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Rothberg A, Lean M, Laferrère B. Remission of type 2 diabetes: always more questions, but enough answers for action. Diabetologia 2024; 67:602-610. [PMID: 38189935 PMCID: PMC10904507 DOI: 10.1007/s00125-023-06069-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 11/07/2023] [Indexed: 01/09/2024]
Abstract
The concept of type 2 diabetes remission is evolving rapidly, and gaining wide public and professional interest, following demonstration that with substantial intentional weight loss almost nine in ten people with type 2 diabetes can reduce their HbA1c level below the diagnostic criterion (48 mmol/mol [6.5%]) without glucose-lowering medications, and improve all features of the metabolic syndrome. Pursuing nomoglycaemia with older drugs was dangerous because of the risk of side effects and hypoglycaemia, so the conventional treatment target was an HbA1c concentration of 53 mmol/mol (7%), meaning that diabetes was still present and allowing disease progression. Newer agents may achieve a normal HbA1c safely and, by analogy with treatments that send cancers or inflammatory diseases into remission, this might also be considered remission. However, although modern glucagon-like peptide-1 receptor agonists and related medications are highly effective for weight loss and glycaemic improvement, and generally safe, many people do not want to take drugs indefinitely, and their cost means that they are not available across much of the world. Therefore, there are strong reasons to explore and research dietary approaches for the treatment of type 2 diabetes. All interventions that achieve sustained weight loss of >10-15 kg improve HbA1c, potentially resulting in remission if sufficient beta cell capacity can be preserved or restored, which occurs with loss of the ectopic fat in liver and pancreas that is found with type 2 diabetes. Remission is most likely with type 2 diabetes of short duration, lower HbA1c and a low requirement for glucose-lowering medications. Relapse is likely with weight regain and among those with a poor beta cell reserve. On current evidence, effective weight management should be provided to all people with type 2 diabetes as soon as possible after diagnosis (or even earlier, at the stage of prediabetes, defined in Europe, Australasia, Canada [and most of the world] as ≥42 and <48 mmol/mol [≥6.0 and <6.5%], and in the USA as HbA1c ≥39 and <48 mmol/mol [≥5.7 and <6.5%]). Raising awareness among people with type 2 diabetes and their healthcare providers that remission is possible will enable earlier intervention. Weight loss of >10 kg and remission lasting 1-2 years may also delay vascular complications, although more evidence is needed. The greatest challenge for research is to improve long-term weight loss maintenance, defining cost-effective approaches tailored to the preferences and needs of people living with type 2 diabetes.
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Affiliation(s)
- Amy Rothberg
- Division of Metabolism, Endocrinology & Diabetes, University of Michigan, Ann Arbor, MI, USA
| | - Michael Lean
- School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK.
| | - Blandine Laferrère
- Division of Endocrinology, Columbia University Irving Medical Center, New York, NY, USA.
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Chimoriya R, Mitlehner K, Khoo CL, Osuagwu UL, Thomson R, Si L, Lean M, Simmons D, Piya MK. Translation of a Diabetes Remission Service into Australian Primary Care: Findings from the Evaluation of DiRECT-Australia. J Diabetes Res 2024; 2024:2350551. [PMID: 38361965 PMCID: PMC10869186 DOI: 10.1155/2024/2350551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 11/02/2023] [Accepted: 01/29/2024] [Indexed: 02/17/2024] Open
Abstract
Background The Diabetes Remission Clinical Trial (DiRECT) study demonstrated that an intensive and structured weight management program in UK primary care resulted in high rates of diabetes remission in adults with recent onset type 2 diabetes mellitus (T2DM). This study was aimed at evaluating the translation of the DiRECT intervention into an Australian primary care setting. Methods All patients enrolled in the DiRECT-Australia Type 2 Diabetes Remission Service in a region of Sydney (Macarthur region, South Western Sydney, Australia) were included. Eligible participants were aged 20-70 years, noninsulin treated, with T2DM of ≤6 years' duration, and body mass index (BMI) ≥ 27 kg/m2. Total diet replacement of 825-853 kcal/day using meal replacements was implemented for 12 weeks, followed by an ongoing structured program until 52 weeks, with regular follow-up with a general practitioner, dietitian, and/or practice nurse. Results Of 39 recruited participants, 32 (82.1%) and 27 (69.2%) completed 12 weeks and 52 weeks of the structured program, respectively. Decrease in weight by -12.0 kg (95% CI: -9.6, -14.4; p < 0.001) and -9.1 kg (95% CI: -5.2, -12.9; p < 0.001) and decrease in glycated haemoglobin (HbA1c) by -1.1% (95% CI: -0.6, -1.6; p < 0.001) and -0.6% (95% CI: -0.1, -1.1; p = 0.013) were observed at 12 and 52 weeks, respectively. At the end of 12 and 52 weeks, 93.8% (30/32) and 55.6% (15/27) of those with follow-up data met the criteria for diabetes remission, respectively. Quality of life and wellbeing scores increased over the course of 12 weeks, remaining significantly higher at 52 weeks. Participants reported they would be willing to pay A$92.50 (95% CI: A$75.80, A$109.30) per fortnight for the low-calorie meal replacement shakes. Conclusions These findings support the feasibility of a structured diabetes remission service in an Australian primary care setting to achieve improvements in glycaemia, weight, and quality of life and wellbeing, and suggest a substantial willingness to pay for diet replacement products among participants.
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Affiliation(s)
- Ritesh Chimoriya
- School of Medicine, Western Sydney University, Campbelltown, NSW, Australia
| | - Kimberly Mitlehner
- School of Medicine, Western Sydney University, Campbelltown, NSW, Australia
| | - Chee L. Khoo
- School of Medicine, Western Sydney University, Campbelltown, NSW, Australia
- Healthfocus Family Practice, Ingleburn, NSW, Australia
| | - Uchechukwu Levi Osuagwu
- School of Medicine, Western Sydney University, Campbelltown, NSW, Australia
- Bathurst Rural Clinical School (BRCS), Western Sydney University, Bathurst, NSW, Australia
| | - Russell Thomson
- School of Computer, Data and Mathematical Sciences, Western Sydney University, Penrith, Australia
| | - Lei Si
- School of Health Sciences, Western Sydney University, Campbelltown, Australia
| | - Michael Lean
- School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - David Simmons
- School of Medicine, Western Sydney University, Campbelltown, NSW, Australia
- Campbelltown and Camden Hospitals, Campbelltown, NSW, Australia
| | - Milan K. Piya
- School of Medicine, Western Sydney University, Campbelltown, NSW, Australia
- Campbelltown and Camden Hospitals, Campbelltown, NSW, Australia
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3
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Chimoriya R, MacMillan F, Lean M, Simmons D, Piya MK. A qualitative study of the perceptions and experiences of participants and healthcare professionals in the DiRECT-Australia type 2 diabetes remission service. Diabet Med 2024:e15301. [PMID: 38311881 DOI: 10.1111/dme.15301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 01/10/2024] [Accepted: 01/22/2024] [Indexed: 02/06/2024]
Abstract
BACKGROUND The UK Diabetes Remission Clinical Trial (DiRECT) study was replicated in an Australian primary care setting. This qualitative study aimed to explore and understand the perceptions and experiences of both participants and healthcare professionals (HCPs) involved in the DiRECT-Australia Type 2 Diabetes Remission Service. METHODS All participants and HCPs delivering the service were invited to participate in semi-structured interviews via online videoconferencing. The interview guides explored perceptions and experiences in DiRECT-Australia, covering aspects such as barriers and facilitators to recruitment and participation, motivations and challenges across service phases, adequacy of support provided and the overall acceptability of the service. All interviews were audio-recorded, transcribed verbatim and analysed using thematic analysis. RESULTS Eight DiRECT-Australia participants and six HCPs (three general practitioners, two practice nurses and one dietitian) participated. Four overarching themes were identified: (1) Enablers and barriers to recruitment and continuous participation in DiRECT-Australia; (2) Motivators and overcoming barriers across the total diet replacement, food reintroduction and weight maintenance phases; (3) Importance of participant-HCP interactions and continuous support; (4) Acceptance and long-term need for DiRECT-Australia. Adherence to total diet replacement was less challenging than anticipated by participants. Transitioning to the food reintroduction phase was difficult but overcome through HCP support. DiRECT-Australia was well accepted by both participants and HCPs, and participants expressed willingness to continue with the service, if provided on a long-term basis. CONCLUSIONS Both participants and HCPs were highly interested in the new diabetes remission service set up in an Australian primary care setting. The acceptability of DiRECT-Australia was underscored by participants emphasising the effectiveness of the service in achieving significant weight loss and diabetes remission. There is a need for long-term and wider implementation of the service to ensure that anyone with recent onset type 2 diabetes is offered the best possible chance to achieve remission.
