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Biomedical subjects

A Avenell

Publications and source records attributed to A Avenell.

At least 37 records · Page 2Linked to original sources
PubMed2004

Systematic review of the long-term effects and economic consequences of treatments for obesity and implications for health improvement.

OBJECTIVES: To undertake a systematic review of the long-term effects of obesity treatments on body weight, risk factors for disease, and disease. METHODS: The study encompassed three systematic reviews that examined different aspects of obesity treatments. (1) A systematic review of obesity treatments in adults where the methods of the Cochrane Collaboration were applied and randomised controlled trials (RCTs) with a follow-up of at least 1 year were evaluated. (2) A systematic epidemiological review, where studies were sought on long-term effects of weight loss on morbidity and/or mortality, and examined through epidemiological modelling. (3) A systematic economic review that sought reports with both costs and outcomes of treatment, including recent reports that assessed the cost-effectiveness of pharmaceutical and surgical interventions. A Markov model was also adopted to examine the cost-effectiveness of a low-fat diet and exercise intervention in adults with obesity and impaired glucose tolerance. RESULTS: The addition of the drugs orlistat or sibutramine was associated with weight loss and generally improved risk factors, apart from diastolic blood pressure for sibutramine. Metformin was associated with decreased mortality after 10 years in obese people with type 2 diabetes. Low-fat diets were associated with continuing weight loss for 3 years and improvements in risk factors, as well as prevention of type 2 diabetes and improved control of hypertension. Insufficient evidence was available to demonstrate the benefits of low calorie or very low calorie diets. The addition of an exercise or behaviour programme to diet was associated with improved weight loss and risk factors for at least 1 year. Studies combining low-fat diets, exercise and behaviour therapy suggested improved hypertension and cardiovascular disease. Family therapy was associated with improved weight loss for 2 years compared to individual therapy. There was insufficient evidence to conclude that individual therapy was more beneficial than group therapy. Weight lost more quickly (within 1 year), from the epidemiology review, may be more beneficial with respect to the risk of mortality. The effects of intentional weight loss need further investigation. Weight loss from surgical and non-surgical interventions for people suffering from obesity was associated with decreased risk of development of diabetes, and a reduction in low-density lipoprotein cholesterol, total cholesterol and blood pressure, in the long term. Targeting high-risk individuals with drugs or surgery was likely to result in a cost per additional life-year or quality-adjusted life-year (QALY) of no more than 13,000 British pounds. There was also suggestive evidence of cost saving from treatment of people with type 2 diabetes with metformin. Targeting surgery on people with severe obesity and impaired glucose tolerance was likely to be more cost-effective at 2329 British pounds per additional life-year. Economic modelling over 6 years for diet and exercise for people with impaired glucose tolerance was associated with a high initial cost per additional QALY, but by the sixth year the cost per QALY was 13,389 British pounds. Results did not include cost savings from diseases other than diabetes, and therefore may be conservative. CONCLUSIONS: The drugs orlistat and sibutramine appear beneficial for the treatment of adults with obesity, and metformin for obese patients with type 2 diabetes. Exercise and/or behaviour therapy appear to improve weight loss when added to diet. Low-fat diets with exercise, or with exercise and behaviour therapy are associated with the prevention of type 2 diabetes and hypertension. Long-term weight loss in epidemiological studies was associated with reduced risk of type 2 diabetes, and may be beneficial for cardiovascular disease. Low-fat diets and exercise interventions in individuals at risk of obesity-related illness are of comparable cost to drug treatments. Long-term pragmatic RCTs of obesity treatments in populations with obesity-related illness or at high risk of developing such illness are needed (to include an evaluation of risk factors, morbidity, quality of life and economic evaluations). Drug trials that include dietary advice, plus exercise and/or behaviour therapy are also needed. Research exploring effective types of exercise, diet or behaviour and also interventions to prevent obesity in adults is required.

Anti-Obesity Agents↗
PubMed2003

Antithyroid drug regimen for treating Graves' hyperthyroidism.

