scholarly journals “It’s just a great muddle when it comes to food”: a qualitative exploration of patient decision making around diet and gout

2021 ◽  
Author(s):  
Jennifer Liddle ◽  
Jane C Richardson ◽  
Samantha L Hider ◽  
Christian D Mallen ◽  
Lorraine Watson ◽  
...  
Keyword(s):  
Weight Loss ◽  
Secondary Analysis ◽  
Dietary Advice ◽  
Dietary Modification ◽  
Control Belief ◽  
Patient Decision Making ◽  
Dietary Changes ◽  
Professional Beliefs ◽  
Lowering Therapy ◽  
Qualitative Exploration

Abstract Objective To understand whether, why and how patients choose to modify their diets after developing gout. Methods An inductive thematic secondary analysis of qualitative data from 43 interviews and 4 focus groups with UK participants with gout (n = 61). Results Participants commonly initiated dietary changes as part of a self-management strategy for gout. Reasons for making such dietary changes included: desperation; a desire for control; belief that it would be possible to achieve successful management through diet al.one; but not weight loss. Participants who did not make changes, or reverted to previous dietary patterns, did so because: they believed urate-lowering therapy was successfully managing their gout; medication allowed ‘normal’ eating’; they did not find ‘proof’ that diet would be an effective treatment; the dietary advice they found was unrealistic, unmanageable or irrelevant. Dietary modification was patient-led but patients would have preferred the support of a healthcare professional. Beliefs that diet could potentially explain and modify the timing of flares gave patients a sense of control over the condition. However, the belief that gout could be controlled through dietary modification appeared to be a barrier to acceptance of management with urate-lowering therapy (ULT). Conclusions Perceptions about gout and diet play a large role in the way patients make decisions about how to manage gout in their everyday lives. Addressing reasons why patients explore dietary ‘solutions’, promoting the value of ULT and weight loss, and drawing on strong evidence to communicate clearly, will be crucial in improving long-term clinical management and patient experience.

scholarly journals OP0172 EFFECT OF WEIGHT LOSS AND LIRAGLUTIDE ON SERUM URATE LEVELS AMONG OBESE KNEE OSTEOARTHRITIS PATIENTS: SECONDARY ANALYSIS OF A RANDOMISED CONTROLLED TRIAL

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 107.1-108
Author(s):  
K. Zobbe ◽  
S. M. Nielsen ◽  
R. Christensen ◽  
A. Overgaard ◽  
H. Gudbergsen ◽  
...  
Keyword(s):  
Weight Loss ◽  
Knee Osteoarthritis ◽  
Secondary Analysis ◽  
Serum Urate ◽  
Advisory Board ◽  
Research Support ◽  
Blood Samples ◽  
Diet Intervention ◽  
Lowering Drug ◽  
The Impact

