ABSTRACT
OBJECTIVE: To determine the efficacy of rTMS in decreasing body mass index (BMI) versus sham stimulation among obese Filipino patients. METHODOLOGY: This was a single-center, randomized, sham-controlled, single-blind, parallel group trial. Participants were 15-65 years old with BMI ≥30 kg/m2 and weight stable for 6 weeks. Participants were randomized to receive real rTMS or sham stimulation. Each underwent 4 sessions of stimulation over 2 weeks. Anthropometrics, total caloric intake (TCI), and VAS score for appetite were taken at baseline, 2, 4, 6, and 12 weeks. RESULTS: A total of 31 patients were randomized with 15 to the treatment and 14 to sham stimulation completing treatment, with 2 lost to follow-up. A significant decrease in BMI was noted after 4 weeks from the start of rTMS in the treatment group, (0.6±0.6, p-value=0.001), with weight change of -1.3±1.3 kg (p-value=0.009), but was no longer observed at 6 weeks onwards. No severe adverse effects were noted. CONCLUSION: rTMS to the DLPFC effectively decreased BMI (0.6±0.6) and weight (-1.3±1.3 kg) from baseline to 4 weeks. At 6-12 weeks after rTMS however, there was no longer a significant difference, indicating that 4 sessions of rTMS may not be enough to produce a prolonged effect on weight loss.
ABSTRACT
Malnutrition as undernutrition, overnutrition, or an imbalance of specific nutrients, can be found in all countries and in both community and hospital settings around the world. The prevalence of malnutrition is unacceptably high in all settings and affects children, adolescents, pregnant women, and sick and older adults. Malnutrition has multiple underlying issues (food insecurity, chronic and acute illnesses, sanitation and safety, and aging in the community), which need to be addressed. At the same time, direct nutrition interventions (food supplements and micronutrient supplementation) help support immediate resolution of malnutrition. Awareness of malnutrition issues in the community and in clinical setting must be stimulated in order to provide better care. Different countries have implemented a wide range of interventions to prevent and treat malnutrition. These include nutrition education, engagement of the community, resolution of sanitation problems affecting food and water, routine screening and assessment and diagnosis of malnutrition (when feasible), and food supplements and micronutrients. Such programs are achieving improved outcomes; however, further engagement and training is needed for more community and clinical health workers. Many countries lack qualified nutrition and dietetics practitioners or have low dietitian-to-patient ratios with suboptimal salaries. Thus, an increase in number of and empowerment of nutrition and dietetics practitioners is desperately needed to help prevent and treat malnutrition globally.
