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217 CNO REPORT 30 Oct 2015

217CNO31OCT2015

clip_image002CNO Report 217

Release Date 30 OCT 2015

Draft Report Compiled by

Ralph Turchiano

http://www.clinicalnews.org

 

In this Issue:

1.       Systematic review examines potential health benefits of pear consumption

2.       Children who take antibiotics gain weight faster than kids who don’t

3.       Vitamin B3 derivative cuts risk of new skin cancers

4.       Study finds medication errors, adverse drug events in 1 out of 2 surgeries studied

5.       York U researchers list products expectant mothers should avoid during first trimester

6.       Study: Low-weight, high-repetition exercise increases bone density up to 8 percent in adults

7.       Obese children’s health rapidly improves with sugar reduction unrelated to calories

8.       The Lancet Diabetes & Endocrinology: Large meta-analysis finds low-fat diets ineffective for achieving long-term weight loss

 

Public Release: 20-Oct-2015

Systematic review examines potential health benefits of pear consumption

In vitro, animal, clinical and epidemiologic studies indicate pear consumption potentially improves gut health and set the stage for further evidence of associated health benefits

Edelman Public Relations

 

PORTLAND, Ore. – Oct. 20, 2015 – To explore the potential health benefits associated with pear consumption and related health outcomes, Joanne Slavin, Ph.D., R.D., professor of food science and nutrition at the University of Minnesota, St. Paul, assisted by food science graduate Holly Reiland, conducted a systematic review of studies from PubMed (database of the National Library of Medicine with citations and abstracts of biomedical literature) and Agricola (database of the National Agricultural Library with citations of agricultural literature) from 1970 to present.

Pears are an excellent source of fiber and a good source of vitamin C for only 100 calories per serving. One medium pear provides about 24 percent of daily fiber needs. They are sodium-free, cholesterol-free, fat-free and contain 190 mg of potassium. The USDA Dietary Guidelines for Americans and CNPP MyPlate advise people who eat more fruits as part of an overall healthy diet are likely to reduce their risk of some chronic diseases, although little is published on the health outcomes associated with individual fruits, including pears.

In the review conducted by Dr. Slavin and Reiland, pears were found to be a source of fructose, sorbitol and dietary fiber. “Americans fall short on dietary fiber,” said Dr. Slavin. “The high content of dietary fiber in pears and their effects on gut health set pears apart from other fruit and deserves further study.” Slavin found the body of evidence for a relationship between pear intake and health outcomes to be sparse and diverse and believes intervention studies with pears that show positive health outcomes, most likely improvements in gut health, are needed.

According to Slavin, an epidemiologic cohort study conducted by Larsson et al.2 found, among individual fruit and vegetable subgroups, inverse associations with total stroke and the consumption of pears, along with apples and leafy green vegetables. In a meta-analysis of twenty prospective cohort studies Hu et al.3 found apples/pears, citrus fruits and leafy vegetables might contribute to stroke protection.

An epidemiologic study conducted by Wedick et al.4 linked the consumption of anthocyanin-rich foods, particularly pears, apples and blueberries, with lower risk of Type 2 diabetes. An additional epidemiologic study via Mink et al.5 indicated flavonoid-rich foods including pears were associated with a significant reduction in mortality from coronary heart disease and cardiovascular disease in postmenopausal women.

While the body of evidence connecting pear intake and health outcomes is still limited, USA Pears has been contributing to research efforts by commissioning independent studies to learn and affirm the heath attributes of pears. Visit http://www.usapears.org for additional pear research, nutrition resources and recipes.

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Public Release: 21-Oct-2015

Children who take antibiotics gain weight faster than kids who don’t

New study suggests that repeated antibiotic use could lead to higher BMI long term

Johns Hopkins University Bloomberg School of Public Health

Kids who receive antibiotics throughout the course of their childhoods gain weight significantly faster than those who do not, according to new Johns Hopkins Bloomberg School of Public Health research.

The findings, published online Oct. 21 in the International Journal of Obesity, suggest that antibiotics may have a compounding effect throughout childhood on body mass index (BMI), a measure often used to determine whether someone is at a healthy weight.

