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Plum supplementation and lipid profile: a systematic review and meta-analysis of randomised controlled trials.
Askarpour, M, Ghalandari, H, Setayesh, L, Ghaedi, E
Journal of nutritional science. 2023;12:e6
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The rate of nutrition-related non-communicable diseases is increasing worldwide. Lipid profile and its alterations have been used both as indicators of metabolic disorders and methods to evaluate patients’ response to dietary interventions. The aim of this study was to investigate the effectiveness of plums on improving parameters of lipid profile. This study is a systematic review and meta-analysis of nine randomised controlled trials with a total of eleven arms and 592 participants. Results show that plum can be beneficial in reducing triacylglycerols [triglycerides] in the unhealthy and low-density lipoprotein cholesterol in all individuals. However, no significant impact regarding blood triacylglycerols and high-density lipoprotein cholesterol levels, could be detected both in crude and subgroup analyses. Authors conclude that further clinical trials, taking advantage of a standard protocol of plum supplementation, should be conducted to elucidate the possible effect that plum supplementation might exert on lipid profile parameters.
Abstract
Plums are abundant in bioactive compounds which have been associated with numerous health benefits. In the present study, we aimed at examining the impact of plum supplementation on lipid profile of individuals. Electronic bibliographical databases were searched for relevant randomised clinical trials. Articles meeting our eligibility criteria were included for data extraction and final analysis. Weighted mean difference (WMD) was estimated using a random-effect model. Of the total articles retrieved in the initial search, nine articles were found to be eligible to be included in the analysis. Our results show that plum supplementation significantly improves total cholesterols levels in the unhealthy individuals. Moreover, plum supplementation reduces the LDL-c levels in the pooled sample (WMD = -11⋅52 mg/dl; 95 % CI -21⋅93, -1⋅11, P = 0⋅03, I 2 = 98⋅7 %) and also in some of the subgroups of individuals (dried plum, unhealthy subjects, duration more than 8 weeks). Moreover, it had a significant reducing effect on TC levels just in unhealthy subjects. Although plum supplementation did not have any significant impact on serum levels of TG nor HDL-c. Our results show that supplementation with plums is potentially effective in reducing serum total cholesterol and LDL-c.
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Effect of supplementation with Chlorella vulgaris on lipid profile in adults: A systematic review and dose-response meta-analysis of randomized controlled trials.
Sherafati, N, Bideshki, MV, Behzadi, M, Mobarak, S, Asadi, M, Sadeghi, O
Complementary therapies in medicine. 2022;66:102822
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Dyslipidaemia is a chronic metabolic disorder that is characterized by increased levels of triglyceride (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and reduced levels of high-density lipoprotein cholesterol (HDL-C). Patients with dyslipidaemia have an increased risk of coronary heart disease, stroke, non-alcoholic fatty liver disease, diabetes and even mortality. The aim of this study was to investigate the effect of Chlorella vulgaris supplementation on lipid profile in adults. This study is a systematic review and meta-analysis of ten randomised controlled trial studies. The studies included a total of 539 individuals (n= 264 in the Chlorella vulgaris group and n= 275 in the control group). Results show that Chlorella vulgaris supplementation resulted in a significant reduction in TC and LDL-C levels, while it had no significant effect on TG and HDL-C levels either in the overall analysis or in the subgroup analysis. Furthermore, the reducing effect of Chlorella vulgaris supplementation on LDL-C levels was significant between zero and 1500 mg/d and it was not significant at higher dosages. Authors conclude that future studies should examine the effect of Chlorella vulgaris supplementation on other biochemical parameters such as glycaemic measures and inflammatory biomarkers.
