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The Cochrane Database of Systematic... Jan 2022Debates on effective and safe diets for managing obesity in adults are ongoing. Low-carbohydrate weight-reducing diets (also known as 'low-carb diets') continue to be... (Review)
Review
BACKGROUND
Debates on effective and safe diets for managing obesity in adults are ongoing. Low-carbohydrate weight-reducing diets (also known as 'low-carb diets') continue to be widely promoted, marketed and commercialised as being more effective for weight loss, and healthier, than 'balanced'-carbohydrate weight-reducing diets.
OBJECTIVES
To compare the effects of low-carbohydrate weight-reducing diets to weight-reducing diets with balanced ranges of carbohydrates, in relation to changes in weight and cardiovascular risk, in overweight and obese adults without and with type 2 diabetes mellitus (T2DM).
SEARCH METHODS
We searched MEDLINE (PubMed), Embase (Ovid), the Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science Core Collection (Clarivate Analytics), ClinicalTrials.gov and WHO International Clinical Trials Registry Platform (ICTRP) up to 25 June 2021, and screened reference lists of included trials and relevant systematic reviews. Language or publication restrictions were not applied.
SELECTION CRITERIA
We included randomised controlled trials (RCTs) in adults (18 years+) who were overweight or living with obesity, without or with T2DM, and without or with cardiovascular conditions or risk factors. Trials had to compare low-carbohydrate weight-reducing diets to balanced-carbohydrate (45% to 65% of total energy (TE)) weight-reducing diets, have a weight-reducing phase of 2 weeks or longer and be explicitly implemented for the primary purpose of reducing weight, with or without advice to restrict energy intake. DATA COLLECTION AND ANALYSIS: Two review authors independently screened titles and abstracts and full-text articles to determine eligibility; and independently extracted data, assessed risk of bias using RoB 2 and assessed the certainty of the evidence using GRADE. We stratified analyses by participants without and with T2DM, and by diets with weight-reducing phases only and those with weight-reducing phases followed by weight-maintenance phases. Primary outcomes were change in body weight (kg) and the number of participants per group with weight loss of at least 5%, assessed at short- (three months to < 12 months) and long-term (≥ 12 months) follow-up.
MAIN RESULTS
We included 61 parallel-arm RCTs that randomised 6925 participants to either low-carbohydrate or balanced-carbohydrate weight-reducing diets. All trials were conducted in high-income countries except for one in China. Most participants (n = 5118 randomised) did not have T2DM. Mean baseline weight across trials was 95 kg (range 66 to 132 kg). Participants with T2DM were older (mean 57 years, range 50 to 65) than those without T2DM (mean 45 years, range 22 to 62). Most trials included men and women (42/61; 3/19 men only; 16/19 women only), and people without baseline cardiovascular conditions, risk factors or events (36/61). Mean baseline diastolic blood pressure (DBP) and low-density lipoprotein (LDL) cholesterol across trials were within normal ranges. The longest weight-reducing phase of diets was two years in participants without and with T2DM. Evidence from studies with weight-reducing phases followed by weight-maintenance phases was limited. Most trials investigated low-carbohydrate diets (> 50 g to 150 g per day or < 45% of TE; n = 42), followed by very low (≤ 50 g per day or < 10% of TE; n = 14), and then incremental increases from very low to low (n = 5). The most common diets compared were low-carbohydrate, balanced-fat (20 to 35% of TE) and high-protein (> 20% of TE) treatment diets versus control diets balanced for the three macronutrients (24/61). In most trials (45/61) the energy prescription or approach used to restrict energy intake was similar in both groups. We assessed the overall risk of bias of outcomes across trials as predominantly high, mostly from bias due to missing outcome data. Using GRADE, we assessed the certainty of evidence as