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Abstract
This is the protocol for a review and there is no abstract. The objectives are as follows: To assess the effects of Chinese herbal medicines for weight loss. Primary objectives include: to examine whether or not Chinese herbal medicines (CHMs), including individualised CHMs and standard Chinese medicine formulae, for example Chinese Patent Medicine (CPMs) and standard Chinese herbal decoctions, are more effective than placebo, and as effective as other interventions used to treat obesity and achieve reductions in bodyweight; to describe the frequency and types of adverse events or adverse drug reactions (ADRs) for CHMs reported in the clinical trials identified and to compare these with data for comparison interventions. Secondary objectives include: to examine the effects of different CHM interventions (for example decoctions or CPMs, single Chinese herbs, CPMs with different ingredients) on treating obesity and overweight; to examine the effects of CHMs in different outcome measures (for example BMI, body fat distribution, mortality); to examine the effects of CHMs in different participant groups (for example different age groups).
Skin cleansers may be an important adjunct to the regimen of those who use cosmetics, have sensitive or compromised skin, or utilize topical therapies. Cleansers emulsify dirt, oil and microorganisms on the skin surface so that they can be easily removed. During cleansing, there is a complex interaction between the cleanser, the moisture skin barrier, and skin pH. Cleansing, with water soap or a liquid cleanser, will affect the moisture skin barrier. Soap will bring about the greatest changes to the barrier and increase skin pH. Liquid facial cleansers are gentler, effecting less disruption of the barrier, with minimal change to skin pH, and can provide people with a cleanser that is a combination of surfactant classes, moisturizers and acidic pH in order to minimize disruption to the skin barrier.
Many randomised controlled trials have been conducted in China to evaluate the effectiveness of traditional Chinese medicine, but much of the information is inaccessible to Western doctors. We estimated the total number of randomised controlled trials published in China and identified problems in applying such methodology to the evaluation of traditional Chinese medicine, which would serve as preparatory work for systematic review and dissemination of the randomised evidence for such medicine.
We randomly selected 28 journals using stratified sampling from a total of 100 Chinese journals of traditional Chinese medicine (4 national, 10 university, 10 provincial or regional, and 4 specialist journals). After special training, eight fifth year medical students (working in pairs) hand searched all the issues of the journals published before 1 January 1997 to identify randomised controlled trials. Discrepancies were settled by one of the principal investigators (S-YZ). Data on methodological quality of randomised controlled trials were extracted from 414 full length articles …
Chinese-herb nephropathy is a progressive form of renal fibrosis that develops in some patients who take weight-reducing pills containing Chinese herbs. Because of a manufacturing error, one of the herbs in these pills (Stephania tetrandra) was inadvertently replaced by Aristolochia fangchi, which is nephrotoxic and carcinogenic.
The diagnosis of a neoplastic lesion in the native urinary tract of a renal-transplant recipient who had Chinese-herb nephropathy prompted us to propose regular cystoscopic examinations and the prophylactic removal of the native kidneys and ureters in all our patients with end-stage Chinese-herb nephropathy who were being treated with either transplantation or dialysis. Surgical specimens were examined histologically and analyzed for the presence of DNA adducts formed by aristolochic acid. All prescriptions written for Chinese-herb weight-reducing compounds during the period of exposure (1990 to 1992) in these patients were obtained, and the cumulative doses were calculated.
Among 39 patients who agreed to undergo prophylactic surgery, there were 18 cases of urothelial carcinoma (prevalence, 46 percent; 95 percent confidence interval, 29 to 62 percent): 17 cases of carcinoma of the ureter, renal pelvis, or both and 1 papillary bladder tumor. Nineteen of the remaining patients had mild-to-moderate urothelial dysplasia, and two had normal urothelium. All tissue samples analyzed contained aristolochic acid-related DNA adducts. The cumulative dose of aristolochia was a significant risk factor for urothelial carcinoma, with total doses of more than 200 g associated with a higher risk of urothelial carcinoma.
The prevalence of urothelial carcinoma among patients with end-stage Chinese-herb nephropathy (caused by aristolochia species) is a high.
Ephedra and ephedrine sometimes are used for weight loss or enhanced athletic performance, but the efficacy and safety of these compounds are uncertain.
To assess the efficacy and safety of ephedra and ephedrine used for weight loss and enhanced athletic performance.
We searched 9 databases using the terms ephedra, ephedrine, adverse effect, side effect, efficacy, effective, and toxic. We included unpublished trials and non-English-language documents. Adverse events reported to the US Food and Drug Administration MedWatch program were assessed.
