Ofra Kalter-Leibovici

Background: Information on the long-term effects of lifestyle interventions after withdrawal among ethnic minority groups is sparse. Objective: To study the long-term cardio-metabolic effects of a 12-month intensive versus moderate culturally congruent lifestyle intervention after program termination. Methods: This is a long-term follow-up of a randomized controlled trial conducted between 2006 and 2008 in a primary care setting. Obese, non-diabetic Arab women aged 35–54 years were included (n=201). Both interventions promoted a calorie-restricted diet and regular physical exercise. The intensive intervention consisted of two monthly physical activity sessions and two monthly meetings with a dietitian. The moderate intervention, designed to follow usual care, consisted of five sessions/year with a dietitian. The main outcome measures were cardio-metabolic risk factors, measured during the trial and after its termination. Results: During a median follow-up of 12 years, women assigned to the intensive intervention had a more favorable BMI trajectory. They were also more likely to have a BMI 2 during follow-up, but this effect diminished over time; hazard ratios (95% confidence intervals) for the intensive vs. moderate intervention were 4.11 (2.17, 7.76) at the intervention end; 2.42 (1.47, 4.01) after 3 years, and 1.43 (0.81, 2.53) after 5 years. Among women with impaired fasting plasma glucose levels at baseline, the intensive intervention was associated with a more favorable glucose trajectory during follow-up. Nevertheless, the lifestyle intervention had no long-term effect on glucose levels among women with normal fasting glucose at baseline. No long-term effects were observed regarding blood pressure, plasma lipid levels, or the incidence of type 2 diabetes. Conclusion: A 12-month intensive lifestyle intervention among obese Arab women had a beneficial effect on BMI after intervention withdrawal, but the likelihood of having a BMI2 diminished over time. It was also associated with an improvement in plasma glucose levels, observed only in women with impaired fasting glucose at baseline. The intervention did not produce sustained long-term improvements in other cardio-metabolic risk factors.

Objectives: To describe the utilization patterns and patient perceptions of individual dietary consultations among people with type 2 diabetes in Israel, and to examine the association between dietary consultation attendance and adherence to the Mediterranean diet. Methods: This cross-sectional study enrolled adults with type 2 diabetes from a specialty diabetes clinic in Israel between July 2022 and May 2023. Participants completed structured interviews in which they were asked to report their perceptions of various diabetes management components, their sources of dietary information, and—among those who had previously attended dietary consultations—their satisfaction with specific aspects of the consultation experience. Medical records were reviewed to determine attendance at dietary consultations. Adherence to the Mediterranean diet was measured using the validated I-MEDAS 17-item questionnaire. Multivariable logistic regression was used to examine the association between attendance at dietary consultation within the past 12 months and adherence to the Mediterranean diet, adjusting for age, sex, socioeconomic status, and obesity (BMI ≥ 30 kg/m²). Results: Overall, 134 patients were interviewed. Their mean age was 69.8 ± 10.7 years, mean diabetes duration was 19.1 ± 9.7 years, and 96.3% were Jewish. Only 29.1% attended a dietary consultation within the past 12 months, and 52.2% had at least one consultation over the preceding 5 years. While 79.9% of participants rated maintaining normal weight and 78.4% rated taking medications as “very helpful” for diabetes control, only 29.9% reported that regular dietitian visits would be “very helpful.” Most participants (74.6%) were unable to name a specific dietary pattern they were following. Among those who recalled ever attending dietary consultations, most reported in interviews that recommendations were culturally aligned with their preferences. No association was found between recent attendance at dietary consultations and adherence to the Mediterranean diet (adjusted OR 1.03, 95% CI 0.39–2.74). Conclusions: Despite having accessible and affordable individual dietary consultations, the utilization of this service remains low, and patient-reported benefit limited. These exploratory findings point to perception-based barriers to engagement that warrant further investigation.