Abstract
OBJECTIVE To summarize available findings on the effect of Chlorella vulgaris supplementation on lipid profile in adults. DESIGN Systematic review and meta-analysis of randomized controlled trials (RCTs). SETTING This study followed 2020 PRISMA guideline. We performed a systematic search in the online databases to identify relevant articles and then, extracted required data from each paper for the meta-analysis. Random-effects models were used to obtain overall mean difference (MD) comparing Chlorella vulgaris supplementation with a control group. MAIN OUTCOME MEASURES Blood lipids including triglyceride (TG), total cholesterol (TC), LDL-C, and HDL-C. RESULTS In total, 10 RCTs with a total sample size of 539 adults (264 in the Chlorella vulgaris group and 275 in the control group) were included. Of the 10 RCTs, four had a low risk of bias for all aspects of the Cochrane risk of bias tool. Also, only two studies determined the chlorella content, purity, potency, and contamination of the supplements used in the intervention. Combining results from these studies showed a summary MD of -2.11 mg/dL (95% CI: -7.28 to 3.06) for TG, -7.47 mg/dL (95% CI: -12.98 to -1.96) for TC, -7.71 mg/dL (95% CI: -14.05 to -1.37) for LDL-C, and -0.45 mg/dL (95% CI: -0.67 to 1.57) for HDL-C, indicating a beneficial effect of Chlorella vulgaris supplementation on TC and LDL-C levels. Based on the dose-response analysis, the reducing effect of Chlorella vulgaris supplementation on LDL-C levels was seen at the dosages between zero and 1500 mg/d (P for non-linearity= 0.01), whereas in higher amounts, this effect was not significant. CONCLUSION We found that Chlorella vulgaris supplementation had a beneficial effect on TC and LDL-C levels with no significant effect on TG and HDL-C levels.
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Comparison of dietary and physical activity behaviors in women with and without polycystic ovary syndrome: a systematic review and meta-analysis of 39 471 women.
Kazemi, M, Kim, JY, Wan, C, Xiong, JD, Michalak, J, Xavier, IB, Ganga, K, Tay, CT, Grieger, JA, Parry, SA, et al
Human reproduction update. 2022;28(6):910-955
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Polycystic ovary syndrome (PCOS) is a heritable, prevalent and complex endocrine disorder. Besides reproductive manifestations of increased risk of infertility and pregnancy complications, women with PCOS often exhibit cardio-metabolic aberrations and are at risk for developing metabolic syndrome, type 2 diabetes and sleep disturbance. The aim of this study was to test the hypothesis that reproductive-aged women with PCOS would exhibit worse dietary and physical activity (PA) behaviours versus their counterparts without PCOS. This study was a systematic review and meta-analysis of 54 studies (61 publications). The studies included a total of 39,471 participants and 116 experimental arms (n = 8736 PCOS [59 arms]). Results showed that women with PCOS exhibit an overall adverse lifestyle behaviour, specifically poorer dietary intakes (lower diet quality, higher cholesterol, lower magnesium, tendency for lower zinc), and lower total PA compared to those without PCOS, despite lower alcohol intakes. Furthermore, compared to women without PCOS, the women with PCOS consumed worse or similar consumption of core food groups (grains, fruits, vegetables, proteins, seeds, nuts, dairy). Authors conclude that providing education on lifestyle modification is crucial for women with PCOS to improve their short- and long-term reproductive, metabolic, and psychological health.
