Investigating the mediators and moderators of child body mass index change in the Time2bHealthy childhood obesity prevention program for parents of preschool-aged children.

OBJECTIVES: The aim of this study was to explore factors which mediated or moderated the effect of the Time2bHealthy online program for parents of preschool-aged children on body mass index (BMI) change. STUDY DESIGN: Mediation and moderation analyses of data from a two-arm parallel randomised controlled trial. METHODS: Randomisation was conducted after baseline measures. The intervention group received an 11-week online program, and the comparison group received emailed links to information from an evidence-based parenting website. Data on the primary outcome (child BMI), potential mediators (energy intake, fruit and vegetable intake, discretionary food intake, physical activity, screen-time, sleep, child feeding, parent self-efficacy or parent role-modelling) and potential moderators (child age, parent age, parent income, parent education or parent living situation) were collected at baseline, 3 months and 6 months. PROCESS macro for SPSS was used to analyse possible mediators and moderators on BMI outcomes. RESULTS: Despite significant food-related outcomes in the main analysis of this trial, no significant mediating or moderating effects were found for any hypothesised mediators or moderators. CONCLUSIONS: This study's null results could be explained by the high proportion of children in the healthy weight range, the study period not being long enough to detect change, the multicomponent nature of the intervention or the relatively small number of outcomes measured. Future childhood obesity interventions should continue to explore the effects of mediators and moderators on BMI and consider collecting data on a wide range of mediating and moderating factors to allow for comparison between studies to develop a better understanding of the factors contributing to successful interventions.

Using data mining to predict success in a weight loss trial.

BACKGROUND: Traditional methods for predicting weight loss success use regression approaches, which make the assumption that the relationships between the independent and dependent (or logit of the dependent) variable are linear. The aim of the present study was to investigate the relationship between common demographic and early weight loss variables to predict weight loss success at 12 months without making this assumption. METHODS: Data mining methods (decision trees, generalised additive models and multivariate adaptive regression splines), in addition to logistic regression, were employed to predict: (i) weight loss success (defined as ≥5%) at the end of a 12-month dietary intervention using demographic variables [body mass index (BMI), sex and age]; percentage weight loss at 1 month; and (iii) the difference between actual and predicted weight loss using an energy balance model. The methods were compared by assessing model parsimony and the area under the curve (AUC). RESULTS: The decision tree provided the most clinically useful model and had a good accuracy (AUC 0.720 95% confidence interval = 0.600-0.840). Percentage weight loss at 1 month (≥0.75%) was the strongest predictor for successful weight loss. Within those individuals losing ≥0.75%, individuals with a BMI (≥27 kg m-2 ) were more likely to be successful than those with a BMI between 25 and 27 kg m-2 . CONCLUSIONS: Data mining methods can provide a more accurate way of assessing relationships when conventional assumptions are not met. In the present study, a decision tree provided the most parsimonious model. Given that early weight loss cannot be predicted before randomisation, incorporating this information into a post randomisation trial design may give better weight loss results.

Consumption of a healthy dietary pattern results in significant reductions in C-reactive protein levels in adults: a meta-analysis.

Consumption of healthy dietary patterns has been associated with reduced risk of cardiovascular disease and metabolic syndrome. Dietary intervention targets disease prevention, so studies increasingly use biomarkers of underlying inflammation and metabolic syndrome progression to examine the diet-health relationship. The extent to which these biomarkers contribute to the body of evidence on healthy dietary patterns is unknown. The aim of this meta-analysis was to determine the effect of healthy dietary patterns on biomarkers associated with adiposity, insulin resistance, and inflammation in adults. A systematic search of Scopus, PubMed, Web of Science, and Cochrane Central Register of Controlled Trials (all years to April 2015) was conducted. Inclusion criteria were randomized controlled trials; effects of dietary patterns assessed on C-reactive protein (CRP), total adiponectin, high-molecular-weight adiponectin, tumor necrosis factor-α, adiponectin:leptin, resistin, or retinol binding protein 4. Random effects meta-analyses were conducted to assess the weighted mean differences in change or final mean values for each outcome. Seventeen studies were included in the review. These reflected research on dietary patterns associated with the Mediterranean diet, Nordic diet, Tibetan diet, and the Dietary Approaches to Stop Hypertension diet. Consumption of a healthy dietary pattern was associated with significant reductions in CRP (weighted mean difference, -0.75 [-1.16, -0.35]; P = .0003). Non-significant changes were found for all other biomarkers. This analysis found evidence for favorable effects of healthy dietary patterns on CRP, with limited evidence for other biomarkers. Future research should include additional randomized controlled trials incorporating a greater range of dietary patterns and biomarkers.