“Your BMI may be forever altered by the antibiotics you take as a child,” says study leader Brian S. Schwartz, MD, MS, a professor in the Department of Environmental Health Sciences at the Bloomberg School. “Our data suggest that every time we give an antibiotic to kids they gain weight faster over time.”

For the study, Schwartz and his colleagues analyzed Geisinger Health System’s electronic health records on 163,820 children between three and 18 years old from Jan. 2001 to Feb. 2012. They examined body weight and height (which are used to determine BMI) and antibiotic use in the previous year as well as any earlier years for which Geisinger had records for the children.

At age 15, children who had taken antibiotics seven or more times during childhood weighed about three pounds more than those who received no antibiotics, they found. Approximately 21 percent of the kids in the study, or almost 30,000 children, had received seven or more prescriptions during childhood. Schwartz says that the weight gain among those frequently prescribed antibiotics is likely an underestimate since the children did not stay with Geisinger throughout childhood so their lifetime antibiotic histories, including antibiotic use outside the health system, would not have been recorded and because the effect of certain antibiotic types was even stronger than the overall average.

“While the magnitude of the weight increase attributable to antibiotics may be modest by the end of childhood, our finding that the effects are cumulative raises the possibility that these effects continue and are compounded into adulthood,” he says.

Scientists working with penicillin learned early on that its byproducts caused weight gain in animals. This led to the modern industrial farming techniques of including small quantities of antibiotics in daily animal feed to fatten up the animals in an accelerated time frame. So a connection with weight gain does make biological sense, Schwartz says.

In humans, meanwhile, there is growing evidence that antibiotics could lead to weight gain because of the effect that they have on what is known as the microbiota, or the microorganisms that inhabit the body. There are 10 times more bacterial cells in the human body than our own cells. Many of these bacteria do their work in the gastrointestinal tract, helping the body to digest food and absorb nutrients. Antibiotics kill off harmful bacteria but also those vital to gastrointestinal health. Research has shown that repeated antibiotics use can forever change the microbiota, altering the way it breaks down food and increasing the calories of nutrients absorbed. This, in turn, can increase weight gain.

Prior studies had suggested that use in the youngest children may cause weight gain, but this study shows that use at any age during childhood contributes to weight gain that accelerates with age.

Schwartz says he thinks that physicians are becoming more judicious in their antibiotic prescribing, but it can be a difficult task. Often parents demand antibiotics for apparent cold viruses and other ailments that will not be helped by them. There have long been concerns that excessive antibiotic use is leading to bacterial strains that are becoming resistant to these potentially lifesaving drugs. But this study suggests that antibiotics can have long-term effects in individual children, he says.

“Systematic antibiotics should be avoided except when strongly indicated,” Schwartz says. “From everything we are learning, it is more important than ever for physicians to be the gatekeepers and keep their young patients from getting drugs that not only won’t help them but may hurt them in the long run.”

Public Release: 21-Oct-2015

Vitamin B3 derivative cuts risk of new skin cancers

New research — New England Journal of Medicine

University of Sydney

A year of treatment with nicotinamide, a form of vitamin B3, significantly lowered the risk of common, non-melanoma skin cancer in high-risk patients, according to University of Sydney research published today in the New England Journal of Medicine.

All 386 participants in the study had a history of skin cancer, increasing their risk for additional skin cancers. Taken as a twice-daily pill for 12 months, nicotinamide reduced the incidence of new non-melanoma skin cancers by 23 per cent relative to placebo controls and cut the incidence of pre-cancerous sun spots by around 15 per cent.

Nicotinamide is safe, affordable, and available over the counter in most countries. The findings have the potential to decrease the health burden and economic cost of skin cancer – the most common form of cancer in fair-skinned populations worldwide.

“This is the first clear evidence that we can reduce skin cancers using a simple vitamin, together with sensible sun protection,” said the study’s senior author, Dr Diona Damian, a professor of dermatology at the University of Sydney and Royal Prince Alfred Hospital. “We hope that these findings can be immediately translated into clinical practice. However, people at high risk of skin cancer still need to practice sun safe behaviour, use sunscreens and have regular check-ups with their doctor,” she emphasised.