Abstract
BACKGROUND Lifestyle (dietary and/or physical activity [PA]) modification is recommended as first-line therapy to manage polycystic ovary syndrome (PCOS). Current recommendations are based on healthy lifestyle practices for the general public since evidence for unique lifestyle approaches in PCOS is limited and low quality. OBJECTIVE AND RATIONALE We aimed to synthesize evidence on dietary and PA behaviors between women with PCOS and those without PCOS. Primary outcomes were overall diet quality, total energy intake and total PA, and secondary outcomes included macronutrients, micronutrients, food groups, foods, glycemic indices, sedentary time and sitting levels. We conducted this work to identify any unique lifestyle behaviors in women with PCOS that could underlie the propensity of weight gain and obesity in PCOS and be targeted for precision nutrition and PA interventions. These findings could be used to inform future practice recommendations and research that more effectively address complications (weight gain, obesity, diabetes, infertility, cardiovascular disease and mental health) in this high-risk population. SEARCH METHODS Databases of MEDLINE, Web of Science, Scopus and CINAHL were searched until 15 February 2022 to identify observational studies documenting dietary and PA behaviors between women with PCOS and without PCOS (Controls). Studies on children, adolescents (<18 years), pregnant or menopausal-aged women (>50 years) were excluded. Data were pooled by random-effects models and expressed as (standardized) mean differences (MD) and 95% CIs. The risk of bias was assessed by the Newcastle-Ottawa scale (NOS). OUTCOMES Fifty-four studies (N = 39 471 participants; [n = 8736 PCOS; 30 735 Controls]) were eligible (96%; [52/54] NOS scores ≥ 7). Women with PCOS had higher cholesterol (MD: 12.78, 95% CI: 1.48 to 24.08 mg/day; P = 0.03; I2 = 19%), lower magnesium (MD: -21.46, 95% CI: -41.03 to -1.91 mg/day; P = 0.03; I2 = 76%), and a tendency for lower zinc (MD: -1.08, 95% CI: -2.19 to -0.03 mg/day; P = 0.05; I2 = 96%) intake, despite lower alcohol consumption (MD: -0.95, 95% CI: -1.67 to 0.22 g/day; P = 0.02; I2 = 0%) versus Controls. Also, women with PCOS had lower total PA (standardized mean difference: -0.38, 95% CI: -0.72 to 0.03; P = 0.03; I2 = 98%). Conversely, energy, macronutrients (carbohydrate, fat, protein, fiber), micronutrients (folic acid, iron, calcium, sodium), glycemic index and glycemic load were similar (all: P ≥ 0.06). Most eligible studies reported lower total adherence to healthy eating patterns or poorer consumption of major food groups (grains, fruits, vegetables, proteins, seeds, nuts, dairy) in women with PCOS, as described narratively since variable study methodology did not permit meta-analyses. WIDER IMPLICATIONS Collective evidence supports that women with PCOS have a lower overall diet quality, poorer dietary intakes (higher cholesterol, lower magnesium and zinc) and lower total PA, despite lower alcohol consumption versus those without PCOS. Considerable heterogeneity among studies reinforces the need for research to address any relative contributions of other factors (e.g. genetic, metabolic or sociodemographic) to the observed differences. These clarifications may contribute to future evidence-based guideline recommendations on monitoring and managing PCOS in the era of precision lifestyle medicine.
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Association of Antenatal Diet and Physical Activity-Based Interventions With Gestational Weight Gain and Pregnancy Outcomes: A Systematic Review and Meta-analysis.
Teede, HJ, Bailey, C, Moran, LJ, Bahri Khomami, M, Enticott, J, Ranasinha, S, Rogozinska, E, Skouteris, H, Boyle, JA, Thangaratinam, S, et al
JAMA internal medicine. 2022;182(2):106-114
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With an obesogenic environment, unhealthy lifestyle, and accelerating weight gain, obesity is now the most common medical condition in the world. Preconception and pregnancy are priority life stages for healthy lifestyles and obesity prevention with excess weight being associated with adverse pregnancy outcomes, long-term noncommunicable disease in women, and epigenetic consequences across generations. The aim of this study was to evaluate the association of different types of diet and physical activity–based antenatal lifestyle interventions with gestational weight gain (GWG) and maternal and neonatal outcomes. This study is a systematic review and meta-analysis of 28 studies together with 89 studies identified during a previous study. The included studies were randomised controlled trials (which involved 34 546 women) that examined diet (n = 14), physical activity (n = 53), diet with physical activity (n = 19), and mixed interventions (n = 31). Results show that compared with routine care, antenatal diet and physical activity–based lifestyle interventions were associated with reduced GWG. Lifestyle interventions were also associated with lower risk of gestational diabetes and total adverse maternal outcomes. Authors conclude by supporting the integration of structured diet and physical activity interventions alongside routine antenatal care, and the development of policies to improve the health of mothers and their offspring around the world.