BACKGROUND: Antithyroid drugs are widely used in the therapy of hyperthyroidism. There are wide variations in the dose, regimen or duration of treatment used by health professionals. OBJECTIVES: To assess the effects of dose, regimen and duration of antithyroid drug therapy for Graves' hyperthyroidism. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (Central), MEDLINE, EMBASE, BIOSIS, CINAHL, HEALTHSTAR, Current Controlled Trials and reference lists. We contacted investigators and hand searched conference abstracts. Most recent search: June 2002. SELECTION CRITERIA: Randomised and quasi-randomised trials of antithyroid medication for Graves' hyperthyroidism were used. DATA COLLECTION AND ANALYSIS: Trial allocation to included, excluded and awaiting assessment categories was made by consensus. Two reviewers independently extracted data and assessed trial quality. Pooling of data for primary outcomes, and select exploratory analyses were undertaken. MAIN RESULTS: Nineteen randomised trials involving 2233 participants were included. Overall the quality of trials as reported was poor; specifically in terms of allocation concealment, assessor blinding and loss to follow-up. Four trials examined the effect of duration of therapy on relapse rates of Graves' hyperthyroidism. In one trial using the Titration regimen, longer duration therapy (18 months) had significantly fewer relapses (37% vs 58%) than six month therapy (Odds ratio (OR) = 0.42, 95% confidence interval (CI) 0.18 to 0.96). In one quasi-randomised trial using the Block-Replace regimen, there was no significant difference between the six and 12 month (relapses rates 41% versus 35%) arms of the study. Extending the duration of therapy to over 18 months was not associated with improved relapse rates (Peto OR = 0.75, 95% CI 0.39 to 1.43). Ten trials examined the effect of Block-Replace versus Titration regime. Relapse rates were similar in both groups at 54% in the Block-Replace group and 58% in the Titration group (Peto OR = 0.83, 95% CI 0.63 to 1.10). Participants reporting rashes (11% versus 5%) and withdrawing due to side effects (16% versus 9%) were significantly higher in the Block-Replace group compared to the Titration group respectively. Three studies considered the addition of thyroxine after initial therapy with antithyroid drugs. There was significant heterogeneity between the studies and the difference between the two groups were not significant (Odds ratio = 0.58, 95% CI 0.05 to 6.21). REVIEWER'S CONCLUSIONS: The evidence (based on three studies) suggests that the optimal duration of antithyroid drug therapy for the Titration regimen is 12 to 18 months. The six month Block-Replace regimen was found to be as effective as the 12 month treatment in one quasi-randomised study. The Titration (low dose) regimen had fewer adverse effects than the Block-Replace (high dose) regimen and was no less effective in trials (based on 10 trials) of equal duration. The incidence of hypothyroidism was not reported and there were no deaths in the study populations.

Antithyroid Agents↗
PubMed2003

A systematic review of protein and energy supplementation for hip fracture aftercare in older people.

OBJECTIVES: To evaluate whether protein and energy supplementation influences recovery after hip fracture. DESIGN: Systematic review of randomised and quasi-randomised trials in people aged 65 y and over. DATA SOURCES: We searched seven electronic databases from 1966 to April 2002, four journals and reference lists of relevant articles. We contacted trial investigators and experts for details of other trials. MAIN OUTCOME MEASURES: Mortality, complications and unfavourable outcome (mortality or survivors with complications) were the primary outcomes. We also sought data on length of hospital stay, functional status after hip fracture, quality of life and compliance with supplementation. RESULTS: In total, 12 randomised trials involving 898 participants were included. Nine trials evaluated protein and energy supplementation (five oral and four nasogastric feeding), and a further three trials tested oral protein supplementation. Potential biases resulting from inadequate allocation concealment and lack of assessor blinding and intention-to-treat analysis, as well as the limited outcome data, mean that the results must be interpreted with caution. Pooled data from eight of the nine trials evaluating protein and energy supplements showed no evidence for an effect on mortality (relative risk 0.92, 95% CI 0.56-1.50). Limited data from only three trials showed that oral protein and energy supplements may reduce unfavourable outcome (relative risk 0.52, 95% CI 0.32-0.84). CONCLUSION: Based on limited evidence, oral protein and energy supplementation after hip fracture may reduce unfavourable outcome. Further evidence from good-quality randomised trials is required to inform clinical practice.