Identification of dietary patterns associated with blood pressure in a sample of overweight Australian adults.

The dietary approaches to stop hypertension (DASH) diet provides strong evidence for an optimal dietary pattern for blood pressure (BP) control; however, investigation at the level of key foods in a dietary pattern is sparse. This study aimed to assess the relationship between dietary patterns driven by key foods with BP in a sample of obese Australian adults. Secondary analysis was conducted on baseline data of 118 participants (45.1±8.4 years, mean BP=124.1±15.8/72.6±9.2 mm Hg) recruited in a weight reduction randomized controlled trial (ACTRN12608000425392). Dietary assessment was by a validated diet history interview. The average of three office BP measurements was taken. Factor analysis extracted dietary patterns and their relation to systolic BP (SBP) and diastolic BP (DBP) was analysed using multiple linear regression. Eight dietary patterns were identified based on leading foods: meat and alcohol; seafood; fats; fruits and nuts; legumes; confectionery; sweet foods; and yeast extracts and seasonings. A lower SBP was associated with alignment with the fruit and nuts pattern (ß=-4.1 (95% confidence interval -7.5 to -0.7) mm Hg) and with seafood for DBP (ß=-2.4 (-4.6 to -0.3) mm Hg). SBP and DBP were higher with yeast extract and seasonings (ß=4.3 (1.4-7.3); 2.5 (0.9-4.0) mm Hg, respectively). In obese adults attending for weight loss, dietary patterns that included larger amounts of fruits and nuts and/or seafood were associated with lower BP at baseline, whereas patterns that were characterised by yeast extract and seasonings were associated with higher BP.

Baseline characteristics associated with different BMI trajectories in weight loss trials: a case for better targeting of interventions.

BACKGROUND/OBJECTIVES: Dietary weight loss interventions have heterogeneous outcomes in long-term studies, with many participants regaining part or all of the lost weight. Growth mixture modelling is a novel analytic approach that can be used to identify different trajectories of weight change during a trial rather than focussing on the total amount of weight lost. SUBJECTS/METHODS: Data were pooled from two 12-month dietary weight loss studies where no significant difference was detected between the treatment and control arms, thus allowing analysis independent of treatment. The data set included 231 subjects (74.5% female), with a mean weight loss of 6.40 kg (4.96). Growth mixture models were used to identify participants with similar trajectories of change in body mass index (BMI). RESULTS: Three subgroups were identified. A rapid and continuing BMI loss over the study period (rapid, n=53), a rapid initial weight loss in the first 3 months with a slowing rate over the remaining 9 months (maintainers, n=146) and those with an initial loss trajectory, which slowed and began to increase at 9 months (recidivists, n=53). Age (s.d.) and BMI (s.d.) were significantly different between the three groups (rapid 53 years (7), 28.99 kg/m(2) (3.30); maintainers 47 years (9), 30.90 kg/m(2) (2.95); recidivists 44 years (7), 34.84 kg/m(2) (1.92), both P<0.001). CONCLUSIONS: Older subjects with lower BMIs were more likely to have a rapid and continuing weight loss in a 1-year dietary-based weight loss intervention. Different interventional approaches may be necessary for different ages and baseline BMIs and stratification prior to randomisation may be necessary to prevent confounding in weight loss trials.

Weight loss effects from vegetable intake: a 12-month randomised controlled trial.

