diet

Celiac disease can present with classic gastrointestinal symptoms (e.g., diarrhea, abdominal pain, bloating, weight loss), atypical or extraintestinal manifestations (e.g., anemia, osteoporosis, neurologic symptoms, infertility, fatigue) or asymptomatic presentations detected from screening.

The first-line serologic screening test measures tissue transglutaminase immunoglobulin A and should be conducted while the patient is consuming gluten.

Complications of celiac disease include nutritional deficiencies, osteoporosis, increased risk of viral infections and pneumonia, and, rarely, risk of malignancy.

Adherence to a lifelong, strict gluten-free diet with regular monitoring of disease activity and nutritional status is key for symptom management and to prevent complications.

Author/s:

Jedid-Jah Blom, Dominica Gidrewicz, Justine Turner, Donald R. Duerksen, M. Ines Pinto-Sánchez

I Am Taking a GLP-1 Weight-Loss Medication—What Should I Know?

Megan George — Thu, 04 Sep 2025 19:54:15 +0000

Date Added:

September 4, 2025

Journal/Publication:

JAMA Internal Medicine

Publication Date:

July 14, 2025

URL:

I Am Taking a GLP-1 Weight-Loss Medication—What Should I Know?

Type:

Patient Education Materials

Format:

Poster

DOI (1):

10.1001/jamainternmed.2025.1133

Keywords

diet

GLP-1

weight loss

PMID (1):

40658429

MeSH

glucagon-like peptide 1

Glucagon-Like Peptide-1 Receptor Agonists

Information for patients about GLP-1 medications. James W. Mold, MD, MPH

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This JAMA Internal Medicine Patient Page describes how glucagon-like peptide-1 (GLP-1) receptor agonists work and what behaviors to adopt while using them.

Author/s:

Farhad Mehrtash, Jody Dushay, JoAnn E. Manson

Lipoprotein(a)

Erin Blanchette — Wed, 30 Apr 2025 21:25:24 +0000

Date Added:

April 30, 2025

Journal/Publication:

JAMA

Publisher:

American Medical Association

Publication Date:

April 24, 2025

URL:

Lipoprotein(a)

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jama.2025.2373

Keywords

Cardiovascular Risk Factors

diet

PMID (1):

40272827

MeSH

Lipoproteins

LDL

Lipoprotein(a)

cardiovascular diseases

diet

A summary of what we know currently about lipoprotein (a) and its association with ASCVD, James W. Mold, MD, MPH

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Lipoprotein(a) is a low-density lipoprotein-like particle that carries oxidized phospholipids and has proinflammatory and proatherogenic properties. In prospective studies, higher levels of lipoprotein(a) are associated with significantly higher risk of atherosclerotic cardiovascular disease (ASCVD) and all-cause mortality.1 In a meta-analysis of 29 069 patients, the incidence of ASCVD events per 1000 person-years was 80.0 (95% CI, 75.3-84.9) among people with lipoprotein(a) greater than or equal to 50 mg/dL and 55.3 (95% CI, 53.4-57.3) for people with lipoprotein(a) less than 15 mg/dL (adjusted hazard ratio, 1.35 [95% CI, 1.11-1.66]).2 A similar association of elevated lipoprotein(a) with ASCVD was observed among 460 506 participants from the UK Biobank study.3 Medications such as pelacarsen, olpasiran, and lepodisiran reduce lipoprotein(a) production in the liver and lower plasma lipoprotein(a) by up to 99%, and are currently undergoing testing in randomized clinical trials to determine whether they reduce rates of ASCVD in people with elevated lipoprotein(a).4

Author/s:

Samia Mora, Florian Kronenberg

Diets

Alex Haga — Sun, 16 Jun 2024 19:22:53 +0000

Date Added:

June 16, 2024

Journal/Publication:

New England Journal of Medicine

Publication Date:

June 12, 2024

Issue:

Volume:

390

URL:

Diets

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1056/NEJMra2211889

Keywords

diet

PMID (1):

38865662

MeSH

A comprehensive review of a number of commonly endorsed diets and their impact on various health-related outcomes.