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Affiliation(s)
- Ritesh Chimoriya
- School of Medicine, Western Sydney University, Campbelltown, New South Wales, Australia
| | - Freya MacMillan
- School of Health Sciences, Western Sydney University, Campbelltown, New South Wales, Australia
| | - Michael Lean
- School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - David Simmons
- School of Medicine, Western Sydney University, Campbelltown, New South Wales, Australia
- Campbelltown and Camden Hospitals, Campbelltown, New South Wales, Australia
| | - Milan K Piya
- School of Medicine, Western Sydney University, Campbelltown, New South Wales, Australia
- Campbelltown and Camden Hospitals, Campbelltown, New South Wales, Australia
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Goudswaard LJ, Smith ML, Hughes DA, Taylor R, Lean M, Sattar N, Welsh P, McConnachie A, Blazeby JM, Rogers CA, Suhre K, Zaghlool SB, Hers I, Timpson NJ, Corbin LJ. Using trials of caloric restriction and bariatric surgery to explore the effects of body mass index on the circulating proteome. Sci Rep 2023; 13:21077. [PMID: 38030643 PMCID: PMC10686974 DOI: 10.1038/s41598-023-47030-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 11/08/2023] [Indexed: 12/01/2023] Open
Abstract
Thousands of proteins circulate in the bloodstream; identifying those which associate with weight and intervention-induced weight loss may help explain mechanisms of diseases associated with adiposity. We aimed to identify consistent protein signatures of weight loss across independent studies capturing changes in body mass index (BMI). We analysed proteomic data from studies implementing caloric restriction (Diabetes Remission Clinical trial) and bariatric surgery (By-Band-Sleeve), using SomaLogic and Olink Explore1536 technologies, respectively. Linear mixed models were used to estimate the effect of the interventions on circulating proteins. Twenty-three proteins were altered in a consistent direction after both bariatric surgery and caloric restriction, suggesting that these proteins are modulated by weight change, independent of intervention type. We also integrated Mendelian randomisation (MR) estimates of the effect of BMI on proteins measured by SomaLogic from a UK blood donor cohort as a third line of causal evidence. These MR estimates provided further corroborative evidence for a role of BMI in regulating the levels of six proteins including alcohol dehydrogenase-4, nogo receptor and interleukin-1 receptor antagonist protein. These results indicate the importance of triangulation in interrogating causal relationships; further study into the role of proteins modulated by weight in disease is now warranted.
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Affiliation(s)
- Lucy J Goudswaard
- Population Health Sciences, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK.
- MRC Integrative Epidemiology Unit, Bristol, UK.
- Physiology, Pharmacology & Neuroscience, University of Bristol, Biomedical Sciences Building, University Walk, Bristol, BS8 1TD, UK.
| | - Madeleine L Smith
- Population Health Sciences, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
- MRC Integrative Epidemiology Unit, Bristol, UK
| | - David A Hughes
- Population Health Sciences, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
- MRC Integrative Epidemiology Unit, Bristol, UK
| | - Roy Taylor
- Newcastle Magnetic Resonance Centre, Translational and Clinical Research Institute, Newcastle University, Newcastle Upon Tyne, NE4 5PL, UK
| | - Michael Lean
- Human Nutrition, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, G31 2ER, UK
| | - Naveed Sattar
- School of Cardiovascular and Medical Science, University of Glasgow, Glasgow, G12 8TA, UK
| | - Paul Welsh
- School of Cardiovascular and Medical Science, University of Glasgow, Glasgow, G12 8TA, UK
| | - Alex McConnachie
- Robertson Centre for Biostatistics, School of Health and Wellbeing, University of Glasgow, Glasgow, G12 8QQ, UK
| | - Jane M Blazeby
- Population Health Sciences, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
| | - Chris A Rogers
- Bristol Medical School, Bristol Trials Centre, University of Bristol, Bristol, BS8 1NU, UK
| | - Karsten Suhre
- Department of Biophysics and Physiology, Weill Cornell Medicine - Qatar, Doha, Qatar
| | - Shaza B Zaghlool
- Department of Biophysics and Physiology, Weill Cornell Medicine - Qatar, Doha, Qatar
| | - Ingeborg Hers
- Physiology, Pharmacology & Neuroscience, University of Bristol, Biomedical Sciences Building, University Walk, Bristol, BS8 1TD, UK
| | - Nicholas J Timpson
- Population Health Sciences, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
- MRC Integrative Epidemiology Unit, Bristol, UK
| | - Laura J Corbin
- Population Health Sciences, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
- MRC Integrative Epidemiology Unit, Bristol, UK
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5
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Luli M, Yeo G, Farrell E, Ogden J, Parretti H, Frew E, Bevan S, Brown A, Logue J, Menon V, Isack N, Lean M, McEwan C, Gately P, Williams S, Astbury N, Bryant M, Clare K, Dimitriadis GK, Finlayson G, Heslehurst N, Johnson B, Le Brocq S, Roberts A, McGinley P, Mueller J, O'Kane M, Batterham RL, Miras AD. The implications of defining obesity as a disease: a report from the Association for the Study of Obesity 2021 annual conference. EClinicalMedicine 2023; 58:101962. [PMID: 37090435 PMCID: PMC10119881 DOI: 10.1016/j.eclinm.2023.101962] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 03/21/2023] [Accepted: 03/27/2023] [Indexed: 04/25/2023] Open
Abstract
Unlike various countries and organisations, including the World Health Organisation and the European Parliament, the United Kingdom does not formally recognise obesity as a disease. This report presents the discussion on the potential impact of defining obesity as a disease on the patient, the healthcare system, the economy, and the wider society. A group of speakers from a wide range of disciplines came together to debate the topic bringing their knowledge and expertise from backgrounds in medicine, psychology, economics, and politics as well as the experience of people living with obesity. The aim of their debate was not to decide whether obesity should be classified as a disease but rather to explore what the implications of doing so would be, what the gaps in the available data are, as well as to provide up-to-date information on the topic from experts in the field. There were four topics where speakers presented their viewpoints, each one including a question-and-answer section for debate. The first one focused on the impact that the recognition of obesity could have on people living with obesity regarding the change in their behaviour, either positive and empowering or more stigmatising. During the second one, the impact of defining obesity as a disease on the National Health Service and the wider economy was discussed. The primary outcome was the need for more robust data as the one available does not represent the actual cost of obesity. The third topic was related to the policy implications regarding treatment provision, focusing on the public's power to influence policy. Finally, the last issue discussed, included the implications of public health actions, highlighting the importance of the government's actions and private stakeholders. The speakers agreed that no matter where they stand on this debate, the goal is common: to provide a healthcare system that supports and protects the patients, strategies that protect the economy and broader society, and policies that reduce stigma and promote health equity. Many questions are left to be answered regarding how these goals can be achieved. However, this discussion has set a good foundation providing evidence that can be used by the public, clinicians, and policymakers to make that happen.