BACKGROUND/OBJECTIVES: Direct evidence for the effects of vegetable intake on weight loss is qualified. The study aimed to assess the effect of higher vegetable consumption on weight loss. SUBJECTS/METHODS: A single blind parallel controlled trial was conducted with 120 overweight adults (mean body mass index=29.98 kg/m(2)) randomised to two energy deficit healthy diet advice groups differing only by doubling the serving (portion) sizes of vegetables in the comparator group. Data were analysed as intention-to-treat using a linear mixed model. Spearmans rho bivariate was used to explore relationships between percentage energy from vegetables and weight loss. RESULTS: After 12 months, the study sample lost 6.5±5.2 kg (P<0.001 time) with no difference between groups (P>0.05 interaction). Both groups increased vegetable intake and lost weight in the first 3 months, and the change in weight was significantly correlated with higher proportions of energy consumed as vegetables (rho=-0.217, P=0.024). Fasting glucose, insulin and triglyceride levels decreased (P<0.001 time) and high-density lipoprotein cholesterol levels increased (P<0.001 time), with no difference between groups. Weight loss was sustained for 12 months by both groups, but the comparator group reported greater hunger satisfaction (P=0.005). CONCLUSIONS: Advice to consume a healthy low-energy diet leads to sustained weight loss, with reductions in cardiovascular disease risk factors regardless of an emphasis on more vegetables. In the short term, consuming a higher proportion of the dietary energy as vegetables may support a greater weight loss and the dietary pattern appears sustainable.

Baseline dietary patterns are a significant consideration in correcting dietary exposure for weight loss.

BACKGROUND/OBJECTIVES: Dietary pattern studies are traditionally the domain of epidemiological research. From a clinical perspective, there is a need to explore the effects of changing food and dietary patterns of individuals. The aim was to identify patterns of food choice in the context of a clinical weight loss trial. Cluster analysis based on reported serves of food groups revealed dietary patterns informative for the clinical setting. SUBJECTS/METHODS: Cluster analysis was conducted using diet history data from two clinical trials at baseline, and outcomes at 3 months were reviewed based on these clusters (n=231). The cluster solution was analysed using defined food groups in serves and with respect to clinical parameters and requirements for selected nutrients. RESULTS: Two distinct dietary patterns were identified from the reported baseline dietary intakes. Subjects in Cluster 1 reported food patterns characterised by higher intakes of low-fat dairy and unsaturated oils and margarine and were generally more closely aligned to food choices encouraged in national dietary guidelines. Subjects in Cluster 2 reported a dietary pattern characterised by non-core foods and drinks, higher- and medium-fat dairy foods, fatty meats and alcohol. At 3 months, Cluster 2 subjects reported greater reductions in energy intake (-5317 kJ; P<0.001) and greater weight loss (-5.6 kg; P<0.05) compared with Cluster 1. CONCLUSIONS: Overweight subjects with reported dietary patterns similar to dietary guidelines at baseline may have more difficulty in reducing energy intake than those with poor dietary patterns. Correcting exposure to non-core foods and drinks was key to successful weight loss.

Poor nutritional status of older subacute patients predicts clinical outcomes and mortality at 18 months of follow-up.

BACKGROUND/OBJECTIVES: Older malnourished patients experience increased surgical complications and greater morbidity compared with their well-nourished counterparts. This study aimed to assess whether nutritional status at hospital admission predicted clinical outcomes at 18 months follow-up. SUBJECTS/METHODS: A retrospective analysis of N=2076 patient admissions (65+ years) from two subacute hospitals, New South Wales, Australia. Analysis of outcomes at 18 months, according to nutritional status at index admission, was performed in a subsample of n = 476. Nutritional status was determined within 72 h of admission using the Mini Nutritional Assessment (MNA). Outcomes, obtained from electronic patient records, included hospital readmission rate, total Length of Stay (LOS), change in level of care at discharge and mortality. Survival analysis, using a Cox proportional hazards model, included age, sex, Major Disease Classification, mobility and LOS at index admission as covariates. RESULTS: At baseline, 30% of patients were malnourished and 53% were at risk of malnutrition. LOS was higher in malnourished and at risk, compared with well-nourished patients (median (interquartile range): 34 (21, 58); 26 (15, 41); 20 (14, 26) days, respectively; P<0.001). Hazard rate for death in the malnourished group is 3.41 (95% confidence interval: 1.07-10.87; P = 0.038) times the well-nourished group. Discharge to a higher level of residential care was 33.1%, 16.9% and 4.9% for malnourished, at-risk and well-nourished patients, respectively; P ≤ 0.001). CONCLUSION: Malnutrition in elderly subacute patients predicts adverse clinical outcomes and identifies a need to target this population for nutritional intervention following hospital discharge.