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Food consumption provides essential and nonessential nutrients in the human body and thereby promotes growth and health. Individual food choice and the potential modification of eating habits are complex issues, influenced by the availability and acceptability of foods.1 The availability of foods depends on physical, political, and economic factors. From the myriad foods that are available or potentially available for consumption, the selection is based on socioeconomic, cultural, and individual factors. Individual foods are parts of diets; diets are characterized by nutrient content, clustering of foods, and temporal consumption patterns. The plethora of diets continually expands, and some diets have been extensively investigated.
We review the underlying rationale for and constituents of the most widely recognized, scientifically explored, and broadly promoted diets (Figure 1). We do not review diets for specific nutritional or metabolic deficiencies or many of the constructed dietary indexes. This review is not intended to detail the clinical efficacy of each diet presented, although we briefly outline some of the well-known potential effects on health and the underlying mechanisms. Even though most (but not all) of the dietary modifications have been driven by the desire to control body weight, we consider important health effects independently of adiposity.

Author/s:

Mary Yannakoulia, Nikolaos Scarmeas

Approach to Obesity Treatment in Primary Care: A Review

Erin Blanchette — Tue, 19 Mar 2024 17:28:36 +0000

Date Added:

March 19, 2024

Journal/Publication:

JAMA Internal Medicine

Publisher:

American Medical Association

Publication Date:

March 11, 2024

URL:

Approach to Obesity Treatment in Primary Care: A Review

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jamainternmed.2023.8526

Keywords

PMID (1):

38466272

MeSH

A review of current recommended primary care approaches for helping patients lose weight and keep it off. James W. Mold, MD, MPH

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Importance: More than 40% of US adults have obesity, which increases the risks for multiple chronic diseases and premature mortality. Historically, nonsurgical interventions often have not led to sufficient weight loss and maintenance to improve health, but highly effective antiobesity medications (AOMs) have recently become available, and additional effective therapeutics are under development. Given that most medical care for adults with obesity is delivered in primary care settings, guidance for integrating weight-management approaches is needed.

Observations: Lifestyle interventions can lead to a mean weight loss of 2% to 9% of initial weight at 1 year and increase the likelihood of weight loss of 5% or more, but weight regain over time is common even with continued treatment. Adjunctive treatments, including AOMs and surgical approaches, can lead to larger, more sustained weight loss and improvements in numerous obesity-associated medical conditions. Highly effective AOMs, including nutrient-stimulated hormone-based therapies, induce mean weight loss of 15% or more. Barriers to intervention, including access to care, have a disproportionate influence on populations most affected by obesity and its consequences.

Conclusions and relevance: Primary care clinicians play a vital role in the assessment, management, and support of patients with obesity. With careful clinical assessment and shared decision-making, a flexible treatment plan can be developed that reflects evidence of treatment efficacy, patient preference, and feasibility of implementation. Adjunctive therapies to lifestyle interventions, including more effective pharmacotherapeutics for obesity, offer hope to patients and the potential for considerable improvements in health and quality of life.

Author/s:

Susan Z Yanovski, Jack A Yanovski

What Is Alpha-Gal Syndrome?

Erin Blanchette — Wed, 13 Dec 2023 16:42:17 +0000

Date Added:

December 13, 2023

Journal/Publication:

JAMA

Publisher:

American Medical Association

Publication Date:

December 8, 2023

URL:

What Is Alpha-Gal Syndrome?

Type:

Patient Education Materials

Format:

Article

DOI (1):

10.1001/jama.2023.23097

Keywords

allergy and clinical immunology

PMID (1):

38064235

MeSH

Food Hypersensitivity

Information for patients about alpha-gal syndrome. James W. Mold, MD, MPH

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Alpha-gal syndrome is a type of food allergy to mammalian (red) meat products.

Alpha-gal syndrome is associated with tick bites, most commonly from the Lone Star tick in the US, but also from different types of ticks in other areas of the world. During a bite, a tick injects a type of sugar molecule (galactose-alpha-1,3-galactose), also called alpha-gal, which leads to formation of an antibody. Because alpha-gal is present on cells of most mammals, including cows, pigs, lambs, and goats, when affected individuals eat these animal products, an allergic reaction may occur.