Eligible studies were controlled trials of ephedra or ephedrine used for weight loss or athletic performance and case reports of adverse events associated with such use. Eligible studies for weight loss were human studies with at least 8 weeks of follow-up; and for athletic performance, those having no minimum follow-up. Eligible case reports documented that ephedra or ephedrine was consumed within 24 hours prior to an adverse event or that ephedrine or an associated product was found in blood or urine, and that other potential causes had been excluded. Of the 530 articles screened, 52 controlled trials and 65 case reports were included in the adverse events analysis. Of more than 18 000 other case reports screened, 284 underwent detailed review.
Two reviewers independently identified trials of efficacy and safety of ephedra and ephedrine on weight loss or athletic performance; disagreements were resolved by consensus. Case reports were reviewed with explicit and implicit methods.
No weight loss trials assessed duration of treatment greater than 6 months. Pooled results for trials comparing placebo with ephedrine (n = 5), ephedrine and caffeine (n = 12), ephedra (n = 1), and ephedra and herbs containing caffeine (n = 4) yielded estimates of weight loss (more than placebo) of 0.6 (95% confidence interval, 0.2-1.0), 1.0 (0.7-1.3), 0.8 (0.4-1.2), and 1.0 (0.6-1.3) kg/mo, respectively. Sensitivity analyses did not substantially alter the latter 3 results. No trials of ephedra and athletic performance were found; 7 trials of ephedrine were too heterogeneous to synthesize. Safety data from 50 trials yielded estimates of 2.2- to 3.6-fold increases in odds of psychiatric, autonomic, or gastrointestinal symptoms, and heart palpitations. Data are insufficient to draw conclusions about adverse events occurring at a rate less than 1.0 per thousand. The majority of case reports are insufficiently documented to allow meaningful assessment.
Ephedrine and ephedra promote modest short-term weight loss (approximately 0.9 kg/mo more than placebo) in clinical trials. There are no data regarding long-term weight loss, and evidence to support use of ephedra for athletic performance is insufficient. Use of ephedra or ephedrine and caffeine is associated with increased risk of psychiatric, autonomic, or gastrointestinal symptoms, and heart palpitations.
Cochrane Reviews have recently started including the quantity I 2 to help readers assess the consistency of the results of studies in meta-analyses. What does this new quantity mean, and why is assessment of heterogeneity so important to clinical practice?
Systematic reviews and meta-analyses can provide convincing and reliable evidence relevant to many aspects of medicine and health care.1 Their value is especially clear when the results of the studies they include show clinically important effects of similar magnitude. However, the conclusions are less clear when the included studies have differing results. In an attempt to establish whether studies are consistent, reports of meta-analyses commonly present a statistical test of heterogeneity. The test seeks to determine whether there are genuine differences underlying the results of the studies (heterogeneity), or whether the variation in findings is compatible with chance alone (homogeneity). However, the test is susceptible to the number of trials included in the meta-analysis. We have developed a new quantity, I 2, which we believe gives a better measure of the consistency between trials in a meta-analysis.
Assessment of the consistency of effects across studies is an essential part of meta-analysis. Unless we know how consistent the results of studies are, we cannot determine the generalisability of the findings of the meta-analysis. Indeed, several hierarchical systems for grading evidence state that the results of studies must be consistent or homogeneous to obtain the highest grading.2–4
Tests for heterogeneity are commonly used to decide on methods for combining studies and for concluding consistency or inconsistency of findings.5 6 But what does the test achieve in practice, and how should the resulting P values be interpreted?
A test for heterogeneity examines the null hypothesis that all studies are evaluating the same effect. The usual test statistic …
Metabolife 356, a multicomponent dietary supplement containing ephedra and caffeine (DSEC) in addition to several other components, is the top-selling dietary weight loss supplement. Given its common use, anecdotal reports of cardiovascular and cerebrovascular adverse events, and paucity of safety data, further research with this DSEC was warranted.
To determine the impact of the DSEC on corrected QT (QTc) interval duration and systolic blood pressure (SBP).
Randomized, double-blind, placebo-controlled, crossover study conducted from January to May 2003.
Fifteen healthy volunteers (mean [SD] age, 26.7 [2.52] years; weight, 72.7 [14.93] kg), 6 (40%) of whom were women, recruited from the University of Connecticut, Storrs campus.
A single dose of the DSEC (containing 19 ingredients including ephedra [12 mg] and caffeine [40 mg]) or matching placebo were administered in a crossover fashion with a 7-day washout period between treatments.
Maximal QTc interval and SBP assessed at 1, 3, and 5 hours after dosing for the DSEC relative to placebo.