Abstract
IMPORTANCE Excessive gestational weight gain (GWG) is common and associated with adverse pregnancy outcomes. Antenatal lifestyle interventions limit GWG; yet benefits of different intervention types and specific maternal and neonatal outcomes are unclear. OBJECTIVE To evaluate the association of different types of diet and physical activity-based antenatal lifestyle interventions with GWG and maternal and neonatal outcomes. DATA SOURCES A 2-stage systematic literature search of MEDLINE, Embase, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, Cochrane Central Register of Controlled Trials, and Health Technology Assessment Database was conducted from February 1, 2017, to May 31, 2020. Search results from the present study were integrated with those from a previous systematic review from 1990 to February 2017. STUDY SELECTION Randomized trials reporting GWG and maternal and neonatal outcomes. DATA EXTRACTION AND SYNTHESIS Data were extracted for random-effects meta-analyses to calculate the summary effect estimates and 95% CIs. MAIN OUTCOMES AND MEASURES Outcomes were clinically prioritized, with mean GWG as the primary outcome. Secondary outcomes included gestational diabetes, hypertensive disorders of pregnancy, cesarean section, preterm delivery, large or small for gestational age neonates, neonatal intensive care unit admission, or fetal death. RESULTS A total of 117 randomized clinical trials of antenatal lifestyle interventions (involving 34 546 women) were included. Overall lifestyle intervention was associated with reduced GWG (-1.15 kg; 95% CI, -1.40 to -0.91), risk of gestational diabetes (odds ratio [OR], 0.79; 95% CI, 0.70-0.89), and total adverse maternal outcomes (OR, 0.89; 95% CI, 0.84-0.94) vs routine care. Compared with routine care, diet was associated with less GWG (-2.63 kg; 95% CI, -3.87 to -1.40) than physical activity (-1.04 kg; 95% CI, -1.33 to -0.74) or mixed interventions (eg, unstructured lifestyle support, written information with weight monitoring, or behavioral support alone) (-0.74 kg; 95% CI, -1.06 to -0.43). Diet was associated with reduced risk of gestational diabetes (OR, 0.61; 95% CI, 0.45-0.82), preterm delivery (OR, 0.43; 95% CI, 0.22-0.84), large for gestational age neonate (OR, 0.19; 95% CI, 0.08-0.47), neonatal intensive care admission (OR, 0.68; 95% CI, 0.48-0.95), and total adverse maternal (OR, 0.75; 95% CI, 0.61-0.92) and neonatal outcomes (OR, 0.44; 95% CI, 0.26-0.72). Physical activity was associated with reduced GWG and reduced risk of gestational diabetes (OR, 0.60; 95% CI, 0.47-0.75), hypertensive disorders (OR, 0.66; 95% CI, 0.48-0.90), cesarean section (OR, 0.85; 95% CI, 0.75-0.95), and total adverse maternal outcomes (OR, 0.78; 95% CI, 0.71-0.86). Diet with physical activity was associated with reduced GWG (-1.35 kg; 95% CI, -1.95 to -0.75) and reduced risk of gestational diabetes (OR, 0.72; 95% CI, 0.54-0.96) and total adverse maternal outcomes (OR, 0.81; 95% CI, 0.69-0.95). Mixed interventions were associated with reduced GWG only. CONCLUSIONS AND RELEVANCE This systematic review and meta-analysis found level 1 evidence that antenatal structured diet and physical activity-based lifestyle interventions were associated with reduced GWG and lower risk of adverse maternal and neonatal outcomes. The findings support the implementation of such interventions in routine antenatal care and policy around the world.
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A systematic review and meta-analysis of school-based interventions with health education to reduce body mass index in adolescents aged 10 to 19 years.
Jacob, CM, Hardy-Johnson, PL, Inskip, HM, Morris, T, Parsons, CM, Barrett, M, Hanson, M, Woods-Townsend, K, Baird, J
The international journal of behavioral nutrition and physical activity. 2021;18(1):1
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Obesity in childhood and adolescence is associated with an increased risk of non-communicable diseases such as Type 2 diabetes, cardiovascular disease, chronic obstructive lung disease and some forms of cancer. The aim of this study was to investigate the effectiveness of health education interventions delivered in school settings to prevent overweight and obesity and/ or reduce BMI in adolescents, and to explore the key features of effectiveness. This study is a systematic review and meta-analysis of 39 publications based on 33 studies. Six studies recruited adolescent girls only, one adolescent boys only and one study included parent-student dyad. Results show that: - Most of the effective interventions were delivered by teachers who were trained prior to the intervention. - School-based interventions are often delivered through school-staff, however, appropriate training/ CPD prior to the intervention could be a crucial component to support the provision and uptake of the intervention. - Many of the effective interventions included parental involvement and modifications to the school environment. - Interventions should target the biological, psychosocial, environmental, and behavioural influences on diet and physical activity. Authors conclude that school-based health education interventions could potentially help in improving BMI outcomes in the adolescent age group.