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Affiliation(s)
- Migena Luli
- Division of Medicine and Integrated Care, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Giles Yeo
- Department of Clinical Biochemistry, Institute of Metabolic Science, Cambridge University, Cambridge, United Kingdom
| | - Emma Farrell
- School of Education, University College Dublin, Dublin, Ireland
| | - Jane Ogden
- School of Psychology, Faculty of Health and Medical Sciences, University of Surrey, Surrey, United Kingdom
| | - Helen Parretti
- Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, United Kingdom
| | - Emma Frew
- Health Economics Unit, Institute of Applied Health Research, University of Birmingham, United Kingdom
| | - Stephen Bevan
- HR Research Development, Institute for Employment, Brighton, United Kingdom
| | - Adrian Brown
- Department of Experimental and Translational Medicine, Faculty of Medical Sciences, University College London, London, United Kingdom
| | - Jennifer Logue
- Lancaster Medical School, Faculty of Health and Medicine, Lancaster University, Lancaster, United Kingdom
| | - Vinod Menon
- Department of Upper Gastrointestinal Team, University Hospitals and Coventry & Warwickshire NHS Trust, Coventry, United Kingdom
| | - Nadya Isack
- Obesity Empowerment Network, London, United Kingdom
| | - Michael Lean
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, Scotland, United Kingdom
| | | | - Paul Gately
- Obesity Institute, Leeds Beckett University, Leeds, United Kingdom
| | | | - Nerys Astbury
- Nuffield Department of Primary Care Sciences, Medical Sciences Division, University of Oxford, Oxford, United Kingdom
| | - Maria Bryant
- Department of Health Sciences and the Hull York Medical School, University of York, York, United Kingdom
| | - Kenneth Clare
- European Coalition for People Living with Obesity, United Kingdom
| | - Georgios K. Dimitriadis
- Department of Endocrinology ASO/EASO COM, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Graham Finlayson
- School of Psychology, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom
| | - Nicola Heslehurst
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, United Kingdom
| | - Brett Johnson
- Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, United Kingdom
| | | | - Audrey Roberts
- European Coalition for People Living with Obesity, United Kingdom
| | - Patrick McGinley
- Department of Finance, Maidstone & Tunbridge Wells NHS Trust, Kent, United Kingdom
| | - Julia Mueller
- Epidemiology Unit, School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Mary O'Kane
- Dietetic Department, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Rachel L. Batterham
- School of Life and Medical Sciences, University College London, London, United Kingdom
| | - Alexander Dimitri Miras
- Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, United Kingdom
- School of Medicine, Ulster University, United Kingdom
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Li DL, El‐harasis M, Montgomery JA, Richardson TD, Kanagasundram A, Estrada JC, Lean M, Benjamin Shoemaker M, Saavedra PJ, Touchton S, Patel B, Herrmann T, John RM, Michaud GF. Durable pulmonary vein isolation with diffuse posterior left atrial ablation using low‐flow, median power, short‐duration strategy. J Cardiovasc Electrophysiol 2022; 33:1655-1664. [DOI: 10.1111/jce.15550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 03/29/2022] [Accepted: 04/13/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Dan L. Li
- Division of CardiologyDepartment of MedicineVanderbilt University Medical CenterNashvilleTN
| | - Majd El‐harasis
- Division of CardiologyDepartment of MedicineVanderbilt University Medical CenterNashvilleTN
| | - Jay A. Montgomery
- Division of CardiologyDepartment of MedicineVanderbilt University Medical CenterNashvilleTN
| | - Travis D. Richardson
- Division of CardiologyDepartment of MedicineVanderbilt University Medical CenterNashvilleTN
| | - Arvindh Kanagasundram
- Division of CardiologyDepartment of MedicineVanderbilt University Medical CenterNashvilleTN
| | - Juan Carlos Estrada
- Division of CardiologyDepartment of MedicineVanderbilt University Medical CenterNashvilleTN
| | | | - M. Benjamin Shoemaker
- Division of CardiologyDepartment of MedicineVanderbilt University Medical CenterNashvilleTN
| | - Pablo J. Saavedra
- Division of CardiologyDepartment of MedicineVanderbilt University Medical CenterNashvilleTN
| | | | | | | | - Roy M. John
- Division of Cardiology, Department of Medicine, Stanford UniversityStanfordCA
| | - Gregory F. Michaud
- Division of CardiologyDepartment of MedicineVanderbilt University Medical CenterNashvilleTN
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Semnani-Azad Z, Khan T, Kabisch S, Kahleova H, Kendall C, Lau D, Wharton S, Leiter L, Lean M, Harris L, Rahelic D, Salas-Salvado J, Sharma A, Sievenpiper J. Effect of Intermittent Fasting Strategies on Cardiometabolic Risk Factors: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials. Curr Dev Nutr 2021. [DOI: 10.1093/cdn/nzab053_084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Objectives
Intermittent fasting (IF) is a popular trending diet, yet there is limited evidence-based support considering its clinical impact on cardiometabolic outcomes. In an effort to inform the European Association for the Study of Diabetes (EASD) clinical practice guidelines for nutrition therapy, we conducted a network meta-analysis of randomized controlled trials (RCTs) comparing IF strategies and continuous energy restriction (CER) on cardiometabolic outcomes using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach.
Methods
MEDLINE, EMBASE, and Cochrane databases were searched through Nov 2020. We included RCTs assessing the effect of IF strategies (alternate-day fasting (ADF), whole-day periodic fasting (WDF), time-restricted feeding (TRF)), CER, and ad libitum diet. Outcomes included body weight, fasting glucose and LDL-cholesterol. Two independent researchers extracted data and assessed risk of bias. A network meta-analysis was performed and data were expressed as mean differences (MD) with 95% confidence intervals (CI). The certainty of the evidence was assessed using GRADE.
Results
We identified 19 RCTs (n = 590) including adults of varying health backgrounds. ADF and CER both showed a benefit for body weight reduction compared to ad libitum diet (18 trials, n = 520; MD −3.95 kg [95% CI −6.09, −1.81] and MD −2.85 kg [95% CI −4.99, −0.71], respectively). For fasting glucose (17 trials, n = 590), TRF showed a benefit compared to ad libitum diet (MD −0.39 mmol/L [95% CI −0.59, −0.20]), to CER (MD −0.25 mmol/L [95% CI, −0.45 to −0.06]) and to WDF (MD −0.20 mmol/L [95% CI, −0.45, −0.05]). Furthermore, ADF showed a benefit in reducing LDL-cholesterol (17 trials, n = 590) compared to ad libitum diet (MD −0.21 mmol/L [95% CI −0.40, −0.1]), and to CER (MD −0.15 mmol/L [95% CI −0.31, −0.01]). The certainty of the evidence ranged from high to moderate due to variable downgrades for imprecision.
Conclusions
Current evidence provides a good indication that IF strategies have similar benefits to CER for weight loss but may have additional benefits for fasting glucose and LDL-cholesterol. Long-term high quality RCTs are needed to clarify the effect of different IF strategies on cardiometabolic outcomes.
Funding Sources
Diabetes and Nutrition Study Group of the EASD, Canadian Institutes of Health Research (CIHR), Diabetes Canada.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Jordi Salas-Salvado
- Universitat Rovira i Virgili, Departament de Bioquímica i Biotecnologia, Unitat de Nutrició Humana
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8
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Dick K, Schneider JE, Briggs A, Lecomte P, Regnier SA, Lean M. Mendelian randomization: estimation of inpatient hospital costs attributable to obesity. Health Econ Rev 2021; 11:16. [PMID: 33990897 PMCID: PMC8122556 DOI: 10.1186/s13561-021-00314-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 05/02/2021] [Indexed: 05/13/2023]
Abstract
BACKGROUND Mendelian Randomization is a type of instrumental variable (IV) analysis that uses inherited genetic variants as instruments to estimate causal effects attributable to genetic factors. This study aims to estimate the impact of obesity on annual inpatient healthcare costs in the UK using linked data from the UK Biobank and Hospital Episode Statistics (HES). METHODS UK Biobank data for 482,127 subjects was linked with HES inpatient admission records, and costs were assigned to episodes of care. A two-stage least squares (TSLS) IV model and a TSLS two-part cost model were compared to a naïve regression of inpatient healthcare costs on body mass index (BMI). RESULTS The naïve analysis of annual cost on continuous BMI predicted an annual cost of £21.61 [95% CI £20.33 - £22.89] greater cost per unit increase in BMI. The TSLS IV model predicted an annual cost of £14.36 [95% CI £0.31 - £28.42] greater cost per unit increase in BMI. Modelled with a binary obesity variable, the naïve analysis predicted that obese subjects incurred £205.53 [95% CI £191.45 - £219.60] greater costs than non-obese subjects. The TSLS model predicted a cost £201.58 [95% CI £4.32 - £398.84] greater for obese subjects compared to non-obese subjects. CONCLUSIONS The IV models provide evidence for a causal relationship between obesity and higher inpatient healthcare costs. Compared to the naïve models, the binary IV model found a slightly smaller marginal effect of obesity, and the continuous IV model found a slightly smaller marginal effect of a single unit increase in BMI.