Knee rotational laxity: an investigation of bilateral asymmetry for comparison with the contralateral uninjured knee.

BACKGROUND: Instability associated with anterior cruciate ligament injury is commonly evaluated against the patient's contralateral knee. The objectives of this study were, therefore, to assess symmetry of rotational knee laxity in vivo under passive torsional loading in uninjured subjects, and to compare mean rotation of this control group with the contralateral, intact knees of anterior cruciate ligament deficient patients. METHODS: Axial knee rotation was measured in 29 patients with unilateral anterior cruciate ligament injury and 15 uninjured age and gender-matched control subjects using an imaging-compatible torsional loading device. Side-to-side differences in internal, external, and range of knee rotation were assessed in the control group and mean bilateral knee rotation was compared to the patients' contralateral knee data at both full extension and 30° of flexion. FINDINGS: Statistically significant differences in symmetry were found in three of the six measures of transverse plane rotation in the uninjured knees; a mean side-to-side difference of 2.2° in range of rotation was detected in the flexed position. No significant differences were observed between the mean values of the healthy control group and the contralateral knees of the anterior cruciate ligament deficient patients. INTERPRETATION: Bilateral asymmetry of rotational laxity occurs in healthy individuals. Nevertheless, comparability of rotational knee laxity between the contralateral limbs of patients and the uninjured population was evidence that rotational laxity was not inherent or developed in the contralateral knees of the anterior cruciate ligament deficient participants.

Double-bundle ACL surgery demonstrates superior rotational kinematics to single-bundle technique during dynamic task.

BACKGROUND: While traditional surgical repair of the anterior cruciate ligament is able to restore anterior-posterior knee stability, laxity in the transverse plane remains. Double-bundle reconstruction has demonstrated greater rotational restraint than the single-bundle technique under passive loading conditions; however, no comparison has been made under physiological weight-bearing conditions. The purpose of this study was to determine differences in rotational knee kinematics during a dynamic task in patients who had received either a single- or double-bundle reconstruction. METHODS: Twenty-two patients exhibiting isolated anterior cruciate ligament rupture were randomly allocated either a single or double-bundle reconstruction. Three-dimensional knee kinematics were measured during a dynamic cutting activity prior to and following surgery. Functional range of rotation was compared between groups pre- and post-operatively and kinematics were assessed against uninjured control subjects. FINDINGS: No difference in overall range of rotation was found under physiological loading conditions. However, a significant interaction of the midpoint of the range of movement was observed; a greater external rotational shift in the single-bundle group followed reconstruction, while the kinematics of the double-bundle patient group shifted closer to those of the control group. INTERPRETATION: The double-bundle reconstruction demonstrated superior outcome in rotational kinematics to the single-bundle technique.

Short term effects of energy restriction and dietary fat sub-type on weight loss and disease risk factors.

