Long term effects of very low energy diet on obstructive sleep apnoea

Diet sangat rendah kalori memperbaiki apnea-hipopnea index pada penderita obstructive sleep apnoea (OSA)

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BMJ 342:d3017, 1 June 2011 © 2011 BMJ Publishing Group Ltd.
Longer term effects of very low energy diet on obstructive sleep apnoea in cohort derived from randomised controlled trial: prospective observational follow-up study.

Kari Johansson, Erik Hemmingsson, Richard Harlid, et al..

Abstract

Objective To determine whether initial improvements in obstructive sleep apnoea after a very low energy diet were maintained after one year in patients with moderate to severe obstructive sleep apnoea.
Design Single centre, prospective observational follow-up study.
Setting Outpatient obesity clinic in a university hospital in Stockholm, Sweden.
Participants 63 men aged 30-65 with body mass index (BMI) 30-40 and moderate to severe obstructive sleep apnoea defined as an apnoea-hypopnoea index ≥15 (events/hour), all treated with continuous positive airway pressure.
Intervention A one year weight loss programme, consisting of an initial very low energy diet for nine weeks (seven weeks of 2.3 MJ/day and two weeks of gradual introduction of normal food) followed by a weight loss maintenance programme.
Main outcome measure Apnoea-hypopnoea index, the main index for severity of obstructive sleep apnoea. Data from all patients were analysed (baseline carried forward for missing data).
Results Of 63 eligible patients, 58 completed the very low energy diet period and started the weight maintenance programme and 44 completed the full programme; 49 had complete measurements at one year. At baseline the mean apnoea-hypopnoea index was 36 events/hour. After the very low energy diet period, apnoea-hypopnoea index was improved by −21 events/hour (95% confidence interval −17 to −25) and weight by −18 kg (−16 to −19; both P<0.001). After one year the apnoea-hypopnoea index had improved by −17 events/hour (−13 to −21) and body weight by −12 kg (−10 to −14) compared with baseline (both P<0.001). Patients with severe obstructive sleep apnoea at baseline had greater improvements in apnoea-hypopnoea index (−25 events/hour) compared with patients with moderate disease (−7 events/hour, P<0.001). At one year, 30/63 (48%, 95% confidence interval 35% to 60%) no longer required continuous positive airway pressure and 6/63 (10%, 2% to 17%) had total remission of obstructive sleep apnoea (apnoea-hypopnoea index <5 events/hour). There was a dose-response association between weight loss and apnoea-hypopnoea index at follow-up (β=0.50 events/kg, 0.11 to 0.88; P=0.013).
Conclusion Initial improvements in obstructive sleep apnoea after treatment with a very low energy diet can be maintained after one year in obese men with moderate to severe disease. Those who lose the most weight or have severe sleep apnoea at baseline benefit most.

Video game playing increases food intake in adolescents

Main video game meningkatkan nafsu makan pada remaja

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American Journal of Clinical Nutrition © 2011 to American Society for Nutrition
Video game playing increases food intake in adolescents: a randomized crossover study.

Jean-Philippe Chaput, Trine Visby, Signe Nyby, et al.

Background: Video game playing has been linked to obesity in many observational studies. However, the influence of this sedentary activity on food intake is unknown.
Objective: The objective was to examine the acute effects of sedentary video game play on various components of energy balance.
Design: With the use of a randomized crossover design, 22 healthy, normal-weight, male adolescents (mean ± SD age: 16.7 ± 1.1 y) completed two 1-h experimental conditions, namely video game play and rest in a sitting position, followed by an ad libitum lunch. The endpoints were spontaneous food intake, energy expenditure, stress markers, appetite sensations, and profiles of appetite-related hormones.
Results: Heart rate, systolic and diastolic blood pressures, sympathetic tone, and mental workload were significantly higher during the video game play condition than during the resting condition (P < 0.05). Although energy expenditure was significantly higher during video game play than during rest (mean increase over resting: 89 kJ; P < 0.01), ad libitum energy intake after video game play exceeded that measured after rest by 335 kJ (P < 0.05). A daily energy surplus of 682 kJ (163 kcal) over resting (P < 0.01) was observed in the video game play condition. The increase in food intake associated with video game play was observed without increased sensations of hunger and was not compensated for during the rest of the day. Finally, the profiles of glucose, insulin, cortisol, and ghrelin did not suggest an up-regulation of appetite during the video game play condition.
Conclusion: A single session of video game play in healthy male adolescents is associated with an increased food intake, regardless of appetite sensations.

Selenium and the Course of Mild Graves' Orbitopathy

Pemberian selenium pada pasien Grave's memperbaiki kualitas hidup, mengurangi orbitopati, dan memperlambat perjalanan penyakit.

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Selenium and the Course of Mild Graves' Orbitopathy
Claudio Marcocci, M.D., George J. Kahaly, M.D., Gerasimos E. Krassas, M.D., Luigi Bartalena, M.D., Mark Prummel, M.D., Matthias Stahl, M.D., Maria Antonietta Altea, M.D., Marco Nardi, M.D., Susanne Pitz, M.D., Kostas Boboridis, M.D., Paolo Sivelli, M.D., George von Arx, M.D., Maarten P. Mourits, M.D., Lelio Baldeschi, M.D., Walter Bencivelli, Ph.D., and Wilmar Wiersinga, M.D. for the European Group on Graves' Orbitopathy
N Engl J Med 2011; 364:1920-1931

BACKGROUND
Oxygen free radicals and cytokines play a pathogenic role in Graves' orbitopathy.
METHODS
We carried out a randomized, double-blind, placebo-controlled trial to determine the effect of selenium (an antioxidant agent) or pentoxifylline (an antiinflammatory agent) in 159 patients with mild Graves' orbitopathy. The patients were given selenium (100 μg twice daily), pentoxifylline (600 mg twice daily), or placebo (twice daily) orally for 6 months and were then followed for 6 months after treatment was withdrawn. Primary outcomes at 6 months were evaluated by means of an overall ophthalmic assessment, conducted by an ophthalmologist who was unaware of the treatment assignments, and a Graves' orbitopathy–specific quality-of-life questionnaire, completed by the patient. Secondary outcomes were evaluated with the use of a Clinical Activity Score and a diplopia score.
RESULTS
At the 6-month evaluation, treatment with selenium, but not with pentoxifylline, was associated with an improved quality of life (P<0.001) and less eye involvement (P=0.01) and slowed the progression of Graves' orbitopathy (P=0.01), as compared with placebo. The Clinical Activity Score decreased in all groups, but the change was significantly greater in the selenium-treated patients. Exploratory evaluations at 12 months confirmed the results seen at 6 months. Two patients assigned to placebo and one assigned to pentoxifylline required immunosuppressive therapy for deterioration in their condition. No adverse events were evident with selenium, whereas pentoxifylline was associated with frequent gastrointestinal problems.
CONCLUSIONS
Selenium administration significantly improved quality of life, reduced ocular involvement, and slowed progression of the disease in patients with mild Graves' orbitopathy.