IMPORTANCE: It is unclear how effective intermittent fasting is for losing weight and body fat, and the effects may depend on the timing of the eating window. This randomized trial compared ...time-restricted eating (TRE) with eating over a period of 12 or more hours while matching weight-loss counseling across groups. OBJECTIVE: To determine whether practicing TRE by eating early in the day (eTRE) is more effective for weight loss, fat loss, and cardiometabolic health than eating over a period of 12 or more hours. DESIGN, SETTING, AND PARTICIPANTS: The study was a 14-week, parallel-arm, randomized clinical trial conducted between August 2018 and April 2020. Participants were adults aged 25 to 75 years with obesity and who received weight-loss treatment through the Weight Loss Medicine Clinic at the University of Alabama at Birmingham Hospital. INTERVENTIONS: All participants received weight-loss treatment (energy restriction ER) and were randomized to eTRE plus ER (8-hour eating window from 7:00 to 15:00) or control eating (CON) plus ER (≥12-hour window). MAIN OUTCOMES AND MEASURES: The co–primary outcomes were weight loss and fat loss. Secondary outcomes included blood pressure, heart rate, glucose levels, insulin levels, and plasma lipid levels. RESULTS: Ninety participants were enrolled (mean SD body mass index, 39.6 6.7; age, 43 11 years; 72 80% female). The eTRE+ER group adhered 6.0 (0.8) days per week. The eTRE+ER intervention was more effective for losing weight (−2.3 kg; 95% CI, −3.7 to −0.9 kg; P = .002) but did not affect body fat (−1.4 kg; 95% CI, −2.9 to 0.2 kg; P = .09) or the ratio of fat loss to weight loss (−4.2%; 95% CI, −14.9 to 6.5%; P = .43). The effects of eTRE+ER were equivalent to reducing calorie intake by an additional 214 kcal/d. The eTRE+ER intervention also improved diastolic blood pressure (−4 mm Hg; 95% CI, −8 to 0 mm Hg; P = .04) and mood disturbances, including fatigue-inertia, vigor-activity, and depression-dejection. All other cardiometabolic risk factors, food intake, physical activity, and sleep outcomes were similar between groups. In a secondary analysis of 59 completers, eTRE+ER was also more effective for losing body fat and trunk fat than CON+ER. CONCLUSIONS AND RELEVANCE: In this randomized clinical trial, eTRE was more effective for losing weight and improving diastolic blood pressure and mood than eating over a window of 12 or more hours at 14 weeks. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03459703
Which fractures are most attributable to osteoporosis? Warriner, Amy H; Patkar, Nivedita M; Curtis, Jeffrey R ...
Journal of clinical epidemiology,
2011, 2011-Jan, 2011-1-00, 20110101, Letnik:
64, Številka:
1
Journal Article
Recenzirano
Odprti dostop
Abstract Background Determining anatomic sites and circumstances under which a fracture may be a consequence of osteoporosis is a topic of ongoing debate and controversy that is important to both ...clinicians and researchers. Methods We conducted a systematic literature review and generated an evidence report on fracture risk based on specific anatomic bone sites and fracture diagnosis codes. Using the Research and Development/University of California at Los Angeles appropriateness process, we convened a multidisciplinary panel of 11 experts who rated fractures according to their likelihood of being because of osteoporosis based on the evidence report. Fracture sites (as determined by International Classification of Diseases Clinical Modification codes) were stratified by four clinical risk factor categories based on age, sex, race/ethnicity (African American and Caucasian), and presence or absence of trauma. Results Consistent with current clinical experience, the fractures rated most likely because of osteoporosis were the femoral neck, pathologic fractures of the vertebrae, and lumbar and thoracic vertebral fractures. The fractures rated least likely because of osteoporosis were open proximal humerus fractures, skull, and facial bones. The expert panel rated open fractures of the arm (except proximal humerus) and fractures of the tibia/fibula, patella, ribs, and sacrum as being highly likely because of osteoporosis in older Caucasian women but a lower likelihood in younger African American men. Conclusion Osteoporosis attribution scores for all fracture sites were determined by a multidisciplinary expert panel to provide an evidence-based continuum of the likelihood of a fracture being associated with osteoporosis.