Aged↗
PubMed2002

Protein and energy supplementation in elderly people at risk from malnutrition.

BACKGROUND: This review was carried out because evidence for the effectiveness of nutritional supplements containing protein and energy which are often prescribed for elderly people is limited. Furthermore malnutrition is more common in this age group and deterioration of nutritional status can occur during a stay in hospital. It is important to establish whether supplementing the diet with protein and energy is an effective way of improving outcomes for older people at risk from malnutrition. OBJECTIVES: This review examines the evidence from trials for improvement in nutritional status and clinical outcomes when extra protein and energy food were provided, usually in the form of commercial 'sip-feeds'. SEARCH STRATEGY: We searched The Cochrane Library (issue 1, 2001), MEDLINE (1966 to February 2001), EMBASE (1980 to March 2001), Health star (1975 to March 2001), CINAHL (1982 to Jan 2001), BIOSIS (1985 to March 2001) and CAB abstracts (1973 to March 2001). We also hand searched nutrition journals and reference lists and contacted 'sip-feed' manufacturers. Date of most recent search: March 2001. SELECTION CRITERIA: Randomised controlled trials and quasi-randomised controlled trials of oral protein and energy supplementation in older people with the exception of groups recovering from cancer treatment or in critical care. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed trials prior to inclusion and independently extracted data and assessed trial quality; any differences were resolved by reaching consensus. Authors of trials were contacted for further information as necessary. MAIN RESULTS: Thirty-one trials with 2464 randomised participants have been included in the review. Most included trials had poor study quality. Mortality data were combined for meta-analysis from twenty-two trials (1755 participants). The Relative Risk (RR) indicated a lower mortality in the supplemented group compared with the control group (0.67; 95% confidence interval (CI) 0.52 to 0.87). The risk of complications (total complications if available, otherwise for example the number of infections by the end of follow-up) from nine trials (608 participants) showed no significant difference (RR 0.93, 95% CI 0.77 to 1.13). We were unable to combine trials for meta-analyses of functional outcome, for example grip strength, walking distance and Barthel Index, however there was little evidence of benefit to functional outcomes from individual studies. Data describing length of stay were available from seven trials (658 participants). There was some indication that mean length of stay was shorter for the supplemented groups (-3.4 days, 95% CI -6.12 to -0.69). REVIEWER'S CONCLUSIONS: Supplementation appears to produce a small but consistent weight gain. There was a statistically significant beneficial effect on mortality and a shorter length of hospital stay. Additional data from large-scale multi-centre trials are still required to provide clear evidence of benefit from protein and energy supplements on mortality and length of hospital stay. Too few data were reported and the time scale of most studies was too short to have a realistic chance of detecting differences in morbidity, functional status and quality of life. Furthermore, most trials do not address the organisational and practical challenges faced by practitioners trying to meet the individual needs and preferences of those at risk from malnutrition.

Aged↗
PubMed2002

Assessment of nutritional status in hospital in-patients.

BACKGROUND: The King's Fund and British Association of Parenteral and Enteral Nutrition recommend that all hospital patients should have height and weight recorded, to detect the need for nutritional support. Systematic review evidence also suggests that protein and energy supplementation of adults in hospital with a wide range of conditions improves outcome. AIM: To assess the recording of weight and height in hospitals. DESIGN: Survey (random sample). METHODS: As part of a survey on the provision of deep venous thrombosis prophylaxis, we collected information on height and weight recording from medical and nursing notes. We randomly selected five medical, five surgical, five orthopaedic, and five obstetrics and gynaecology directorates from across Scotland. Six hundred case notes were requested, and 88% were available for data extraction. Some 67% of hospital episodes provided information about weight, and 41% on both height and weight. General medicine directorates had the lowest recording of weight, and in medical and surgical directorates, both weight and height were rarely recorded in comparison with the other two directorates (p<0.001). DISCUSSION: Our survey suggests that recommendations to assess nutritional risk are not being followed, and that many patients at risk of malnutrition are not being detected or treated.