Caregiving can provide purpose and life satisfaction but is often linked to increased burden and reduced quality of life. Understanding mechanisms influencing caregivers’ experiences is crucial for effective support. One key factor is illness integration—the extent to which caregivers incorporate the patient’s illness into their identity. Caregivers may feel engulfed, reject, accept, or find enrichment in the illness, shaping their psychological outcomes. This study examines the relationships between illness integration, care burden, well-being, and attachment orientation to illuminate identity processes in caregiving and guide interventions to reduce strain and foster resilience. The results from our cross-sectional online survey of 162 informal caregivers indicated that caregivers predominantly accepted their loved ones’ illness into their identity, and this acceptance was in turn associated with both their well-being and care-burden. Caregivers high on attachment anxiety reported greater feelings of engulfment by the illness, leading to increased burden and diminished well-being. On the other hand, caregivers high on avoidant attachment struggled to accept the illness, and also experienced heightened burden. This study underscores the significance of illness integration in shaping caregivers’ experiences. The findings highlight the need to promote adaptive integration processes and address attachment-related challenges, reducing caregiver strain and enhancing resilience.

Despite progress in therapy, heart failure (HF) inflicts a heavy burden of hospital admissions. In this study, we identified among 1360 community-dwelling HF patients (mean age 70.7 ± 11.3 years, 72.5% men) subgroups sharing similar profiles of unplanned hospital admissions, based on the admission causes and frequency of each cause. Hospital discharge summaries were reviewed for the main admission cause. Patient subgroups were identified via cluster analysis. We investigated baseline predictors associated with these subgroups, using multinomial logistic models. During 3421 patient-years, there were 5192 hospital admissions, of which 4252 (82%) were unplanned. We identified five patient subgroups (clusters 1–5) with distinctive hospitalization profiles. HF accounted for approximately one-third of admissions in the first patient cluster (23% of the patient sample). In contrast, patients in the second cluster (39% of the patient sample) were hospitalized for various reasons, with no single prominent admission cause identified. The other three clusters, comprising 16% of the patient sample, accounted for 42% of all unplanned hospitalizations. While patients in the third cluster were hospitalized mainly due to ischemic heart disease and arrhythmia, patients in the fourth and fifth clusters shared a high burden of recurrent HF admissions. The five patient clusters differed by baseline predictors, including age, functional capacity, comorbidity burden, hemoglobin, and cause of HF. HF patients differ significantly in the causes and overall burden of unplanned hospitalizations. The patient subgroups identified and predictors for these subgroups may guide personalized interventions to reduce the burden of unplanned hospitalizations among HF patients. Trial registration: ClinicalTrials.gov, NCT00533013. Registered 20 September 2007. https://clinicaltrials.gov/study/NCT00533013.

Background: A significant percentage of patients with congenital heart disease surviving into adulthood will develop arrhythmias. These arrhythmias are associated with an increased risk of adverse events and death. We aimed to assess arrhythmia prevalence, risk factors, and associated health care usage in a large national cohort of patients with adult congenital heart disease. Methods and Results: Adults with a documented diagnosis of congenital heart disease, insured by Clalit and Maccabi health services between January 2007 and December 2011, were included. We assessed the associations between arrhythmia and subsequent hospitalization rates and death with mixed negative binomial and Cox proportional hazard models, respectively. Among 11 653 patients with adult congenital heart disease (median age, 47 years [interquartile range, 31–62]), 8.7% had a tachyarrhythmia at baseline, 1.5% had a conduction disturbance, and 0.5% had both. Among those without a baseline arrhythmia, 9.2% developed tachyarrhythmias, 0.9% developed a conduction disturbance, and 0.3% developed both during the study period. Compared with no arrhythmia (reference group), arrhythmia in the previous 6 months was associated with a higher multivariable adjusted hospitalization rate, 1.33‐fold higher than the rate of the reference group (95% CI, 1.00–1.76) for ventricular arrhythmia, 1.27‐fold higher (95% CI, 1.17–1.38) for atrial arrhythmias, and 1.33‐fold higher (95% CI, 1.04–1.71) for atrioventricular block. Atrial tachyarrhythmias were associated with an adjusted mortality hazard ratio (HR) of 1.65 (95% CI, 1.44–2.94), and ventricular tachyarrhythmias with a >2‐fold increase in mortality risk (HR, 2.06 [95% CI, 1.44–2.94]). Conclusions: Arrhythmias are significant comorbidities in the adult congenital heart disease population and have a significant impact on health care usage and survival.