Background:There is a strong association between gout and obesity. Lowering urate is the cornerstone of gout management [1] and urate levels correlate strongly with central obesity. Previous studies suggest that weight loss has a positive effect on serum urate, however, the studies are sparse and small [2].Objectives:To assess the impact of an initial low-calorie diet-induced weight loss and subsequent randomisation to the body weight-lowering drug liraglutide (a glucagon-like peptide 1 receptor agonist) or placebo on serum urate levels.Methods:In the LOSE-IT trial (NCT02905864), a randomised, double-blinded, placebo-controlled, parallel group, single-centre trial [3], 156 obese individuals with knee osteoarthritis, but without gout, were offered an initial 8-week intensive diet intervention (week -8 to 0) on Cambridge Weight Plan (800-1000 kcal/day) followed by a weight loss maintenance period in which participants were randomised to either liraglutide 3 mg/day or placebo for 52 weeks. We conducted a secondary analysis of blood samples collected at week -8, 0 and 52. The primary outcome measure was change in serum urate. We used paired t-test for the change from week -8 to 0, and for change from week 0 to 52 we used an ANCOVA model adjusted for stratification factors (sex, age category and obesity class), and the level of the outcome at baseline. Data were analysed as observed (i.e. no imputation of missing data).Results:156 individuals were randomised and 155 had blood samples taken at baseline. In the initial intensive diet intervention period (week -8 to 0) they lost a mean of 12.5 kg (95% CI -13.1 to -11.9, n 156). In the following 52 weeks, the liraglutide group lost an additional 4.1 kg (SE 1.2, n 71) whereas the control group was almost unchanged with a weight loss of 0.2 kg (SE 1.2, n 66). Looking at the main outcome of serum urate levels change, the initial intensive diet resulted in a mean decrease of 0.21 mg/dL (95% CI 0.35 to 0.07, n 155) for the entire cohort. In the following year (week 0 to 52) the liraglutide group exhibited a further mean decrease in serum urate of 0.48 mg/dL (SE 0.11, n 69), whereas the placebo group exhibited a slight decrease in mean serum urate of 0.07 mg/dL (SE 0.12, n 65) resulting in a significant between-group difference of -0.40 mg/dL (95% CI -0.69 to -0.12, n 134) – see Figure 1. Four participants in each group experienced serious adverse events; no deaths were observed.Conclusion:This secondary analysis of the LOSE-IT trial suggests that liraglutide provides a potential novel serum urate lowering drug mechanism in obese patient populations, with potential implication for gout treatment.References:[1]Richette P et al. 2016.Ann Rheum Dis2017;76:29–42.[2]Nielsen SM et al.Ann Rheum Dis2017 76(11):1870-1882.[3]Gudbergsen H et al.BMJ2019. 71–2.Disclosure of Interests:Kristian Zobbe: None declared, Sabrina Mai Nielsen: None declared, Robin Christensen: None declared, Anders Overgaard: None declared, henrik gudbergsen Speakers bureau: Pfizer 2016, Marius Henriksen: None declared, Henning Bliddal Grant/research support from: received research grant fra NOVO Nordic, Consultant of: consultant fee fra NOVO Nordic, Lene Dreyer: None declared, Lisa Stamp: None declared, Filip Krag Knop Shareholder of: Minority shareholder in Antag Therapeutics Aps, Grant/research support from: AstraZeneca, Gubra, Novo Nordisk, Sanofi and Zealand Pharma, Consultant of: Amgen, AstraZeneca, Boehringer Ingelheim, Carmot Therapeutics, Eli Lilly, MSD/Merck, Mundipharma, Novo Nordisk, Sanofi and Zealand Pharma., Speakers bureau: AstraZeneca, Bayer, Boehringer Ingelheim, Eli Lilly, MedImmune, MSD/Merck, Mundipharma, Norgine, Novo Nordisk, Sanofi and Zealand Pharma., Lars Erik Kristensen Consultant of: UCB Pharma (Advisory Board), Sannofi (Advisory Board), Abbvie (Advisory Board), Biogen (Advisory Board), Speakers bureau: AbbVie, Amgen, Biogen, Bristol-Myers Squibb, Celgene, Eli Lilly, Gilead, Forward Pharma, Janssen Pharmaceuticals, MSD, Novartis, Pfizer, and UCB Pharma

scholarly journals The Effects of Time-Restricted Eating versus Standard Dietary Advice on Weight, Metabolic Health and the Consumption of Processed Food: A Pragmatic Randomised Controlled Trial in Community-Based Adults

Nutrients ◽  
2021 ◽  
Vol 13 (3) ◽  
pp. 1042
Author(s):  
Nicholas Phillips ◽  
Julie Mareschal ◽  
Nathalie Schwab ◽  
Emily Manoogian ◽  
Sylvie Borloz ◽  
...  
Keyword(s):  
Weight Loss ◽  
Randomised Controlled Trial ◽  
Controlled Trial ◽  
Smartphone Application ◽  
Metabolic Health ◽  
Dietary Advice ◽  
Processed Food ◽  
Significant Difference ◽  
Randomised Controlled ◽  
Pragmatic Randomised Controlled Trial