Individuals receiving the DSEC had a longer maximal QTc interval (mean [SD], 419.4 [11.8] vs 396.1 [15.7] milliseconds; P<.001) and higher SBP (mean [SD], 123.5 [10.98] vs 118.93 [9.62] mm Hg; P =.009) compared with placebo. Participants who received the DSEC were more likely to experience a QTc interval increase of at least 30 milliseconds vs placebo (8 individuals [53.3%] vs 1 individual [6.7%]; relative risk, 2.67 [95% confidence interval, 1.40-5.10]). There were no significant sex-related differences.
The ephedra- and caffeine-containing dietary supplement Metabolife 356 increased the mean maximal QTc interval and SBP. Since the actual ingredient or ingredients in Metabolife 356 responsible for these findings are not known, patients should be instructed to avoid this and similar dietary supplements until more information is known about their safety.
To review the evidence on the diet and nutrition causes of obesity and to recommend strategies to reduce obesity prevalence.
The evidence for potential aetiological factors and strategies to reduce obesity prevalence was reviewed, and recommendations for public health action, population nutrition goals and further research were made.
Protective factors against obesity were considered to be: regular physical activity (convincing); a high intake of dietary non-starch polysaccharides (NSP)/fibre (convincing); supportive home and school environments for children (probable); and breastfeeding (probable). Risk factors for obesity were considered to be sedentary lifestyles (convincing); a high intake of energy-dense, micronutrient-poor foods (convincing); heavy marketing of energy-dense foods and fast food outlets (probable); sugar-sweetened soft drinks and fruit juices (probable); adverse social and economic conditions-developed countries, especially in women (probable). A broad range of strategies were recommended to reduce obesity prevalence including: influencing the food supply to make healthy choices easier; reducing the marketing of energy dense foods and beverages to children; influencing urban environments and transport systems to promote physical activity; developing community-wide programmes in multiple settings; increased communications about healthy eating and physical activity; and improved health services to promote breastfeeding and manage currently overweight or obese people.
The increasing prevalence of obesity is a major health threat in both low- and high income countries. Comprehensive programmes will be needed to turn the epidemic around.
Herbal medicinal products are widely used, vary greatly in content and quality, and are actively tested in randomized, controlled trials (RCTs). The authors' objective was to develop recommendations for reporting RCTs of herbal medicine interventions, based on the need to elaborate on the 22-item CONSORT (Consolidated Standards of Reporting Trials) checklist. Telephone calls were made and a consensus meeting was held with 16 participants in Toronto, Canada, to develop these recommendations. The group agreed on context-specific elaborations of 9 CONSORT checklist items for RCTs of herbal medicines. Item 4, concerning the herbal medicine intervention, required the most extensive elaboration. These recommendations have been developed to improve the reporting of RCTs using herbal medicine interventions.
The prevalence of overweight in children and adolescents and obesity in adults in the United States has increased over several decades.
To provide current estimates of the prevalence and trends of overweight in children and adolescents and obesity in adults.
Analysis of height and weight measurements from 3958 children and adolescents aged 2 to 19 years and 4431 adults aged 20 years or older obtained in 2003-2004 as part of the National Health and Nutrition Examination Survey (NHANES), a nationally representative sample of the US population. Data from the NHANES obtained in 1999-2000 and in 2001-2002 were compared with data from 2003-2004.
Estimates of the prevalence of overweight in children and adolescents and obesity in adults. Overweight among children and adolescents was defined as at or above the 95th percentile of the sex-specific body mass index (BMI) for age growth charts. Obesity among adults was defined as a BMI of 30 or higher; extreme obesity was defined as a BMI of 40 or higher.
In 2003-2004, 17.1% of US children and adolescents were overweight and 32.2% of adults were obese. Tests for trend were significant for male and female children and adolescents, indicating an increase in the prevalence of overweight in female children and adolescents from 13.8% in 1999-2000 to 16.0% in 2003-2004 and an increase in the prevalence of overweight in male children and adolescents from 14.0% to 18.2%. Among men, the prevalence of obesity increased significantly between 1999-2000 (27.5%) and 2003-2004 (31.1%). Among women, no significant increase in obesity was observed between 1999-2000 (33.4%) and 2003-2004 (33.2%). The prevalence of extreme obesity (body mass index > or =40) in 2003-2004 was 2.8% in men and 6.9% in women. In 2003-2004, significant differences in obesity prevalence remained by race/ethnicity and by age. Approximately 30% of non-Hispanic white adults were obese as were 45.0% of non-Hispanic black adults and 36.8% of Mexican Americans. Among adults aged 20 to 39 years, 28.5% were obese while 36.8% of adults aged 40 to 59 years and 31.0% of those aged 60 years or older were obese in 2003-2004.
The prevalence of overweight among children and adolescents and obesity among men increased significantly during the 6-year period from 1999 to 2004; among women, no overall increases in the prevalence of obesity were observed. These estimates were based on a 6-year period and suggest that the increases in body weight are continuing in men and in children and adolescents while they may be leveling off in women.
