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ADHD medication discontinuation and persistence across the lifespan: a retrospective observational study using population-based databases.
Brikell, I, Yao, H, Li, L, Astrup, A, Gao, L, Gillies, MB, Xie, T, Zhang-James, Y, Dalsgaard, S, Engeland, A, et al
The lancet. Psychiatry. 2024;(1):16-26
Abstract
BACKGROUND Although often intended for long-term treatment, discontinuation of medication for ADHD is common. However, cross-national estimates of discontinuation are missing due to the absence of standardised measures. The aim of this study was to determine the rate of ADHD treatment discontinuation across the lifespan and to describe similarities and differences across countries to guide clinical practice. METHODS We did a retrospective, observational study using population-based databases from eight countries and one Special Administrative Region (Australia, Denmark, Hong Kong, Iceland, the Netherlands, Norway, Sweden, the UK, and the USA). We used a common analytical protocol approach and extracted prescription data to identify new users of ADHD medication. Eligible individuals were aged 3 years or older who had initiated ADHD medication between 2010 and 2020. We estimated treatment discontinuation and persistence in the 5 years after treatment initiation, stratified by age at initiation (children [age 4-11 years], adolescents [age 12-17 years], young adults [age 18-24 years], and adults [age ≥25 years]) and sex. Ethnicity data were not available. FINDINGS 1 229 972 individuals (735 503 [60%] males, 494 469 females [40%]; median age 8-21 years) were included in the study. Across countries, treatment discontinuation 1-5 years after initiation was lowest in children, and highest in young adults and adolescents. Within 1 year of initiation, 65% (95% CI 60-70) of children, 47% (43-51) of adolescents, 39% (36-42) of young adults, and 48% (44-52) of adults remained on treatment. The proportion of patients discontinuing was highest between age 18 and 19 years. Treatment persistence for up to 5 years was higher across countries when accounting for reinitiation of medication; at 5 years of follow-up, 50-60% of children and 30-40% of adolescents and adults were covered by treatment in most countries. Patterns were similar across sex. INTERPRETATION Early medication discontinuation is prevalent in ADHD treatment, particularly among young adults. Although reinitiation of medication is common, treatment persistence in adolescents and young adults is lower than expected based on previous estimates of ADHD symptom persistence in these age groups. This study highlights the scope of medication treatment discontinuation and persistence in ADHD across the lifespan and provides new knowledge about long-term ADHD medication use. FUNDING European Union Horizon 2020 Research and Innovation Programme.
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Habitual dietary phosphorus intake and urinary excretion in chronic kidney disease patients: a 3-day observational study.
Salomo, L, Kamper, AL, Poulsen, GM, Poulsen, SK, Astrup, A, Rix, M
European journal of clinical nutrition. 2017;(6):798-800
Abstract
Hyperphosphatemia in chronic kidney disease (CKD) is associated with vascular calcification, cardiovascular morbidity and mortality. The aim of this study was to estimate the daily dietary phosphorus intake compared with recommendations in CKD patients and to evaluate the reproducibility of the 24-h urinary phosphorus excretion. Twenty CKD patients stage 3-4 from the outpatient clinic, collected 24-h urine and kept dietary records for 3 consecutive days. The mean daily phosphorus intake was 1367±499, 1642±815 and 1426±706 mg/day, respectively (P=0.57). The mean urinary phosphorus excretion was 914±465, 954±414 and 994±479 mg/day, respectively (P=0.21). In this population of CKD patients stage 3-4 the daily phosphorus intake was above the recommended. Twenty-four-hour urinary phosphorus excretion was reproducible and the data indicate that a single 24-h urine collection is sufficient to estimate the individual phosphorus excretion.
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Long-term effects of weight reduction on the severity of psoriasis in a cohort derived from a randomized trial: a prospective observational follow-up study.
Jensen, P, Christensen, R, Zachariae, C, Geiker, NR, Schaadt, BK, Stender, S, Hansen, PR, Astrup, A, Skov, L
The American journal of clinical nutrition. 2016;(2):259-65
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Abstract
BACKGROUND Weight reduction may reduce the severity of psoriasis, but little is known about the long-term effects. OBJECTIVE We aimed to investigate long-term effects of weight reduction in psoriasis. DESIGN We previously conducted a randomized trial (n = 60) involving patients with psoriasis who were allocated to a control group or a low-energy diet (LED) group. Here we followed the participants for an additional 48-wk period. In total, 56 patients with psoriasis [mean ± SD body mass index (in kg/m(2)): 34.4 ± 5.3] underwent a 64-wk weight-loss program consisting of an initial 16-wk randomized phase with an LED for 8 wk and 8 wk of normal food intake combined with 2 LED products/d, followed by a 48-wk period of weight maintenance with the latter diet. After the randomization phase, the control group received the same 8 + 8-wk LED intervention, and all patients were then followed for 48 wk while on the weight-loss maintenance diet. The main outcome was the Psoriasis Area and Severity Index (PASI), and secondary outcome was the Dermatology Life Quality Index (DLQI). RESULTS For the present study, 56 patients were eligible, 38 agreed to participate, and 32 completed. After the 16-wk LED-only period, the mean weight loss was -15.0 kg (95% CI: -16.6, -13.4 kg), and PASI and DLQI were reduced by -2.3 (95% CI: -3.1, -1.5) and -2.3 (95% CI: -3.2, -1.4), respectively. At week 64, the mean weight loss compared with baseline was -10.1 kg (95% CI: -12.0, -8.1 kg), and PASI and DLQI were maintained at -2.9 (95% CI: -3.9, -1.9) and -1.9 (95% CI: -3.0, -0.9), respectively. CONCLUSION Long-term weight loss in patients with psoriasis has long-lasting positive effects on the severity of psoriasis. This trial was registered at clinicaltrials.gov as NCT01137188.