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Affiliation(s)
- Katherine Dick
- Avalon Health Economics, 26 Washington St. 2nd Floor, Morristown, NJ, 07960, USA.
| | - John E Schneider
- Avalon Health Economics, 26 Washington St. 2nd Floor, Morristown, NJ, 07960, USA
| | - Andrew Briggs
- Avalon Health Economics, 26 Washington St. 2nd Floor, Morristown, NJ, 07960, USA
- London School of Hygiene and Tropical Medicine, Keppel St, Bloomsbury, London, WC1E 7HT, UK
| | - Pascal Lecomte
- Novartis AG, WSJ - 210.15.30.23, CH-4056, Basel, Switzerland
| | | | - Michael Lean
- University of Glasgow, University Avenue, Glasgow, G12 8QQ, Scotland
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Williamson K, Nimegeer A, Lean M. Rising prevalence of BMI ≥40 kg/m 2 : A high-demand epidemic needing better documentation. Obes Rev 2020; 21:e12986. [PMID: 32017386 PMCID: PMC7078951 DOI: 10.1111/obr.12986] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 10/31/2019] [Accepted: 11/18/2019] [Indexed: 12/13/2022]
Abstract
Whilst previously rare, some surveys indicate substantial increases in the population with body mass index (BMI) ≥40 kg/m2 since the 1980s. Clinicians report emerging care challenges for this population, often with high resource demands. Accurate prevalence data, gathered using reliable methods, are needed to inform health care practice, planning, and research. We searched digitally for English language sources with measured prevalence data on adult BMI ≥40 collected since 2010. The search strategy included sources identified from recent work by NCD-RisC (2017), grey sources, a literature search to find current sources, and digital snowball searching. Eighteen countries, across five continents, reported BMI ≥40 prevalence data in surveys since 2010: 12% of eligible national surveys examined. Prevalence of BMI ≥40 ranged from 1.3% (Spain) to 7.7% (USA) for all adults, 0.7% (Serbia) to 5.6% (USA) for men, and 1.8% (Poland) to 9.7% (USA) for women. Limited trend data covering recent decades support significant growth of BMI ≥40 population. Methodological limitations include small samples and data collection methods likely to exclude people with very high BMIs. BMI ≥40 data are not routinely reported in international surveys. Lack of data impairs surveillance of population trends, understanding of causation, and societal provision for individuals living with higher weights.
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Affiliation(s)
- Kath Williamson
- School of Medicine, Dentistry and NursingUniversity of GlasgowGlasgowUK
- NHS LothianEdinburghUK
| | - Amy Nimegeer
- MRC/CSO Social and Public Health Sciences UnitUniversity of GlasgowGlasgowUK
| | - Michael Lean
- School of Medicine, Dentistry and NursingUniversity of GlasgowGlasgowUK
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10
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Churuangsuk C, Kherouf M, Combet E, Lean M. Low-carbohydrate diets for overweight and obesity: a systematic review of the systematic reviews. Obes Rev 2018; 19:1700-1718. [PMID: 30194696 DOI: 10.1111/obr.12744] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 05/17/2018] [Accepted: 06/14/2018] [Indexed: 01/06/2023]
Abstract
Low-carbohydrate diets are being widely recommended, but with apparently conflicting evidence. We have conducted a formal systematic review of the published systematic reviews of RCTs between low-carbohydrate vs. control (low-fat/energy-restricted) diets in adults with overweight and obesity. In MEDLINE, Embase, Web of Knowledge and Cochrane Database of Systematic Reviews, searched from inception to September 2017, we identified 12 systematic reviews, 10 with meta-analyses. Differences in methods, study quality, weight change and citations of published systematic reviews were assessed by AMSTAR-2. Review methods varied in definitions of low-carbohydrate diet, databases searched and bias assessment. Overall review quality was high in two, moderate in three, critically low in seven. Among meta-analyses, 4/5 with critically low quality showed low-carbohydrate diet superiority for weight loss (0.7-4.0 kg), while high quality meta-analyses reported little or no difference between diets. Greater numbers of participants correlated with smaller differences in weight loss (r = 0.73, p = 0.03). More citations correlated with lower review quality (rho = -0.9, p = 0.037), with larger differences in weight loss (rho = -0.9, p = 0.037), and with journal impact factor (rho = 1.0, p = 0.01). In conclusion, publication acceptance and citations appear to favour apparently larger effect sizes above methodological quality. Better quality reviews and RCTs are needed, before recommending low-carbohydrate diets as preferred to other approaches for energy restriction.
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Affiliation(s)
- C Churuangsuk
- Human Nutrition, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - M Kherouf
- Human Nutrition, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - E Combet
- Human Nutrition, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
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11
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Affiliation(s)
- Michael Lean
- Human Nutrition, School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow G31 2ER, UK.
| | - Catherine Hankey
- Human Nutrition, School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow G31 2ER, UK
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12
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Churuangsuk C, Lean M, Combet E. Low-carbohydrate diet score is associated with higher glycated haemoglobin: a secondary analysis of the UK national diet and nutrition surveys year 1–6. Clin Nutr 2018. [DOI: 10.1016/j.clnu.2018.06.2064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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13
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Douglas A, Wild S, Cezard G, Gill J, Lean M, McKnight J, Sattar N, Sheikh A, Tuomilehto J, Wallia S, Bhopal R. 1.4-O8Progression to diabetes in Indian and Pakistani adults with impaired glycaemia in central Scotland: follow-up by record linkage in the PODOSA trial (Prevention of Diabetes & Obesity in South Asians). Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky047.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- A Douglas
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, United Kingdom
| | - S Wild
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, United Kingdom
| | - G Cezard
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, United Kingdom
| | - J Gill
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom
| | - M Lean
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom
| | - J McKnight
- Metabolic Unit, NHS Lothian, Edinburgh, United Kingdom
| | - N Sattar
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom
| | - A Sheikh
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, United Kingdom
| | | | - S Wallia
- NHS Greater Glasgow & Clyde, United Kingdom
| | - R Bhopal
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, United Kingdom
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14
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Jocelyn NA, Wylie CE, Lean M, Barrelet A, Foote AK. Association of neutrophil morphology with bacterial isolates in equine tracheal wash samples. Equine Vet J 2018; 50:752-758. [PMID: 29603335 DOI: 10.1111/evj.12837] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 02/23/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Tracheal wash sample neutrophilia is common in lower airway inflammation of various causes; however, relevance of cytomorphological features to culture of bacterial pathogens has not been established. OBJECTIVES To investigate whether the presence of nondegenerate or degenerate neutrophils in tracheal washes is associated with culture of bacteria and, if so, whether this is influenced by age or temporal factors. STUDY DESIGN Cross-sectional study. METHODS Tracheal wash samples submitted to Rossdales LLP from 1/1/2013 to 31/7/2015 were evaluated using set criteria. Neutrophilia and degenerate neutrophilia (graded ≥2/4 on Rossdales cytological scale [0-4]) were analysed in relation to bacterial isolates considered potentially pathogenic in respiratory disease. Statistical analyses included multivariable logistic regression to identify associations between two separate outcomes: 1) the presence of neutrophilia compared with no neutrophilia and 2) the presence of degenerate neutrophilia compared with nondegenerate neutrophilia and four independent variables. RESULTS Sufficient data for inclusion in the multivariable model for nondegenerate neutrophilia were available from 1100 horses. Culture of potentially pathogenic bacteria was associated with increased odds of degenerate neutrophilia compared with samples with negative culture (OR 4.5, 95% CI 3.1, 6.4, P-value<0.001). Horses over 9 years old had lower odds of having degenerate neutrophilia than those aged 1-3 years (OR 0.6, 95% CI 0.4, 0.9, P-value<0.02). In the spring/summer, horses had reduced odds of a degenerate neutrophilia compared with winter (OR 0.4, 95% CI 0.3, 0.7, P-value <0.001). MAIN LIMITATIONS The study relied on routine laboratory submissions, with no control over sample collection or submitted clinical history. CONCLUSIONS Cytological evaluation of tracheal washes should include cytomorphological features of the neutrophil response. The presence of degenerate neutrophils, especially in young horses, indicates added value of culture and sensitivity for antimicrobial therapeutics. The absence of degenerate changes, in combination with clinical factors, can help support diagnosis of a nonseptic cause of airway neutrophilia.