Evidence based medicine insists on rigorous standards to appraise clinical interventions. Failure to apply the same rules to its own tools could be equally damaging
The advent of evidence based medicine has generated considerable interest in developing and applying methods that can improve the appraisal and synthesis of data from diverse studies. Some methods have become an integral part of systematic reviews and meta-analyses, with reviewers, editors, instructional handbooks, and guidelines encouraging their routine inclusion. However, the evidence for using these methods is sometimes lacking, as the reliance on funnel plots shows.
The funnel plot is a scatter plot of the component studies in a meta-analysis, with the treatment effect on the horizontal axis and some measure of weight, such as the inverse variance, the standard error, or the sample size, on the vertical axis. Light and Pillemer proposed in 1984: “If all studies come from a single underlying population, this graph should look like a funnel, with the effect sizes homing in on the true underlying value as n increases. [If there is publication bias] there should be a bite out of the funnel.”1 Many meta-analyses show funnel plots or perform various tests that examine whether there is asymmetry in the funnel plot and directly interpret the results as showing evidence for or against the presence of publication bias.
The plot's wide popularity followed an article published in the BMJ in 1997.2 That pivotal article has already received over 800 citations (as of December 2005) in the Web of Science. With two exceptions, this is more citations than for any other paper published by the BMJ in the past decade. The authors were careful to state many reasons why funnel plot asymmetry may not necessarily reflect publication bias. However, apparently many readers did not go beyond the …
Anti-obesity effect of Bofutsushosan, a Chinese traditional medicine, was investigated using genetically obese Zucker rats. Obese Zucker rats were orally administered Bofutsushosan for two months mixed with powder diet (1%, wt/wt). Bofutsushosan did not affect daily food intake. However, body weight gain was suppressed in the drug treated rats as compared with control rats. Two months treatment with Bofutsushosan increased body temperature and brown adipose tissue weight. These data showed that Bofutsushosan suppressed body weight gain by increasing energy expenditure, thermogenesis. It is concluded that Bofutsushosan may be useful for the treatment of obesity.
Conflicting results have been reported concerning the association between body weight and longevity. The shape of the curve relating weight to all-cause mortality has been variously described as linear, J-shaped, and even U-shaped. To assess the validity of the evidence for optimal weight recommendations, we examined the 25 major prospective studies on the subject. Each study had at least one of three major biases: (1) failure to control for cigarette smoking, (2) inappropriate control of biologic effects of obesity, such as hypertension and hyperglycemia, and (3) failure to control for weight loss due to subclinical disease. The presence of these biases leads to a systematic underestimate of the impact of obesity on premature mortality. Although these biases preclude a valid assessment of optimal weight from existing data, available evidence suggests that minimum mortality occurs at relative weights at least 10% below the US average.
(JAMA 1987;257:353-358)
The Cochrane Handbook for Systematic Reviews of Interventions (the Handbook) has undergone a substantial update, and Version 5 of the Handbook is now available online at www.cochrane-handbook.org and in RevMan 5. In addition, for the first time, the Handbook will soon be available as a printed volume, published by Wiley-Blackwell. We are anticipating release of this at the Colloquium in Freiburg. Version 5 of the Handbook describes the new methods available in RevMan 5, as well as containing extensive guidance on all aspects of Cochrane review methodology. It has a new structure, with 22 chapters divided into three parts. Part 1, relevant to all reviews, introduces Cochrane reviews, covering their planning and preparation, and their maintenance and updating, and ends with a guide to the contents of a Cochrane protocol and review. Part 2, relevant to all reviews, provides general methodological guidance on preparing reviews, covering question development, eligibility criteria, searching, collecting data, within-study bias (including completion of the Risk of Bias table), analysing data, reporting bias, presenting and interpreting results (including Summary of Findings tables). Part 3 addresses special topics that will be relevant to some, but not all, reviews, including particular considerations in addressing adverse effects, meta-analysis with non-standard study designs and using individual participant data. This part has new chapters on incorporating economic evaluations, non-randomized studies, qualitative research, patient-reported outcomes in reviews, prospective meta-analysis, reviews in health promotion and public health, and the new review type of overviews of reviews.
At least 100 cases of extensive interstitial fibrosis of the kidneys were observed in Belgium in women who had followed a weight-loss regimen that included the use of Chinese herbs. The possible relation between the renal disease and these Chinese herbs was investigated. It was shown that the prescribed Chinese herb called Stephania tetrandra was, in fact, inadvertently replaced by another Chinese herb, namely Aristolochia fangchi in the powdered extracts delivered in Belgium and in France. The development of renal disease in about 100 patients exposed to the so-called Stephania tetrandra stresses the need for more stringent control of herbal medicine.