Adult↗
PubMed2001

Lessons for search strategies from a systematic review, in The Cochrane Library, of nutritional supplementation trials in patients after hip fracture.

BACKGROUND: A key aim when conducting systematic reviews of randomized controlled trials (RCTs) is to include all of the evidence, if possible. Serious bias may result if trials are missed through inadequate search strategies. OBJECTIVE: The objective was to evaluate the search plan for identifying RCTs in nutrition as part of a systematic review, in The Cochrane Library, of nutritional supplementation trials in patients after hip fracture. DESIGN: We identified potential studies by searching the electronic databases BIOSIS, CABNAR, CINAHL, EMBASE, HEALTHSTAR, and MEDLINE; reference lists in trial reports; and other relevant articles. We also contacted investigators and other experts for information and searched 4 nutrition journals by hand. RESULTS: We identified 15 RCTs that met the predefined inclusion criteria. The search plan identified 8 trials each in EMBASE, HEALTHSTAR, and MEDLINE and 7 in BIOSIS and CABNAR. BIOSIS was the only electronic database source of 2 trials. Eleven trials were identified by searching electronic databases and 2 unpublished trials were identified via experts in the field. We found one trial, published only as a conference abstract, by searching nutrition journals by hand. After publication of the protocol for the review in The Cochrane Library, we were informed of another unpublished trial. CONCLUSIONS: We found that a limited search plan based on only MEDLINE or one of the other commonly available databases would have failed to locate nearly one-half of the studies. To protect against bias, the search plan for a systematic review of nutritional interventions should be comprehensive.

Bias↗
PubMed2000

Vitamin D and vitamin D analogues for preventing fractures associated with involutional and post-menopausal osteoporosis.

BACKGROUND: Due to their known effects on bone metabolism, Vitamin D and related compounds have been proposed for the prevention of osteoporosis and fractures. OBJECTIVES: To determine the effects of supplementation with Vitamin D or a Vitamin D analogue in the prevention of fractures of the axial and appendicular skeleton in elderly men or women with involutional or post-menopausal osteoporosis. SEARCH STRATEGY: We searched MEDLINE, EMBASE, BIOSIS, CINAHL, HealthPLAN, Dissertation Abstracts, Index to UK Theses, Current Contents, and bibliographies of identified trials and reviews. Trials were also obtained from the Cochrane Musculoskeletal Injuries Group trials register. Date of the most recent search: December 1995. SELECTION CRITERIA: Any randomised or quasi-randomised trial which compared Vitamin D or a Vitamin D analogue, either alone or in combination with calcium supplementation, with a placebo, no intervention, or the administration of calcium supplements, with fracture as an outcome, in elderly men or women with involutional or post-menopausal osteoporosis. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed trial quality, by use of a seven item scale, and extracted data. Additional information was sought from trialists. Where possible the data were pooled. MAIN RESULTS: Fourteen trials recording 13 different comparisons were included. In the only trial of Vitamin D alone, protection against hip fracture was not confirmed. Two regimens, each represented by one large trial, which showed limited evidence of efficacy in reducing the incidence of hip or other appendicular skeleton fractures were: 1) Oral Vitamin D when accompanied by calcium supplementation. 2) 1,25 dihydroxy Vitamin D (calcitriol). This appeared more effective than calcium in a direct comparison. Regimens showing limited evidence of efficacy in reducing the incidence of vertebral deformity were: 1) 1,25 dihydroxy Vitamin D (calcitriol), which appeared more effective than calcium in one large trial, and more effective than placebo from pooled results of two small trials. 2) Oral 1-alpha hydroxy Vitamin D (alfacalcidol), when administered with calcium supplements (two small trials, which lacked power to confirm a possible effect). Hypercalcaemia and gastro-intestinal symptoms, reported in less than 5% of participants, were slightly more common when Vitamin D analogues were taken. However, the risk of death was marginally less. REVIEWER'S CONCLUSIONS: Uncertainty remains about the efficacy of regimens which include Vitamin D or its analogues in fracture prevention. Particularly if co-supplementation of calcium is required, significant cost differences are likely to exist between regimens. Further randomised trials with economic evaluation are desirable before community fracture prevention programmes employing Vitamin D supplementation can be confidently introduced.

