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Embargoed for release until 5:00 p.m. ET on Monday 26 June 2023
Annals of Internal Medicine Tip Sheet
@Annalsofim
Below please find summaries of new articles that will be published in the next issue of Annals of Internal Medicine. The summaries are not intended to substitute for the full articles as a source of information. This information is under strict embargo and by taking it into possession, media representatives are committing to the terms of the embargo not only on their own behalf, but also on behalf of the organization they represent.
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1. Intermittent fasting and traditional calorie counting about equal for weight loss
Abstract: https://www.acpjournals.org/doi/10.7326/M23-0052
Editorial: https://www.acpjournals.org/doi/10.7326/M23-1396
FREE summary: https://www.acpjournals.org/doi/10.7326/P23-0003
URL goes live when the embargo lifts
A small randomized controlled trial found that time-restricted eating, also known as intermittent fasting, produced similar weight loss results to traditional calorie counting in a racially diverse population of adults with obesity. The study also showed that participants who engaged in 8-hour time restricted eating had improved insulin sensitivity compared to those in the control group who ate their calories any time over 10 or more hours a day. The study is published in Annals of Internal Medicine.
Obesity is a major health issue. Many traditional weight loss diets involve counting calories, which can be cumbersome and difficult to do well. Time-restricted eating, without calorie counting, has become a popular weight loss strategy because it is simple to do. Whether it’s effective in producing weight loss, especially beyond the short term, is unclear.
Researchers from the University of Illinois Chicago studied 90 adults with obesity from the Greater Chicago area to determine whether intermittent fasting or calorie restricted eating would be more effective for weight control and cardiometabolic risk reduction. Participants were randomly assigned to 1 of 3 groups: 8-hour time-restricted eating (eating from noon to 8:00 p.m. only, without calorie counting); calorie restriction (reduce 25% of their calories daily), or no change in calorie consumption, with eating taking place over 10 hours or more throughout the day. Both the time-restricted eating and calorie restriction groups met regularly with a dietician. Participants were not blinded. The authors found that participants who engaged in time-restricted eating ate 425 fewer calories per day than the control group and lost about 10 more pounds than the control group after one year. The calorie-restricted group ate 405 fewer calories per day and lost about 12 more pounds after one year. Participants showed high adherence to both interventions.
The authors of an accompanying editorial from the Anschutz Health and Wellness Center and Division of General Internal Medicine, University of Colorado School of Medicine say that access to dieticians likely helped participants in the restricted eating group make healthier food choices. They believe the results of this study can help guide clinical decision-making partially by taking individual preferences into consideration, rather than just choosing a diet that may be more effective. They emphasize that the results of this study highlight the substantial individual variability in weight loss using these interventions, and that further research is needed to determine who would most benefit from each of these interventions.
Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with corresponding author Krista A. Varady, PhD, please contact varady@uic.edu.
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2. Clinicians are missing opportunities to use medication in treatment of alcohol use disorder
Abstract: https://www.acpjournals.org/doi/10.7326/M23-0641
Editorial: https://www.acpjournals.org/doi/10.7326/M23-1419
URL goes live when the embargo lifts
A study of Medicare data found that very few patients hospitalized for alcohol use disorder (AUD) were treated with an approved medication to promote behavior change. The researchers say interventions to increase prescribing by generalists and non–addiction specialists are needed to increase medication prescribing in this high-risk population. The report is published in Annals of Internal Medicine.
In the United States, 29 million adults have AUD, and alcohol contributes to more than 140,000 deaths annually. Hospitalizations provide an opportunity to promote behavior change by initiating treatment with medications for AUD including naltrexone, acamprosate, and disulfiram. Low prescribing rates for hospitalized patients have been observed in single center studies, but nationwide data are lacking.