The primary cause of non-melanoma skin cancer is sun exposure. Despite intensive sun protection campaigns, the incidence of skin cancer continues to increase worldwide. In Australia, non-melanoma skin cancers affect more than half of the population. It is four times as common as all other cancers combined, and costs the nation more than $500 million annually.

The most common types of non-melanoma skin cancer are basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). SCCs can metastasise or spread to lymph nodes and internal organs. BCCs rarely spread but can cause huge cosmetic problems as they often occur on the face. Nicotinamide had comparable efficacy in preventing BCCs and SCCs.

Study details

In this study, 386 patients (average age 66 years) who had at least two non-melanoma skin cancers in the last five years – and were therefore considered to be at high risk – were randomly assigned to daily nicotinamide or placebo for 12 months. The study population reflected the mix of patients typically seen in a skin cancer clinic.

The rate of new non-melanoma skin cancer was 23 per cent lower in the nicotinamide group compared to the placebo group. The average number of actinic keratoses (pre-cancerous sun spots) in the nicotinamide group was consistently lower during treatment, ranging from an 11 per cent reduction at three months, to a 20 per cent at nine months.

The study was not designed to test whether nicotinamide would benefit people in the general population who have not had skin cancer, or whether it could be effective in reducing melanoma. Whilst the researchers hope to investigate these questions in the future, there is currently no evidence that nicotinamide should be used in these settings.

This study builds on a decade of evidence from preclinical and early clinical studies, which suggests nicotinamide enhances the repair of DNA in skin cells damaged by sunlight. Nicotinamide also appears to protect the skin’s immune system from UV radiation by providing skin cells an extra energy boost when they are in repair-mode after sun exposure.

Nicotinamide was very well tolerated, with no difference in adverse events, blood results or blood pressure. Nicotinamide is a different form of vitamin B3 to nicotinic acid or niacin. Nicotinic acid commonly causes headaches, flushing and low blood pressure, but these side effects are not seen with nicotinamide.

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The ONTRAC (Oral Nicotinamide To Reduce Actinic Cancer) study was funded by The National Health and Medical Research Council of Australia and conducted at Royal Prince Alfred and Westmead Hospitals in Sydney.

Public Release: 25-Oct-2015

Study finds medication errors, adverse drug events in 1 out of 2 surgeries studied

Massachusetts General Hospital

 

The first study to measure the incidence of medication errors and adverse drug events during the perioperative period – immediately before, during and right after a surgical procedure – has found that some sort of mistake or adverse event occurred in every second operation and in 5 percent of observed drug administrations. The study of more than 275 operations at Massachusetts General Hospital (MGH), which will appear in Anesthesiology, the official medical journal of the American Society of Anesthesiologists, also found that a third of the errors resulted in adverse drug events or harm to patients. The report is being published online to coincide with a presentation at the ANESTHESIOLOGY® 2015 annual meeting in San Diego.

“We found that just over 1 in 20 perioperative medication administrations resulted in a medication error or an adverse drug event,” says Karen C. Nanji, MD, MPH, of the MGH Department of Anesthesia, Critical Care & Pain Medicine, lead author of the report. “Given that Mass. General is a national leader in patient safety and had already implemented approaches to improve safety in the operating room, perioperative medication error rates are probably at least as high at many other hospitals. Prior to our study, the literature on perioperative medication error rates was sparse and consisted largely of self-reported data, which we know under-represents true error rates. Now that we have a better idea of the actual rate and causes of the most common errors, we can focus in developing solutions to address the problems.”

Nanji explains that, while drug orders on inpatient floors go through a process in which they are checked several times by different providers – the ordering physician, pharmacist and nurses administering the medications – the rapidity with which the condition of patients in the operating room can change doesn’t allow time for that sort of double- and triple-checking during surgical procedures. Although operating rooms at MGH and other hospitals have installed electronic documentation and bar-coded syringe labeling systems to reduce errors, in other patient care the measures that have cut errors areas have all started with a rigorous analysis of the incidence and type of errors that were occurring.

To conduct such an analysis for perioperative settings, four specially trained members of the research team observed 225 anesthesia providers – anesthesiologists, nurse anesthetists, and resident physicians – during 277 randomly selected operations conducted at the MGH from November 2013 to June 2014. From the time a provider took responsibility for a patient in the preoperative area until the patient arrived in the recovery room or intensive care unit, the observers documented every medication administration, including any medication errors – defined as any kind of mistake in the process of ordering or administering a drug – or adverse drug event – harm or injury to a patient related to a drug, whether or not it was caused by an error.