Author/s:

Fatema Mollah, Mark A Zacharek, Mariel R Benjamin

Dietary recommendations for prevention of atherosclerosis

Saige Blanchard — Mon, 28 Feb 2022 06:00:00 +0000

Date Added:

February 28, 2022

Journal/Publication:

Cardiovascular Research

Publisher:

European Society of Cardiology

Publication Date:

July 6, 2021

Volume:

173

URL:

Dietary recommendations for prevention of atherosclerosis

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

https://doi.org/10.1093/cvr/cvab173

Keywords

Atherosclerosis

Coronary Heart Disease

cardiovascular disease

diet

PMID (1):

34229346

MeSH

Cardiovascular Disease

A review of the current evidence regarding dietary strategies for lowering cardiovascular disease risk. James W. Mold, MD, MPH

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This review aims at summarizing updated evidence on cardiovascular disease (CVD) risk associated with consumption of specific food items to substantiate dietary strategies for atherosclerosis prevention. A systematic search on PubMed was performed to identify meta-analyses of cohort studies and RCTs with CVD outcomes. The evidence is highly concordant in showing that, for the healthy adult population, low consumption of salt and foods of animal origin, and increased intake of plant-based foods—whole grains, fruits, vegetables, legumes, and nuts—are linked with reduced atherosclerosis risk. The same applies for the replacement of butter and other animal/tropical fats with olive oil and other unsaturated-fat-rich oil. Although the literature reviewed overall endorses scientific society dietary recommendations, some relevant novelties emerge. With regard to meat, new evidence differentiates processed and red meat—both associated with increased CVD risk—from poultry, showing a neutral relationship with CVD for moderate intakes. Moreover, the preferential use of low-fat dairies in the healthy population is not supported by recent data, since both full-fat and low-fat dairies, in moderate amounts and in the context of a balanced diet, are not associated with increased CVD risk; furthermore, small quantities of cheese and regular yogurt consumption are even linked with a protective effect. Among other animal protein sources, moderate fish consumption is also supported by the latest evidence, although there might be sustainability concerns. New data endorse the replacement of most high glycemic index (GI) foods with both whole grain and low GI cereal foods. As for beverages, low consumption not only of alcohol, but also of coffee and tea is associated with a reduced atherosclerosis risk while soft drinks show a direct relationship with CVD risk. This review provides evidence-based support for promoting appropriate food choices for atherosclerosis prevention in the general population.

Dietary Approaches to Improve Efficacy and Control Side Effects of Levodopa Therapy in Parkinson's Disease: A Systematic Review

Saige Blanchard — Mon, 03 Jan 2022 06:00:00 +0000

Date Added:

January 3, 2022

Journal/Publication:

Advances in Nutrition

Publisher:

Oxford University Press

Publication Date:

June 10, 2021

Issue:

Volume:

Pages:

2265-2287

URL:

Dietary Approaches to Improve Efficacy and Control Side Effects of Levodopa Therapy in Parkinson's Disease: A Systematic Review

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1093/advances/nmab060

Keywords

PMID (1):

34113965

MeSH

A review of evidence on dietary modifications and nutritional supplements to improve tolerability and effectiveness of L-dopa in the treatment of patients with Parkinson’s Disease. James W. Mold, MD, MPH

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Although levodopa remains the most effective drug for symptomatic management of Parkinson's Disease (PD), treatment during advanced disease stages may raise unpredictable motor fluctuations and other complications. Counteracting these complications with other pharmacological therapies may prompt a vicious circle of side effects, and here, nutritional therapy may have great potential. Knowledge about the role of diet in PD is emerging and multiple studies have investigated nutritional support specifically with respect to levodopa therapy. With this systematic review, we aim to give a comprehensive overview of dietary approaches to optimize levodopa treatment in PD. A systematic search was performed using the databases of PubMed and Scopus between January 1985 and September 2020. Nutritional interventions with the rationale to optimize levodopa therapy in human PD patients were eligible for this study and their quality was assessed with the Cochrane risk-of-bias tool. In total, we included 22 papers that addressed the effects of dietary proteins (n = 10), vitamins (n = 7), fiber (n = 2), soybeans (n = 1), caffeine (n = 1), and ketogenic diets (n = 1) on levodopa therapy. Interventions with protein redistribution diets (PRDs), dietary fiber, vitamin C, and caffeine improved levodopa absorption, thereby enhancing clinical response and reducing motor fluctuations. Furthermore, supplementation of vitamin B-12, vitamin B-6, and folic acid successfully reduced high homocysteine concentrations that emerged from levodopa metabolism and promoted many metabolic and clinical complications, such as neuropathology and osteoporosis. In conclusion, dietary interventions have the potential to optimize levodopa efficacy and control side effects. Nutrition that improves levodopa absorption, including PRDs, fiber, vitamin C, and caffeine, is specifically recommended when fluctuating clinical responses appear. Supplements of vitamin B-12, vitamin B-6, and folic acid are advised along with levodopa initiation to attenuate hyperhomocysteinemia, and importantly, their potential to treat consequent metabolic and clinical complications warrants future research.