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Affiliation(s)
- N A Jocelyn
- Department of Clinical Sciences and Services, Royal Veterinary College, London, UK
| | - C E Wylie
- Rossdales Laboratories, Rossdales LLP, Newmarket, Suffolk, UK
| | - M Lean
- Rossdales Laboratories, Rossdales LLP, Newmarket, Suffolk, UK
| | - A Barrelet
- Rossdales Laboratories, Rossdales LLP, Newmarket, Suffolk, UK
| | - A K Foote
- Rossdales Laboratories, Rossdales LLP, Newmarket, Suffolk, UK
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15
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Thom G, Lean M. Who wants weight loss? What do they need? Time to re-think non-surgical approaches in obesity management. Clin Obes 2016; 6:361-364. [PMID: 27984851 DOI: 10.1111/cob.12172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 09/28/2016] [Indexed: 11/30/2022]
Affiliation(s)
- G Thom
- Department of Human Nutrition, University of Glasgow, Glasgow, UK
| | - M Lean
- Department of Human Nutrition, University of Glasgow, Glasgow, UK
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16
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Tournoy J, Overman M, Pendleton N, O'Neill T, Bartfai G, Casanueva F, Forti G, Rastrelli G, Giwercman A, Han T, Huhtaniemi I, Kula K, Lean M, Punab M, Lee D, Correa E, Verschueren S, Antonio L, Gielen E, Rutter M, Vanderschueren D, Wu F. P2‐419: Evaluation of 25‐Hydroxyvitamin D and 1,25‐Dihydroxyvitamin D and Cognitive Decline in the European Male Ageing Study. Alzheimers Dement 2016. [DOI: 10.1016/j.jalz.2016.06.1631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
| | | | | | | | | | - Felipe Casanueva
- Instituto Salud Carlos III, Complejo Hospitalario Universitario de SantiagoSantiagoSpain
| | | | | | | | - Thang Han
- The University of ManchesterManchesterUnited Kingdom
| | | | | | | | - Margus Punab
- United Laboratories of Tartu University ClinicsTartuEstonia
| | - David Lee
- University of ManchesterManchesterUnited Kingdom
| | - Elon Correa
- University of ManchesterManchesterUnited Kingdom
| | | | | | | | | | | | - Frederick Wu
- University of ManchesterManchesterUnited Kingdom
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17
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Leslie W, Taylor R, Lean M. Weight Loss with Liquid Formula Diets in Obese Patients with and without Diabetes. FASEB J 2015. [DOI: 10.1096/fasebj.29.1_supplement.594.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Wilma Leslie
- School of MedicineUniversity of GlasgowGlasgowUnited Kingdom
| | - Roy Taylor
- Newcastle Magnetic Resonance Centre Newcastle UniversityNewcastleUnited Kingdom
| | - Michael Lean
- School of MedicineUniversity of GlasgowGlasgowUnited Kingdom
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18
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Hutch A, He M, Reilly A, Lean M, Leslie W, Hankey C. The stigmata of obesity. Thoughts and attitudes of adolescent school pupils. Appetite 2015. [DOI: 10.1016/j.appet.2014.12.195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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19
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Affiliation(s)
| | | | - Michael Lean
- School of MedicineUniversity of GlasgowGlasgowUnited Kingdom
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20
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Grieve E, Fenwick E, Yang HC, Lean M. The disproportionate economic burden associated with severe and complicated obesity: a systematic review. Obes Rev 2013; 14:883-94. [PMID: 23859626 DOI: 10.1111/obr.12059] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Revised: 05/29/2013] [Accepted: 05/29/2013] [Indexed: 12/16/2022]
Abstract
Burden of disease studies typically classify individuals with a body mass index (BMI) ≥ 30 kg m(-2) as a single group ('obese') and make comparisons to those with lower BMIs. Here, we review the literature on the additional economic burden associated with severe obesity or classes 3 and 4 obesity (BMI ≥ 40 kg m(-2) ), the fastest growing category of obesity, with the aim of exploring and disaggregating differences in resource use as BMI increases beyond 40 kg m(-2) . We recognize the importance of comparing classes 3 and 4 obesity to less severe obesity (classes 1 and 2) as well as quantifying the single sub-class impacts (classes 3 and 4). Although the latter analysis is the aim of this review, we include results, where found in the literature, for movement between the recognized subclasses and within classes 3 and 4 obesity. Articles presenting data on the economic burden associated with severe obesity were identified from a search of Ovid MEDLINE, EMBASE, EBSCO CINAHL and Cochrane Library databases. Data were extracted on the direct costs, productivity costs and resource use associated with severe obesity along with estimates of the multiplier effects associated with increasing BMI. Fifteen studies were identified, of which four disaggregated resource use for BMI ≥ 40 kg m(-2) . The multiplier effects derived for a variety of different types of costs incurred by the severely obese compared with those of normal weight (18.5 kg m(-2) < BMI < 25 kg m(-2) ) ranged from 1.5 to 3.9 for direct costs, and from 1.7 to 8.0 for productivity costs. There are few published data on the economic burden of obesity disaggregated by BMI ≥ 40 kg m(-2) . By grouping people homogenously above a threshold of BMI 40 kg m(-2) , the multiplier effects for those at the highest end of the spectrum are likely to be underestimated. This will, in turn, impact on the estimates of cost-effectiveness for interventions and policies aimed at the severely obese.
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Affiliation(s)
- E Grieve
- Health Economics and Health Technology Assessment, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
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21
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Wallia S, Bhopal RS, Douglas A, Bhopal R, Sharma A, Hutchison A, Murray G, Gill J, Sattar N, Lawton J, Tuomilehto J, Mcknight J, Forbes J, Lean M, Sheikh A. Culturally adapting the prevention of diabetes and obesity in South Asians (PODOSA) trial. Health Promot Int 2013; 29:768-79. [PMID: 23574693 DOI: 10.1093/heapro/dat015] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Type 2 diabetes is extremely common in South Asians, e.g. in men from Pakistani and Indian populations it is about three times as likely as in the general population in England, despite similarities in body mass index. Lifestyle interventions reduce the incidence of diabetes. Trials in Europe and North America have not, however, reported on the impact on South Asian populations separately or provided the details of their cross-cultural adaptation processes. Prevention of diabetes and obesity in South Asians (PODOSA) is a randomized, controlled trial in Scotland of an adapted, lifestyle intervention aimed at reducing weight and increasing physical activity to reduce type 2 diabetes in Indians and Pakistanis. The trial was adapted from the Finnish Diabetes Prevention Study. We describe, reflect on and discuss the following key issues: The core adaptations to the trial design, particularly the delivery of the intervention in homes by dietitians rather than in clinics. The use of both a multilingual panel and professional translators to help translate and/or develop materials. The processes and challenges of phonetic translation. How intervention resources were adapted, modified, newly developed and translated into Urdu and Gurmukhi (written Punjabi). The insights gained in PODOSA (including time pressures on investigators, imperfections in the adaptation process, the power of verbal rather than written information, the utilization of English and the mother-tongue languages simultaneously by participants and the costs) might help the research community, given the challenge of health promotion in multi-ethnic, urban societies.