BACKGROUND AND AIMS: Decreasing energy intake relative to energy expenditure is the indisputable tenet of weight loss. In addition to caloric restriction modification of the type of dietary fat may provide further benefits. The aim of the present study was to examine the effect of energy restriction alone and with dietary fat modification on weight loss and adiposity, as well as on risk factors for obesity related disease. METHODS AND RESULTS: One-hundred and fifty overweight men and women were randomized into a 3month controlled trial with four low fat (30% energy) dietary arms: (1) isocaloric (LF); (2) isocaloric with 10% polyunsaturated fatty acids (LF-PUFA); (3) low calorie (LF-LC) (-2MJ); (4) low calorie with 10% PUFA (LF-PUFA-LC). Primary outcomes were changes in body weight and body fat and secondary outcomes were changes in fasting levels of leptin, insulin, glucose, lipids and erythrocyte fatty acids. Changes in dietary intake were assessed using 3day food records. One-hundred and twenty-two participants entered the study and 95 completed the study. All groups lost weight and body fat (P<0.0001 time effect for both), but the LC groups lost more weight (P=0.026 for diet effect). All groups reduced total cholesterol levels (P<0.0001 time effect and P=0.017 intervention effect), but the LC and PUFA groups were better at reducing triacylglycerol levels (P=0.056 diet effect). HDL increased with LF-LC and LF-PUFA but not with LF-PUFA-LC (0.042 diet effect). The LF and LF-LC groups reported greater dietary fat reductions than the two PUFA groups (P=0.043). CONCLUSION: Energy restriction has the most potent effect on weight loss and lipids, but fat modification is also beneficial when energy restriction is more modest.

Factors associated with unprotected anal intercourse between HIV-positive men and regular male partners in a Sydney cohort.

Blood plasma HIV-RNA load (BPVL) is the strongest predictor of HIV-1 transmission during sex. Unprotected anal intercourse (UAI) is the highest risk activity for transmission among men who have sex with men (MSM). Awareness of BPVL may influence rates of UAI. We assessed whether optimism towards antiretroviral therapy (ART) and/or biomedical factors influenced sexual activities with regular partners. Questionnaires were administered to 109 HIV-positive MSM participating in a cross-sectional study of BPVL and seminal viral load. The survey assessed HIV transmission beliefs and sexual practices with regular male partners in the past three months. Sixty-nine of 109 (63.3%) had been in a regular relationship and 42 reported having had anal sex. Unprotected receptive anal intercourse without ejaculation (URAI - e) was associated with awareness that their most recent BPVL was detectable (>50 RNA copies/mL) and not taking ART. Receptive UAI with ejaculation (URAI + e) was associated with not taking ART, having a sexually transmissible infection and having an HIV-positive partner; the latter was also associated with insertive UAI with ejaculation (UIAI + e). Treatment optimism was not associated with UAI. In this cohort, sexual practices were based more upon knowledge of biomedical factors rather than attitudes regarding transmission risks.

Long-term effects of increased dietary polyunsaturated fat from walnuts on metabolic parameters in type II diabetes.

BACKGROUND/OBJECTIVES: Most dietary interventions have metabolic effects in the short term, but long-term effects may require dietary fat changes to influence body composition and insulin action. This study assessed the effect of sustained high polyunsaturated fatty acids (PUFA) intake through walnut consumption on metabolic outcomes in type II diabetes. SUBJECTS/METHODS: Fifty overweight adults with non-insulin-treated diabetes (mean age 54+/-8.7 years) were randomized to receive low-fat dietary advice +/-30 g per day walnuts targeting weight maintenance (around 2000 kcal, 30% fat) for 1 year. Differences between groups were assessed by changes in anthropometric values (body weight, body fat, visceral adipose tissue) and clinical indicators of diabetes over treatment time using the general linear model. RESULTS: The walnut group consumed significantly more PUFA than the control (P=0.035), an outcome attributed to walnut consumption (contributing 67% dietary PUFA at 12 months). Most of the effects were seen in the first 3 months. Despite being on weight maintenance diets, both groups sustained a 1-2 kg weight loss, with no difference between groups (P=0.680). Both groups showed improvements in all clinical parameters with significant time effects (P<0.004), bar triacylglycerol levels, but these were just above normal to begin with. The walnut group produced significantly greater reductions in fasting insulin levels (P=0.046), an effect seen largely in the first 3 months. CONCLUSIONS: Dietary fat can be manipulated with whole foods such as walnuts, producing reductions in fasting insulin levels. Long-term effects are also apparent but subject to fluctuations in dietary intake if not of the disease process.

Video-recorded participant behaviours: the association between food choices and observed behaviours from a web-based diet history interview.