Author/s:

Boelens Keun, J., Arnoldussen, I., Vriend, C., Van de Rest, O.

Can We Say What Diet Is Best for Health?

John Bayhi — Thu, 16 Jan 2020 16:26:48 +0000

Date Added:

January 16, 2020

Journal/Publication:

Annual Review of Public Health

Publisher:

Annual Reviews

Publication Date:

March 1, 2014

Volume:

Pages:

83-103

URL:

Can we say what diet is best for health?

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1146/annurev-publhealth-032013-182351

Keywords

PMID (1):

24641555

MeSH

Dietary Carbohydrates

An evidence-based review of what we currently know about what we should be eating. It appears that Michael Pollan was right when he wrote, in The Omnivore’s Dilemma, “Eat good food, not too much, mostly vegetables.” The only thing he left out was to try to avoid highly processed food of any kind. James W. Mold, MD, MPH

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Diet is established among the most important influences on health in modern societies. Injudicious diet figures among the leading causes of premature death and chronic disease. Optimal eating is associated with increased life expectancy, dramatic reduction in lifetime risk of all chronic disease, and amelioration of gene expression. In this context, claims abound for the competitive merits of various diets relative to one another. Whereas such claims, particularly when attached to commercial interests, emphasize distinctions, the fundamentals of virtually all eating patterns associated with meaningful evidence of health benefit overlap substantially. There have been no rigorous, long-term studies comparing contenders for best diet laurels using methodology that precludes bias and confounding, and for many reasons such studies are unlikely. In the absence of such direct comparisons, claims for the established superiority of any one specific diet over others are exaggerated. The weight of evidence strongly supports a theme of healthful eating while allowing for variations on that theme. A diet of minimally processed foods close to nature, predominantly plants, is decisively associated with health promotion and disease prevention and is consistent with the salient components of seemingly distinct dietary approaches. Efforts to improve public health through diet are forestalled not for want of knowledge about the optimal feeding of Homo sapiens but for distractions associated with exaggerated claims, and our failure to convert what we reliably know into what we routinely do. Knowledge in this case is not, as of yet, power; would that it were so.

Author/s:

Katz, DL, Meller, S

Unprocessed Red Meat and Processed Meat Consumption: Dietary Guideline Recommendations From the Nutritional Recommendations (NutriRECS) Consortium

John Bayhi — Thu, 03 Oct 2019 13:31:55 +0000

Date Added:

October 9, 2019

Journal/Publication:

Annals of Internal Medicine

Publisher:

American College of Physicians

Publication Date:

October 1, 2019

URL:

Unprocessed Red Meat and Processed Meat Consumption: Dietary Guideline Recommendations From the Nutritional Recommendations (NutriRECS) Consortium

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

Keywords

MeSH

This guideline suggests that there is very little evidence that limiting intakes of red meat and processed meats cause significant harm to the person. Environmental harms are not considered. James W. Mold, MD, MPH

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DESCRIPTION:

Dietary guideline recommendations require consideration of the certainty in the evidence, the magnitude of potential benefits and harms, and explicit consideration of people's values and preferences. A set of recommendations on red meat and processed meat consumption was developed on the basis of 5 de novo systematic reviews that considered all of these issues.

METHODS:

The recommendations were developed by using the Nutritional Recommendations (NutriRECS) guideline development process, which includes rigorous systematic review methodology, and GRADE methods to rate the certainty of evidence for each outcome and to move from evidence to recommendations. A panel of 14 members, including 3 community members, from 7 countries voted on the final recommendations. Strict criteria limited the conflicts of interest among panel members. Considerations of environmental impact or animal welfare did not bear on the recommendations. Four systematic reviews addressed the health effects associated with red meat and processed meat consumption, and 1 systematic review addressed people's health-related values and preferences regarding meat consumption.

RECOMMENDATIONS:

The panel suggests that adults continue current unprocessed red meat consumption (weak recommendation, low-certainty evidence). Similarly, the panel suggests adults continue current processed meat consumption (weak recommendation, low-certainty evidence).