To catch events not apparent to the observers and to confirm that the events they flagged were actually errors, team members also reviewed chart data from the hospital’s anesthesia information management system for all patients whose care had been observed. The study team met weekly to review the recorded events, determine whether or not they constituted true medication errors or adverse drug events, and classify events as to their severity and whether or not they could have been prevented.

Overall, it was determined that 124 of the 277 observed operations included at least one medication error or adverse drug event. Of the almost 3,675 medication administrations in the observed operations, 193 events, involving 153 medication errors and 91 adverse drug events, were recorded either by direct observation or by chart review. Almost 80 percent of those events were determined to have been preventable. One-third of the observed medication errors led to an adverse drug event, and the remainder had the potential to cause an adverse event. Of the adverse drug events that were recorded, 20 percent were not associated with a medication error.

The most frequently observed errors were mistakes in labeling, incorrect dosage, neglecting to treat a problem indicated by the patient’s vital signs, and documentation errors. Of all the observed adverse drug events and the medication errors that could have resulted in patient harm – four of which were intercepted by operating room staff before affecting the patient – 30 percent were considered significant, 69 percent serious and less than 2 percent life-threatening; none were fatal. The overall medication error rate of around 5 percent was the same among anesthesiologists, nurse anesthetists and residents. Medication errors and adverse drug events were more common with longer procedures, especially those lasting longer than six hours and involving 13 or more medication administrations.

“While the frequency of errors and adverse events is much higher than has previously been reported in perioperative settings, it is actually in line with rates found in inpatient wards and outpatient clinics, where error rates have been systematically measured for many years,” says Nanji. “We definitely have room for improvement in preventing perioperative medication errors, and now that we understand the types of errors that are being made and their frequencies, we can begin to develop targeted strategies to prevent them. We already have an electronic anesthesia management and documentation system for medications, patient vital signs and other events occurring in the operating room; and our next step will be to design more comprehensive decision support to further reduce the incidence of errors in the perioperative setting, something that I suspect the MGH will be one of the first centers to have in place.”

“This study is especially valuable because it looked in a detailed way into medication errors in the operating room, where many of the safety strategies used in other settings have not yet been adopted, and used trained observers to document these errors,” added study senior author David Bates, MD, MSc, of the Department of Medicine at Brigham and Women’s Hospital. “The operating room has been a hard environment to evaluate, but we used observers familiar with anesthetic care to do the observation.”

Public Release: 26-Oct-2015

York U researchers list products expectant mothers should avoid during first trimester

The list is long and includes cleaning solvents, pesticides, nonsteroidal anti-inflammatory drugs

York University

 

TORONTO, October 26, 2015 — Expectant mothers in their first trimester should avoid certain cosmetics, cleaning agents and medicines, to protect the developing fetal brain from chemicals that can trigger autism, York U health researchers have found.

“The products that we use on a daily basis, such as creams and cosmetics, contain chemicals that could potentially affect a developing baby during pregnancy,” says Professor Dorota Crawford in the School of Kinesiology and Health Science, Faculty of Health.

The list is long: cleaning solvents, pesticides, nonsteroidal anti-inflammatory drugs such as acetylsalicylic acid; misoprostol (a drug used for inducing labor); polychlorinated bisphenyls used as industrial lubricants; polybrominated diphenyl ethers found in wood and textiles; phthalates in PVC flooring, children’s toys, and cosmetics and lotions.

The researchers, Crawford and co-authors Christine Wong and Joshua Wais, report that aside from the type of chemical a pregnant woman is exposed to, the duration, the frequency and the concentration level also impact a developing brain at the prenatal stage.

“We recommend that women learn about health effects from exposure to chemical substances in the environment,” says PhD candidate Wong, adding that assessment information is found in the Integrated Risk Information System (IRIS) database maintained by the US Environmental Protection Agency.

According to the researchers, prenatal brain development undergoes constant changes and its normal functioning depends greatly on the presence of specific genes at any given time. Since environmental factors influence the expression levels of these critical genes, it is important for an expectant mother to be aware and cautious of exposure to these factors.

