Strategi menjaga berat badan

Penelitian berikut membandingkan strategi mempertahankan penurunan berat badan. Para ahli melakukan randomized two-phase trial terhadap >1000 penderita obesitas disertai hipertensi dan dyslipidemia, yang telah mengalami penurunan berat badan minimal 4 kg dalam 6 bulan (fase 1).

Subyek di-randomized untuk fase 2, intervensi untuk mempertahankan penurunan berat badan selama 30 bulan berikut kelompok 1) monthly personal contact, kelompok 2)unlimited access to an interactive technology-based intervention, atau kelompok 3)self-directed control.

 

Hasilnya BB rata2 96,7 kg. Penurunan BB fase 1 rata2 8,5 kg. Setelah randomization kelompok 1 BB naik 4,0 kg ; kelompok 3 BB naik 5,5 kg. Kelompok 2 mengalami kenaikan BB lebih kecil dibanding kelompok 3 tapi perbedaannya tidak bermakna. Setelah 30 bulan juga ada perbedaan bermakna antara kelompok 1 dan kelompok 2. Pada akhir penelitian 71% subyek BB-nya tetap di bawah BB awal.

 

Kesimpulan sebagian besar penderita obesitas yang berhasil menurunkan BB berhasil mempertahankan BB-nya. Kontrol setiap bulan (monthly brief personal contact) merupakan cara terbaik untuk mempertahankan BB.

 

Berikut ini abstract dari penelitian tersebut

 

JAMA 2008;299(10): 1139-1148. Vol. 299 No. 10, March 12, 2008 © 2008 American Medical Association.
Comparison of Strategies for Sustaining Weight Loss. The Weight Loss Maintenance Laura P. Svetkey, MD; Victor J. Stevens, PhD; Phillip J. Brantley, PhD;  Lawrence J. Appel, MD; Jack F. Hollis, PhD; Catherine M. Loria, PhD; William M. Vollmer, PhD; Christina M. Gullion, PhD; Kristine Funk; Patti Smith; Carmen Samuel-Hodge, PhD; Valerie Myers, PhD; Lillian F. Lien, MD; Daniel Laferriere; Betty Kennedy, PhD; Gerald J. Jerome, PhD; Fran Heinith; David W. Harsha, PhD; Pamela Evans; Thomas P. Erlinger, MD; Arline T. Dalcin; Janelle Coughlin, PhD; Jeanne Charleston; Catherine M. Champagne, PhD; Alan Bauck; Jamy D. Ard, MD; Kathleen Aicher; for the Weight Loss Maintenance Collaborative Research Group

 

Context  Behavioral weight loss interventions achieve short-term success, but re-gain is common.

Objective  To compare 2 weight loss maintenance interventions with a self-directed control group.

Design, Setting, and Participants  Two-phase trial in which 1032 overweight or obese adults (38% African American, 63% women) with hypertension, dyslipidemia, or both who had lost at least 4 kg during a 6-month weight loss program (phase 1) were randomized to a weight-loss maintenance intervention (phase 2). Enrollment at 4 academic centers occurred August 2003-July 2004 and randomization, February-December 2004. Data collection was completed in June 2007.

Interventions  After the phase 1 weight-loss program, participants were randomized to one of the following groups for 30 months: monthly personal contact, unlimited access to an interactive technology–based intervention, or self-directed control.

Main Outcome  Changes in weight from randomization.

Results  Mean entry weight was 96.7 kg. During the initial 6-month program, mean weight loss was 8.5 kg. After randomization, weight regain occurred. Participants in the personal-contact group regained less weight (4.0 kg) than those in the self-directed group (5.5 kg; mean difference at 30 months, –1.5 kg; 95% confidence interval [CI], –2.4 to –0.6 kg; P = .001). At 30 months, weight regain did not differ between the interactive technology–based (5.2 kg) and self-directed groups (5.5 kg; mean difference –0.3 kg; 95% CI, –1.2 to 0.6 kg; P = .51); however, weight regain was lower in the interactive technology–based than in the self-directed group at 18 months (mean difference, –1.1 kg; 95% CI, –1.9 to –0.4 kg; P = .003) and at 24 months (mean difference, –0.9 kg; 95% CI, –1.7 to –0.02 kg; P = .04). At 30 months, the difference between the personal-contact and interactive technology–based group was –1.2 kg (95% CI –2.1 to –0.3; P = .008). Effects did not differ significantly by sex, race, age, and body mass index subgroups. Overall, 71% of study participants remained below entry weight.

Conclusions  The majority of individuals who successfully completed an initial behavioral weight loss program maintained a weight below their initial level. Monthly brief personal contact provided modest benefit in sustaining weight loss, whereas an interactive techonology–based intervention provided early but transient benefit.

Pola makan dan Timbulnya Sindroma Metabolik

Penelitian tentang hubungan antara sindroma metabolic dan asupan makanan dilakukan atas >9.500 partisipan berusia 45-64 tahun dan diikuti selama 9 tahun. Selama penelitian insiden sindroma metabolik sebesar 3.782

 

Hasil penelitian menunjukkan bahwa pola Western diet berhubungan dengan timbulnya sindroma metabolic, terutama asupan daging, gorengan, dan diet soda. Sebaliknya susu (dairy product) justru memberikan proteksi.

 

Kesimpulan Western diet, terutama daging, gorengan dan diet soda menyebabkan timbulnya sindroma metabolic, namun dairy product dapat mencegah sindroma metabolik.