There has been considerable interest in traditional Chinese herbal therapy (TCHT) as a new treatment for atopic dermatitis. To establish the efficacy and safety of this treatment, a daily decoction of a formula containing ten herbs that has been found to be beneficial in open studies was tested in a double-blind placebo-controlled study. 40 adult patients with longstanding, refractory, widespread, atopic dermatitis were randomised into two groups to receive 2 months' treatment of either the active formulation of herbs (TCHT) or placebo herbs, followed by a crossover to the other treatment after a 4-week washout period. The main outcome measures were extent and severity of erythema and surface damage as judged by standardised body scores. The patients' own assessments of the overall response to treatment were also sought. The geometric mean score for erythema at the end of active treatment was 12.6 (95% confidence interval [CI] 5.9 to 22.0) and at the end of the placebo phase was 113 (65 to 180). The geometric mean score for surface damage was 11.3 (5.8 to 21.8) and 111.0 (68 to 182), respectively. The 95% CI for the mean geometric ratio for the two values with active treatment was 0.04 to 0.22 for erythema (p less than 0.0005) and 0.04 to 0.27 for surface damage (p less than 0.0005). Of the 31 patients who completed the study and expressed a preference, 20 preferred that phase of the trial in which they received TCHT whereas 4 patients preferred placebo (p less than 0.02). There was a subjective improvement in itching (p less than 0.001) and sleep (p less than 0.078) during the TCHT treatment phase. No side-effects were reported by the patients although many commented on the unpalatability of the decoction. TCHT seems to benefit patients with atopic dermatitis. Palatability of the treatment needs to be improved and its safety assured.
Height was measured in a health screening of the population in Nord-Trøndelag, Norway. Correlations were computed for 24,281 pairs of spouses, 43,613 pairs of parents and offspring, 19,168 pairs of siblings, 1,318 pairs of grandparents and grandchildren, 1,218 cognate avuncular pairs, 849 noncognate avuncular pairs, 175 pairs of same-sexed twins, and smaller groups of other types of relatives. Fitting of structural equation models showed proportions of additive genetic variance of approximately 0.8 for both sexes and small sex-specific effects that probably reflect genetic dominance or environmental sibling effects. The correlations between parents and offspring were significantly lower in old than young cohorts, seeming to imply some kind of interaction effect between genes and environment.
Several epidemiological studies have reported that the regional distribution of body fat is a significant and independent risk factor for cardiovascular disease (CVD) and related mortality. Although these associations are well established, the causal mechanisms are not fully understood. Numerous studies have, however, shown that specific topographic features of adipose tissue are associated with metabolic complications that are considered as risk factors for CVD such as insulin resistance, hyperinsulinemia, glucose intolerance and type II diabetes mellitus, hypertension, and changes in the concentration of plasma lipids and lipoproteins. The present article summarizes the evidence on the metabolic correlates of body fat distribution. Potential mechanisms for the association between body fat distribution, metabolic complications, and CVD are reviewed, with an emphasis on plasma lipoprotein levels and plasma lipid transport. From the evidence available, it seems likely that subjects with visceral obesity represent the subgroup of obese individuals with the highest risk for CVD. Although body fat distribution is now considered as a more significant risk factor for CVD and related death rate than obesity per se, further research is clearly needed to identify the determinants of body fat distribution and the causal mechanisms involved in the metabolic alterations. It appears certain, however, that an altered plasma lipid transport is a significant component of the relation between body fat distribution and CVD.
Phenylpropanolamine (PPA) is contained in about 106 products, over half of which are available over-the-counter (OTC). Most are cough/cold remedies; nine are OTC diet aids. More than nine million Americans were using OTC diet aids in 1981, making PPA the fifth most used drug in the United States, responsible for over $200 million in revenues. The safety of PPA remains controversial. Although most controlled studies indicate minimal pressor effects with recommended doses, adverse drug reactions (ADRs) continue to be documented. Since 1965, 142 ADRs have been reported in 85 studies, 69% of these in North America. Many such cases may go unrecognized. About two thirds of all ADRs occurred in females and in patients under 30. Of ADRs attributed to legitimately sold PPA products, 85% occurred after consumption of OTC products versus only 15% after prescription drugs. The PPA product often contained combination ingredients, or PPA was consumed along with additional drugs. An overdose of PPA was taken in about a third of the cases. After ingestion of non-overdose amounts, 82% of the ADRs were severe. The most frequent side effects involved symptoms compatible with acute hypertension, with severe headache the most common complaint. Twenty-four intracranial hemorrhages, eight seizures, and eight deaths (most due to stroke) were associated with PPA ingestion. We have summarized these data in an effort to alert clinicians to the prevalence of usage of PPA products and the potential for adverse effects. In patients who present with elevated blood pressure or signs of acute hypertension, especially hypertensive encephalopathy of undetermined origin, we recommend inquiry about recent ingestion of PPA-containing diet aids and cough/cold products and suggest having such patients remain upright rather than supine.