Aged↗
PubMed2000

Nutritional supplementation for hip fracture aftercare in the elderly.

BACKGROUND: Fractures of the hip are an important cause of later ill health and mortality in elderly people. People with hip fractures are often malnourished at the time of fracture, and have poor food intake in hospital. OBJECTIVES: This review assesses the effects of nutritional interventions in elderly people recovering from hip fracture. SEARCH STRATEGY: We searched the Cochrane Musculoskeletal Injuries Group trials register, the Cochrane Controlled Trials Register, Medline, Nutrition Abstracts and Reviews, Embase, Biosis, Cinahl, Healthstar and reference lists. We contacted investigators, and hand searched Proceedings of the Nutrition Society, Clinical Nutrition and The Journal of Parenteral and Enteral Nutrition. Date of the most recent search: June 1999. SELECTION CRITERIA: Randomised and quasi-randomised trials of nutritional interventions of mainly older patients (aged over 65 years) with hip fracture. DATA COLLECTION AND ANALYSIS: Trial allocation to included, excluded and awaiting assessment categories, was by consensus. Both reviewers independently extracted data and assessed trial quality. Additional information was sought from all trialists. Pooling of data for primary outcomes and select exploratory analyses were undertaken. MAIN RESULTS: Fifteen randomised trials involving 943 participants were included. Overall the quality of trials was poor; specifically in terms of allocation concealment, assessor blinding and intention to treat analysis. This, and the limited availability of outcome data, mean that the following results must be interpreted with caution. Oral multinutrient feeds (providing non-protein energy, protein, some vitamins and minerals), evaluated by six trials, may reduce unfavourable outcome (death or complications) (14/66 versus 26/73; Peto odds ratio 0.28, 95% confidence interval 0.11 to 0.67), but did not demonstrate an effect on mortality (12/91 versus 14/97; Peto odds ratio 0.82, 95% confidence interval 0.34 to 1.96). Four trials, examining nasogastric multinutrient feeding, showed no evidence for an effect on mortality (Peto odds ratio 0.98, 95% confidence interval 0.44 to 2.17), but the studies were heterogeneous regarding case-mix. Insufficient information was provided to evaluate unfavourable outcome. The effect of protein in an oral feed, tested in two trials, showed no evidence for an effect on mortality (Peto odds ratio 0.93, 95% confidence interval 0.31 to 2.79), but may have reduced days spent in rehabilitation wards. Two trials, testing intravenous thiamin (vitamin B1) and other water soluble vitamins, or 1-alpha-hydroxycholecalciferol (an active form of vitamin D) respectively, produced no evidence of benefit for either vitamin supplement. REVIEWER'S CONCLUSIONS: The strongest evidence for the effectiveness of nutritional supplementation exists for oral protein and energy feeds, but the evidence is still very weak. Future trials are required which overcome the defects of the reviewed studies, particularly inadequate size, methodology and outcome assessment.

Aged↗
PubMed1999

Measurement of abdominal fat by magnetic resonance imaging, dual-energy X-ray absorptiometry and anthropometry in non-obese men and women.