Abstract
BACKGROUND Adolescents are increasingly susceptible to obesity, and thus at risk of later non-communicable diseases, due to changes in food choices, physical activity levels and exposure to an obesogenic environment. This review aimed to synthesize the literature investigating the effectiveness of health education interventions delivered in school settings to prevent overweight and obesity and/ or reduce BMI in adolescents, and to explore the key features of effectiveness. METHODS A systematic search of electronic databases including MEDLINE, CINAHL, PsychINFO and ERIC for papers published from Jan 2006 was carried out in 2020, following PRISMA guidelines. Studies that evaluated health education interventions in 10-19-year-olds delivered in schools in high-income countries, with a control group and reported BMI/BMI z-score were selected. Three researchers screened titles and abstracts, conducted data extraction and assessed quality of the full text publications. A third of the papers from each set were cross-checked by another reviewer. A meta-analysis of a sub-set of studies was conducted for BMI z-score. RESULTS Thirty-three interventions based on 39 publications were included in the review. Most studies evaluated multi-component interventions using health education to improve behaviours related to diet, physical activity and body composition measures. Fourteen interventions were associated with reduced BMI/BMI z-score. Most interventions (n = 22) were delivered by teachers in classroom settings, 19 of which trained teachers before the intervention. The multi-component interventions (n = 26) included strategies such as environment modifications (n = 10), digital interventions (n = 15) and parent involvement (n = 16). Fourteen studies had a low risk of bias, followed by 10 with medium and nine with a high risk of bias. Fourteen studies were included in a random-effects meta-analysis for BMI z-score. The pooled estimate of this meta-analysis showed a small difference between intervention and control in change in BMI z-score (- 0.06 [95% CI -0.10, - 0.03]). A funnel plot indicated that some degree of publication bias was operating, and hence the effect size might be inflated. CONCLUSIONS Findings from our review suggest that school-based health education interventions have the public health potential to lower BMI towards a healthier range in adolescents. Multi-component interventions involving key stakeholders such as teachers and parents and digital components are a promising strategy.
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Prevention of Type 2 Diabetes by Lifestyle Changes: A Systematic Review and Meta-Analysis.
Uusitupa, M, Khan, TA, Viguiliouk, E, Kahleova, H, Rivellese, AA, Hermansen, K, Pfeiffer, A, Thanopoulou, A, Salas-Salvadó, J, Schwab, U, et al
Nutrients. 2019;11(11)
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With Type 2 Diabetes growing globally this paper analyses whether T2D is preventable with lifestyle measures including diet. Seven RCTs were included for review with a total of 4090 participants, and 2466 incidents of T2D, and were chosen on the basis that the lifestyle interventions included both physical exercise and diet (typically Mediterranean Diet). They found that diet and lifestyle intervention reduced the risk of T2D by 47%. Sustained risk reduction was also found in follow-up studies up to 10 years later with participants maintaining improved blood glucose control. Lifestyle interventions may also reduce risk factors for cardiovascular disease. Weight reduction was considered a cornerstone of preventing T2D and adherence to lifestyle changes a key element in long term prevention. Dietary foods reviewed include processed meats, white rice and sugars which correlated highly with T2D whilst leafy greens, berries, wholegrains, legumes, dietary fibre and yoghurt correlate with a lower risk of T2D. Dietary patterns of skipping breakfast and snacking correlate higher with T2D. Different criteria for evaluating physical activity estimate that it reduces risk factors by 50%. In conclusion there is high evidence that lifestyle factors which optimise diet, increase physical activity and promote weight reduction are preventative factors for T2D and can be sustained long term.