Researchers from Harvard Medical School, Massachusetts General Hospital, and Beth Israel Deaconess Medical Center characterized and analyzed data related to medication for AUD treatment from a national Medicare sample of 20,401 patients from 2015 to 2017. The authors found that only 0.7 percent of patients initiated medication for AUD within two days of hospital discharge, and an additional 1.3 percent initiated medication within 30 days of discharge. Among patients with a primary diagnosis of AUD, 2.3 percent initiated medication treatment within two days of discharge. The authors note that the most predictive demographic factor for discharge initiation of medication treatment was younger age. Medication treatment for AUD was also more likely among persons with involvement of psychiatry or addiction medicine.
An accompanying editorial by authors from the White River Junction VA Medical Center and VA Greater Los Angeles Healthcare System highlights that the results of this study provides powerful evidence for a missed opportunity to address AUD. They point to previous research addressing this gap, which resulted in a 64-percent increase of persons receiving medication-based treatment for AUD. This study was also associated with a decrease in all-cause, 30-day readmission rates. The authors emphasize that health systems need to ensure ready availability of inpatient addiction medicine consultation, with consideration of telehealth consultation services for rural hospitals and those without sufficient local expertise in addiction medicine.
Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with the corresponding author Eden Y. Bernstein, MD, please email EYBERNSTEIN@mgh.harvard.edu.
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3. Indefinite anticoagulation unlikely to have mortality benefits or be cost-effective for most patients with unprovoked VTE
Abstract: https://www.acpjournals.org/doi/10.7326/M22-3559
URL goes live when the embargo lifts
A modeling study suggests that continuing anticoagulation therapy indefinitely, which is recommended in all patients with a first unprovoked venous thromboembolism (VTE), has little chance of improving life expectancy for most patients and is unlikely to ever be cost effective. Clinicians should use shared decision making to incorporate individual patient preferences and values when considering treatment duration for unprovoked VTE. The analysis is published in Annals of Internal Medicine.
In some patients who develop blood clots, or VTE, there is no clear reason why the clot formed. In these cases, guidelines recommend treating with anticoagulation for at least 3 months. Thereafter, a lifelong decision must be made to either discontinue anticoagulation or continue it indefinitely. The tradeoffs between benefits, harms, and costs of indefinite anticoagulation have not been formally assessed.
Researchers from the University of Calgary, Calgary, Alberta and the University of Ottawa, Ottawa, Ontario, Canada conducted a modeling study of a hypothetical cohort of 1,000 persons aged 55 years to evaluate long-term outcomes of indefinite anticoagulation treatment. They also analyzed data related to treatment costs and quality-adjusted life-years (QALYs). The authors found that indefinite anticoagulation prevented 368 recurrent VTE events, including 14 fatal pulmonary emboli, but induced 114 additional major bleeding events, which included 30 intracranial hemorrhages and 11 deaths from bleeding. Indefinite anticoagulation cost CAD $16,014 more per person and did not increase QALYs. According to the authors, their findings can help clinicians better understand and explain to their patients the tradeoffs between recurrent VTE and major bleeding events when choosing to discontinue or continue anticoagulation indefinitely. They also emphasize that the close tradeoffs demonstrated in the analysis highlight the need for clinicians to incorporate patient preferences and values when considering treatment duration for unprovoked VTE.
Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with the corresponding author Faizan Khan, PhD, please email fkhan039@uottawa.ca.
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Also published in this issue:
Achieving Equity in Residency and Fellowship Applications With a Partial Blindfold: A Call for Measuring the Distance Traveled
Tara Vijayan, MD, MPH; Christopher J. Graber, MD, MPH; Christina E. Harris, MD; and Daniel Kozman, MD, MPH
Ideas and Opinions
Abstract: https://www.acpjournals.org/doi/10.7326/M23-0334
Hunger and the Obesity Epidemic: Old Insights Reaffirmed by New Medicines?
Rory Taylor, MBChB
Ideas and Opinions
Abstract: https://www.acpjournals.org/doi/10.7326/M23-0744
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