OBJECTIVE: To investigate whether the dual-energy X-ray absorptiometry (DEXA) was a better predictor of abdominal fat, measured by magnetic resonance imaging (MRI) at the level of L2-L3, than anthropometric measurements in non-obese men and non-obese women. DESIGN: Observational, cross sectional study. SUBJECTS: 34 healthy subjects (17 men and 17 women) aged 20-53 y with a body mass index (BMI) < 30 kg/m2. MEASUREMENTS: Fat distribution parameters including waist circumference and waist-to-hip ratio (WHR); intra abdominal fat (IAF) by MRI; and central abdominal fat (CAF) by DEXA. RESULTS: Measurement of IAF by MRI, was highly correlated to the CAF measured by DEXA. In men, both waist circumference and WHR had similar correlation to IAF as DEXA. In women, waist circumference was less well correlated with IAF than DEXA, and the WHR had a weaker non significant correlation with IAF. CONCLUSIONS: In non-obese men; DEXA, waist circumference and WHR can predict IAF equally well, while in non-obese women, DEXA is superior to waist circumference and much better than WHR.

Abdomen↗
PubMed1998

Anomalies in the measurement of changes in bone mineral density of the spine by dual-energy X-ray absorptiometry.

Dual-energy X-ray absorptiometry (DXA) is frequently used for longitudinal studies of bone mineral status because of the high precision obtained, but evidence is emerging that the accuracy of measurements of changes may be a limitation because of artefacts of the analysis procedure, in particular, a dependence of the measured bone area (BA) on the bone mineral content (BMC). Results of spine bone mineral measurements taken at intervals with two DXA scanners, a Hologic QDR 1000 W, and a Norland XR 26 HS, were examined. There was a consistent correlation between changes in BA and in BMC, with a slope of approximately 0.25 when expressed as percentages. A real change of BA of the magnitude observed is not feasible. There were no differences among the correlations for different instruments, genders, ages, or weight changes. There would appear to be an underestimation of changes in bone mineral density (BMD), but there is a possibility that some of the anomaly is manifested as an overestimation of a change in BMC. Phantom measurements were undertaken with the DXA scanners mentioned above and with a Lunar DPX. The phantoms consisted of simulations of the spine cut from aluminium sheet, so that the effective BMD could be varied. The dependence of the measured BA on BMC varied with the phantom outline, particularly the thickness of the transverse processes. Evidence was obtained of both an underestimate of BMD changes and an overestimate of BMC changes. There are errors in measuring spine changes, but these do not seem to be as serious as a previous report suggests for the Hologic scanner and are not likely to lead to misinterpretation of results.

Absorptiometry, Photon↗
PubMed1997

Weight loss with high and low carbohydrate 1200 kcal diets in free living women.

This randomised controlled trial examined anthropometric changes and cardiovascular benefits of six months of weight management in 110 free living women, aged 18-68 y and BMI 25-50 kg/m2, who received 1200 kcal/d diet treatments of either high (58% energy, n = 57) or low (35% energy, n = 53) carbohydrate (CHO) content. Body weight, plasma total, HDL and LDL cholesterol, triglyceride and blood pressure were measured. Examination at three months showed women on high CHO lost (mean +/- s.e.m) 4.3 +/- 0.5 kg and those on low CHO lost 5.6 +/- 0.6 kg of body weight. Changes in risk factors did not significantly differ between the two diet treatments throughout the study. However those on high CHO diets significantly lowered their plasma total cholesterol by 0.33 mmol/l (95% CI: 0.10, 0.55), LDL cholesterol by 0.23 mmol/l (0.02, 0.43) and HDL cholesterol by 0.05 mmol/l (0.03, 0.10), while women on low CHO diets lowered only plasma triglyceride by 0.28 mmol/l (0.08, 0.48). Blood pressure did not change significantly on either diet. After six months, women on high CHO lost 5.6 +/- 0.8 kg and those on low CHO lost 6.8 +/- 0.8 kg. On the high CHO diet, total cholesterol remained significantly below the baseline value at 0.34 mmol/l (0.13, 0.56), triglyceride was significantly lowered by 0.27 mmol/l (0.10, 0.45), and HDL cholesterol returned to the baseline value. On the low CHO diet, triglyceride remained the only risk factor to be significantly improved. A subgroup of 46 postmenopausal women lost significantly (P < 0.05) more weight on the low CHO diet than high CHO diet. In conclusion, these results provided some support for preferring a high CHO diet to a lower CHO approach in weight management, from the point of view of risk reduction, but do not indicate a consistently more rapid weight loss with either diet.