Abstract
Prevention of type 2 diabetes (T2D) is a great challenge worldwide. The aim of this evidence synthesis was to summarize the available evidence in order to update the European Association for the Study of Diabetes (EASD) clinical practice guidelines for nutrition therapy. We conducted a systematic review and, where appropriate, meta-analyses of randomized controlled trials (RCTs) carried out in people with impaired glucose tolerance (IGT) (six studies) or dysmetabolism (one study) to answer the following questions: What is the evidence that T2D is preventable by lifestyle changes? What is the optimal diet (with a particular focus on diet quality) for prevention, and does the prevention of T2D result in a lower risk of late complications of T2D? The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was applied to assess the certainty of the trial evidence. Altogether seven RCTs (N = 4090) fulfilled the eligibility criteria and were included in the meta-analysis. The diagnosis of incident diabetes was based on an oral glucose tolerance test (OGTT). The overall risk reduction of T2D by the lifestyle interventions was 0.53 (95% CI 0.41; 0.67). Most of the trials aimed to reduce weight, increase physical activity, and apply a diet relatively low in saturated fat and high in fiber. The PREDIMED trial that did not meet eligibility criteria for inclusion in the meta-analysis was used in the final assessment of diet quality. We conclude that T2D is preventable by changing lifestyle and the risk reduction is sustained for many years after the active intervention (high certainty of evidence). Healthy dietary changes based on the current recommendations and the Mediterranean dietary pattern can be recommended for the long-term prevention of diabetes. There is limited or insufficient data to show that prevention of T2D by lifestyle changes results in a lower risk of cardiovascular and microvascular complications.
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Comparison of the Effectiveness of Lifestyle Modification with Other Treatments on the Incidence of Type 2 Diabetes in People at High Risk: A Network Meta-Analysis.
Yamaoka, K, Nemoto, A, Tango, T
Nutrients. 2019;11(6)
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The prevalence of diabetes has been increasing worldwide. The accompanying increase in the prevalence of diabetes-related complications and the occurrence of diabetes are likely to have a substantial impact on healthcare costs. The aim of the study was to compare the effectiveness of lifestyle modifications to other treatments for patients at high risk of type 2 diabetes. The study design is a systemic review of published literature and a network meta-analysis of data from each selected study. Forty-seven interventions were used for the analyses. The results of the meta-analysis highlight the efficacy of lifestyle modification in preventing the onset of type 2 diabetes in high-risk patients in comparison with standard treatment or placebo as well as other treatments. The proportion of patients with onset of type 2 diabetes in the intervention (lifestyle modification) group was approximately twice as low as compared to the control (standard intervention) group. Authors conclude that lifestyle modification is the superior treatment intervention among 12 treatments for the prevention of type 2 diabetes in high-risk individuals.
Abstract
BACKGROUND Many clinical trials have been conducted to verify the effects of interventions for prevention of type 2 diabetes (T2D) using different treatments and outcomes. The aim of this study was to compare the effectiveness of lifestyle modifications (LM) with other treatments in persons at high risk of T2D by a network meta-analysis (NMA). METHODS Searches were performed of PUBMED up to January 2018 to identify randomized controlled trials. The odds ratio (OR) with onset of T2D at 1 year in the intervention group (LM, dietary, exercise, or medication) versus a control group (standard treatments or placebo) were the effect sizes. Frequentist and Bayesian NMAs were conducted. RESULTS Forty-seven interventions and 12 treatments (20,113 participants) were used for the analyses. The OR in the LM was approximately 0.46 (95% CI: 0.33 to 0.61) times lower compared to the standard intervention by the Bayesian approach. The effects of LM compared to other treatments by indirect comparisons were not significant. CONCLUSIONS This meta-analysis further strengthened the evidence that LM reduces the onset of T2D compared to standard and placebo interventions and appears to be at least as effective as nine other treatments in preventing T2D.
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Body mass index, abdominal fatness, weight gain and the risk of psoriasis: a systematic review and dose-response meta-analysis of prospective studies.
