, and support patients in maintaining healthy lifestyles. Consistent engagement with healthcare professionals enhances accountability and provides a structured approach to disease prevention and management.
Regular monitoring of key biomarkers is fundamental to effective chronic disease management and prevention. By understanding and tracking these biomarkers, individuals can make informed decisions about their health, catch potential issues early, and implement timely interventions. Coupled with healthy lifestyle choices, regular biomarker testing can significantly enhance health outcomes. Embrace these strategies and work closely with healthcare providers to prioritize your health and well-being.
5. Reversal of Chronic Diseases
Reversing chronic diseases through lifestyle changes is not just a hopeful notion but a proven reality supported by numerous success stories and scientific evidence. By making dedicated efforts to improve diet, increase physical activity, manage stress, and monitor biomarkers, many individuals have successfully reversed the progression of chronic conditions.
Success Stories and Evidence Supporting the Reversal of Chronic Diseases through Lifestyle Changes
One notable example is John, a 55-year-old man diagnosed with type 2 diabetes. By adopting a low-carbohydrate, high-fiber diet, engaging in regular exercise, and closely monitoring his blood glucose and HbA1c levels, John managed to bring his blood sugar levels back to normal within a year, reducing his dependence on medication and reversing his diabetes.
Another example is Letitia, who struggled with cardiovascular disease. By following a plant-based diet rich in antioxidants, engaging in regular aerobic exercise, and reducing stress through mindfulness practices, Letitia significantly improved her heart health, evidenced by lower cholesterol levels and reduced inflammation markers such as hsCRP.
These success stories are backed by scientific research. Studies published in leading medical journals have shown that lifestyle interventions can lead to substantial improvements in health outcomes, often reversing the course of chronic diseases. For instance, research has demonstrated that intensive lifestyle changes can reverse coronary artery disease and that a whole-food, plant-based diet can lead to significant improvements in type 2 diabetes management.
Step-by-Step Guide on How to Implement Lifestyle Changes to Reverse Chronic Conditions
- Assess and Set Clear Goals: Begin with a thorough assessment of current health status, including biomarker levels and lifestyle habits. Set realistic and specific goals for improvement.
- Create a Balanced Diet Plan: Adopt a balanced diet rich in whole foods, such as fruits, vegetables, whole grains, lean proteins, and healthy fats. Reduce intake of processed foods, refined sugars, and unhealthy fats.
- Establish a Regular Exercise Routine: Incorporate regular physical activity into your daily routine. Aim for at least 150 minutes of moderate-intensity aerobic exercise per week, complemented by strength training and flexibility exercises.
- Manage Stress Effectively: Practice stress reduction techniques such as mindfulness meditation, yoga, deep breathing exercises, and adequate sleep.
- Monitor Biomarkers Regularly: Track key biomarkers regularly (for example every 6 months) to monitor progress and make necessary adjustments to your lifestyle and treatment plan.
- Be Consistent and Patient: Maintain consistency in implementing lifestyle changes and be patient. Reversing chronic diseases is a gradual process that requires sustained effort.
- Stay Educated and Motivated: Continuously seek out information on health and wellness. Join support groups or communities that encourage positive lifestyle changes.
Role of Healthcare Practitioners in Supporting Individuals
Healthcare practitioners play a critical role in the journey toward reversing chronic diseases. They provide essential guidance, support, and accountability throughout the process. Practitioners can help:
- Develop personalized health plans that align with individual goals.
- Monitor biomarker levels and interpret results to guide decision-making.
- Offer encouragement and motivation during challenging times.
- Educate individuals about the importance of lifestyle changes and their impact on health.
By working together, individuals and healthcare providers can create a comprehensive approach to reversing chronic diseases and fostering long-term wellness.
6. Practical Tips for Individuals and Practitioners
How Individuals Can Incorporate Lifestyle Changes into Their Daily Routines
Incorporating lifestyle changes into daily routines can feel daunting, but starting with small steps makes the process manageable. Individuals can begin by making one or two simple changes, such as swapping sugary drinks for water or committing to a short daily walk. Gradually increasing these changes helps build momentum and fosters long-term habits.