Despite recent advances, controversy continues about the inheritance of the amount and distribution of body fat. We have studied the genetic and 'cultural' (nongenetic) transmission between generations of the body mass index, sum of six skinfold measurements, percentage of body fat, fat mass, fat-free mass, and two indicators of fat distribution. These data were obtained in 1698 members of 409 families, which included the following pairs of family members: spouses, (maximum number of pairs = 348), foster parent-adopted child (322), siblings by adoption (120), first-degree cousins (95), uncle/aunt-nephew/niece (88), parent-natural child (1239), full sibs (370), dizygotic twins (69), and monozygotic twins (87). The total transmissible variance ranged from about 40 percent for the amount of subcutaneous fat to 60 percent for the pattern of subcutaneous fat distribution. Biological inheritance accounted for only 5 percent of the variance for subcutaneous fat and the body mass index, but 20 to 30 percent for the percentage of body fat, fat mass, fat-free mass, and fat distribution. These data suggest that the amount of internal fat is influenced by heredity more than the amount of subcutaneous fat. Furthermore, we consistently found that nongenetic influences are quite important in determining the amount and distribution of body fat in the population. These estimates may differ in the subpopulation of obese individuals.
The relation between body weight and overall mortality remains controversial despite considerable investigation.
We examined the association between body-mass index (defined as the weight in kilograms divided by the square of the height in meters) and both overall mortality and mortality from specific causes in a cohort of 115,195 U.S. women enrolled in the prospective Nurses' Health Study. These women were 30 to 55 years of age and free of known cardiovascular disease and cancer in 1976. During 16 years of follow-up, we documented 4726 deaths, of which 881 were from cardiovascular disease, 2586 from cancer, and 1259 from other causes.
In analyses adjusted only for age, we observed a J-shaped relation between body-mass index and overall mortality. When women who had never smoked were examined separately, no increase in risk was observed among the leaner women, and a more direct relation between weight and mortality emerged (P for trend < 0.001). In multivariate analyses of women who had never smoked and had recently had stable weight, in which the first four years of follow-up were excluded, the relative risks of death from all causes for increasing categories of body-mass index were as follows: body-mass index < 19.0 (the reference category), relative risk = 1.0; 19.0 to 21.9, relative risk = 1.2; 22.0 to 24.9, relative risk = 1.2; 25.0 to 26.9, relative risk = 1.3; 27.0 to 28.9, relative risk = 1.6; 29.0 to 31.9, relative risk = 2.1; and > or = 32.0, relative risk = 2.2 (P for trend < 0.001). Among women with a body-mass index of 32.0 or higher who had never smoked, the relative risk of death from cardiovascular disease was 4.1 (95 percent confidence interval, 2.1 to 7.7), and that of death from cancer was 2.1 (95 percent confidence interval, 1.4 to 3.2), as compared with the risk among women with a body-mass index below 19.0. A weight gain of 10 kg (22 lb) or more since the age of 18 was associated with increased mortality in middle adulthood.
Body weight and mortality from all causes were directly related among these middle-aged women. Lean women did not have excess mortality. The lowest mortality rate was observed among women who weighed at least 15 percent less than the U.S. average for women of similar age and among those whose weight had been stable since early adulthood.
The aim of this work was to explore the influences of the shared familial environment and the nonshared individual environment on body mass index in light of convincing evidence for genetic influence. A cross-sectional adoption design was used, including information on adult adoptees and their biological fathers and mothers, biological full siblings and paternal and maternal half siblings, and adoptive fathers and mothers. Body mass index (weight/height2) was derived from reported height and weight. A model of familial resemblance based on path analysis is used to test for effects of genetic influence and for effects of the environment shared among family members: transmission from the adoptive father and adoptive mother to the adoptee, from biological father and biological mother to biological children they reared, from the biological father to maternal half-siblings, from the biological mother to paternal half-siblings, and among biological siblings who may have lived together. The model also incorporates effects of assortative mating of the biological parents and of the adoptive parents, of shared preadoptive environmental influences between the biological mother and the adoptee, and of selective placement of the adoptee. The estimated heritability was 0.34 (standard error 0.03). No parameter indicating effects of shared familial environment either before or after adoption, assortative mating, or selective placement was significant. There was strong evidence for genetic effects, and no evidence for any effects related to the shared family environment--all familial resemblance in adults can be attributed to genetic influences. However, more than half of the interindividual differences in body mass index is due to nonshared individual environmental influences.