Adolescent↗
PubMed1997

Waist circumference reduction and cardiovascular benefits during weight loss in women.

OBJECTIVE: To examine the relationship between waist circumference and cardiovascular risk factors during weight loss, and to consider possible waist reduction targets for weight management. DESIGN: Single strand six month weight loss study on food based diets in 110 women aged 18-68 y, and body mass index > or = 25 kg/m2 set at an outpatient clinic. MAIN OUTCOME MEASURES: Waist circumference, weight, body mass index (BMI), total plasma cholesterol, low (LDL) and high density lipoprotein (HDL) cholesterol, triglyceride, and blood pressure. RESULTS: Anthropometric and metabolic measurements improved with mean weight loss of 4.9 (s.e.m. +/- 0.4) kg at three months and 6.2 (s.e.m. +/- 0.4) kg at six months. Weight loss closely related to waist reduction (% Weight loss = 0.85 x Waist reduction (cm)-2.09; r = 0.79). The proportion of subjects with waist circumference below Action Level 1 (< 80 cm) or above Action Level 2 (> or = 88 cm) were 9 and 60% at baseline, 29 and 38% at three months and 36 and 33% at six months. Waist reduction (adjusted for age, smoking, alcohol consumption, diet treatment and baseline dependent and independent variables) correlated significantly with falls in total cholesterol (r = 0.31; P < 0.01), LDL cholesterol (r = 0.35; P < 0.01) and diastolic blood pressure (r = 0.32; P < 0.01), but not significantly with HDL cholesterol, triglyceride or systolic blood pressure. BMI showed similar correlations, whereas waist to hip ratio changes were not associated with changes in any cardiovascular risk factors. Amongst those whose waist fell by > or = 5 cm, 45 at three months and 43 at six months, there were > or = 10% improvements in at least one risk factor for 71 and 84% respectively. Amongst those whose waist fell by 5-10 cm, 40 women at three months and 30 at six months, at least one risk factor improved by > or = 10% in 70% and in 83% respectively. CONCLUSIONS: Waist reduction of 5-10 cm in Caucasian women, across a range of baseline BMI 25-50 kg/m2 or waist circumference 72-133 cm, may be used as guideline to encourage overweight women to achieve a realistic target with a high probability of health benefits.

Adult↗
PubMed1997

Short-term effects of dietary sodium intake on bone metabolism in postmenopausal women measured using urinary deoxypyridinoline excretion.

The influence of Na load on bone metabolism was investigated in postmenopausal women using urinary deoxypyridinoline (DPD) as a marker of bone resorption. In a cross-over study, fourteen postmenopausal women were divided into two groups of seven. A fixed diet providing 816 mg Ca/d with either 60 or 170 mmol Na/d was consumed. At the end of an 8 d period the groups switched diets for a further 8 d period. Urine was collected daily for the last 4 d of each period. There was no significant difference in DPD excretion between high-Na and low-Na diets (129 nmol/d v. 132 nmol/d; P = 0.18). There was, however, a significant relationship (P = 0.02) between the changes in DPD excretion and urinary Ca. Plasma Mg fell from 0.83 to 0.81 mmol/l on the high Na intake (P < 0.001), but there was no significant effect on plasma Ca or intact parathyroid hormone levels. It is concluded that varying dietary Na intake may affect Ca and Mg metabolism, but we were unable to demonstrate an effect on bone resorption at the levels of intake used.

Aged↗
PubMed1997

A one-year trial to assess the value of orlistat in the management of obesity.