 

Circulation. 2008;117:754-761. February 12, 2008 © 2008 American Heart Association, Inc.
Dietary Intake and the Development of the Metabolic Syndrome. The Atherosclerosis Risk in Communities Study. Pamela L. Lutsey, MPH; Lyn M. Steffen, PhD, MPH, RD; June Stevens, PhD, MS, RD  

 

Background— The role of diet in the origin of metabolic syndrome (MetSyn) is not well understood; thus, we sought to evaluate the relationship between incident MetSyn and dietary intake using prospective data from 9514 participants (age, 45 to 64 years) enrolled in the Atherosclerosis Risk in Communities (ARIC) study.

 

Methods and Results— Dietary intake was assessed at baseline via a 66-item food frequency questionnaire. We used principal-components analysis to derive "Western" and "prudent" dietary patterns from 32 food groups and evaluated 10 food groups used in previous studies of the ARIC cohort. MetSyn was defined by American Heart Association guidelines. Proportional-hazards regression was used. Over 9 years of follow-up, 3782 incident cases of MetSyn were identified. After adjustment for demographic factors, smoking, physical activity, and energy intake, consumption of a Western dietary pattern (P_trend=0.03) was adversely associated with incident MetSyn. After further adjustment for intake of meat, dairy, fruits and vegetables, refined grains, and whole grains, analysis of individual food groups revealed that meat (P_trend<0.001), fried foods (P_trend=0.02), and diet soda (P_trend=< 0.001) also were adversely associated with incident MetSyn, whereas dairy consumption (P_trend=0.006) was beneficial. No associations were observed between incident MetSyn and a prudent dietary pattern or intakes of whole grains, refined grains, fruits and vegetables, nuts, coffee, or sweetened beverages.

 

Conclusions— These prospective findings suggest that consumption of a Western dietary pattern, meat, and fried foods promotes the incidence of MetSyn, whereas dairy consumption provides some protection. The diet soda association was not hypothesized and deserves further study.

Kegemukan meningkatkan risiko kanker

Kegemukan yang diukur dengan peningkatan indeks massa tubuh (IMT) berhubungan dengan risiko terjadinya penyakit kanker pada usia dewasa. Peneliti dari UK dan Swiss mendapatkan bahwa risiko kanker berhubungan dengan peningkatan IMT sebesar 5 kg/m2.

 

Hasil penelitian menunjukkan pada laki2 peningkatan IMT berhubungan signifikan dengan adenokarsinoma esophagus (RR 1.52) dan tiroid (1.33), usus besar (1.24) dan kanker ginjal (1.24). Pada wanita peningkatan IMT berhubungan signifikan dengan adenokarsinoma endometrium (1.59), kantung empedu (1.59), esophagus (1.51) dan ginjal (1.34). Selain itu juga didapatkan hubungan (RR <1.20) pada laki2 untuk kanker rectal, melanoma maligna, sedangkan pada wanita kanker payudara, pancreas, tiroid dan kolon; serta untuk laki dan perempuan leukemia, multiple pyeloma dan limfoma non-Hodgkin. Temuan ini berlaku untuk populasi di Amerika, Eropa, Australia dan Asia-Pasifik.

 

Kesimpulan peningkatan IMT berhubungan dengan peningkatan risiko penyakit keganasan.

 

The Lancet 22 February 2008 Vol 371 Issue 9612 Pp 569-578 (doi:10.1016/S0140-6736(08)60269-X) © 2008 Elsevier Ltd.
Body-mass index and incidence of cancer: a systematic review and meta-analysis of prospective observational studies, Dr Andrew G Renehan PhD, Margaret Tyson PhD, Matthias Egger MD, Richard F Heller MD and Marcel Zwahlen PhD.

 

Background

Excess bodyweight, expressed as increased body-mass index (BMI), is associated with the risk of some common adult cancers. We did a systematic review and meta-analysis to assess the strength of associations between BMI and different sites of cancer and to investigate differences in these associations between sex and ethnic groups.

 

Methods

We did electronic searches on Medline and Embase (1966 to November 2007), and searched reports to identify prospective studies of incident cases of 20 cancer types. We did random-effects meta-analyses and meta-regressions of study-specific incremental estimates to determine the risk of cancer associated with a 5 kg/m² increase in BMI.

 

Findings

We analysed 221 datasets (141 articles), including 282 137 incident cases. In men, a 5 kg/m² increase in BMI was strongly associated with oesophageal adenocarcinoma (RR 1·52, p<0·0001) and with thyroid (1·33, p=0·02), colon (1·24, p<0·0001), and renal (1·24, p <0·0001) cancers. In women, we recorded strong associations between a 5 kg/m² increase in BMI and endometrial (1·59, p<0·0001), gallbladder (1·59, p=0.04), oesophageal adenocarcinoma (1·51, p<0·0001), and renal (1·34, p<0·0001) cancers. We noted weaker positive associations (RR <1·20) between increased BMI and rectal cancer and malignant melanoma in men; postmenopausal breast, pancreatic, thyroid, and colon cancers in women; and leukaemia, multiple myeloma, and non-Hodgkin lymphoma in both sexes. Associations were stronger in men than in women for colon (p<0·0001) cancer. Associations were generally similar in studies from North America, Europe and Australia, and the Asia–Pacific region, but we recorded stronger associations in Asia–Pacific populations between increased BMI and premenopausal (p=0·009) and postmenopausal (p=0·06) breast cancers.

 

Interpretation

Increased BMI is associated with increased risk of common and less common malignancies. For some cancer types, associations differ between sexes and populations of different ethnic origins. These epidemiological observations should inform the exploration of biological mechanisms that link obesity with cancer.