This review article by Crawford and coauthors Christine Wong and Joshua Wais, titled “Prenatal exposure to common environmental factors affects brain lipids and increases risk of developing Autism Spectrum Disorders,” was recently published in the European Journal of Neuroscience. The authors summarize existing research on environmental agents that can affect the level of important lipid mediators including prostaglandin E2 or PGE2. This major lipid molecule naturally found in the brain is important in regulating the expression of essential genes required for early brain development and its proper function.

Crawford says only a few clinical studies have delved into the dosage level and exposure time that affects the developing brain. “Specific concentration ranges for chemicals and the duration of exposure in humans still need to be established through research.”

Investigation into molecular mechanisms that lead to how these chemicals disrupt the growing brain and also how the chemicals enter the fetal brain will be crucial to understand how they may contribute to brain pathologies, according to Crawford.

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York University is known for championing new ways of thinking that drive teaching and research excellence. Our 52,000 students receive the education they need to create big ideas that make an impact on the world. Meaningful and sometimes unexpected careers result from cross-discipline programming, innovative course design and diverse experiential learning opportunities. York students and graduates push limits, achieve goals and find solutions to the world’s most pressing social challenges, empowered by a strong community that opens minds. York U is an internationally recognized research university – our 11 faculties and 24 research centres have partnerships with 200+ leading universities worldwide.

Media Contact: Gloria Suhasini, York University, 416-736-2100, ext. 22094, suhasini@yorku.ca

Public Release: 26-Oct-2015

Study: Low-weight, high-repetition exercise increases bone density up to 8 percent in adults

Findings defy prior assumptions that heavy weightlifting is necessary for building bone mass

Portavoce Public Relations

BALTIMORE – October 26, 2015 – A new research study published in The Journal of Sports Medicine and Physical Fitness finds that low-weight, high-repetition resistance training increases bone mineral density in adults, challenging assumptions that heavy weight-training is required to build bone mineral density. Participants who completed the study experienced up to 8 percent bone mineral density increases in the legs, pelvis, arms and spine.

The full study titled, “Low Load, High Repetition Resistance Training Program Increases Bone Mineral Density In Untrained Adults,” is now available at http://www.minervamedica.it/en/journals/sports-med-physical-fitness/article.php?cod=R40Y9999N00A150155&acquista=1. The findings indicate that this type of strength training may be an effective and maintainable method of increasing bone mineral density in older people and sedentary groups. A secondary finding indicates postmenopausal women and osteopenic individuals (those with low bone mineral density) would benefit most from a low-weight, high-repetition exercise regimen.

“These findings challenge the traditional thought that high-weight, low-repetition exercise is the ideal way to increase bone mineral density,” said Jinger Gottschall, Associate Professor and lead researcher of the study conducted at Penn State. “This is such a profound finding because low-weight, high-repetition exercise is easily attainable by anybody and everybody. This approach could help at-risk populations minimize the risk of osteoporosis.”

In the study, 20 untrained adults (people who completed less than 30 minutes of exercise per week for the previous six months) completed a 27-week group exercise program. Participants were assigned to one of two groups that either completed full-body weight-training workouts or workouts focused on building core muscles, in addition to cardiovascular workouts. The weight-training group completed two to three BODYPUMP(R); classes per week, a low-weight, high-repetition resistance training program in which the participants used a bar and self-selected weights.

The study analysis found:

·         Participants in the weight-training group demonstrated an 8 percent increase in leg bone mineral density, a 7 percent increase in pelvis bone mineral density, a 4 percent increase in arm bone mineral density and a 4 percent increase in spine bone mineral density. The core group’s bone mineral density did not change significantly.

·         Postmenopausal women and osteopenic individuals experienced significant bone mineral density increases of up to 29 percent.

·         A positive correlation between squat strength and pelvis bone mineral density, a link that indicates the exercises used in the study could effectively decrease the risk of a hip fracture.

Significant bone mineral density increases for osteopenic and postmenopausal people

Two osteopenic individuals and three postmenopausal women participated in the study, and both groups experienced much higher increases in bone mineral density than the rest of the group. Individuals with osteopenia experienced leg and pelvis bone mineral density increases of 29 percent, more than triple the results other participants experienced. The postmenopausal participants’ bone mineral density increases ranged from 10 to 22 percent.