BACKGROUND: Automation of dietary assessments allows participant behaviour to be captured by video observation. It also allows clinicians to identify areas that effect reporting accuracy. The present observational study describes the differences in behaviour according to the type of foods selected by participants using a dietary assessment website encompassing diet history methodology. METHODS: Eleven free-living adults with type 2 diabetes mellitus were video recorded while using a dietary assessment website in a laboratory setting. Significant observable events were identified using TRANSANA software and matched for time of occurrence with grouped food item selections from the website. The frequency and proportion of behaviour types per food group were calculated and trends of associations between food groups and observed behaviour type were determined using weighted chi-square analyses. RESULTS: Sixteen categories of observed behaviour type were constructed from 7724 significant observable events. The food groups with the highest percentage of observed behaviour types were savoury sauces (7.66%), takeaways (6.47%), sugary foods (6.27%), fats and oils (5.93%), and alcoholic beverages (5.93%), which are all socially undesirable food groups. Self-touching of the face, head movement, postural movement and movement in the chair were observed significantly more often than other observed behaviour types across all food groups. CONCLUSIONS: Behaviours related to the reporting of foods during a dietary assessment may have significant implications for dietary practice.

Results of an Aboriginal community-based renal disease management program incorporating point of care testing for urine albumin:creatinine ratio.

INTRODUCTION: There has been a significant increase in the burden of renal disease among Aboriginal Australians over the past 15 years. Urine albumin:creatinine ratio (ACR) is a well-established marker of microalbuminuria and can be conveniently performed on the DCA 2000 point-of-care testing (POCT) analyser (Bayer Australia; Melbourne, VIC, Australia) with an on-site result available in 7 min. The application of the urine ACR POCT for renal disease risk assessment was pioneered by our group in the Umoona Kidney Project. This article describes the results of the management arm of the Umoona Kidney Project, which used point-of-care urine ACR testing for the first time within a management framework to monitor albuminuria in patients at highest risk of renal disease. The article also examines the analytical quality of POCT results and overall community acceptance of the Umoona Kidney Project. METHODS: Adults clinically assessed by Flinders Medical Centre renal specialists as being at greatest risk for renal disease were offered the ACE inhibitor (ACEI) perindopril on a voluntary basis. Selected renal markers, including POCT urine ACR (conducted on-site by Umoona's Aboriginal health worker team), plasma electrolytes, urea, creatinine, calculated glomerular filtration rate and blood pressure were measured six monthly. Regular quality control testing was undertaken to monitor the analytical performance of the POCT analyser. A culturally appropriate questionnaire was designed and implemented to assess community satisfaction with the project. RESULTS: In all, 231 patient management consultations were conducted over a two year period, with over 70% of patients having four or more (up to a maximum of eight) consultations; 35 patients (mean age 49.2 [+/-2.3] years, 54% males) participated voluntarily in the management arm. All were overtly hypertensive, hypertensive with other risk factors or had diabetes. The renal status of these patients was followed for a mean of 63 +/- 4.5 weeks. In total, 111 POCT urine ACR tests were performed for patient management (mean 3.2 tests per patient). There was no significant difference in POCT urine ACR in the study period with a median (and inter-quartile range) of 5.7 mg/mmol (1.2-15.2) pre-ACEI and 4.3 mg/mmol (1.3-16.7) post-ACEI treatment (p = 0.50, Wilcoxon signed ranks test). The calculated glomerular filtration rate altered from 110 to 118 mL/min (p = 0.019, paired t-test). There was no change in the group plasma potassium, urea and creatinine. Collectively these results indicate a stabilisation in renal function among the management group. Blood pressure (both lying and standing) fell significantly in the study period. The imprecision for urine ACR quality control POCT conducted during the management program was within nationally and internationally accepted precision goals for urine albumin, creatinine and ACR. Fifty community members completed the satisfaction questionnaire. Three-quarters of respondents felt there were no cultural barriers in providing a urine sample for urine ACR POCT. CONCLUSIONS: The management arm of the Umoona Kidney Project was effective in stabilising the renal function and improving the blood pressure of community members identified to be at greatest risk of kidney disease. POCT urine ACR testing can be utilised, not only for community risk assessment, but also for patient management. The Umoona Kidney Project was well accepted by the health service and community members.