OBJECTIVES: This paper describes the methodology of a multicentre study designed to assess the efficacy and tolerability of orlistat 120 mg tid as therapy for inducing weight loss in excess of that achieved with a moderately calorie-restricted diet alone. The results from a single centre are presented to illustrate the nature of the response. DESIGN: This was a double-blind, randomized, parallel-group, placebo-controlled multicentre study. A four-week, single-blind, placebo run-in period preceded a 52 week double-blind treatment period during which patients received either orlistat or placebo three times a day. At the start of the run-in period, all patients were placed on a diet containing approximately 30% of calories as fat and designed to cause an energy deficit of approximately 600 kcal/d. SUBJECTS: Patients of either sex, more than 18 y of age, with a body mass index (BMI) between 30 and 43 kg/m2 were eligible for enrolment. MEASUREMENTS: Efficacy assessments included: measurements of body weight; anthropometry; quality of life; blood pressure; serum lipids; fasting serum glucose and insulin. Safety assessments included: adverse events; vital signs; ECG; renal and gallbladder ultrasound; haematology; serum biochemistry. OUTCOME: In the single centre there was a reduction in body weight of 5.5 +/- 4.5 (s.d.) kg (5.7% reduction) in the placebo group and 8.6 +/- 5.4kg in the orlistat-treated group (8.4% reduction) by six months. Thereafter, the placebo group tended to relapse whereas the orlistat group maintained their loss (2.6% vs 8.4% reduction from initial value at 52 weeks). Total and LDL cholesterol fell by 0.05 mmol/l (1.6%) and 0.14 mmol/l (4.2%), respectively, in orlistat treated patients. The drop-out rate was 48% in the placebo group and 39% in the orlistat group. Intestinal symptoms related to orlistat were significantly increased compared to placebo but were well tolerated. Fat soluble vitamin levels remained within the normal range in the treatment group; the reduction seen in alpha-tocopherol levels in patients receiving orlistat was normalized by the decrease in plasma cholesterol concentrations. Beta-carotene and vitamin D concentrations also decreased in orlistat-treated patients. CONCLUSIONS: This preliminary analysis suggests that orlistat, when used with a health-promoting low-fat and moderately energy-restricted diet, confers advantages in the long-term management of obesity.

Adult↗
PubMed1996

Comparisons between fat measurements by dual-energy X-ray absorptiometry, underwater weighing and magnetic resonance imaging in healthy women.

OBJECTIVE: To compare the results of measurements of total and regional fat by dual-energy X-ray absorptiometry (DXA), underwater weighing (UWW) and magnetic resonance imaging (MRI) in women. DESIGN: 13 volunteer pre-menopausal women measured with a Norland XR26 HS DXA instrument, hydrodensitometry equipment and a 0.08 Tesla MRI scanner. SETTING: Aberdeen Royal Infirmary. RESULTS: There were high correlations between measurements of total-body fat by the different techniques, but poor agreement. The mean values of fat as a percentage of the total body mass were UWW = 28.6%, DXA = 40.0%, MRI = 23.0%, although the MRI excluded the head, forearms and feet, estimated from the DXA measurements to contain 8% of the body fat. Although the correlations were apparently linear in the ranges examined, those including the Norland DXA had high intercepts. Bland and Altman plots showed no dependence of the differences on the degree of fatness. Evidence was obtained from in vivo comparisons and phantom measurements that the fat calibration of the Norland DXA had changed during a three year period, suggesting that fat calibration errors contributed to the MRI/DXA differences. Previous comparisons between the Norland DXA and other brands indicate that Hologic and Lunar instruments would show a closer agreement with MRI and UWW. Profiles of fat distribution along the body showed variations in the DXA/MRI ratio, particularly in the chest, with the DXA pattern thought to be the less accurate. The DXA measurements of bone mineral, fat and lean tissue were used to demonstrate the variable proportion of bone in fat-free tissue, leading to errors in UWW. CONCLUSIONS: Each method has its assumptions, which are often not sufficiently appreciated. Each method may be useful for testing and improving the assumptions in the other methods. No method can yet be regarded as a satisfactory reference technique.

Absorptiometry, Photon↗