Pelvis and leg strength prevent fractures

In the study, people in the weight-training group experienced 25 percent greater increase in leg strength than those in the core group. Changes in leg strength were also strongly correlated with changes in pelvic bone mineral density.

According to the National Osteoporosis Foundation, by 2020 approximately 14 million people over the age of 50 are expected to have osteoporosis and another 47 million to have low bone mass.(1) After age 40, bone mineral density declines at an accelerated rate;(2) therefore, it is crucial to build a peak bone mass before this rapid decline and to maintain bone mass later in life.

The hip is the most common and devastating fracture site for elderly people with osteoporosis.(3) According to Gottschall, a large proportion of fall-related deaths are due to complications following a hip fracture. One out of five hip fracture patients die within a year of their injury. Maintaining a healthy bone mineral density in the pelvis and legs can help prevent these life-altering breaks, says Gottschall. High-repetition exercise is a great way for people to build full-body strength.

“Heavy weightlifting has been shown to increase bone mineral density, however many older and inactive adults cannot safely participate in this type of strenuous activity. The exercise regimen used in this study is a more feasible option,” said Bryce Hastings, Group Fitness Research Officer, Les Mills International. “The beauty of LES MILLS BODYPUMP is that it is built on high-repetition choreography and instructors can identify progressive movement options for participants of any fitness level so they can build strength and bone density.”

axial skeleton with aging. Journal of Clinical Investigation. 1981; 67:328-335

(3) Niu K, Aloha R, Guo H, et al. Effect of office based brief high-impact exercise on bone mineral density in healthy premenopausal women: the Sendai Bone Health Concept Study. Journal of Bone and Mineral Metabolism. 2010; 28:568-77.

Public Release: 27-Oct-2015

Obese children’s health rapidly improves with sugar reduction unrelated to calories

Study indicates that calories are not created equal; sugar and fructose are dangerous

University of California – San Francisco

Reducing consumption of added sugar, even without reducing calories or losing weight, has the power to reverse a cluster of chronic metabolic diseases, including high cholesterol and blood pressure, in children in as little as 10 days, according to a study by researchers at UC San Francisco and Touro University California.

“This study definitively shows that sugar is metabolically harmful not because of its calories or its effects on weight; rather sugar is metabolically harmful because it’s sugar,” said lead author Robert Lustig, MD, MSL, pediatric endocrinologist at UCSF Benioff Children’s Hospital San Francisco. “This internally controlled intervention study is a solid indication that sugar contributes to metabolic syndrome, and is the strongest evidence to date that the negative effects of sugar are not because of calories or obesity.”

Jean-Marc Schwarz, PhD of the College of Osteopathic Medicine at Touro University California and senior author of the paper added, “I have never seen results as striking or significant in our human studies; after only nine days of fructose restriction, the results are dramatic and consistent from subject to subject. These findings support the idea that it is essential for parents to evaluate sugar intake and to be mindful of the health effects of what their children are consuming.”

The paper will appear online on October 27, and in the February 2016 issue of the Journal Obesity.

Restricting Sugar Intake

Metabolic syndrome is a cluster of conditions — increased blood pressure, high blood glucose level, excess body fat around the waist, and abnormal cholesterol levels — that occur together and increase risk of heart disease, stroke, and diabetes. Other diseases associated with metabolic syndrome, such as non-alcoholic fatty liver disease and type 2 diabetes, now occur in children — disorders previously unknown in the pediatric population.

Participants were identified through the Weight Assessment for Teen and Child Health Clinic (WATCH) at UCSF Benioff Children’s Hospital San Francisco, an interdisciplinary obesity clinic dedicated to targeting metabolic dysfunction rather than weight loss. Recruitment was limited to Latino and African-American youth because of their higher risk for certain conditions associated with metabolic syndrome, such as high blood pressure and type 2 diabetes.