Effects of nandrolone decanoate compared with placebo or testosterone on HIV-associated wasting.

Objectives Current research is unclear about the most effective pharmacological agents for managing the loss of weight and fat-free mass common in HIV/AIDS. The aim of this study was to compare nandrolone decanoate with placebo and testosterone. Methods The study was a multicentre randomized double-blind placebo-controlled trial. Three hundred and three adult HIV-positive male patients with a weight loss of 5-15% in the last 12 months, or a body mass index of 17-19 kg/m(2), or a body cell mass/height ratio lower than 13.5 kg/m, were randomly assigned to receive nandrolone decanoate (150 mg), testosterone (250 mg) or placebo intramuscularly every 2 weeks for 12 weeks. Fat-free mass, weight, immune markers and perception of treatment were the main outcome measures. Results Treatment with nandrolone resulted in significantly greater increases in fat-free mass [mean increase 1.34 kg; 95% confidence interval (CI) 0.60; 2.08 kg] and in weight (mean increase 1.48 kg; 95% CI 0.82; 2.14 kg) compared with placebo. The mean increase in weight with nandrolone of 1.00 kg (95% CI 0.27; 1.74 kg) when compared with testosterone was significant, although the difference in fat free mass did not reach significance (mean increase 0.69 kg; 95% CI-0.13; 1.51 kg). Patient perception of benefit was significantly greater in the nandrolone group when compared with both the placebo and the testosterone groups. Conclusions Treatment with nandrolone decanoate increased body weight when compared with placebo and testosterone. Nandrolone decanoate treatment resulted in greater increases in fat-free mass than placebo and demonstrated a trend for a significant increase when compared with testosterone.

Low plasma vitamin E levels in major depression: diet or disease?

OBJECTIVE: Levels of vitamin E have been reported to be lower in patients suffering major depression, but whether this is due to inadequate dietary intake or the pathophysiology of depression is not known, and was the subject of the present study. SETTING: Wollongong, Australia. METHODS: Plasma vitamin E (alpha-tocopherol) was measured in 49 adults with major depression, age (mean+/-s.d.): 47+/-12 y. In a subset (n=19) usual dietary intake of vitamin E was determined by diet history. RESULTS: Subjects had significantly lower plasma alpha-tocopherol (4.71+/-0.13 mumol/mmol cholesterol) than has previously been reported for healthy Australians, and plasma alpha-tocopherol was inversely related to depression score (by Beck Depression Inventory) (r=-0.367, P<0.009). Diet analysis indicated that 89% of subjects met or exceeded the recommended intake for vitamin E, and dietary intake was not related to plasma alpha-tocopherol level in this subset. CONCLUSION: These findings suggest that plasma levels of alpha-tocopherol are lower in depression, but this is not likely to be the result of inability to meet recommended dietary intake. .

Calculating energy requirements for men with HIV/AIDS in the era of highly active antiretroviral therapy.

OBJECTIVES: 1. To determine if resting energy expenditure (REE) adjusted for body composition is elevated in HIV-positive males when compared with healthy controls in the era of highly active antiretroviral therapy. 2. To examine the accuracy of prediction equations for estimating REE in people with HIV. 3. To determine if REE adjusting for body composition is significantly different between those HIV-positive subjects reporting lipodystrophy (LD) or weight loss (>or=5%) and those who are weight stable when compared to controls. DESIGN: Cross-sectional study. SETTING: Tertiary referral hospital HIV unit and an outpatient clinic specializing in HIV care. SUBJECTS: HIV-positive males (n=70) and healthy male controls (n=16). METHODS: REE was measured using indirect calorimetry. Body composition was assessed using bioelectrical impedance analysis. RESULTS: 1. REE when adjusted for fat-free mass and fat mass using the general linear model (analysis of covariance) was greater in HIV-positive subjects than controls (7258+/-810 kJ, n=70 vs 6615+/-695 kJ, n=16, P<0.05). 2. The Harris and Benedict, Schofield, Cunningham and the two equations previously published by Melchior and colleagues in HIV-positive subjects all gave an estimate of REE significantly different from the measured REE in the HIV-positive subjects, therefore a new prediction equation was developed. The inability of the published equations to predict REE in the different HIV-positive subgroups reflected the heterogeneity in body composition. 3. REE adjusted for fat-free and fat mass was significantly greater in the both the HIV patients who were weight stable and those with lipodystrophy compared with the healthy controls. CONCLUSION: REE is significantly higher in HIV-positive males when compared with healthy controls. Body composition abnormalities common in HIV render the use of standard prediction equations for estimating REE invalid. When measuring REE in HIV-positive males adjustment steps should include fat-free and fat mass.

