Objective-To evaluate the efficacy and safety of a carbohydrate restricted versus a low fat diet on weight loss, metabolic markers, body composition, and cardiac function tests in severely obese adolescents.Study design-Subjects were randomized to one of two diets: a high protein, low carbohydrate (20 g/day) diet (HPLC) or low fat (30% of calories) (LF) regimen for 13 weeks; close monitoring was maintained to evaluate safety. After the intervention, no clinical contact was made until followup measurements were obtained at 24 and 36 weeks from baseline. The primary outcome was change in BMI-Z-score at 13, 24, and 36 weeks.Results-Forty-six subjects (24 HPLC, 22 in LF) initiated and 33 subjects completed the intervention; follow-up data were available on approximately half of the subjects. Significant reduction in BMI-Z-score (BMI-Z) was achieved in both groups during intervention, and was significantly greater for the HPLC group (p=0.03). Both groups maintained significant BMI-Z reduction at follow-up; changes were not significantly different between groups. Loss of lean body mass was not spared in the HPLC group. No serious adverse effects were observed related to metabolic profiles, cardiac function, or subjective complaints. Conclusions-The HPLC diet is a safe and effective option for medically supervised weight loss in severely obese adolescents. KeywordsObesity; obesity treatment; body composition; hyperlipidemia; insulin resistance; satiety Effective treatment options for childhood and adolescent obesity are limited, particularly for those who are severely obese. The recent report on treatment of childhood obesity from an Expert Committee recommended a staged approach, with greater intensity interventions for those who are severely obese and for whom traditional lifestyle changes have not been successful (1). Identification of effective treatments for severely obese children is very important for at least two reasons. First, the increased prevalence of childhood obesity has been particularly striking in the severe range, i.e., those with BMI for age above the 99 th percentile Corresponding author: Nancy F. Krebs, MD, MS, University of Colorado Denver, 12700 East 19 th Ave -Box C225, Aurora, CO 80045, nancy.krebs@ucdenver.edu. No reprints available from author. Edited by Sherman and WFB The authors declare no conflicts of interest.Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. 2,3). Secondly, the risk of significant co-morbidities increases sharply for those in this category (4). NIH Public AccessOne approach that has been used in selected treatment cente...
Study objective: To estimate the annual period prevalence of co-occurring psychiatric illness and substance misuse among patients in primary care. Design: Analysis of the general practice research database. Setting: England and Wales, 1993-1998. Participants: Registered patients at 230 general practices representing 3.1% of the population. A comorbid case was defined as one with both a psychiatric diagnosis and substance misuse diagnosis (not including alcohol or tobacco) within a calendar year. A potentially chronic comorbid case was one that met this definition and, in addition, was treated in subsequent years for either a psychiatric condition or substance misuse. Main results: The annual period prevalence of comorbidity increased from 50/100 000 patient years of exposure (PYE) to 80/100 000 PYE, an increase of 62% during the study period. Rates of comorbid psychoses, comorbid schizophrenia, and comorbid paranoia increased by 147%, 128%, and 144%. The average age of comorbid cases decreased from 38 years to 34 years. Over 80% of comorbid cases were newly diagnosed in each study year, although many are treated in subsequent years for either psychiatric illness or substance misuse.Conclusions: This study provides data on the nature and extent of comorbidity in primary care in England and Wales. As the comorbidity rate is increasing by about 10% each year, and as comorbid cases are becoming younger, it is probable that the comorbidity rate will have increased beyond the study end point.
BackgroundHigh-protein, low-carbohydrate diets (HP) have been reported to produce greater short-term weight loss as compared to a low-fat, low-calorie diet (LFLC). Feelings of satiety related to ketosis have been hypothesized to result in a lower caloric intake in HP diets.ObjectiveTo investigate the effects of the HP vs LFLC diets on subjective ratings of hunger and fullness in relation to weight loss and energy intake in severely obese adolescents. We hypothesized that subjects assigned to the HP diet will lose more weight, consume fewer total calories, and report feeling more fullness and less hunger than those on the LFLC diet.MethodsThirty-three adolescents (18 males and 15 females, mean (± SD), age 14.1 ± 1.7 years, and BMI 37.4 ± 3.8) were randomly assigned to the HP or LFLC diet for 13 weeks. Throughout the 13 weeks subjects recorded food intake and also feelings of fullness and hunger 9 times during the day using a 10 cm visual analog scale with 0 cm = ‘not at all hungry/full’ and 10 cm = ‘extremely hungry/full.’ To assess compliance with the HP diet, beta-hydroxybutyrate (βHB) levels were measured at 13 weeks.ResultsHP subjects lost significantly more weight (-9.0 vs -5.1 kg, p = .01) and had higher βHB levels (2.28 vs 1.00 mmol/L, p = .002). Based upon a similar number of diet/satiety records (7.8 vs 8.7, p = .35 in HP vs LFLC, respectively), daily energy intake was not different between the groups (12.0 kcal/kg/d for HP vs 14.0 kcal/kg/d for LFLC, p = .20) and no differences in hunger or fullness were reported between groups. Weight loss did not correlate with hunger scores, nor was energy intake correlated with hunger or fullness scores or with weight loss. There was a trend for inverse correlation between weight loss and fullness scores (r = .31, p = .08), with greater fullness corresponding to less weight loss.ConclusionsAlthough significantly greater weight loss was achieved by subjects on the HP diet, differences in total energy intake or in perceived hunger or fullness do not appear to account for these differences. These findings suggest that alternative explanations merit consideration.Supported by NIH Grants MO1-RR00069 (Pediatric General Clinical Research Center) and T32 DK007496 and the National Cattleman's Beef Association.
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