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Affiliation(s)
- S Wallia
- Edinburgh Ethnicity and Health Research Group, Centre for Population Health Sciences, The University of Edinburgh, Medical School, Teviot Place, Edinburgh EH8 9AG, UK
| | - R S Bhopal
- Edinburgh Ethnicity and Health Research Group, Centre for Population Health Sciences, The University of Edinburgh, Medical School, Teviot Place, Edinburgh EH8 9AG, UK
| | - A Douglas
- Edinburgh Ethnicity and Health Research Group, Centre for Population Health Sciences, The University of Edinburgh, Medical School, Teviot Place, Edinburgh EH8 9AG, UK
| | - R Bhopal
- Edinburgh Ethnicity and Health Research Group, Centre for Population Health Sciences, The University of Edinburgh, Medical School, Teviot Place, Edinburgh EH8 9AG, UK
| | - A Sharma
- Edinburgh Ethnicity and Health Research Group, Centre for Population Health Sciences, The University of Edinburgh, Medical School, Teviot Place, Edinburgh EH8 9AG, UK
| | - A Hutchison
- Edinburgh Ethnicity and Health Research Group, Centre for Population Health Sciences, The University of Edinburgh, Medical School, Teviot Place, Edinburgh EH8 9AG, UK
| | - G Murray
- Edinburgh Ethnicity and Health Research Group, Centre for Population Health Sciences, The University of Edinburgh, Medical School, Teviot Place, Edinburgh EH8 9AG, UK
| | - J Gill
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G128QQ, UK
| | - N Sattar
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G128QQ, UK
| | - J Lawton
- Edinburgh Ethnicity and Health Research Group, Centre for Population Health Sciences, The University of Edinburgh, Medical School, Teviot Place, Edinburgh EH8 9AG, UK
| | - J Tuomilehto
- South Ostrobothnia Central Hospital, 60220 Seinäjoki, Finland Centre for Vascular Prevention, Danube-University Krems, 3500 Krems, Austria
| | - J Mcknight
- Metabolic Unit, Anne Ferguson Building, Western General Hospital, Crewe Road, Edinburgh EH4 2XU, UK
| | - J Forbes
- Edinburgh Ethnicity and Health Research Group, Centre for Population Health Sciences, The University of Edinburgh, Medical School, Teviot Place, Edinburgh EH8 9AG, UK
| | - M Lean
- Centre for Population & Health Sciences, University of Glasgow, Glasgow, UK
| | - A Sheikh
- Edinburgh Ethnicity and Health Research Group, Centre for Population Health Sciences, The University of Edinburgh, Medical School, Teviot Place, Edinburgh EH8 9AG, UK
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22
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Abstract
It has been known for many years that substantial weight loss, achieved by bariatric surgery or non-surgical means can mean normalize glucose tolerance. Recent randomized controlled trial evidence indicates that >15 kg weight loss is necessary, to this and it may lead to near normalization (doubling) of life expectancy. Less than 5% of patients achieve this through even the best, evidence-based medical weight management programme (Counterweight http://www.counterweight.org). A weight loss of >15 kg is easily achievable by 8 weeks very low-energy diet (VLED)/LELD (Low energy Liquid-formula Diet) in compliant patients, with little difference between 400 and 800 kcal day(-1) , but weight maintenance after VLED has until recently been so poor that VLED is not, at present, recommended in clinical guidelines. However, mean weight loss close to >15 kg can be maintained 18-24 months using a variety of maintenance strategies. These include a structured reintroduction of foods linked to an education programme with behavioural strategies, intermittent VLED use and prescribable anti-obesity drugs (dexfenfluramine, orlistat, sibutramine). Most of these studies have been in non-diabetic subjects. A new 'curative' paradigm in type 2 diabetes mellitus management, aiming to normalize glucose tolerance and health risks by achieving and maintaining >15 kg loss, as soon as possible after diagnosis, should be highly acceptable to patients, generating many additional Quality Adjusted Life Years (QALYs). It is likely to be highly cost-effective by avoiding the current recommended, mainly palliative, model, using polypharmacy which provides an overall risk reduction of only 5-10%. Clinical trials are on-going to establish the feasibility of delivering formula (LELD) and a maintenance programme to large numbers of patients within routine primary care. There is urgent need, to run similar studies in diabetic patients. New approaches to long-term (lifelong) maintenance of weight loss and a non-diabetic state may include anti-obesity drugs.
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Affiliation(s)
- M Lean
- Centre for Population & Health Sciences, Human Nutrition, University of Glasgow, Glasgow, UK
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23
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Gauliard B, Grieve D, Wilson R, Crozier A, Jenkins C, Mullen WD, Lean M. The effects of dietary phenolic compounds on cytokine and antioxidant production by A549 cells. J Med Food 2008; 11:382-4. [PMID: 18598184 DOI: 10.1089/jmf.2007.593] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Levels of inflammatory cytokines are raised in chronic obstructive pulmonary disease (COPD). A diet rich in antioxidant vitamins may protect against the development of COPD. This study examined the effects of phenolic compounds and food sources on cytokine and antioxidant production by A549 cells. The effects of the following phenolic compounds on basal and interleukin (IL)-1-stimulated release of IL-8, IL-6, and reduced glutathione (GSH) were examined: resveratrol; Bouvrage, a commercially available raspberry juice (Ella Drinks Ltd., Alloa, Clacksmannanshire, UK); and quercetin 3'-sulfate. Purification of the raspberry juice by high-performance liquid chromatography gave three fractions: Fraction 1 contained phenolic acid and vitamin C, Fraction 2 contained flavonoids and ellagic acid, and Fraction 3 contained anthocyanins and ellagitannins. IL-8 production was increased in the presence of IL-1 (165 vs. 6,011 pg/mL, P < .0001). None of the compounds tested had any significant effect on GSH. Resveratrol at concentrations > or =50 micromol/mL significantly inhibited IL-8 and IL-6 production. Similar findings were made with raspberry juice at concentrations > or =25 microL/mL, and Fractions 1 and 3 were best able to inhibit IL-8 production. Quercetin 3'-sulfate, at 25 micromol/mL, inhibited IL-8 and IL-6 production. The changes observed in IL-8 were paralleled by changes in tumor necrosis factor-alpha. Thus, phenolic compounds can significantly alter cytokine and antioxidant production.
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Affiliation(s)
- Benoit Gauliard
- Division of Developmental Medicine, Glasgow Royal Infirmary, University of Glasgow, Glasgow, United Kingdom
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24
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Rimmer J, Peake HL, Santos CMC, Lean M, Bardin P, Robson R, Haumann B, Loehrer F, Handel ML. Targeting adenosine receptors in the treatment of allergic rhinitis: a randomized, double-blind, placebo-controlled study. Clin Exp Allergy 2007; 37:8-14. [PMID: 17210036 DOI: 10.1111/j.1365-2222.2006.02546.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND There is evidence that adenosine plays a role in the pathogenesis of asthma and rhinitis; however, it is currently unclear whether adenosine receptors are useful therapeutic targets in the treatment of allergic airway diseases. OBJECTIVE The study evaluated the efficacy of intranasal treatment with an adenosine A(2A) receptor agonist/adenosine A(3) receptor antagonist (50 micro g), administered twice daily for 7 days, to reduce nasal symptoms and release of inflammatory mediators following intranasal allergen challenge in patients with allergic rhinitis (AR). The compound was compared with twice-daily treatment with intranasal fluticasone proprionate nasal spray (FPANS) for 7 days. METHODS A randomized, double-blind, double-dummy, placebo-controlled, three-way balanced, incomplete block, crossover study was conducted on 48 males with verified AR. Following intranasal challenge with either an extract from the house dust mite (HDM), Dermatophagoides pteronyssinus, rye grass or cat dander, nasal responses and the concentrations of albumin, tryptase, myeloperoxidase, eosinophilic cationic protein, epithelial neutrophil-activating protein-78 (ENA-78), IL-5 and IL-8 in nasal secretions were measured and treatment groups were compared. RESULTS Drug improved nasal blockage but had no significant effect on rhinorrhoea, number of sneezes or peak nasal inspiratory flow measurements when compared with placebo. Drug reduced tryptase release after EAR but did not significantly reduce the levels of other mediators. CONCLUSION A novel agonist/antagonist of adenosine A(2A) and A(3) receptors appears to have limited clinical benefit in both the early-phase and the late-phase response to intranasal allergen challenge. However, reduction of some pro-inflammatory mediators suggests that comparable, more selective compounds may have additional benefits meriting further investigation.