Planning healthy meals is essential, so setting aside time each week for meal preparation can be beneficial. By focusing on whole foods and incorporating plenty of fruits, vegetables, and whole grains, individuals can create nutritious and satisfying meals. Scheduling physical activity is equally important; individuals should block out time in their calendars for exercise, aiming for at least 30 minutes of moderate activity each day.
In addition to scheduled workouts, finding opportunities to incorporate movement throughout the day can make a big difference. This could include taking the stairs instead of the elevator, parking further away from entrances, or taking short walking breaks during work hours. Practicing mindfulness is another valuable strategy; dedicating a few minutes each day to mindfulness or meditation can help reduce stress and improve overall well-being.
Tracking progress is crucial for motivation, and individuals can keep a journal or use apps to log food intake, exercise, and biomarker results. This not only helps visualize progress but also encourages accountability.
Tips for Healthcare Practitioners to Support and Motivate Individuals
Healthcare practitioners play a vital role in guiding individuals through lifestyle changes. Building strong relationships based on trust and open communication is essential. Practitioners should show empathy and understanding to create a supportive environment that encourages individuals to share their challenges and successes.
Setting realistic goals is another critical aspect of support. Working together to establish achievable, personalized health goals helps individuals focus on progress rather than perfection. Providing educational resources about chronic disease management, healthy eating, and exercise empowers individuals with the knowledge they need to make informed decisions.
Regular follow-up appointments are crucial for discussing progress and celebrating successes. Practitioners should encourage individuals to return for check-ins, allowing for ongoing support and motivation. Celebrating small wins, no matter how minor they may seem, can significantly boost a patient’s motivation to continue on their health journey.
Tools and Resources for Tracking Progress and Maintaining Motivation
To facilitate tracking progress, various tools and resources are available. Mobile apps like MyFitnessPal, Lose It! or Lifesum can assist individuals in monitoring food intake and exercise, helping them stay accountable for their health goals. Wearable devices, such as Fitbit or Apple Watch, provide a practical way to track physical activity levels and motivate users to meet daily goals.
Encouraging individuals to keep a health journal can also be beneficial. By logging daily meals, exercise, mood, and biomarker levels, individuals gain valuable insights into their health and foster self-awareness. Joining local or online support groups can create a sense of community and encourage individuals to share their experiences, challenges, and successes with others on similar journeys.
Directing individuals to reputable educational websites, such as the American Heart Association or Diabetes.org, can provide them with evidence-based information on lifestyle changes and chronic disease management. These resources can help reinforce their commitment to healthier living.
Conclusion
In summary, making lifestyle changes and regularly monitoring biomarkers is vital for managing and reversing chronic diseases. By adopting healthier habits and maintaining consistent check-ups, individuals can significantly improve their health outcomes.
It’s essential to start small and gradually implement changes, focusing on sustainable lifestyle adjustments that can lead to long-term success. Both individuals and healthcare practitioners play crucial roles in this journey, prioritizing prevention and fostering healthier communities.
Start today, take small steps, and gradually implement changes for a healthier future. Whether you’re an individual taking the first steps toward better health or a practitioner guiding your individuals, together, we can make a meaningful difference in the fight against chronic diseases.
Key Biomarker Tests
References
- Wharton, S. et al. Obesity in adults: a clinical practice guideline. CMAJ 192, E875–E891 (2020).
- Wright, N., Wilson, L., Smith, M., Duncan, B. & McHugh, P. The BROAD study: A randomised controlled trial using a whole food plant-based diet in the community for obesity, ischaemic heart disease or diabetes. Nutr & Diabetes 7, e256–e256 (2017).
- ElSayed, N. A. et al. 2. Classification and Diagnosis of Diabetes: Standards of Care in Diabetes – 2023. Diabetes Care 46, S19–S40 (2023).
