Determining optimal approaches for weight maintenance

Penelitian ini menilai efektivitas 2 program pendukung dan dua jenis diet dalam mempertahankan penurunan berat badan.

 

Diikuti oleh 200 wanita yang telah berhasil turun >5% BB, desain randomized controlled, 2x2 faktorial. Dibandingkan antara program pendukung intensif terhadap program pendukung sederhana. Dan dibandingkan antara diet tinggi karbohidrat terhadap diet tinggi mono-unsaturated fatty acid (MUFA)

 

Setelah 2 tahun didapatkan tidak ada beda signifikan antara kedua program pendukung.

Sedangkan diet tinggi MUFA menyebabkan kadar kolesterol total dan LDL lebih tinggi signifikan dibanding konsumsi diet tinggi karbohidrat.

 

Kesimpulan setelah berhasil mencapai penurunan BB sebaiknya diikuti dengan program pendukung, meskipun sederhana (dan murah) namun terbukti dapat mempertahankan penurunan BB.

 

Research

CMAJ. May 12, 2009; 180 (10). doi:10.1503/cmaj.080974. © 2009 Canadian Medical Association or its licensors

Determining optimal approaches for weight maintenance: a randomized controlled trial

Kelly S. Dale, PhD MSc, Kirsten A. McAuley, MBChB PhD, Rachael W. Taylor, PhD BSc, Sheila M. Williams, DSc BSc, Victoria L. Farmer, MSc, Paul Hansen, PhD MEc, Sue M. Vorgers, RN, Alexandra W. Chisholm, MCApSc PhD and Jim I. Mann, DM PhD

From the Departments of Human Nutrition (Dale, McAuley, Taylor, Vorgers, Chisholm, Mann), Preventive and Social Medicine (Williams), and Economics (Hansen), University of Otago; and the Edgar National Centre for Diabetes Research (McAuley, Taylor, Farmer, Mann), Dunedin, New Zealand

Background: Weight regain often occurs after weight loss in overweight individuals. We aimed to compare the effectiveness of 2 support programs and 2 diets of different macronutrient compositions intended to facilitate long-term weight maintenance.

Methods: Using a 2 x 2 factorial design, we randomly assigned 200 women who had lost 5% or more of their initial body weight to an intensive support program (implemented by nutrition and activity specialists) or to an inexpensive nurse-led program (involving "weigh-ins" and encouragement) that included advice about high-carbohydrate diets or relatively high-monounsaturated-fat diets.

Results: In total, 174 (87%) participants were followed-up for 2 years. The average weight loss (about 2 kg) did not differ between those in the support programs (0.1 kg, 95% confidence interval [CI] –1.8 to 1.9, p = 0.95) or diets (0.7 kg, 95% CI –1.1 to 2.4, p = 0.46). Total and low-density lipoprotein (LDL) cholesterol levels were significantly higher among those on the high-monounsaturated-fat diet (total cholesterol: 0.17 mmol/L, 95% CI 0.01 to 0.33; p = 0.040; LDL cholesterol: 0.16 mmol/L, 95% CI 0.01 to 0.31; p = 0.039) than among those on the high-carbohydrate diet. Those on the high-monounsaturated-fat diet also had significantly higher intakes of total fat (5% total energy, 95% CI 3% to 6%, p < 0.001) and saturated fat (2% total energy, 95% CI 1% to 2%, p < 0.001). All of the other clinical and laboratory measures were similar among those in the support programs and diets.

Interpretation: A relatively inexpensive program involving nurse support is as effective as a more resource-intensive program for weight maintenance over a 2-year period. Diets of different macronutrient composition produced comparable beneficial effects in terms of weight loss maintenance.

Indeks massa tubuh sebagai prediktor mortalitas

Hubungan antara indeks massa tubuh (IMT) dan mortalitas terlihat dalam penelitian prospektif berikut yang melibatkan 900 ribu subyek dewasa.

 

Kematian terendah adalah pada IMT 22,5 - 25 kg/m2.

 

Setiap peningkatan IMT 5 kg/m2 meningkatkan kematian (overall mortality) 30%.

Untuk kematian akibat penyakit vaskuler meningkat 40%.

Untuk kematian akibat diabetik, penyakit ginjal, dan penyakit hati meningkat 60-120%.

Untuk kematian akibat penyakit keganasan meningkat 10%.

Untuk penyakit pernapasan meningkat 20%.

 

IMT <22,5 kg/m2 terjadi peningkatan kematian akibat penyakit pernapasan dan kanker paru, terutama bagi perokok.

 

IMT 30-35 kg/m2 angka survival berkurang 2-4 tahun. IMT 40-45 kg/m2 angka survival berkurang 8-10 tahun (setara efek merokok)

 

 

The Lancet, Volume 373, Issue 9669, Pages 1083 - 1096, 28 March 2009

 

Body-mass index and cause-specific mortality in 900 000 adults: collaborative analyses of 57 prospective studies

 

Background

The main associations of body-mass index (BMI) with overall and cause-specific mortality can best be assessed by long-term prospective follow-up of large numbers of people. The Prospective Studies Collaboration aimed to investigate these associations by sharing data from many studies.

Methods

Collaborative analyses were undertaken of baseline BMI versus mortality in 57 prospective studies with 894 576 participants, mostly in western Europe and North America (61% [n=541 452] male, mean recruitment age 46 [SD 11] years, median recruitment year 1979 [IQR 1975—85], mean BMI 25 [SD 4] kg/m2). The analyses were adjusted for age, sex, smoking status, and study. To limit reverse causality, the first 5 years of follow-up were excluded, leaving 66 552 deaths of known cause during a mean of 8 (SD 6) further years of follow-up (mean age at death 67 [SD 10] years): 30 416 vascular; 2070 diabetic, renal or hepatic; 22 592 neoplastic; 3770 respiratory; 7704 other.