Objective
Time‐restricted eating (TRE) can reduce body weight, but it is unclear how it influences dietary patterns and behavior. Therefore, this study assessed the effects of TRE on diet quality, ...appetite, and several eating behaviors.
Methods
Adults with obesity were randomized to early TRE plus energy restriction (eTRE + ER; 8‐hour eating window from 7:00 a.m. to 3:00 p.m.) or a control eating schedule plus energy restriction (CON + ER; ≥12‐hour window) for 14 weeks. Food intake was assessed via the Remote Food Photography Method, while eating patterns, appetite, and eating behaviors were assessed via questionnaires.
Results
A total of 59 participants completed the trial, of whom 45 had valid food records. eTRE + ER did not affect eating frequency, eating restraint, emotional eating, or the consistency of mealtimes relative to CON + ER. eTRE + ER also did not affect overall diet quality. The intensity and frequency of hunger and fullness were similar between groups, although the eTRE + ER group was hungrier while fasting.
Conclusions
When combined with a weight‐loss program, eTRE does not affect diet quality, meal frequency, eating restraint, emotional eating, or other eating behaviors relative to eating over more than a 12‐hour window. Rather, participants implement eTRE as a simple timing rule by condensing their normal eating patterns into a smaller eating window.
Objective
Data are mixed on whether intermittent fasting improves weight loss and cardiometabolic health. Here, the effects of time‐restricted eating (TRE) in participants who consistently adhered ≥5 ...d/wk every week were analyzed.
Methods
Ninety patients aged 25 to 75 years old with obesity were randomized to early TRE (eTRE; 8‐hour eating window from 07:00 to 15:00) or a control schedule (≥12‐hour window) for 14 weeks. A per‐protocol analysis of weight loss, body composition, cardiometabolic health, and other end points was performed.
Results
Participants who adhered to eTRE ≥5 d/wk every week had greater improvements in body weight (−3.7 ± 1.2 kg; p = 0.003), body fat (−2.8 ± 1.3 kg; p = 0.04), heart rate (−7 ± 3 beats/min; p = 0.02), insulin resistance (−2.80 ± 1.36; p = 0.047), and glucose (−9 ± 5 mg/dL; p = 0.047) relative to adherers in the control group. They also experienced greater improvements in mood, including fatigue and anger; however, they self‐reported sleeping less and taking longer to fall asleep.
Conclusions
For those who can consistently adhere at least 5 d/wk, eTRE is a valuable approach for improving body weight, body fat, cardiometabolic health, and mood. Further research is needed to determine whether eTRE's effects of shortening sleep but reducing fatigue are healthful or not.
Osteoporosis Diagnosis and Medical Treatment Warriner, Amy H., MD; Saag, Kenneth G., MD, MSc
The Orthopedic clinics of North America,
04/2013, Letnik:
44, Številka:
2
Journal Article
Recenzirano
Osteoporosis, the presence of either low bone mineral density or a history of a fragility fracture, is known to be associated with an increased risk of future fracture. Fracture prevention is ...possible through use of both nonpharmacologic and prescription treatments. Despite recent controversy regarding the safety of calcium supplementation and the appropriate dosing of calcium and vitamin D, calcium and vitamin D remain an important part of bone health. However, prescription osteoporosis treatments should be considered for those at higher risk for fracture, and there are currently several treatment options available.