moderate to very low across outcomes. Participants without and with T2DM lost weight when following weight-reducing phases of both diets at the short (range: 12.2 to 0.33 kg) and long term (range: 13.1 to 1.7 kg). In overweight and obese participants without T2DM: low-carbohydrate weight-reducing diets compared to balanced-carbohydrate weight-reducing diets (weight-reducing phases only) probably result in little to no difference in change in body weight over three to 8.5 months (mean difference (MD) -1.07 kg, (95% confidence interval (CI) -1.55 to -0.59, I = 51%, 3286 participants, 37 RCTs, moderate-certainty evidence) and over one to two years (MD -0.93 kg, 95% CI -1.81 to -0.04, I = 40%, 1805 participants, 14 RCTs, moderate-certainty evidence); as well as change in DBP and LDL cholesterol over one to two years. The evidence is very uncertain about whether there is a difference in the number of participants per group with weight loss of at least 5% at one year (risk ratio (RR) 1.11, 95% CI 0.94 to 1.31, I = 17%, 137 participants, 2 RCTs, very low-certainty evidence). In overweight and obese participants with T2DM: low-carbohydrate weight-reducing diets compared to balanced-carbohydrate weight-reducing diets (weight-reducing phases only) probably result in little to no difference in change in body weight over three to six months (MD -1.26 kg, 95% CI -2.44 to -0.09, I= 47%, 1114 participants, 14 RCTs, moderate-certainty evidence) and over one to two years (MD -0.33 kg, 95% CI -2.13 to 1.46, I= 10%, 813 participants, 7 RCTs, moderate-certainty evidence); as well in change in DBP, HbA1c and LDL cholesterol over 1 to 2 years. The evidence is very uncertain about whether there is a difference in the number of participants per group with weight loss of at least 5% at one to two years (RR 0.90, 95% CI 0.68 to 1.20, I = 0%, 106 participants, 2 RCTs, very low-certainty evidence). Evidence on participant-reported adverse effects was limited, and we could not draw any conclusions about these. AUTHORS' CONCLUSIONS: There is probably little to no difference in weight reduction and changes in cardiovascular risk factors up to two years' follow-up, when overweight and obese participants without and with T2DM are randomised to either low-carbohydrate or balanced-carbohydrate weight-reducing diets.
Topics: Adult; Body Weight; Carbohydrates; Diet, Carbohydrate-Restricted; Energy Intake; Female; Heart Disease Risk Factors; Humans; Male
PubMed: 35088407
DOI: 10.1002/14651858.CD013334.pub2 -
International Journal of Molecular... Jan 2021Androgens represent the main hormones responsible for maintaining hormonal balance and function in the prostate and testis. As they are involved in prostate and... (Review)
Review
Androgens represent the main hormones responsible for maintaining hormonal balance and function in the prostate and testis. As they are involved in prostate and testicular carcinogenesis, more detailed information of their active concentration at the site of action is required. Since the introduction of the term intracrinology as the local formation of active steroid hormones from inactive precursors of the adrenal gland, mainly dehydroepiandrosterone (DHEA) and DHEA-S, it is evident that blood circulating levels of sex steroid hormones need not reflect their actual concentrations in the tissue. Here, we review and critically evaluate available methods for the analysis of human intraprostatic and intratesticular steroid concentrations. Since analytical approaches have much in common in both tissues, we discuss them together. Preanalytical steps, including various techniques for separation of the analytes, are compared, followed by the end-point measurement. Advantages and disadvantages of chromatography-mass spectrometry (LC-MS, GC-MS), immunoanalytical methods (IA), and hybrid (LC-IA) are discussed. Finally, the clinical information value of the determined steroid hormones is evaluated concerning differentiating between patients with cancer or benign hyperplasia and between patients with different degrees of infertility. Adrenal-derived 11-oxygenated androgens are mentioned as perspective prognostic markers for these purposes.