In the study, 43 children between the ages of 9 and 18 who were obese and had at least one other chronic metabolic disorder, such as hypertension, high triglyceride levels or a marker of fatty liver, were given nine days of food, including all snacks and beverages, that restricted sugar but substituted starch to maintain the same fat, protein, carbohydrate, and calorie levels as their previously reported home diets. Baseline fasting blood levels, blood pressure, and glucose tolerance were assessed before the new menu plan was adopted. The study menu restricted added sugar (while allowing fruit), but substituted it by adding other carbohydrates such as bagels, cereal and pasta so that the children still consumed the same number of calories from carbohydrate as before, but total dietary sugar was reduced from 28 to 10 percent, and fructose from 12 to 4 percent of total calories, respectively. The food choices were designed to be “kid food” – turkey hot dogs, potato chips, and pizza all purchased at local supermarkets, instead of high sugar cereals, pastries, and sweetened yogurt.

Children were given a scale and told to weigh themselves everyday, with the goal of weight stability, not weight loss. When weight loss did occur (a decrease of an average of 1 percent over the 10-day period but without change in body fat), they were given more of the low-sugar foods.

“When we took the sugar out, the kids started responding to their satiety cues,” said Schwarz. “They told us it felt like so much more food, even though they were consuming the same number of calories as before, just with significantly less sugar. Some said we were overwhelming them with food.”

Reducing Harmful Metabolic Effects of Obesity

After just 9 days on the sugar-restricted diet, virtually every aspect of the participants’ metabolic health improved, without change in weight. Diastolic blood pressure decreased by 5mm, triglycerides by 33 points, LDL-cholesterol (known as the “bad” cholesterol) by 10 points, and liver function tests improved. Fasting blood glucose went down by 5 points, and insulin levels were cut by one-third.

“All of the surrogate measures of metabolic health got better, just by substituting starch for sugar in their processed food — all without changing calories or weight or exercise,” said Lustig. “This study demonstrates that ‘a calorie is not a calorie.’ Where those calories come from determines where in the body they go. Sugar calories are the worst, because they turn to fat in the liver, driving insulin resistance, and driving risk for diabetes, heart, and liver disease. This has enormous implications for the food industry, chronic disease, and health care costs.”

Public Release: 29-Oct-2015

The Lancet Diabetes & Endocrinology: Large meta-analysis finds low-fat diets ineffective for achieving long-term weight loss

The Lancet

Low-fat diets do not lead to greater weight loss in the long term compared to higher-fat diets (eg, low-carbohydrate or Mediterranean diets) of similar intensity, according to a large meta-analysis involving more than 68000 adults, published in The Lancet Diabetes & Endocrinology journal.

“There is no good evidence for recommending low-fat diets,” says lead author Dr Deirdre Tobias from Brigham and Women’s Hospital and Harvard Medical School, Boston, USA. “Behind current dietary advice to cut out the fat, which contains more than twice the calories per gram of carbohydrates and protein, the thinking is that simply reducing fat intake will naturally lead to weight loss. But our robust evidence clearly suggests otherwise.” [1]

Tobias and colleagues did a systematic review and meta-analysis of all randomised trials comparing the effectiveness of low-fat diets to other diets, including no diet, at improving long-term weight loss (at least 1 year) in non-pregnant adults up to the end of July 2014. They took into account the intensity of the diets which ranged from just pamphlets or instructions at the beginning of the programme to intensive multi-component programmes including counselling sessions, meetings with dieticians, food diaries, and cooking lessons.

Analysis of 53 studies involving 68128 adults showed no difference in the average weight loss between reduced-fat diets and higher-fat diets. Indeed, reduced-fat diets only led to greater weight loss when compared with no diet at all, and resulted in less weight loss compared with low-carbohydrate interventions, although differences in weight change were small (weighted mean difference 1.15 kg/2.5 lbs). Similarly, when just considering trials without a weight loss goal (eg, those assessing lipids or cancer endpoints), participants following a reduced-fat diet lost similar amounts of weight on average compared to those on other diets.

According to Dr Tobias, “The science does not support low-fat diets as the optimal long-term weight loss strategy. To effectively address the obesity epidemic, we will need more research to identify better approaches for long-term weight loss and weight maintenance, including the need to look beyond differences in macronutrient composition–the proportion of calories that come from fat, carbohydrate, and protein. Long-term adherence is critical for the success of any dietary intervention, and one should also take into account other long-term health effects of their dietary choices.”[1]

 

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