PRIMARY FUNDING SOURCE:

None. (PROSPERO 2017: CRD42017074074; PROSPERO 2018: CRD42018088854)

Author/s:

Johnston, BC, Zeraatkar, D, Han, MA, Vernooij RWM, Valli, C, El Dib, R, Marshall, C, Stover, PJ, Fairweather-Taitt, S, Wojcik, G, Bhatia, F, de Souza, R, Brotons, C, Meerpohl, JJ, Patel, CJ, Djulbegovic, B, Alonso-Coello, P, Bala, MM, Guyatt, GH

Changes in nut consumption influence long-term weight change in US men and women

John Bayhi — Fri, 27 Sep 2019 12:59:01 +0000

Date Added:

September 27, 2019

Journal/Publication:

BMJ Nutrition, Prevention & Health

Publisher:

BMJ Publishing Group Ltd & NNEdPro Global Centre for Nutrition and Health (Cambridge)

Publication Date:

September 23, 2019

URL:

Changes in nut consumption influence long-term weight change in US men and women

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.1136/bmjnph-2019-000034

Keywords

MeSH

Epidemiological Studies

More evidence that eating nuts is good for people. James W. Mold, MD, MPH

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Background Nut consumption has increased in the US but little evidence exists on the association between changes in nut consumption and weight change. We aimed to evaluate the association between changes in total consumption of nuts and intakes of different nuts (including peanuts) and long-term weight change, in three independent cohort studies.

Methods and findings Data collected in three prospective, longitudinal cohorts among health professionals in the US were analysed. We included 27 521 men (Health Professionals Follow-up Study, 1986 to 2010), 61 680 women (Nurses’ Health Study, 1986 to 2010), and 55 684 younger women (Nurses’ Health Study II, 1991 to 2011) who were free of chronic disease at baseline in the analyses. We investigated the association between changes in nut consumption over 4-year intervals and concurrent weight change over 20–24 years of follow-up using multivariate linear models with an unstructured correlation matrix to account for within-individual repeated measures. 21 322 individuals attained a body mass index classification of obesity (BMI ≥30 kg/m2) at the end of follow-up.

Average weight gain across the three cohorts was 0.32 kg each year. Increases in nut consumption, per 0.5 servings/day (14 g), was significantly associated with less weight gain per 4-year interval (p<0.01 for all): −0.19 kg (95% CI -0.21 to -0.17) for total consumption of nuts, -0.37 kg (95% CI -0.45 to -0.30) for walnuts, -0.36 kg (95% CI -0.40 to -0.31) for other tree nuts, and -0.15 kg (95% CI -0.19 to -0.11) for peanuts.

Increasing intakes of nuts, walnuts, and other tree nuts by 0.5 servings/day was associated with a lower risk of obesity. The multivariable adjusted RR for total nuts, walnuts, and other tree nuts was 0.97 (95% CI 0.96 to 0.99, p=0.0036), 0.85 (95% CI 0.81 to 0.89, p=0.0002), and 0.89 (95% CI 0.87 to 0.91, p<0.0001), respectively. Increasing nut consumption was also associated with a lower risk of gaining ≥2 kg or ≥5 kg (RR 0.89–0.98, p<0.01 for all).

In substitution analyses, substituting 0.5 servings/day of nuts for red meat, processed meat, French fries, desserts, or potato, chips (crisps) was associated with less weight gain (p<0.05 for all).

Our cohorts were largely composed of Caucasian health professionals with relatively higher socioeconomic status; thus the results may not be generalisable to other populations.

Conclusion Increasing daily consumption of nuts is associated with less long-term weight gain and a lower risk of obesity in adults. Replacing 0.5 servings/day of less healthful foods with nuts may be a simple strategy to help prevent gradual long-term weight gain and obesity.

Author/s:

X, Li, Y, Guasch-Ferre, M, Willett, WC, Drouin-Chartier, JP, Bhupathiraju, SN, Tobias, DK

Dietary Supplement Ingredient Advisory List

Brian Desmarais — Sun, 19 May 2019 01:19:00 +0000

Date Added:

May 18, 2019

Publisher:

Food and Drug Administration

Publication Date:

May 8, 2019

URL:

Dietary Supplement Ingredient Advisory List

Type:

Public Health Announcements

Format:

Web Page

Keywords

MeSH

Tetrahydroisoquinolines

The FDA is warning consumers not to purchase dietary supplements containing four specific substances considered hazardous to health, andarine, higenamine, hordenine, and 1,4-DMAA, all of which have a variety of other names listed in the article.