Weight loss is key to controlling the increasing prevalence of metabolic syndrome (MS) and its components, i.e., central obesity, hypertension, prediabetes and dyslipidaemia. The goals of our study were two-fold. First, we characterised the relationships between eating duration, unprocessed and processed food consumption and metabolic health. During 4 weeks of observation, 213 adults used a smartphone application to record food and drink consumption, which was annotated for food processing levels following the NOVA classification. Low consumption of unprocessed food and low physical activity showed significant associations with multiple MS components. Second, in a pragmatic randomised controlled trial, we compared the metabolic benefits of 12 h time-restricted eating (TRE) to standard dietary advice (SDA) in 54 adults with an eating duration > 14 h and at least one MS component. After 6 months, those randomised to TRE lost 1.6% of initial body weight (SD 2.9, p = 0.01), compared to the absence of weight loss with SDA (−1.1%, SD 3.5, p = 0.19). There was no significant difference in weight loss between TRE and SDA (between-group difference −0.88%, 95% confidence interval −3.1 to 1.3, p = 0.43). Our results show the potential of smartphone records to predict metabolic health and highlight that further research is needed to improve individual responses to TRE such as a shorter eating window or its actual clock time.

scholarly journals ‘Not just a piece of skin in front of you’—a qualitative exploration of the experiences of adolescents with eczema and psoriasis with healthcare professionals

BMJ Open ◽  
2021 ◽  
Vol 11 (1) ◽  
pp. e041108
Author(s):  
Isabella Joy de Vere Hunt ◽  
Abigail McNiven ◽  
Amanda Roberts ◽  
Himesh Parmar ◽  
Tess McPherson
Keyword(s):  
Young People ◽  
Skin Disease ◽  
Healthcare Professionals ◽  
Healthcare Delivery ◽  
Healthcare Providers ◽  
Secondary Analysis ◽  
Emotional Impact ◽  
Skin Conditions ◽  
The Uk ◽  
Qualitative Exploration

BackgroundThere is little qualitative research in the UK focussing on adolescents’ experience of their healthcare providers, and inflammatory skin conditions are a common heath problem in adolescence.AimTo explore the experiences of adolescents with eczema and psoriasis with healthcare professionals, and to distil the participants’ key messages for their healthcare providers.DesignThis is a secondary thematic analysis of interviews with adolescents with eczema or psoriasis.ParticipantsThere were a total of 41 text transcripts of interviews with young people with eczema or psoriasis who had given permission for secondary analysis; 23 of the participants had eczema, and 18 psoriasis. Participants were living in the UK at time of interview, and aged 15–24 years old.ResultsWe have distilled the following key messages from young people with eczema and psoriasis for healthcare providers: (1) address the emotional impact; (2) give more information, with the subtheme and (3) appreciate patient research. We identified the following eczema-specific themes: (ECZ-4) ‘It’s not taken seriously’; (ECZ-5) offer choice in treatment and (ECZ-6) lack of structure/conflicting advice. Two psoriasis-specific themes were identified: (PSO-4) feeling dehumanised/treat me as a person; and (PSO-5) think about how treatments will affect daily life.ConclusionThis qualitative data analysis highlights the need for greater recognition of the emotional impact of skin disease in adolescence, and for more comprehensive provision of information about the conditions. We call for greater sensitivity and flexibility in our approach to adolescents with skin disease, with important implications for healthcare delivery to this group.

scholarly journals Changes in blood lipid concentrations associated with changes in intake of dietary saturated fat in the context of a healthy low-carbohydrate weight-loss diet: a secondary analysis of the Diet Intervention Examining The Factors Interacting with Treatment Success (DIETFITS) trial

2019 ◽  
Vol 109 (2) ◽  
pp. 433-441 ◽  
Author(s):  
Cynthia W Shih ◽  
Michelle E Hauser ◽  
Lucia Aronica ◽  
Joseph Rigdon ◽  
Christopher D Gardner
Keyword(s):  
Weight Loss ◽  
Lipid Profile ◽  
Secondary Analysis ◽  
Saturated Fat ◽  
Blood Lipid ◽  
Carbohydrate Intake ◽  
Fat Intake ◽  
Weight Loss Diet ◽  
Low Carbohydrate ◽  
Saturated Fat Intake