Thiazolidinediones are synthetic peroxisome proliferator-activated receptor γ agonists used to treat type 2 diabetes mellitus. Clinical evidence indicates that thiazolidinediones increase fracture ...risks in type 2 diabetes mellitus patients, but the mechanism by which thiazolidinediones augment fracture risks is not fully understood. Several groups recently demonstrated that thiazolidinediones stimulate osteoclast formation, thus proposing that thiazolidinediones induce bone loss in part by prompting osteoclastogenesis. However, numerous other studies showed that thiazolidinediones inhibit osteoclast formation. Moreover, the molecular mechanism by which thiazolidinediones modulate osteoclastogenesis is not fully understood. Here we independently address the role of thiazolidinediones in osteoclastogenesis in vitro and furthermore investigate the molecular mechanism underlying the in vitro effects of thiazolidinediones on osteoclastogenesis. Our in vitro data indicate that thiazolidinediones dose-dependently inhibit osteoclastogenesis from bone marrow macrophages, but the inhibitory effect is considerably reduced when bone marrow macrophages are pretreated with RANKL. In vitro mechanistic studies reveal that thiazolidinediones inhibit osteoclastogenesis not by impairing RANKL-induced activation of the NF-κB, JNK, p38 and ERK pathways in bone marrow macrophages. Nonetheless, thiazolidinediones inhibit osteoclastogenesis by suppressing RANKL-induced expression of NFATc1 and c-Fos, two key transcriptional regulators of osteoclastogenesis, in bone marrow macrophages. In addition, thiazolidinediones inhibit the RANKL-induced expression of osteoclast genes encoding matrix metalloproteinase 9, cathepsin K, tartrate-resistant acid phosphatase and carbonic anhydrase II in bone marrow macrophages. However, the ability of thiazolidinediones to inhibit the expression of NFATc1, c-Fos and the four osteoclast genes is notably weakened in RANKL-pretreated bone marrow macrophages. These in vitro studies have not only independently demonstrated that thiazolidinediones exert inhibitory effects on osteoclastogenesis but have also revealed crucial new insights into the molecular mechanism by which thiazolidinediones inhibit osteoclastogenesis.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
PURPOSE OF REVIEWOsteoporosis is a growing concern among people living with HIV (PLWH) because of the recognized risk of fractures, which bring with them morbidity and mortality. New evidence is ...helping clinicians understand how to prevent and manage osteoporosis in this subpopulation.
RECENT FINDINGSThe benefit of calcium and vitamin D is variable in osteoporosis literature in general, but evidence supports the use of these supplements in PLWH to prevent the loss of bone mineral density when initiating antiretroviral therapy and in enhancing the effectiveness of antiosteoporosis treatments. Of the osteoporosis treatments, alendronate and zoledronate are the only two with substantial evidence of safety and effectiveness in PLWH, but the studies have been small and of limited duration. There are no randomized controlled studies of raloxifene, denosumab or teriparatide in PLWH. Of increasing interest is the possible benefit of statins on bone health through decreased inflammation.
SUMMARYOsteoporosis is recognized as an issue for PLWH. Although some of the available osteoporosis treatments have proven safe and effective, future studies of the novel treatments, such as statins, along with well-designed studies of established osteoporosis treatments for use in PLWH are needed to further guide the clinical management of osteoporosis in this population.
PURPOSE OF REVIEWOsteoporosis is a growing problem worldwide, with the greatest burden resulting from fractures. Currently available are several treatment options that are effective in reducing ...fracture risk. Patient adherence to these medications is required for benefit to be seen. Yet, similar to other chronic asymptomatic diseases, adherence to osteoporosis therapies is poor. The reasons for suboptimal adherence are multiple but include fear of possible side effects, dosing requirements, and an unwillingness to take a medication for a ‘silent’ disease. Poor adherence leads to reduced effectiveness, increased morbidity, and increased medical costs.
RECENT FINDINGSEfforts to improve adherence to osteoporosis treatments are ongoing. The first obstacle in improving adherence to osteoporosis treatments is determining causes of poor adherence. Despite several identifiable causes, improving adherence is difficult. Passive patient education with printed information alone does not appear very effective. Physician–patient interaction, including discussion of bone mineral density results, discussion of osteoporosis medication benefits, and feedback of treatment effects, may be more effective.
SUMMARYImproved patient education, better tolerated and less frequently dosed medications, and more healthcare provider–patient interaction may improve adherence and lead to greater fracture reduction.
Rheumatologic diseases are associated with a proinflammatory state, which is thought to lead to many of the bone changes seen in treatment-naive patients. However, glucocorticoids remain a common ...treatment option for rheumatologic diseases and are known to have a negative impact on bone through direct effects on bone cells and indirect effects on calcium absorption. Despite the anti-inflammatory effect of glucocorticoids, fracture risk rises within the first 3 months of treatment. As such, osteoporosis prevention and treatment needs to be considered in all patients started on chronic glucocorticoids (≥3 months of treatment). For very low risk patients, conservative management with non-pharmacologic strategies may be appropriate. For the moderate to high fracture risk patients treated with glucocorticoids, pharmacologic treatment with 1 of the 4 approved medications should be considered. The challenge of educating physicians and patients of the risks of glucocorticoid induced osteoporosis remain.
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