Topics: Adrenal Glands; Androgens; Animals; Gonadal Steroid Hormones; Humans; Male; Prostate; Steroids; Testis
PubMed: 33466491
DOI: 10.3390/ijms22010466 -
The Journal of Physiology Aug 2023Naturally log-scaled quantities abound in the nervous system. Distributions of these quantities have non-intuitive properties, which have implications for data analysis... (Review)
Review
Naturally log-scaled quantities abound in the nervous system. Distributions of these quantities have non-intuitive properties, which have implications for data analysis and the understanding of neural circuits. Here, we review the log-scaled statistics of neuronal spiking and the relevant analytical probability distributions. Recent work using log-scaling revealed that interspike intervals of forebrain neurons segregate into discrete modes reflecting spiking at different timescales and are each well-approximated by a gamma distribution. Each neuron spends most of the time in an irregular spiking 'ground state' with the longest intervals, which determines the mean firing rate of the neuron. Across the entire neuronal population, firing rates are log-scaled and well approximated by the gamma distribution, with a small number of highly active neurons and an overabundance of low rate neurons (the 'dark matter'). These results are intricately linked to a heterogeneous balanced operating regime, which confers upon neuronal circuits multiple computational advantages and has evolutionarily ancient origins.
Topics: Action Potentials; Neurons; Models, Neurological
PubMed: 36086892
DOI: 10.1113/JP282758 -
Yearbook of Medical Informatics Aug 2020Contemporary bioethics was fledged and is sustained by challenges posed by new technologies. These technologies have affected many lives. Yet health informatics affects...
Contemporary bioethics was fledged and is sustained by challenges posed by new technologies. These technologies have affected many lives. Yet health informatics affects more lives than any of them. The challenges include the development and the appropriate uses and users of machine learning software, the balancing of privacy rights against the needs of public health and clinical practice in a time of Big Data analytics, whether and how to use this technology, and the role of ethics and standards in health policy. Historical antecedents in statistics and evidence-based practice foreshadow some of the difficulties now faced, but the scope and scale of these challenges requires that ethics, too, be brought to scale in parallel, especially given the size of contemporary data sets and the processing power of new computers. Fortunately, applied ethics affords a variety of tools to help identify and rank applicable values, support best practices, and contribute to standards. The bioethics community can in partnership with the informatics community arrive at policies that promote the health sciences while reaffirming the many and varied rights that patients expect will be honored.
Topics: Artificial Intelligence; Big Data; Bioethical Issues; Confidentiality; Humans; Information Dissemination; Learning Health System; Medical Informatics; Privacy; Public Policy
PubMed: 32303095
DOI: 10.1055/s-0040-1701966 -
Neuronal Signaling Apr 2022Inflammatory stimuli and consequent pro-inflammatory immune responses may facilitate neurodegeneration and threaten survival following pathogen infection or trauma, but... (Review)
Review
Inflammatory stimuli and consequent pro-inflammatory immune responses may facilitate neurodegeneration and threaten survival following pathogen infection or trauma, but potential controllers preventing these risks are incompletely understood. Here, we argue that small RNA regulators of acetylcholine (ACh) signaling, including microRNAs (miRs) and transfer RNA fragments (tRFs) may tilt the balance between innate and adaptive immunity, avoid chronic inflammation and prevent the neuroinflammation-mediated exacerbation of many neurological diseases. While the restrictive permeability of the blood-brain barrier (BBB) protects the brain from peripheral immune events, this barrier can be disrupted by inflammation and is weakened with age. The consequently dysregulated balance between pro- and anti-inflammatory processes may modify the immune activities of brain microglia, astrocytes, perivascular macrophages, oligodendrocytes and dendritic cells, leading to neuronal damage. Notably, the vagus nerve mediates the peripheral cholinergic anti-inflammatory reflex and underlines the consistent control of body-brain inflammation by pro-inflammatory cytokines, which affect cholinergic functions; therefore, the disruption of this reflex can exacerbate cognitive impairments such as attention deficits and delirium. RNA regulators can contribute to re-balancing the cholinergic network and avoiding its chronic deterioration, and their activities may differ between men and women and/or wear off with age. This can lead to hypersensitivity of aged patients to inflammation and higher risks of neuroinflammation-driven cholinergic impairments such as delirium and dementia following COVID-19 infection. The age- and sex-driven differences in post-transcriptional RNA regulators of cholinergic elements may hence indicate new personalized therapeutic options for neuroinflammatory diseases.