Crohn disease (CD) burden has increased with globalization/urbanization, and the rapid rise is attributed to environmental changes rather than genetic drift. The Study Of Urban and Rural CD Evolution (SOURCE, n = 380) has considered diet-omics domains simultaneously to detect complex interactions and identify potential beneficial and pathogenic factors linked with rural-urban transition and CD. We characterize exposures, diet, ileal transcriptomics, metabolomics, and microbiome in newly diagnosed CD patients and controls in rural and urban China and Israel. We show that time spent by rural residents in urban environments is linked with changes in gut microbial composition and metabolomics, which mirror those seen in CD. Ileal transcriptomics highlights personal metabolic and immune gene expression modules, that are directly linked to potential protective dietary exposures (coffee, manganese, vitamin D), fecal metabolites, and the microbiome. Bacteria-associated metabolites are primarily linked with host immune modules, whereas diet-linked metabolites are associated with host epithelial metabolic functions.

Nutrition-related chronic diseases are a major problem among Indigenous populations. Appropriate dietary intake assessment tools are needed for nutritional surveillance and intervention; however, tools designed to measure the habitual dietary intake of Indigenous persons are largely lacking. We developed a digital food frequency questionnaire (FFQ) to measure habitual consumption among Australian Aboriginal adults and support personalized nutrition counseling. The primary contributors to energy, select nutrients, and inter-person variation (83 food groups) were identified from nationally representative 24 h recall (24HR) data, and they accounted for >80% of the total intake and inter-person variation of the nutrients of interest. Based on community input, a meal-based FFQ format was adopted, with a main food/beverage list of 81 items and the capacity to report on >300 additional items via the digital platform. The nutrient database was based on the Australian Food and Nutrient Database. Data for the first 60 study participants (70% female; median age: 48 years) were used to assess the FFQ’s utility. The participants’ median [IQR] reported energy intake (10,042 [6968–12,175] kJ/day) was similar to their median [IQR] estimated energy expenditure (10,197 [8636–11,551] kJ/day). Foods/beverages on the main FFQ list accounted for between 66% and 90% of the participants’ reported energy and nutrient intakes; the remainder came from participant-selected extra items. The digital FFQ platform provides a potentially valuable resource for monitoring habitual dietary intake among Aboriginal adults and supporting chronic disease prevention and management interventions.

Marginalized racial/ethnic minorities have disproportionately high rates of type 2 diabetes prevalence, complications and mortality. Researchers and policymakers have typically addressed these disparities using a deficit-based discourse focused on individual/cultural deficiencies or failure. A mixed-methods study was used to compare the deficit discourse to the perspectives of adults with diabetes in the Arab minority in Israel, using data from 10 focus groups (5 men’s, 5 women’s) and 296 quantitative in-person surveys. Both qualitative and quantitative data were triangulated. In addition, multivariable regression models tested associations between diabetes management perspectives and participant characteristics. Contrary to the deficit-based characterizations of patients as fatalistic and unknowledgeable, participants viewed diabetes as a chronic disease with serious complications. They expressed more support for patient responsibility in diabetes management than for passive fatalism, and were less fatalistic as educational level and adequacy of diabetes self-care training increased. The impact of social/environmental barriers and changing cultural norms on lifestyle behaviors was highlighted. Over 95% used prescription medications for diabetes management, although 35% reported economic barriers. The deficit discourse is not well-aligned with Arab patients’ evolving perceptions and needs, and has deflected attention from the socioeconomic/structural determinants of health, and the healthcare system’s responsibility to provide effective, culturally-relevant diabetes services.