1. At Two Years, Low-carb Diet Beats Low-Fat for HDL-Cholesterol Levels
Link to summary (live at 5:00 p.m. on August 2): http://annals.org/content/153/3/I-35
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Previous studies comparing low-carbohydrate and low-fat diets have not included comprehensive behavioral treatment. Researchers sought to evaluate the long-term effects of a low-carbohydrate versus a low-fat diet when combined with a comprehensive lifestyle modification program. Three hundred and seven patients were randomly assigned to either a low-carbohydrate (n=153) or low-fat (n=154) diet with behavior treatment. Weight at two years was the primary outcome, but other effects were measured throughout the study period. At three, six, and 12 months, patients were evaluated for weight, serum lipid concentrations, blood pressure, urinary ketones, bone mineral density, and body composition. The researchers found no differences in weight, body composition, or bone mineral density between the two groups at any point during the study. At two years, both groups had lost a clinically significant amount of weight (about 7 percent of body weight), showing that successful weight loss can be achieved with either approach when coupled with a behavioral modification program. However, the low-carbohydrate diet produced a greater increase in plasma HDL cholesterol concentration than did the low-fat diet at all assessments points during the two-year study.
2. Nonoptimal Lipid Levels in Young Adulthood Leads to Atherosclerosis Later in Life
Link to summary (live at 5:00 p.m. on August 2): http://annals.org/content/153/3/I-25
Dyslipidemia (high cholesterol and triglycerides) causes coronary heart disease in older patients. However, it is not known if nonopitmal lipid levels in otherwise healthy young adults contribute to atherosclerosis later in life. Researchers studied 3,258 patients between the ages of 18 and 30 to determine whether those with abnormal lipid levels were more likely to have calcium buildup in their coronary arteries later in life. The researchers found associations between cumulative exposure to dyslipidemia at a young age and the presence of coronary artery calcium 15 to 20 years later. They conclude that young people should develop healthy habits early in life, as what they eat and how much they exercise now can have lasting effects on their heart health.
3. Drug Trials Funded by Industry More Likely to Report Positive Outcomes
Article link (live at 5:00 p.m. on August 2): http://annals.org/content/153/3/158.abstract
Clinicaltrials.gov is a publicly available database that provides details of clinical trials. Researchers studied 546 drug trials listed at clinicaltrials.gov to determine if funding source was associated with published outcomes. Of the trials studied, 346 (63 percent) were primarily funded by industry, 74 (14 percent) by government, and 126 (23 percent) by nonprofit or nonfederal organizations. The researchers found that industry-funded trials reported positive outcomes in 85.4 percent of publications, compared with 50 percent for government-funded trials and 71.9 percent for organization-funded trials. Trials funded by nonprofit or nonfederal sources with industry contributions were also more likely to report positive outcomes than those without industry funding. In addition, industry-funded trials were less likely to be published within two years of completion than were trials with other funding sources.
4. Extended Time on Breathing Machine Often Leads to Disability, Extensive Care
Link to summary (live at 5:00 p.m. on August 2): http://annals.org/content/153/3/I-56
Each year, more than 300,000 critically ill patients receive breathing support for extended periods of time, which is known as "prolonged mechanical ventilation." Researchers conducted a one-year prospective cohort study to determine the trajectories of care and resource utilization for these patients. The study included 126 patients who received prolonged mechanical ventilation (ventilation for at least four days with tracheostomy placement, or ventilation for at least 21 days without tracheostomy), their 126 surrogates, and 54 intensive care unit physicians. The researchers interviewed physicians in the hospital to elicit prognosis. They interviewed all 126 patients and their surrogates in the hospital and at three and 12 months after discharge to determine the patients' survival, functional status, and type and duration of postdischarge care. The researchers found that patients on prolonged ventilation have poor outcomes in the next year. If they survive, they often are profoundly disabled and require extensive care. They conclude that surrogate decision makers should be fully informed of the risks and benefits when considering a course of prolonged life support.
5. ACP Publishes its Process for Developing Clinical Recommendations
Article link (live at 5:00 p.m. on August 2): http://annals.org/content/153/3/194.abstract
Clinical recommendations from ACP represent the official opinion of the College. Originally, the Clinical Guidelines Committee of the American College of Physicians (ACP) was established to evaluate medical advances and develop clinical recommendations for diagnostic tests and technologies. Today, ACP clinical guidelines have expanded to address screening, diagnosis, and treatment of diseases relevant to internal medicine and its subspecialties. Both clinical practice guidelines and clinical guidance statements follow a multistep development process that includes a systematic review of the evidence, deliberation of the evidence by the committee, summary recommendations, and evidence and recommendations grading. Funding for ACP recommendations comes from the ACP operational budget. Members of the Clinical Guidelines Committee are volunteers, and are not paid for their time.
Early Release Announcement:
A progress report on the state of comparative effectiveness research (CER) will be released early online at www.annals.org. Author, Dr. Harold C. Sox, chaired an Institute of Medicine committee that identified priorities for CER In June 2009.
Journal
Annals of Internal Medicine