PubMed: 35211331
DOI: 10.1042/NS20210035 -
Sensors (Basel, Switzerland) Aug 2022Numerous studies have sought to demonstrate the utility of digital measures of motor function in Parkinson’s disease. Frameworks, such as V3, document digital measure...
Numerous studies have sought to demonstrate the utility of digital measures of motor function in Parkinson’s disease. Frameworks, such as V3, document digital measure development: technical verification, analytical and clinical validation. We present the results of a study to (1) technically verify accelerometers in an Apple iPhone 8 Plus and ActiGraph GT9X versus an oscillating table and (2) analytically validate software tasks for walking and pronation/supination on the iPhone plus passively detect walking measures with the ActiGraph in healthy volunteers versus human raters. In technical verification, 99.4% of iPhone and 91% of ActiGraph tests show good or excellent agreement versus the oscillating table as the gold standard. For the iPhone software task and algorithms, intraclass correlation coefficients (ICCs) > 0.75 are achieved versus the human raters for measures when walking distance is >10 s and pronation/supination when the arm is rotated more than two times. Passively detected walking start and end time was accurate to approx. 1 s and walking measures were accurate to one unit, e.g., one step. The results suggest that the Apple iPhone and ActiGraph GT9X accelerometers are fit for purpose and that task and passively collected measures are sufficiently analytically valid to assess usability and clinical validity in Parkinson’s patients.
Topics: Algorithms; Gait; Healthy Volunteers; Humans; Pronation; Supination; Walking
PubMed: 36016036
DOI: 10.3390/s22166275 -
Surgery Jul 2021Physicians use perioperative decision-support tools to mitigate risks and maximize benefits to achieve the most successful outcome for patients. Contemporary... (Review)
Review
Physicians use perioperative decision-support tools to mitigate risks and maximize benefits to achieve the most successful outcome for patients. Contemporary risk-assessment practices augment surgeons' judgement and experience with decision-support algorithms driven by big data and machine learning. These algorithms accurately assess risk for a wide range of postoperative complications by parsing large datasets and performing complex calculations that would be cumbersome for busy clinicians. Even with these advancements, large gaps in perioperative risk assessment remain; decision-support algorithms often cannot account for risk-reduction therapies applied during a patient's perioperative course and do not quantify tradeoffs between competing goals of care (eg, balancing postoperative pain control with the risk of respiratory depression or balancing intraoperative volume resuscitation with the risk for complications from pulmonary edema). Multiobjective optimization solutions have been applied to similar problems successfully but have not yet been applied to perioperative decision support. Given the large volume of data available via electronic medical records, including intraoperative data, it is now feasible to successfully apply multiobjective optimization in perioperative care. Clinical application of multiobjective optimization would require semiautomated pipelines for analytics and reporting model outputs and a careful development and validation process. Under these circumstances, multiobjective optimization has the potential to support personalized, patient-centered, shared decision-making with precision and balance.