Aune, D, Snekvik, I, Schlesinger, S, Norat, T, Riboli, E, Vatten, LJ
European journal of epidemiology. 2018;33(12):1163-1178
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Psoriasis is an immune-mediated inflammatory skin disease characterised by red, itchy, scaly and flaky skin. Research has shown an association between adiposity and inflammation cytokine release triggered by adipose tissue and increased body mass index and psoriasis. In this meta-analysis, seven prospective studies were included, and the association between BMI, abdominal fat, and psoriasis was examined. According to this meta-analysis, the relative risk of psoriasis increases by 19% for every 5-unit increase in BMI, 24% for a 10 cm increase in waist circumference, 37% for a 0.1-unit increase in waist-to-hip ratio, and 11% for a 5 kg weight gain. The risk of psoriasis was lower for people with a BMI below 20, and it was significantly higher for those with a BMI between 22.5-24. Psoriasis risk was positively associated with waist circumference, waist-to-hip ratio, and weight gain. Psoriasis risk escalates by 2-4 times with an increase in each measure of adiposity. Several potential strategies to reduce the risk of psoriasis are identified in this meta-analysis, including weight loss, dietary factors, and physical activity. To evaluate their effectiveness and develop appropriate strategies, further robust studies are needed. Healthcare professionals can use the results of this study to develop potential therapeutic strategies to reduce the risk of psoriasis by understanding the mechanisms and factors associated with the disease.
Abstract
Greater body mass index (BMI) has been associated with increased risk of psoriasis in case-control and cross-sectional studies, however, the evidence from prospective studies has been limited. We conducted a systematic review and dose-response meta-analysis of different adiposity measures and the risk of psoriasis to provide a more robust summary of the evidence based on data from prospective studies. PubMed and Embase databases were searched for relevant studies up to August 8th 2017. Summary relative risks (RRs) and 95% confidence intervals (CIs) were calculated using a random effects model. The summary relative risk (RR) for a 5 unit increment in BMI was 1.19 (95% CI 1.10-1.28, I2 = 83%, n = 7). The association appeared to be stronger at higher compared to lower levels of BMI, pnonlinearity < 0.0001, and the lowest risk was observed at a BMI around 20. The summary RR was 1.24 (95% CI 1.17-1.31, I2 = 0%, pheterogeneity = 0.72, n = 3) per 10 cm increase in waist circumference, 1.37 (95% CI 1.23-1.53, I2 = 0%, pheterogeneity = 0.93, n = 3) per 0.1 unit increase in waist-to-hip ratio, and 1.11 (95% CI 1.07-1.16, I2 = 47%, pheterogeneity = 0.15, n = 3) per 5 kg of weight gain. Adiposity as measured by BMI, waist circumference, waist-to-hip ratio, and weight gain is associated with increased risk of psoriasis.
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Effectiveness and safety of carbohydrate counting in the management of adult patients with type 1 diabetes mellitus: a systematic review and meta-analysis.
Vaz, EC, Porfírio, GJM, Nunes, HRC, Nunes-Nogueira, VDS
Archives of endocrinology and metabolism. 2018;62(3):337-345
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Glycaemic control of patients with diabetes mellitus is important because it impacts the development of diabetic complications. Carbohydrate counting is a meal planning tool that allows for great variation and flexibility in food choices among individuals with diabetes mellitus. The aim of the study was to evaluate the effectiveness and safety of carbohydrate counting in the treatment of adult patients with type 1 diabetes mellitus using a systematic literature review. The study included randomised controlled trials with at least 3 months of follow-up, and evaluation of outcomes in which patients were randomly divided into two groups. The meta-analysis showed that the final haemoglobin A1c (HbA1c) - a test that shows the average blood glucose levels for the last two to three months - was significantly lower in the carbohydrate counting group than in the control group. Authors conclude that the meta-analysis showed evidence favouring the use of carbohydrate counting in the management of adult patients with type 1 diabetes mellitus. However, this benefit was limited to the final HbA1c.