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MESH Headings
- Adenosine A2 Receptor Antagonists
- Adenosine A3 Receptor Antagonists
- Administration, Intranasal
- Adolescent
- Adult
- Allergens
- Androstadienes/therapeutic use
- Animals
- Anti-Allergic Agents/therapeutic use
- Anti-Inflammatory Agents, Non-Steroidal/administration & dosage
- Anti-Inflammatory Agents, Non-Steroidal/therapeutic use
- Betamethasone/therapeutic use
- Biomarkers/analysis
- Cross-Over Studies
- Double-Blind Method
- Drug Therapy, Combination
- Fluticasone
- Humans
- Interleukin-5/blood
- Interleukin-8/blood
- Male
- Middle Aged
- Nasal Lavage Fluid/chemistry
- Nasal Provocation Tests
- Placebos
- Purinergic P1 Receptor Antagonists
- Purines/administration & dosage
- Purines/therapeutic use
- Rhinitis, Allergic, Perennial/drug therapy
- Rhinitis, Allergic, Perennial/immunology
- Rhinitis, Allergic, Perennial/metabolism
- Tetrazoles/administration & dosage
- Tetrazoles/therapeutic use
- Time Factors
- Treatment Failure
- Tryptases/analysis
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Affiliation(s)
- J Rimmer
- Woolcock Institute of Medical Research, University of Sydney, Sydney, NSW, Australia.
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25
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Abstract
BACKGROUND Obesity, with all its consequences, is audaciously confronting medical professionals and health service providers worldwide. Diet and exercise intervention is an essential part of any weight management strategy, but may not succeed in isolation. Effective approaches for routine practice are more likely to involve affordable, efficacious and well-tolerated drug therapy than the more expensive, case selective approach of bariatric surgery. OBJECTIVES AND CONCLUSIONS Advancement of pharmacotherapy is expanding the battery of available drugs; the clinician is faced with an increasingly complex therapeutic decision. Which drug to use, and when, is influenced by a range of factors, discussed here. There is a large body of high quality evidence in the literature to support the presently available drugs; however, many questions remain unanswered including duration of therapy and whether longer-term goals of improved morbidity and mortality are achievable. Clinician and patient awareness of these issues will provide a more informed therapeutic decision and ultimately improve the potential for reaching the weight management targets.
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Affiliation(s)
- M Lean
- Division of Developmental Medicine, Human Nutrition Section, University of Glasgow, Royal Infirmary, Queen Elizabeth Building, Glasgow, UK.
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26
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Abstract
BACKGROUND People with schizophrenia make poor dietary choices. AIMS To measure the impact of giving free fruit and vegetables for 6 months on eating habits in schizophrenia. METHOD We randomly allocated 102 people with schizophrenia in two areas of Scotland to receive free fruit and vegetables for 6 months, supported by instruction in meal planning and food preparation; free fruit and vegetables alone; or to continue as before. Diet was assessed using the Scottish Health Survey questionnaire. Blood samples to measure micronutrients were taken and mental state, body mass index, level of physical activity and future risk of coronary heart disease (CHD) were assessed. RESULTS After the intervention, those who received free fruit and vegetables, or free fruit and vegetables and associated instruction, were consuming significantly more fruit and vegetables than those in the treatment as usual group. Consumption fell to pre-intervention levels 12 months after the intervention stopped. There was no between-group difference at any time in blood micronutrients, body mass index, physical activity or risk of CHD. CONCLUSIONS The diet of people with schizophrenia improved when they were given free fruit and vegetables but this was given free fruit and vegetables but this was not sustained after withdrawal of the intervention. A support programme added no benefit.
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Affiliation(s)
- Robin G McCreadie
- Director of Clinical Research, Crichton Royal Hospital, Dumfries DG1 4TG, UK.
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Anderson AS, Bush H, Lean M, Bradby H, Williams R, Lea E. Evolution of atherogenic diets in South Asian and Italian women after migration to a higher risk region. J Hum Nutr Diet 2005; 18:33-43. [PMID: 15647097 DOI: 10.1111/j.1365-277x.2004.00584.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND To identify differences in the evolution of the diets of South Asian and Italian migrants, a cross-sectional, multiethnic study was undertaken in Glasgow, Scotland. METHODS Five groups of women aged 20-42 years comprising general population (n = 35), South Asian migrants (n = 35) British-born controls (n = 37), Italian migrants (n = 30) and British-born (n = 38) participated in an interviewer administered structured questionnaire on issues relating to health, diet and food selection. Anthropometric measurements were made and subjects completed a 7-day weighed diet inventory. RESULTS Compared with the general population, dietary differences were greatest amongst first generation migrant groups. There were major differences between the two migrant groups. South Asian migrants tended to display a more atherogenic profile (fat 42.4% energy, saturated fat 15.0% energy, vitamin C 5.1 mg per 1000 kJ) than the general population (fat 39.1% energy, saturated fat 13.5% energy, vitamin C 6.8 mg per 1000 kJ), and Italian migrants (fat 35.7% energy, saturated fat 12.1% energy, vitamin C 10.9 mg per 1000 kJ). However, South Asian groups had higher intakes of polyunsaturated fatty acids which may be cardioprotective. CONCLUSIONS South Asian migrants to Scotland appear to develop adverse dietary elements in the first generation, which are modified in subsequent generations, whereas Italians' diets remain cardioprotective in the migrant generation but deteriorate in subsequent generations.
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Affiliation(s)
- A S Anderson
- Centre for Public Health Nutrition Research, Department of Medicine, Ninewells Medical University of Dundee, Dundee, UK.
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Huxley RR, Lean M, Crozier A, John JH, Neil HAW. Effect of dietary advice to increase fruit and vegetable consumption on plasma flavonol concentrations: results from a randomised controlled intervention trial. J Epidemiol Community Health 2004; 58:288-9. [PMID: 15026440 PMCID: PMC1732715 DOI: 10.1136/jech.2003.014274] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- R R Huxley
- Division of Public Health and Primary Care, Institute of Health Sciences, University of Oxford, Headington, Oxford, UK.
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Stone P, Ream E, Richardson A, Thomas H, Andrews P, Campbell P, Dawson T, Edwards J, Goldie T, Hammick M, Kearney N, Lean M, Rapley D, Smith AG, Teague C, Young A. Cancer-related fatigue--a difference of opinion? Results of a multicentre survey of healthcare professionals, patients and caregivers. Eur J Cancer Care (Engl) 2003; 12:20-7. [PMID: 12641553 DOI: 10.1046/j.1365-2354.2003.00329.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
UNLABELLED The objective of this study was to investigate the perceptions of patients with cancer, their caregivers and healthcare professionals (HCPs) about fatigue and its impact on quality of life. It was a cross-sectional survey, the respondents were patients with cancer attending three UK regional cancer centres (n = 1,370), their informal caregivers (n = 1,370) and a random selection of HCPs (oncologists/nurses/radiographers/haematologists; n = 1,098). The response rates for patients, caregivers and HCPs were 42%, 33% and 34% respectively. Fatigue was reported to affect 56% of patients and to have a considerable impact on quality of life. Caregivers also recognized that fatigue was a common problem, with significant effects on patients' quality of life and impact on themselves. Healthcare professionals recognized that fatigue was a common problem for their patients but overestimated its impact on some aspects of patients' daily lives. Although most HCPs reported that they prescribed/recommended treatment for over half of their patients, only 14% of patients reported receiving any such treatment. The most common advice was to take more rest and relaxation. CONCLUSIONS patients with cancer report that fatigue is a common and distressing symptom and the importance of this symptom is generally recognized by both HCPs and lay-carers. Healthcare professionals need more information about the effectiveness of existing interventions for cancer-related fatigue and further research is required to improve the current management of this debilitating symptom.