ABSTRACTBackgroundFor low-carbohydrate diets, a public health approach has focused on the replacement of carbohydrates with unsaturated fats. However, little research exists on the impacts of saturated fat intake on the lipid profile in the context of whole-food-based low-carbohydrate weight-loss diets.ObjectivesThe primary aim of this secondary analysis of the DIETFITS weight loss trial was to evaluate the associations between changes in percentage of dietary saturated fatty acid intake (%SFA) and changes in low-density lipoproteins, high-density lipoproteins, and triglyceride concentrations for those following a healthy low-carbohydrate (HLC) diet. The secondary aim was to examine these associations specifically for HLC dieters who had the highest 12-month increases in %SFA.MethodsIn the DIETFITS trial, 609 generally healthy adults, aged 18–50 years, with body mass indices of 28–40 kg/m2 were randomly assigned to a healthy low-fat (HLF) or HLC diet for 12 months. In this analysis, linear regression, both without and with adjustment for potential confounders, was used to measure the association between 12-month change in %SFA and blood lipids in 208 HLC participants with complete diet and blood lipid data.ResultsParticipants consumed an average of 12–18% of calories from SFA. An increase of %SFA, without significant changes in absolute saturated fat intake, over 12 months was associated with a statistically significant decrease in triglycerides in the context of a weight-loss study in which participants simultaneously decreased carbohydrate intake. The association between increase in %SFA and decrease in triglycerides was no longer significant when adjusting for 12-month change in carbohydrate intake, suggesting carbohydrate intake may be a mediator of this relationship.ConclusionsThose on a low-carbohydrate weight-loss diet who increase their percentage intake of dietary saturated fat may improve their overall lipid profile provided they focus on a high-quality diet and lower their intakes of both calories and refined carbohydrates. This trial was registered at clinicaltrials.gov as NCT01826591.

scholarly journals A Simple Liking Survey Captures Behaviors Associated with Weight Loss in a Worksite Program among Women at Risk of Type 2 Diabetes

Nutrients ◽  
2021 ◽  
Vol 13 (4) ◽  
pp. 1338
Author(s):  
Mastaneh Sharafi ◽  
Pouran Faghri ◽  
Tania B. Huedo-Medina ◽  
Valerie B. Duffy
Keyword(s):  
Physical Activity ◽  
Weight Loss ◽  
Latent Variable ◽  
Secondary Analysis ◽  
Diabetes Prevention Program ◽  
Analysis Of Covariance ◽  
Term Care ◽  
Variable Approach ◽  
Average Loss ◽  
Highly Correlated

In a secondary analysis, we assessed the ability of dietary and physical activity surveys to explain variability in weight loss within a worksite-adapted Diabetes Prevention Program. The program involved 58 overweight/obese female employees (average age = 46 ± 11 years SD; average body mass index = 34.7 ± 7.0 kg/m2 SD) of four long-term care facilities who survey-reported liking and frequency of dietary and physical activity behaviors. Data were analyzed using a latent variable approach, analysis of covariance, and nested regression analysis to predict percent weight change from baseline to intervention end at week 16 (average loss = 3.0%; range—6% gain to 17% loss), and follow-up at week 28 (average loss = 2.0%; range—8% gain to 16% loss). Using baseline responses, restrained eaters (reporting liking but low intakes of high fat/sweets) achieved greater weight loss at 28 weeks than those reporting high liking/high intake (average loss = 3.5 ± 0.9% versus 1.0 ± 0.8% S.E., respectively). Examining the dietary surveys separately, only improvements in liking for a healthy diet were associated significantly with weight loss (predicting 44% of total variance, p < 0.001). By contrasting liking versus intake changes, women reporting concurrent healthier diet liking and healthier intake lost the most weight (average loss = 5.4 ± 1.1% S.E.); those reporting eating healthier but not healthier diet liking (possible misreporting) gained weight (average gain = 0.3 ± 1.4% S.E.). Change in liking and frequency of physical activity were highly correlated but neither predicted weight loss independently. These pilot data support surveying dietary likes/dislikes as a useful measure to capture dietary behaviors associated with weight loss in worksite-based programs. Comparing dietary likes and intake may identify behaviors consistent (appropriate dietary restraint) or inconsistent (misreporting) with weight loss success.