James W. Mold, MD, MPH

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The FDA Dietary Supplement Ingredient Advisory List is intended to quickly alert the public when the FDA identifies ingredients that do not appear to be lawfully included in products marketed as dietary supplements.

Effect of a Long Bout Versus Short Bouts of Walking on Weight Loss During a Weight‐Loss Diet: A Randomized Trial

Jeffrey Wilson — Wed, 03 Apr 2019 14:08:01 +0000

Date Added:

April 3, 2019

Journal/Publication:

Obesity

Publisher:

The Obesity Society

Publication Date:

February 9, 2019

Issue:

Volume:

URL:

Effect of a Long Bout Versus Short Bouts of Walking on Weight Loss During a Weight‐Loss Diet: A Randomized Trial

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.1002/oby.22416

Keywords

PMID (1):

30737894

MeSH

weight reduction programs

In this RCT involving diet and physical activity, two 25 minute bouts a day of moderate physical activity 6 days per week was associated with significantly more weight loss than one 50 minute bout of moderate physical activity per day 6 days a week. James W. Mold, MD, MPH

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OBJECTIVE:

This study aimed to evaluate the effect of different daily physical activity (PA) frequencies, while maintaining the same daily volume of PA, on weight loss, carbohydrate metabolism, and lipid metabolism in women with overweight or obesity throughout a 24-week intervention.

METHODS:

During their weight-loss plan, 65 women (BMI = 27-35 kg/m2 ; age = 18-40 years) who had a sedentary lifestyle were randomly allocated to the following groups: diet plus a long bout of moderate physical activity (LBP) (one 50-minute bout of moderate-intensity PA) 6 d/wk or diet plus short bouts of moderate physical activity (SBP) (two 25-minute bouts of moderate-intensity PA) 6 d/wk. Anthropometric and blood measurements were taken at baseline and at 24 weeks.

RESULTS:

Compared with the LBP group, the SBP group had a greater decrease in weight (SBP: -8.08 ± 2.20 kg; LBP: -6.39 ± 2.28 kg; P = 0.019), BMI (SBP: -3.11 ± 0.87 kg/m2 ; LBP: -2.47 ± 0.86 kg/m2 ; P = 0.027), and waist circumference (SBP: -8.78 ± 2.62 cm; LBP: -5.76 ± 2.03 cm; P = 0.026). No significant differences were seen in carbohydrate and lipid metabolism characteristics after 24 weeks.

CONCLUSIONS:

PA undertaken in two shorter bouts per day could be more effective for weight loss than PA undertaken in a daily long bout in adult women in a 24-week weight-loss program.

Author/s:

Madjd, Amenah, Taylor, Moira A., Delavari, Alireza,, Reza, Macdonald, Ian A., Farshchi, Hamid R.

Primary care-led weight management for remission of type 2 diabetes (DiRECT): an open-label, cluster-randomised trial

Jeffrey Wilson — Wed, 06 Mar 2019 16:21:52 +0000

Date Added:

March 6, 2019

Journal/Publication:

The Lancet

Publisher:

Elsevier

Publication Date:

December 5, 2017

Issue:

10120

Volume:

391

Pages:

541-551

URL:

Primary care-led weight management for remission of type 2 diabetes (DiRECT): an open-label, cluster-randomised trial

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.1016/S0140-6736(17)33102-1

Keywords

diet

diabetes

type 2 diabetes

PMID (1):

29221645

MeSH

diabetes mellitus, type 2

insulin

hypoglycemic agents

antihypertensive agents

diet

chronic disease

This study, called the DiRECT trial, showed that it is possible to “cure” type 2 diabetes without meds in a significant number of patients with a carefully controlled diet and maintenance program.

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BACKGROUND:

Type 2 diabetes is a chronic disorder that requires lifelong treatment. We aimed to assess whether intensive weight management within routine primary care would achieve remission of type 2 diabetes.