To estimate the relative prevalence of different types and combinations of practices among weight-loss practitioners and to describe the relations between individual characteristics and various features of weight-loss regimens.
A telephone survey of a random digit-dialed probability sample of adults in the continental United States who reported that they were trying to lose weight.
A total of 1431 persons 18 years or older who were attempting to lose weight.
Self-reports of a detailed inventory of more than 35 specific practices that might be used as part of a voluntary weight-loss plan, along with information about individual characteristics such as current weight, weight-loss history, demographic profile, motivations to lose weight, sources of information, and knowledge about diet and health.
The average respondent had a current weight-loss attempt lasting from 5 to 6 months, had tried a similar plan before, and had averaged one attempt a year for the past 2 years. Seventy-one percent of women and 62% of men reported that they were both changing their diet and exercising more as part of a current weight-loss attempt. Frequently reported weight-loss practices included weighing oneself regularly (71% and 70% for women and men, respectively), walking (58% and 44%), using diet soft drinks (52% and 45%), taking vitamins and minerals (33% and 26%), counting calories (25% and 17%), skipping meals (21% and 20%), using commercial meal replacements, (15% and 13%), taking diet pills (14% and 7%), and participating in organized weight-loss programs (13% and 5%). Sex, education, and overweight status influenced the choice of a weight-loss practice.
Individual approaches to weight-loss vary and are characterized by their duration and by their recurrent nature. Policy efforts should be directed toward increasing the long-term effectiveness of individual weight-loss plans.
Irritable bowel syndrome (IBS) is a common functional bowel disorder for which there is no reliable medical treatment.
To determine whether Chinese herbal medicine (CHM) is of any benefit in the treatment of IBS.
Randomized, double-blind, placebo-controlled trial conducted during 1996 through 1997.
Patients were recruited through 2 teaching hospitals and 5 private practices of gastroenterologists, and received CHM in 3 Chinese herbal clinics.
A total of 116 patients who fulfilled the Rome criteria, an established standard for diagnosis of IBS.
Patients were randomly allocated to 1 of 3 treatment groups: individualized Chinese herbal formulations (n = 38), a standard Chinese herbal formulation (n = 43), or placebo (n = 35). Patients received 5 capsules 3 times daily for 16 weeks and were evaluated regularly by a traditional Chinese herbalist and by a gastroenterologist. Patients, gastroenterologists, and herbalists were all blinded to treatment group.
Change in total bowel symptom scale scores and global improvement assessed by patients and gastroenterologists and change in the degree of interference in life caused by IBS symptoms assessed by patients.
Compared with patients in the placebo group, patients in the active treatment groups (standard and individualized CHM) had significant improvement in bowel symptom scores as rated by patients (P=.03) and by gastroenterologists (P=.001), and significant global improvement as rated by patients (P=.007) and by gastroenterologists (P=.002). Patients reported that treatment significantly reduced the degree of interference with life caused by IBS symptoms (P=.03). Chinese herbal formulations individually tailored to the patient proved no more effective than standard CHM treatment. On follow-up 14 weeks after completion of treatment, only the individualized CHM treatment group maintained improvement.
Chinese herbal formulations appear to offer improvement in symptoms for some patients with IBS.
If someone is genetically predisposed to be physically inactive, is he or she predestined to become obese? the article by Samaras and colleagues in this issue contributes to our understanding of this question by examining the relation of physical activity and dietary behaviors to adiposity while controlling for genetic influences.
The use of Chinese herbal remedies is increasing in the UK. We report the presence of a nephrotoxic compound in herb samples, which led to end-stage renal failure in two patients. We suggest that use of these products is regulated more tightly.
Lifestyle changes to lose weight can be difficult; hence, both prescription and nonprescription diet products are appealing. Usage patterns of the nonprescription products phenylpropanolamine (PPA) and ephedra are of particular interest because of recent safety concerns.
To estimate the prevalence of overall and specific nonprescription weight loss product use by demographic characteristics, prescription diet pill use, diabetic status, and lifestyle choices.
The Behavioral Risk Factor Surveillance System, a random-digit telephone survey conducted in 1998 in 5 states: Florida, Iowa, Michigan, West Virginia, and Wisconsin.
Population-based sample of 14 679 noninstitutionalized adults 18 years or older.
Prevalence of nonprescription weight loss product use in 1996-1998.