- ElSayed, N. A. et al. 3. Prevention or Delay of Diabetes and Associated Comorbidities: Standards of Care in Diabetes – 2023. Diabetes Care 46, S19–S40 (2023).
- ElSayed, N. A. et al. 8. Obesity and Weight Management for the Prevention and Treatment of Type 2 Diabetes: Standards of Care in Diabetes – 2023. Diabetes Care 46, S128–S139(2023).
- Gropper, S. S. The Role of Nutrition in Chronic Disease. Nutrients 15, 664 (2023).
- Malik, V. S. & Hu, F. B. Sugar-Sweetened Beverages and Cardiometabolic Health: An Update of the Evidence. Nutrients 11, 1840 (2019).
- Dorcely, B. et al. Novel biomarkers for prediabetes, diabetes, and associated complications. DMSO Volume 10, 345–361 (2017).
- Kahn, S., Hull, R. & Utzschneider, K. Mechanisms linking obesity to insulin resistance and type 2 diabetes. Nature 444, 840–846 (2006).
- Shoelson, S. E. Inflammation and insulin resistance. Journal of Clinical Investigation 116, 1793–1801 (2006).
- Carson, T. L., Hidalgo, B., Ard, J. D. & Affuso, O. Dietary Interventions and Quality of Life: A Systematic Review of the Literature. Journal of Nutrition Education and Behavior 46, 90–101 (2014).
- Lichtenstein, A. H. et al. 2021 Dietary Guidance to Improve Cardiovascular Health: A Scientific Statement From the American Heart Association. Circulation 144, (2021).
- Holick MF. Vitamin D deficiency. N Engl J Med. Jul 19, 357, 266-81 (2007).
- Califf, R. M. Biomarker definitions and their applications. Exp Biol Med (Maywood) 243, 213–221 (2018).
- Uusitupa, M. et al. Prevention of Type 2 Diabetes by Lifestyle Changes: A Systematic Review and Meta-Analysis. Nutrients 11, 2611 (2019).
- Reaven GM. The insulin resistance syndrome: definition and dietary approaches to treatment. Annu Rev Nutr. 25, 391-406 (2005)
- Centers for Disease Control and Prevention. About Chronic Diseases. Available at: https://www.cdc.gov/chronicdisease/about/index.htm (Accessed: 2024).
- National Heart, Lung, and Blood Institute. Maintaining a Healthy Weight. Available at: https://www.nhlbi.nih.gov/health/educational/lose_wt/ (Accessed: 2024).
- Rao, D. P., Dai, S., Lagace, C. & Krewski, D. Metabolic syndrome and chronic disease. Chronic Diseases and Injuries in Canada 34, (2014).
- Bays, H. E. et al. Ten things to know about ten cardiovascular disease risk factors. American Journal of Preventive Cardiology 5, 100149 (2021).
- Wiklund, P. The role of physical activity and exercise in obesity and weight management: Time for critical appraisal. Journal of Sport and Health Science 5, 151–154 (2016).
- Eijsvogels, T. M. H., Molossi, S., Lee, D., Emery, M. S. & Thompson, P. D. Exercise at the Extremes. Journal of the American College of Cardiology 67, 316–329 (2016).
- Bischoff, S. C. et al. ESPEN practical guideline: Clinical nutrition in liver disease. Clinical Nutrition 39, 3533–3562 (2020).
- Masenga, S. K., Kabwe, L. S., Chakulya, M. & Kirabo, A. Mechanisms of Oxidative Stress in Metabolic Syndrome. IJMS 24, 7898 (2023).
- Ruiz, L. D., Zuelch, M. L., Dimitratos, S. M. & Scherr, R. E. Adolescent Obesity: Diet Quality, Psychosocial Health, and Cardiometabolic Risk Factors. Nutrients 12, 43 (2019).
- Boden, G. Obesity and Free Fatty Acids. Endocrinology and Metabolism Clinics of North America 37, 635–646 (2008).
- Boden, G. Obesity, insulin resistance and free fatty acids. Current Opinion in Endocrinology, Diabetes & Obesity 18, 139–143 (2011).