Key PointsQuestionWhat are the long-term effects of severe vs moderate energy restriction on lean mass and other aspects of body composition?FindingsThis randomized clinical trial included 101 postmenopausal women with obesity. At 12 months, participants who had undergone severe energy restriction experienced approximately 2-fold greater weight and fat loss, approximately 1.5 times as much loss of whole-body lean mass (proportional to total weight lost), and approximately 2.5 times as much loss of total hip bone mineral density compared with participants who had undergone moderate energy restriction.MeaningAlthough severe energy restriction is an effective obesity treatment, caution is necessary when implementing it in postmenopausal women, especially those with osteopenia or osteoporosis.

Mammary gland neoplasms in horses are uncommon and may initially be confused with mastitis. Masses from the mammary glands of two horses with chronic discharges were examined by cytology and histopathology. Both masses were diagnosed as papillary ductal adenocarcinomas with extensive intraductal and intralobular involvement and only focal infiltration of the adjacent stroma. Complementary immunohistochemical studies were made of both fresh and formalin-fixed tumour tissue, and attempts were made to assess the steroid receptor status of fresh tissue biochemically to assess the possibility of hormonal treatment as an adjunct to surgery. The results of these tests for oestrogen and progesterone receptors were negative.

A 6-month-old Quarter Horse weanling filly was presented with lethargy, weight loss, inappetance, mild diarrhoea, marked ventral oedema and severe panhypoproteinaemia. Serum antibody titres for Lawsonia intracellularis were very high but PCR to detect faecal shedding of the organism was negative. Proliferative enteropathy due to L. intracellularis infection was diagnosed. After treatment for 4 weeks with oral erythromycin and rifampicin the filly made a complete recovery.

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We have previously shown that a severely energy-restricted diet leads to greater loss of weight, fat, lean mass and bone mineral density (BMD) at 12 months in postmenopausal women with obesity than a moderately energyrestricted diet. We now aim to evaluate whether these effects are sustained longer term (ie, at 36 months). 101 postmenopausal women were randomized to either 12 months of moderate (25 to 35%) energy restriction with a food-based diet (moderate intervention), or 4 months of severe (65 to 75%) energy restriction with a total meal replacement diet followed by moderate energy restriction for 8 months (severe intervention). Body weight and composition were measured at 0, 24 and 36 months. Participants in the severe intervention lost~1.5 to 1.7 times as much weight, waist circumference, whole-body fat mass and visceral adipose tissue compared to those in the moderate intervention, and were 2.6 times more likely (42% versus 16%) to have lost 10% or more of their initial body weight at 36 months (P < 0.01 for all). However, those in the severe versus moderate intervention lost 1.4 times as much whole-body lean mass (P < 0.01), albeit this was proportional to total weight lost and there was no greater loss of handgrip strength, and they also lost~2 times as much total hip BMD between 0 and 36 months (P < 0.05), with this bone loss occurring in the first 12 months. Thus, severe energy restriction is more effective than moderate energy restriction for reducing weight and adiposity in postmenopausal women in the long term (3 years), but attention to BMD loss in the first year is required. Trial registration: Australian New Zealand Clinical Trials Registry Reference Number: 12612000651886, anzctr.org.au.