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Affiliation(s)
- P Stone
- Department of Psychiatry, St Georges Hospital Medical School, London SW17 ORE, UK.
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Rissanen A, Lean M, Rössner S, Segal KR, Sjöström L. Predictive value of early weight loss in obesity management with orlistat: an evidence-based assessment of prescribing guidelines. Int J Obes (Lond) 2003; 27:103-9. [PMID: 12532161 DOI: 10.1038/sj.ijo.0802165] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2001] [Revised: 06/25/2002] [Accepted: 06/28/2002] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To assess the clinical usefulness of published guidelines for the use of orlistat, by studying whether weight loss >/=2.5 kg during a 4 week dietary lead-in period, and weight losses of >/=5% after 12 weeks and >/=10% after 6 months of drug therapy predict weight loss and risk factor changes after 2 years. DESIGN A retrospective analysis of pooled data from 2 multicentre, randomised, placebo-controlled clinical trials with similar design. SETTING Twenty-nine centres throughout Europe. PARTICIPANTS Two hundred and twenty men and women (BMI 28-43 kg/m(2)) who completed 2 years of treatment. INTERVENTION After a 4 week hypocaloric diet plus placebo, 2 years of treatment with orlistat 120 mg tid, plus a hypocaloric diet for the first year and a weight maintenance diet in year two. MAIN OUTCOME MEASURES Weight loss and obesity-related risk factor changes. RESULTS Weight loss >/=5% body weight after 12 weeks of diet plus orlistat therapy was a good indicator of 2 year weight loss, whereas weight loss of >/=2.5 kg during the 4 week lead-in and >/=10% after 6 months did not add significantly to the prediction of 2 year outcomes. Patients who lost >/=5% of their weight at 12 weeks (n=104, 47.3%) lost significantly more weight after 2 years than others: -11.9% (95% confidence interval (CI) -13.4% to -10.3%) vs -4.7% (-5.7% to -3.7%) (P=0.0001), and had significantly greater reductions in total cholesterol, LDL-cholesterol, triglycerides, glucose, insulin, and blood pressure. Among those who achieved >/=5% weight loss at 12 weeks, the overall health benefits were not significantly greater in patients who went on to lose >/=10% body weight at 6 months compared with those who did not achieve >/=10% weight loss by month 6. CONCLUSIONS Of the criteria currently suggested for assessing response to orlistat treatment, weight loss of >/=5% at 12 weeks accurately predicts sustained improvements in weight and major risk factors at 2 years, while other suggested criteria are less useful.
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Affiliation(s)
- A Rissanen
- Obesity Research Unit, Helsinki University Central Hospital, Helsinki, Finland.
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Abstract
AIMS To describe the organization and implementation of nutrition policies, and examine intervention strategies for dietary change in three Scandinavian countries. METHODS Descriptions of nutrition policies and dietary intervention strategies are based on published nutrition policy research and reports. RESULTS All countries studied have adopted formal nutrition policies. Norway issued its first white paper in 1976, the Finnish National Nutrition Council published an action plan in 1989, and the Swedish Government issued an official action plan in 1995. Norway has a centralized National Nutrition Council with a permanent administration whereas the responsibilities and administration are more spread out between several authorities and groups in Finland and Sweden. Amongst the dietary intervention strategies employed, a Norwegian nutrition campaign, symbol labelling of foods in Sweden, the community-based North Karelia Project in Finland, and mass catering in Finland and Sweden have been selected as potentially transferable. CONCLUSIONS Policy documents serve as guidelines for activities and assist in achieving dietary targets. A responsible administrative body with advice from a standing expert committee is valuable for implementation. Guidelines, recommendations or voluntary labelling standards can be incentives to product development and changes to food production. Regional demonstration projects may also encourage action and collaboration.
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Affiliation(s)
- G Roos
- Department of Human Nutrition, University of Glasgow, Glasgow Royal Infirmary, Glasgow, UK
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Lean M. Helping the obese man lose weight. Practitioner 2001; 245:800-2, 805-7. [PMID: 11677895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Affiliation(s)
- M Lean
- Department of Human Nutrition, Glosgow University, Glosgow Royal Infirmary
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34
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Lean M. Nutrition and dietary advice in diabetes. Practitioner 2001; 245:231-8. [PMID: 11258191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Affiliation(s)
- M Lean
- Department of Human Nutrition, Glasgow University
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35
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Lean M. Cutting fat absorption to halt weight gain. Practitioner 1998; 242:860-5. [PMID: 10441885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Affiliation(s)
- M Lean
- Dept of Human Nutrition, University of Glasgow
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Friedman DS, Katz LJ, Augsburger JJ, Lean M. Holmium laser sclerostomy in glaucomatous eyes with prior surgery: 24-month results. Ophthalmic Surg Lasers 1998; 29:17-22. [PMID: 9474595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND OBJECTIVE To evaluate the effectiveness of holmium laser sclerostomy in glaucoma patients who have had prior intraocular surgery. PATIENTS AND METHODS The authors conducted a retrospective analysis of outcomes for 25 patients who underwent holmium laser sclerostomy from 1991 to 1993. RESULTS Postoperative success (defined as a drop in intraocular pressure of 30% and a final intraocular pressure of less than 22 mm Hg) at 24 months ranged from 36% to 52%, depending on criteria chosen for success. There were no major complications from the procedure. CONCLUSIONS Holmium laser sclerostomy can be successful in a highly select group of patients undergoing filtration procedures who have had prior intraocular surgery.
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Affiliation(s)
- D S Friedman
- William and Anna Goldberg Glaucoma Service, Wills Eye Hospital, Philadelphia, PA, USA
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37
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Lean M. Why is losing weight so hard? Practitioner 1997; 241:253-6. [PMID: 9218401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- M Lean
- Department of Human Nutrition, University of Glasgow
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Yudkin JS, Blauth C, Drury P, Fuller J, Henley J, Lancaster T, Lankester J, Lean M, Pentecost B, Press V, Rothman D. Prevention and management of cardiovascular disease in patients with diabetes mellitus: an evidence base. Diabet Med 1996; 13:S101-21. [PMID: 8894461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- J S Yudkin
- Centre for Diabetes and Cardiovascular Risk, University College London Medical School, Whittington Hospital, UK
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40
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Hopayian K, Garrow J, Lean M, Anderson A. An obese woman who asks for slimming pills. Practitioner 1995; 239:419-20, 423-5. [PMID: 7659664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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41
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Thomas BJ, Thomas BJ, Brenchley S, Connor H, Elkeles RS, Govindji A, Hartland BV, Lean M, Lord K, Southgate DAT. Diabetic foods and the diabetic diet: A British Diabetic Association Discussion Paper. J Hum Nutr Diet 1992. [DOI: 10.1111/j.1365-277x.1992.tb00155.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
An assay is described based on a high pressure liquid chromatography system for measurement of vitamin D3 and 25-hydroxyvitamin D3 concentration in adipose tissue and muscle. The sensitivity of the assay is less than 1 ng/g of tissue. Neither vitamin D3 nor 25-hydroxyvitamin D3 were found in tissues of vitamin D-deficient rats using this method. 25-Hydroxyvitamin D3 could not be detected in adipose tissue and very little was found in muscle of normal rats. The mean vitamin D3 concentrations in 15 samples of human perirenal adipose tissue was 45.3 ng/g +/- 22.2 (SD) and in 6 samples of axillary tissue 115.6 ng/g +/- 52.4 (SD). Human adipose tissue contains a substantial amount of vitamin D3 and its contribution to the maintenance of vitamin D status is discussed.
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