Abstract
OBJECTIVE This study aimed to evaluate the effectiveness and safety of carbohydrate counting (CHOC) in the treatment of adult patients with type 1 diabetes mellitus (DM1). MATERIALS AND METHODS We performed a systematic review of randomized studies that compared CHOC with general dietary advice in adult patients with DM1. The primary outcomes were changes in glycated hemoglobin (HbA1c), quality of life, and episodes of severe hypoglycemia. We searched the following electronic databases: Embase, PubMed, Lilacs, and the Cochrane Central Register of Controlled Trials. The quality of evidence was analyzed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE). RESULTS A total of 3,190 articles were identified, and two reviewers independently screened the titles and abstracts. From the 15 potentially eligible studies, five were included, and 10 were excluded because of the lack of randomization or different control/intervention groups. Meta-analysis showed that the final HbA1c was significantly lower in the CHOC group than in the control group (mean difference, random, 95% CI: -0.49 (-0.85, -0.13), p = 0.006). The meta-analysis of severe hypoglycemia and quality of life did not show any significant differences between the groups. According to the GRADE, the quality of evidence for severe hypoglycemia, quality of life, and change in HbA1c was low, very low, and moderate, respectively. CONCLUSION The meta-analysis showed evidence favoring the use of CHOC in the management of DM1. However, this benefit was limited to final HbA1c, which was significantly lower in the CHOC than in the control group.
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Lifestyle Risk Factors for Serrated Colorectal Polyps: A Systematic Review and Meta-analysis.
Bailie, L, Loughrey, MB, Coleman, HG
Gastroenterology. 2017;152(1):92-104
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Colorectal cancer (CRC) is a heterogeneous disease thought to result from the accumulation of various aberrant mutations in the cells lining the colorectal mucosa. The aim of this systematic review and meta-analysis was to evaluate modifiable and lifestyle factors and the risk of serrated polyps (a type of growth that stick out from the surface of the colon or rectum) of the colorectum. A search of 3 databases yielded a potential 2446 studies for inclusion, from which 43 remained for systematic review. Results indicate that smoking, alcohol consumption, body fatness, dietary fat and meat consumption increased the risk of developing serrated polyps. Whereas, nonsteroidal anti-inflammatory drugs, aspirin and dietary folate decreased this risk. Authors conclude that their findings strengthen public health messages promoting awareness and change in order to reduce the risk of these precancerous lesions and consequently CRC.
Abstract
BACKGROUND & AIMS Certain subsets of colorectal serrated polyps (SP) have malignant potential. We performed a systematic review and meta-analysis to investigate the association between modifiable lifestyle factors and risk for SPs. METHODS We conducted a systematic search of Medline, Embase, and Web of Science for observational or interventional studies that contained the terms risk or risk factor, and serrated or hyperplastic, and polyps or adenomas, and colorectal (or synonymous terms), published by March 2016. Titles and abstracts of identified articles were independently reviewed by at least 2 reviewers. Adjusted relative risk (RR) and 95% confidence interval (CI) were combined using random effects meta-analyses to assess the risk of SP, when possible. RESULTS We identified 43 studies of SP risk associated with 7 different lifestyle factors: smoking, alcohol, body fatness, diet, physical activity, medication, and hormone-replacement therapy. When we compared the highest and lowest categories of exposure, factors we found to significantly increase risk for SP included tobacco smoking (RR, 2.47; 95% CI, 2.12-2.87), alcohol intake (RR, 1.33; 95% CI, 1.17-1.52), body mass index (RR, 1.40; 95% CI, 1.22-1.61), and high intake of fat or meat. Direct associations for smoking and alcohol, but not body fat, tended to be stronger for sessile serrated adenomas/polyps than hyperplastic polyps. In contrast, factors we found to significantly decrease risks for SP included use of nonsteroidal anti-inflammatory drugs (RR, 0.77; 95% CI, 0.65-0.92) or aspirin (RR, 0.81; 95% CI, 0.67-0.99), as well as high intake of folate, calcium, or fiber. No significant associations were detected between SP risk and physical activity or hormone replacement therapy. CONCLUSIONS Several lifestyle factors, most notably smoking and alcohol, are associated with SP risk. These findings enhance our understanding of mechanisms of SP development and indicate that risk of serrated pathway colorectal neoplasms could be reduced with lifestyle changes.