Table 3.
Benefits of lifestyle intervention and surgery on neurological complications
| Method | Age (years); Sample Size | Metabolic Selection Criteria | Study Duration | Metabolic Observations | Neurological Observations | Ref. |
|---|---|---|---|---|---|---|
| Cognitive impairment, dementia risk and cerebral volume/integrity | ||||||
| Caloric restriction | 60.5±7.6; n=50 | Normal to overweight subjects (mean BMI of 28±3.7) | 3 months | Decreased BMI (0.8), CRP (0.22pg/mL) and insulin (3.5 μIU/mL) | Improved memory performance (increase in verbal memory score) | 125 |
| Caloric restriction, dietary changes and exercise | 52.3±9.6; n=124 | BMI=25–40 (mean BMI of 32.8±3.8) | 4 months | Decreased BMI (3.3), improved cardiovascular fitness and reduced blood pressure | Improved executive function-memory-learning and psychomotor speed | 126 |
| Intentional weight loss | 56.9±9.7; n=21 | BMI=30–50 (mean BMI of 36.7) | ~4 months | Decreased BMI (3.5) and fat mass (7.5kg) | Improvements in hand-grip strength and cognitive function (Mini-Mental State Examination, Short Portable Mental Status Questionnaire, and Trail-Making Test) | 127 |
| Caloric restriction and exercise | 70±4; n=28 | BMI=37.2±5.4 | 12 months | Decreased body weight (8.6±3.8kg), visceral fat (787±896cm3) and CRP (1.8±3.4mg/dL) and increased insulin sensitivity | Improvement in cognitive function (Mini-Mental State Examination, Word Fluency Test and Trail-Making Test) | 128 |
| Caloric restriction | 50±0.8; n=106 | BMI=33.7±0.4 | 12 months | Decreased body weight (13.7±1.8kg), plasma glucose (5.4mg/dL) and insulin (3.6 μIU/mL) | Improved working memory (Digit span backward test) | 129 |
| Dietary intervention | 61.1±1.6; n=20 (females only) | BMI=27–40 | 6 months | Decreased BMI (3.6), waist circumference (0.04m),plasma insulin (1.3μIU/mL) and FFA(0.13mmol/l) | Improved memory performance, increased hippocampal brain activity using MRI | 130 |
| Caloric-restriction | 60+; n=80 | BMI≥30 | 12 months | Decreased BMI (1.7 ±1.8); Improved HOMA; CRP | Improved memory, cognition and executive function | 102 |
| Diet, exercise, cognitive training | FINGER trial 69.3±4.7; n=1,260 | Baseline BMI=28.3 (no exclusions) | 24 months | Decreased BMI 0.49 (±0.05) | Improved processing speed and executive function | 103 |
| Omega-3 supplementation, exercise, cognitive stimulation | 60–80; n=22 | n/a | 6 months | No significant metabolic improvements | Preserved and increased gray matter volume in intervention group compared to controls, no improvements in cognitive function | 104 |
| Bariatric Surgery | 21–41; n=137 | Patients with morbid obesity | 12 months | Lower BMI | Improved cognitive performance | 116 |
| Polyneuropathy | ||||||
| Diet; exercise | 60±8.4; n=32 | Baseline BMI = 32.1 ±4.4 (pre-diabetics selected) | 12 months | Decreased BMI and total cholesterol | Increased intra epidermal nerve innervation; decreased neuropathic pain | 105 |
| Exercise | 30–70; n=174 | Patients with type 2 diabetes | 12 months | Increased HDL | Increased intra epidermal nerve innervation | 106 |
| Exercise | n=36 | MetS | 6 months | Increased intra epidermal nerve innervation | Increased intra epidermal nerve innervation | 107 |
| Bariatric Surgery | n=17 | Patients with morbid obesity (BMI≥40) | 12 months | Improved BMI, fasting glucose, HbA1C, C-peptide, insulin and HOMA-IR | Neuropathy incidence lower (measures not reported) | 121 |
AD - Alzheimer’s disease; BMI - body mass index; CRP - C-reactive protein; HbA1C - hemoglobin A1C; HDL - high density lipoprotein; HOMA - Homeostatic Model Assessment; FFA - free fatty acids; FINGER: Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability; IR - insulin resistance; MetS - Metabolic Syndrome; MRI – magnetic resonance imaging