By Louis Kuritzky, MD
Does It Really Make a Difference What Weight-reduction Diet You Choose?
SOURCE: Johnston BC, et al. Comparison of weight-loss among named diet programs in overweight and obese adults: A meta-analysis. JAMA 2014;312:923-933.
Since two-thirds of American adults are currently overweight or obese, we would all like to be able to help patients choose the "best" diet. The list of choices and categories is lengthy, with vocal advocates for the Atkins diet, the Zone diet, South Beach diet, Jenny Craig, Ornish, etc. Of course, were any of these diets sufficiently effective and easily adopted so that they could gain widespread advocacy, we wouldn’t be faced with such an obesity epidemic in the first place! So apparently there is no "simple answer." Among the choices we have, then, which one might be the best?
Johnston et al performed a meta-analysis of weight-loss trials (n = 48 trials and 7286 subjects), including the above-mentioned diets. Diets were categorized further as low-carbohydrate or low-fat.
Although there were measurable statistical differences between diets, they were of dubious clinical significance. For instance, at the 12-month follow-up, low-carbohydrate diets were associated with a mean weight reduction of 7.99 kg vs 7.27 kg on low-fat diets. Within-group diet differences (e.g., comparing Atkins and Zone diets, both of which are categorized as low carbohydrate) favored the former, but these differences were also very small (< 2 kg at 6 months).
Because of the modest outcome differences between diets, the authors conclude that whatever diet the patient can best adhere to should be recommended.
Treatment of Depression with Botulinum Toxin
SOURCE: Magid M, et al. Treatment of major depressive disorder using botulinum toxin A: A 24-week randomized, double-blind, placebo-controlled study. J Clin Psychiatry 2014;75:837-844.
The need for additional treatments for depression stems from the observation that only a minority of patients achieve full remission on currently available antidepressant medications, each of which with its own adverse effect profile. In the 1963 musical "Bye Bye Birdie," Dick van Dyke sang the song "Put on a Happy Face" (words by Lee Adams, music by Charles Strouse) to Janet Leigh. Having followed Dick’s advice, Janet undergoes a prompt and readily visible transformation of her energy and mood. Well, maybe there was some substance to that advice, as suggested by this clinical trial of botulinum toxin (B-TOX).
The "Facial Feedback Hypothesis" suggests that when one volitionally produces a particular facial expression (e.g., frowning, smiling), concordant emotions are experienced, perhaps through some CNS feedback mechanism. So, might elimination of frown muscle tone with B-TOX improve mood?
Magid et al randomized 30 patients with depression to B-TOX vs. placebo administered at baseline in the facial glabellar region frown musculature. Depression scores were measured over 24 weeks post-injection.
B-TOX was associated with a statistically significant reduction in depression scores, which persisted throughout the 24-week interval, even though the cosmetic effects upon the facial frown musculature dissipated by 12-16 weeks.
Reductions in depression scores on the Beck Depression Inventory were impressive: more than one-third of B-TOX recipients achieved at least a 50% reduction in depression scores.
B-TOX appears to be a prompt and effective treatment for depression.
So You Were a Compliant Patient and Did Your Colonoscopy and Had an Adenoma Removed. Did it Pay Off? Well, Maybe.
SOURCE: Løberg M, et al. Long-term colorectal-cancer mortality after adenoma removal. N Engl J Med 2014;371:799-807.
Compared to other preventive health screening interventions, adherence to colonoscopy (COL) recommendations is substantially less than that of other interventions. The payoff of reduced risk of colon cancer (CCA) seems insufficient inducement to undergo the procedural preparation and intervention for many of our patients. Just how big is the payoff?
Løberg et al investigated the impact on CCA mortality of adenoma removal during COL screening. They compared the CCA mortality over a 14-year interval (median follow up = 7.7 years) for persons who had undergone colonoscopic adenoma removal with the CCA mortality in the entire adult population of Norway. The primary outcome of the study was the rate of CCA mortality, as assessed by the Stratified Mortality Ratio (SMR): the rate of CCA deaths in persons with adenomas removed vs the CCA death rate in the general adult population.
Based on 383 CCA deaths among 40,826 adenoma patients, compared to 398 CCA deaths in the general population, the overall SMR (including all classes of adenomas excised) demonstrated a trend toward lower CCA mortality (SMR, 0.96; confidence interval, 0.87-1.06).
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