Findings

In both sexes, mortality was lowest at about 22·5—25 kg/m2. Above this range, positive associations were recorded for several specific causes and inverse associations for none, the absolute excess risks for higher BMI and smoking were roughly additive, and each 5 kg/m2 higher BMI was on average associated with about 30% higher overall mortality (hazard ratio per 5 kg/m2 [HR] 1·29 [95% CI 1·27—1·32]): 40% for vascular mortality (HR 1·41 [1·37—1·45]); 60—120% for diabetic, renal, and hepatic mortality (HRs 2·16 [1·89—2·46], 1·59 [1·27—1·99], and 1·82 [1·59—2·09], respectively); 10% for neoplastic mortality (HR 1·10 [1·06—1·15]); and 20% for respiratory and for all other mortality (HRs 1·20 [1·07—1·34] and 1·20 [1·16—1·25], respectively). Below the range 22·5—25 kg/m2, BMI was associated inversely with overall mortality, mainly because of strong inverse associations with respiratory disease and lung cancer. These inverse associations were much stronger for smokers than for non-smokers, despite cigarette consumption per smoker varying little with BMI.

Interpretation

Although other anthropometric measures (eg, waist circumference, waist-to-hip ratio) could well add extra information to BMI, and BMI to them, BMI is in itself a strong predictor of overall mortality both above and below the apparent optimum of about 22·5—25 kg/m2. The progressive excess mortality above this range is due mainly to vascular disease and is probably largely causal. At 30—35 kg/m2, median survival is reduced by 2—4 years; at 40—45 kg/m2, it is reduced by 8—10 years (which is comparable with the effects of smoking). The definite excess mortality below 22·5 kg/m2 is due mainly to smoking-related diseases, and is not fully explained.

Kebiasaan minum teh panas dan kanker esofagus

Bagi penggemar minuman bersuhu tinggi sebaiknya berhati2 karena suhu tinggi berhubungan dengan timbulnya kanker esofagus.

Hal ini dibuktikan dalam penelitian di Iran. Minum teh panas berisiko 2 kali sedangkan minum teh sangat panas berisiko 8 kali terjadinya kanker esofagus. Minum teh lebih 2-3 menit setelah dituang berisiko 2,5 kali. Minum teh kurang 2 menit setelah dituang berisiko 5,5 kali.

 

Tea drinking habits and oesophageal cancer in a high risk area in northern Iran: population based case-control study

Farhad Islami, research fellow^1,2,3, Akram Pourshams, associate professor¹, Dariush Nasrollahzadeh, PhD student^1,4, Farin Kamangar, research fellow⁵, Saman Fahimi, PhD student^1,6, Ramin Shakeri, research fellow¹, Behnoush Abedi-Ardekani, pathologist¹, Shahin Merat, associate professor¹, Homayoon Vahedi, associate professor¹, Shahryar Semnani, associate professor and director⁷, Christian C Abnet, investigator⁵, Paul Brennan, group head², Henrik Møller, professor and director³, Farrokh Saidi, professor¹, Sanford M Dawsey, senior investigator⁵, Reza Malekzadeh, professor and director¹, Paolo Boffetta, group head and cluster coordinator²

¹ Digestive Disease Research Center, Shariati Hospital, Tehran University of Medical Sciences, 14117 Tehran, Iran, ² International Agency for Research on Cancer, Lyon, France, ³ King's College London, Thames Cancer Registry, London, ⁴ Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden, ⁵ Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA, ⁶ Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Cambridge, ⁷ Golestan Research Center of Gastroenterology and Hepatology, Gorgan University of Medical Sciences, Gorgan, Iran

Objective To investigate the association between tea drinking habits in Golestan province, northern Iran, and risk of oesophageal squamous cell carcinoma.

Design Population based case-control study. In addition, patterns of tea drinking and temperature at which tea was drunk were measured among healthy participants in a cohort study.

Setting Golestan province, northern Iran, an area with a high incidence of oesophageal squamous cell carcinoma.

Participants 300 histologically proved cases of oesophageal squamous cell carcinoma and 571 matched neighbourhood controls in the case-control study and 48 582 participants in the cohort study.

Main outcome measure Odds ratio of oesophageal squamous cell carcinoma associated with drinking hot tea.

Results Nearly all (98%) of the cohort participants drank black tea regularly, with a mean volume consumed of over one litre a day. 39.0% of participants drank their tea at temperatures less than 60°C, 38.9% at 60-64°C, and 22.0% at 65°C or higher. A moderate agreement was found between reported tea drinking temperature and actual temperature measurements (weighted 0.49). The results of the case-control study showed that compared with drinking lukewarm or warm tea, drinking hot tea (odds ratio 2.07, 95% confidence interval 1.28 to 3.35) or very hot tea (8.16, 3.93 to 16.9) was associated with an increased risk of oesophageal cancer. Likewise, compared with drinking tea four or more minutes after being poured, drinking tea 2-3 minutes after pouring (2.49, 1.62 to 3.83) or less than two minutes after pouring (5.41, 2.63 to 11.1) was associated with a significantly increased risk. A strong agreement was found between responses to the questions on temperature at which tea was drunk and interval from tea being poured to being drunk (weighted 0.68).

Conclusion Drinking hot tea, a habit common in Golestan province, was strongly associated with a higher risk of oesophageal cancer.