Seven percent reported overall nonprescription weight loss product use, 2% reported PPA use, and 1% reported ephedra product use. Overall use was especially common among young obese women (28.4%). Moreover, 7.9% of normal-weight women reported use. There was no difference in nonprescription weight loss product use by daily consumption of fruits and vegetables; however, more users than nonusers reported being physically active (for those who exercised >/=30 minutes 5 times per week, odds ratio, 1.5; 95% confidence interval, 1.2-2.0). Among prescription weight loss product users, 33.8% also took nonprescription product.
With increasing rates of obesity, nonprescription product use is likely to increase. Clinicians should know about their patients' use of both prescription and nonprescription weight loss products.
Traditional Chinese medicine (TCM) is an alternative method of therapy that can be administered in oral, topical, or injectable forms. It emphasizes the importance of using many herbs that are combined in different formulations for each individual patient. Since it is not possible to discuss all applications of TCM in every skin disorder, psoriasis and atopic dermatitis are used as the prototypes in illustrating the use of TCM. A number of studies have shown the usefulness of TCM in the treatment of these skin conditions, and thus it is worthwhile for dermatologists throughout the West to gain some familiarity with this method. We attempt to provide a general overview of TCM through a discussion of efficacy, mechanisms of action, and side effects of various TCMs. A warning regarding the possible contamination of TCMs is also included. In the future, perhaps a better understanding of TCM will be gained through more systematic analysis and controlled studies with a placebo arm. It is our hope that this article will provide dermatologists with a more complete understanding of the role and ramifications of TCM therapy.
Excess bodyweight is the sixth most important risk factor contributing to the overall burden of disease worldwide. 1.1 billion adults and 10% of children are now classified as overweight or obese. Average life expectancy is already diminished; the main adverse consequences are cardiovascular disease, type 2 diabetes, and several cancers. The complex pathological processes reflect environmental and genetic interactions, and individuals from disadvantaged communities seem to have greater risks than more affluent individuals partly because of fetal and postnatal imprinting. Obesity, with its array of comorbidities, necessitates careful clinical assessment to identify underlying factors and to allow coherent management. The epidemic reflects progressive secular and age-related decreases in physical activity, together with substantial dietary changes with passive over-consumption of energy despite the neurobiological processes controlling food intake. Effective long-term weight loss depends on permanent changes in dietary quality, energy intake, and activity. Neither the medical management nor the societal preventive challenges are currently being met.
Obesity is becoming a global epidemic in both children and adults. It is associated with numerous comorbidities such as cardiovascular diseases (CVD), type 2 diabetes, hypertension, certain cancers, and sleep apnea/sleep-disordered breathing. In fact, obesity is an independent risk factor for CVD, and CVD risks have also been documented in obese children. Obesity is associated with an increased risk of morbidity and mortality as well as reduced life expectancy. Health service use and medical costs associated with obesity and related diseases have risen dramatically and are expected to continue to rise. Besides an altered metabolic profile, a variety of adaptations/alterations in cardiac structure and function occur in the individual as adipose tissue accumulates in excess amounts, even in the absence of comorbidities. Hence, obesity may affect the heart through its influence on known risk factors such as dyslipidemia, hypertension, glucose intolerance, inflammatory markers, obstructive sleep apnea/hypoventilation, and the prothrombotic state, in addition to as-yet-unrecognized mechanisms. On the whole, overweight and obesity predispose to or are associated with numerous cardiac complications such as coronary heart disease, heart failure, and sudden death because of their impact on the cardiovascular system. The pathophysiology of these entities that are linked to obesity will be discussed. However, the cardiovascular clinical evaluation of obese patients may be limited because of the morphology of the individual. In this statement, we review the available evidence of the impact of obesity on CVD with emphasis on the evaluation of cardiac structure and function in obese patients and the effect of weight loss on the cardiovascular system.
Fatty acid synthase (EC 2. 3. 1. 85, abbr. FAS) is reported as a potential new therapeutic target for the treatment of obesity. Thirty one Chinese medicinal herbs used in weight reducing prescriptions of Traditional Chinese Medicine (TCM) were investigated for FAS inhibition. It was found that 17 of these herbs exhibited FAS inhibitor activity, and 9 were highly potent FAS inhibitors. The inhibitory potencies of the active components of tuber fleeceflower root, parasitic loranthus, green tea leaf and ginkgo leaf were similar to or greater than cerulenin and C75. The first three of these four herbs significantly reduced body weight of rats upon their oral incubation. Moreover, tuber fleeceflower root and parasitic loranthus significantly reduced food intake in rats. These results indicate that many of weight reducing herbs used in TCM do so by inhibiting FAS. They also hold promise for the development of new nontoxic and low cost weight reducing substances from these herbs.
Quantifying heterogeneity in a meta-analysis
- Higgins
The PRISMA Statement for Reporting Systematic and Meta-Analyses of Studies That Evaluate Interventions: Explanation and Elaboration
- Liberati