The effect of treatment on radiological progression in rheumatoid arthritis: a systematic review of randomized placebo-controlled trials.

OBJECTIVE: To undertake a systematic review of randomized placebo-controlled trials to assess and rank the efficacy of pharmacological interventions in preventing radiological progression of rheumatoid arthritis. METHODS: The two outcome measures were the weighted standardized mean difference and the odds of progression of X-ray scores pooled as close to 12 months as possible to minimize heterogeneity. RESULTS: A total of 38 trials were identified. Of these, 13 were excluded, leaving data on 3907 subjects. Infliximab, cyclosporin, sulphasalazine, leflunomide, methotrexate, parenteral gold, corticosteroids, auranofin and interleukin 1 receptor antagonist were statistically better than placebo in terms of change in erosion scores. All agents were equivalent statistically, with the exception of infliximab (which was superior to the last five agents). There were similar findings for the odds of progression, with the exception of auranofin (P=0.06) and the infliximab-methotrexate comparison (P=0.07). Other agents did not reach statistical significance in either outcome measure. With the exception of the antimalarials, the magnitude of the effect was consistent with the effect seen in short-term disease activity trials. CONCLUSION: There is published evidence which supports the efficacy of nine agents in decreasing radiological progression in rheumatoid arthritis.

A comparison of megestrol acetate, nandrolone decanoate and dietary counselling for HIV associated weight loss.

This randomized, prospective study compared three treatments, nandrolone decanoate (ND), megestrol acetate (MA) or dietary counselling, for managing human immunodeficiency syndrome (HIV) associated weight loss. It was centred on a Tertiary referral hospital, Sydney, Australia. Fifteen patients were randomized to receive ND (100 mg/fortnight), or MA (400 mg/day) or dietary counselling for 12 weeks. Those patients randomized to dietary counselling were further randomized to receive nandrolone or megestrol after completing the dietary counselling arm. Weight, fat free mass (FFM), percentage body fat mass (FM), dietary intake and appetite were assessed before commencing and at the completion of each treatment arm. Weight increased significantly in all treatment arms (dietary counselling 1.13 kg +/- 0.36, nandrolone 4.01 kg +/- 1.68, megestrol 10.20 kg +/- 4.51, p < 0.05 paired t-test). FFM increased significantly in patients receiving ND (3.54 +/- 1.98 kg, p=0.001) and those receiving MA (2.76 +/- 0.55 kg, p=0.002), whereas the change in those receiving dietary counselling alone was not significant. Percentage body fat mass increased significantly only in those receiving MA (7.77 +/- 4.85%, p=0.049). The change in weight and percentage body fat mass was significantly greater in those receiving MA than the other two treatment arms. The increase in FFM was significantly greater in both the nandrolone and megestrol arms than the dietary counselling arm. It was concluded that ND and MA both resulted in an increase in FFM greater than dietary counselling alone. Megestrol produced a significantly greater increase in weight, percentage fat mass, intake and appetite than did the other two treatment arms, suggesting it may be the preferred agent, particularly in a palliative care setting in which weight, appetite and intake increase are desirable without regard to the composition of the body. The long-term use of these agents in people with HIV should be reviewed in the context of improved survival on highly active antiretroviral therapy regimens.