METHODS:

We did this open-label, cluster-randomised trial (DiRECT) at 49 primary care practices in Scotland and the Tyneside region of England. Practices were randomly assigned (1:1), via a computer-generated list, to provide either a weight management programme (intervention) or best-practice care by guidelines (control), with stratification for study site (Tyneside or Scotland) and practice list size (>5700 or ≤5700). Participants, carers, and research assistants who collected outcome data were aware of group allocation; however, allocation was concealed from the study statistician. We recruited individuals aged 20-65 years who had been diagnosed with type 2 diabetes within the past 6 years, had a body-mass index of 27-45 kg/m2, and were not receiving insulin. The intervention comprised withdrawal of antidiabetic and antihypertensive drugs, total diet replacement (825-853 kcal/day formula diet for 3-5 months), stepped food reintroduction (2-8 weeks), and structured support for long-term weight loss maintenance. Co-primary outcomes were weight loss of 15 kg or more, and remission of diabetes, defined as glycated haemoglobin (HbA1c) of less than 6·5% (<48 mmol/mol) after at least 2 months off all antidiabetic medications, from baseline to 12 months. These outcomes were analysed hierarchically. This trial is registered with the ISRCTN registry, number 03267836.

FINDINGS:

Between July 25, 2014, and Aug 5, 2017, we recruited 306 individuals from 49 intervention (n=23) and control (n=26) general practices; 149 participants per group comprised the intention-to-treat population. At 12 months, we recorded weight loss of 15 kg or more in 36 (24%) participants in the intervention group and no participants in the control group (p<0·0001). Diabetes remission was achieved in 68 (46%) participants in the intervention group and six (4%) participants in the control group (odds ratio 19·7, 95% CI 7·8-49·8; p<0·0001). Remission varied with weight loss in the whole study population, with achievement in none of 76 participants who gained weight, six (7%) of 89 participants who maintained 0-5 kg weight loss, 19 (34%) of 56 participants with 5-10 kg loss, 16 (57%) of 28 participants with 10-15 kg loss, and 31 (86%) of 36 participants who lost 15 kg or more. Mean bodyweight fell by 10·0 kg (SD 8·0) in the intervention group and 1·0 kg (3·7) in the control group (adjusted difference -8·8 kg, 95% CI -10·3 to -7·3; p<0·0001). Quality of life, as measured by the EuroQol 5 Dimensions visual analogue scale, improved by 7·2 points (SD 21·3) in the intervention group, and decreased by 2·9 points (15·5) in the control group (adjusted difference 6·4 points, 95% CI 2·5-10·3; p=0·0012). Nine serious adverse events were reported by seven (4%) of 157 participants in the intervention group and two were reported by two (1%) participants in the control group. Two serious adverse events (biliary colic and abdominal pain), occurring in the same participant, were deemed potentially related to the intervention. No serious adverse events led to withdrawal from the study.

INTERPRETATION:

Our findings show that, at 12 months, almost half of participants achieved remission to a non-diabetic state and off antidiabetic drugs. Remission of type 2 diabetes is a practical target for primary care.

Author/s:

Lean, Michael E.J., Leslie, Wilma S., Barnes, Alison C., Brosnahan, Naomi, Thom, George, McCombie, Louise, Peters, Carl, Zhyzhneuskaya, Sviatlana, Al-Mrabeh, Ahmad, Hollingsworth, Kieren G., Rodrigues, Angela M., Rehackova, Lucia, Adamson, Ashley J., Sniehotta, Falko F., Mathers, John C., Ross, Hazel M., McIlvenna, Yvonne, Stefanetti, Renae, Trenell, Michael, Welsh, Paul, Kean, Sharon, Ford, Ian, McConnachie, Alex, Sattar, Naveed, Taylor, Roy

Antioxidants: In Depth

Jeffrey Wilson — Sun, 24 Feb 2019 20:01:46 +0000

Date Added:

February 24, 2019

Publication Date:

May 4, 2016

URL:

Antioxidants: In Depth

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Web Page

Keywords

MeSH

A review of the evidence related to the use of anti-oxidant supplements from the NIH.

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Antioxidants are man-made or natural substances that may prevent or delay some types of cell damage. Diets high in vegetables and fruits, which are good sources of antioxidants, have been found to be healthy; however, research has not shown antioxidant supplements to be beneficial in preventing diseases. Examples of antioxidants include vitamins C and E, selenium, and carotenoids, such as beta-carotene, lycopene, lutein, and zeaxanthin. This fact sheet provides basic information about antioxidants, summarizes what the science says about antioxidants and health, and suggests sources for additional information.

Author/s:

National Institutes of Health, Chun, Ock, Frei, Balz, Gardner, Christopher, Alekel, D. Lee, Killen, John Jr.