Topics: Algorithms; Anesthesia; Clinical Decision-Making; Decision Support Techniques; Humans; Pain Management; Pain Measurement; Perioperative Care; Risk Assessment; Surgical Procedures, Operative
PubMed: 33334583
DOI: 10.1016/j.surg.2020.11.005 -
Oxidative Medicine and Cellular... 2016The present paper aims at reviewing and commenting on the analytical methods applied to antioxidant and antioxidant capacity assessment in plant-derived products.... (Review)
Review
The present paper aims at reviewing and commenting on the analytical methods applied to antioxidant and antioxidant capacity assessment in plant-derived products. Aspects related to oxidative stress, reactive oxidative species' influence on key biomolecules, and antioxidant benefits and modalities of action are discussed. Also, the oxidant-antioxidant balance is critically discussed. The conventional and nonconventional extraction procedures applied prior to analysis are also presented, as the extraction step is of pivotal importance for isolation and concentration of the compound(s) of interest before analysis. Then, the chromatographic, spectrometric, and electrochemical methods for antioxidant and antioxidant capacity determination in plant-derived products are detailed with respect to their principles, characteristics, and specific applications. Peculiarities related to the matrix characteristics and other factors influencing the method's performances are discussed. Health benefits of plants and derived products are described, as indicated in the original source. Finally, critical and conclusive aspects are given when it comes to the choice of a particular extraction procedure and detection method, which should consider the nature of the sample, prevalent antioxidant/antioxidant class, and the mechanism underlying each technique. Advantages and disadvantages are discussed for each method.
Topics: Analytic Sample Preparation Methods; Antioxidants; Phytochemicals; Plant Extracts; Plants
PubMed: 28044094
DOI: 10.1155/2016/9130976 -
Frontiers in Psychology 2022The various social issues that accompany economic development pose new challenges for leaders to integrate economic benefits, social responsibility, and environmental... (Review)
Review
The various social issues that accompany economic development pose new challenges for leaders to integrate economic benefits, social responsibility, and environmental protection. In this context, various new leadership styles have emerged. Among them, sustainable leadership reveals the key role of leaders in balancing the triple goals of economy, society and environment, and has become an important part of leadership theory research in recent years. We searched the literature related to sustainable leadership in databases such as Web of Science, EBSCO and CNKI. Based on the existing literature, we systematically review the origins, connotations, analytical perspectives, measurement methods, and conceptual comparisons of sustainable leadership. And we also construct an integrated analytical framework of sustainable leadership on the premise of sorting out and summarizing the antecedents and consequences of sustainable leadership. Finally, we provide an outlook on the future research areas of sustainable leadership in order to further promote research of sustainable leadership.
PubMed: 36420377
DOI: 10.3389/fpsyg.2022.1045570 -
PharmacoEconomics May 2019This paper provides an educational review covering the consideration of costs for cost-effectiveness analysis (CEA), summarising relevant methods and research from the... (Review)
Review
This paper provides an educational review covering the consideration of costs for cost-effectiveness analysis (CEA), summarising relevant methods and research from the published literature. Cost data are typically generated by applying appropriate unit costs to healthcare resource-use data for patients. Trial-based evaluations and decision analytic modelling represent the two main vehicles for CEA. The costs to consider will depend on the perspective taken, with conflicting recommendations ranging from focusing solely on healthcare to the broader 'societal' perspective. Alternative sources of resource-use are available, including medical records and forms completed by researchers or patients. Different methods are available for the statistical analysis of cost data, although consideration needs to be given to the appropriate methods, given cost data are typically non-normal with a mass point at zero and a long right-hand tail. The choice of covariates for inclusion in econometric models also needs careful consideration, focusing on those that are influential and that will improve balance and precision. Where data are missing, it is important to consider the type of missingness and then apply appropriate analytical methods, such as imputation. Uncertainty around costs should also be reflected to allow for consideration on the impacts of the CEA results on decision uncertainty. Costs should be discounted to account for differential timing, and are typically inflated to a common cost year. The choice of methods and sources of information used when accounting for cost information within CEA will have an effect on the subsequent cost-effectiveness results and how information is presented to decision makers. It is important that the most appropriate methods are used as overlooking the complicated nature of cost data could lead to inaccurate information being given to decision makers.
Topics: Cost-Benefit Analysis; Decision Making; Decision Support Techniques; Delivery of Health Care; Health Care Costs; Humans; Models, Econometric; Quality-Adjusted Life Years
PubMed: 30746613
DOI: 10.1007/s40273-019-00771-y