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Seasonal variations in growth and body composition of 8-11-y-old Danish children.
Dalskov, SM, Ritz, C, Larnkjær, A, Damsgaard, CT, Petersen, RA, Sørensen, LB, Hjorth, MF, Ong, KK, Astrup, A, Mølgaard, C, et al
Pediatric research. 2016;(2):358-63
Abstract
BACKGROUND Earlier studies on seasonality in growth reported the largest height gains during spring and largest body weight gains during autumn. We examined seasonality in height, body weight, BMI, fat mass index (FMI), and fat-free mass index (FFMI) among contemporary Danish 8-11-y olds. METHODS A total of 760 children from the OPUS School Meal Study provided >2,200 measurements on height, body weight, and composition between September and June. Average velocities were calculated using change-score analyses based on 3-mo intervals. As a complementary analysis, point velocities derived from estimated growth curves were fitted using semiparametric regression that included covariate adjustment and allowed flexible modeling of the time trend. RESULTS Average velocities showed the following trends: height was higher than the average (6.10 cm/y) in January-April. Body weight was below the average (4.02 kg/y) in August-January and above in January-May; BMI (average: 0.49 kg/ m(2)/y) and FFMI (average: 0.17 kg/m(2)/y) showed similar trends. In contrast, FMI was above the average (0.38 kg/m(2)/y) in November-March. Similar trends were seen for point velocities. CONCLUSION Our findings suggest seasonality in growth and body composition of Danish children. We recovered the well-known height velocity peak during spring time, but unlike earlier studies, we found coincident peaks in body weight, BMI, and FFMI velocities.
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Dietary protein and urinary nitrogen in relation to 6-year changes in fat mass and fat-free mass.
Ankarfeldt, MZ, Gottliebsen, K, Ängquist, L, Astrup, A, Heitmann, BL, Sørensen, TI
International journal of obesity (2005). 2015;(1):162-8
Abstract
BACKGROUND In contrast to the physiological expectation, observational studies show that greater protein intake is associated with subsequent body weight (BW) gain. An increase in fat-free mass (FFM) due to the anabolic effects of protein could explain this. OBJECTIVE To examine associations between protein intake and subsequent changes in fat mass (FM) and FFM in longitudinal, observational data. DESIGN A health examination, including measures of FM and FFM by bioelectrical impedance at baseline and follow-up 6 years later, was conducted. Diet history interviews (DHI) were performed, and 24-h urinary nitrogen collection at baseline was done. In total, 330 participants with DHI, of whom 227 had validated and complete 24-h urine collection data, were analyzed. Macronutrient energy substitution models were used. RESULTS Mean estimated protein intake was 14.6 E% from DHI and 11.3 E% from urinary nitrogen. Estimated from DHI, FM increased 46 g per year, with every 1 E% protein substituted for fat (95% confidence interval (CI) = 13, 79; P = 0.006), and FFM increased 15 g per year (1, 30; P = 0.046). Results were similar in other substitution models. Estimated from urinary nitrogen, FM increased 53 g per year, with 1 E% protein substituted for other macronutrients (24, 81; P < 0.0005), and FFM increased 18 g per year (6, 31; P = 0.004). CONCLUSION Within a habitual range, a greater protein intake was associated with BW gain, mostly in FM. This is in contrast to the expectations based on physiological and clinical trials, and calls for a better understanding of how habitual dietary protein influences long-term energy balance, versus how greater changes in dietary proteins may influence short-term energy balance.
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Interactions of dietary protein and adiposity measures in relation to subsequent changes in body weight and waist circumference.
Ankarfeldt, MZ, Angquist, L, Jakobsen, MU, Overvad, K, Tjønneland, A, Halkjaer, J, Astrup, A, Sørensen, TI
Obesity (Silver Spring, Md.). 2014;(9):2097-103
Abstract
OBJECTIVE To investigate if dietary protein and degree of adiposity interacts in relation to change in body weight and waist circumference (WC) in the general population. METHODS In total 22,433 middle-aged individuals with dietary assessment at baseline and anthropometry at baseline and at follow-up about 5 years later were analyzed with multiple linear regression and dietary macronutrient substitution models. Interactions between dietary protein and baseline body mass index (BMI) and baseline WC adjusted for BMI (WCBMI ) (divided in tertiles; nine groups total), were analyzed in relation to changes in body weight (BW) and changes WC adjusted for change in BW. RESULTS Baseline intake of protein was not significantly associated with changes in weight or waist circumference. Across the nine groups of baseline BMI and WCBMI there were no distinct trends in the associations between dietary protein, whether replacing carbohydrate or fat, and weight change. However, individuals in the highest tertile of baseline BMI (irrespective of baseline WCBMI ) had significantly inverse change in waist circumference when protein replaced carbohydrate, but not when protein replaced fat. CONCLUSION Replacing carbohydrate with protein in the diet may prevent a relative increase in WC in individuals with a greater BMI.