scholarly journals Session 3 (Joint with the British Dietetic Association): Management of obesity Weight-loss interventions in the treatment of obesity

2009 ◽  
Vol 69 (1) ◽  
pp. 34-38 ◽  
Author(s):  
C. R. Hankey
Keyword(s):  
Physical Activity ◽  
Weight Loss ◽  
Energy Expenditure ◽  
Energy Intake ◽  
Weight Maintenance ◽  
Dietary Advice ◽  
Excess Body Weight ◽  
Lifestyle Interventions ◽  
Post Intervention ◽  
Weight Losses

Treatments to induce weight loss for the obese patient centre on the achievement of negative energy balance. This objective can theoretically be attained by interventions designed to achieve a reduction in energy intake and/or an increase in energy expenditure. Such ‘lifestyle interventions’ usually comprise one or more of the following strategies: dietary modification; behaviour change; increases in physical activity. These interventions are advocated as first treatment steps in algorithms recommended by current clinical obesity guidelines. Medication and surgical treatments are potentially available to those unable to implement ‘lifestyle interventions’ effectively by achieving losses of between 5 kg and 10 kg. It is accepted that the minimum of 5% weight loss is required to achieve clinically-meaningful benefits. Dietary treatments differ widely. Successful weight loss is most often associated with quantification of energy intake rather than macronutrient composition. Most dietary intervention studies secure a weight loss of between 5 kg and 10 kg after intervention for 6 months, with gradual weight regain at 1 year where weight changes are 3–4 kg below the starting weight. Some dietary interventions when evaluated at 2 and 4 years post intervention report the effects of weight maintenance rather than weight loss. Specific anti-obesity medications are effective adjuncts to weight loss, in most cases doubling the weight loss of those given dietary advice only. Greater physical activity alone increases energy expenditure by insufficient amounts to facilitate clinically-important weight losses, but is useful for weight maintenance. Weight losses of between half and three-quarters of excess body weight are seen at 10 years post intervention with bariatric surgery, making this arguably the most effective weight-loss treatment.

Abstract P066: A Refined Carbohydrate Diet Attenuates Weight Loss in Insulin Resistant Individuals

Circulation ◽  
2012 ◽  
Vol 125 (suppl_10) ◽  
Author(s):  
Kristina A Harris ◽  
Sheila G West ◽  
Jack P Vanden Heuvel ◽  
Penny M Kris-Etherton
Keyword(s):  
Weight Loss ◽  
Waist Circumference ◽  
Secondary Analysis ◽  
Density Lipoprotein ◽  
Whole Grains ◽  
Interaction Time ◽  
P Value ◽  
Refined Grains ◽  
Cholesterol Ratio ◽  
Insulin Resistant

Introduction: Weight loss is attenuated in individuals with insulin resistance (IR) who follow a traditional high-carbohydrate, calorie-restricted diet. However, the type of carbohydrate may modulate this response. We studied the effects of whole grains vs. refined grains on weight loss in individuals with increased waist circumference (M: >102 cm, F: >88 cm) and at least 1 other metabolic syndrome characteristic. Hypothesis: In a secondary analysis, we hypothesized that IR individuals (estimated by a triglyceride:high-density lipoprotein cholesterol ratio > 3.5) would lose more weight on a hypocaloric diet with whole grains vs. refined grains. Methods: Overweight or obese (BMI 25–42 kg/m2) men and women (n=50) 35–55 yrs were randomized to a controlled-feeding diet with whole vs. refined grains for 12 weeks [6 weeks isocaloric then 6 weeks hypocaloric (∼500 kcal/d)]. Results: [All comparisons represented as IR mean±SEM vs. insulin sensitive (IS) mean±SEM, p-value)]. Compared to the IS group (n=29), the IR group (n=21) was predominately male (14 M/7 F vs. 11M/18F, p=0.04), weighed more (107.5±3.3 vs. 93.9±3.0 kg, p=0.005), and had increased waist circumference (113±2.2 vs. 106±1.5 cm, p=0.02). IR status did not affect overall percent body weight (%BW) lost over the course of the study (−4.0±0.4 vs. −4.5±0.3 %BW; p for interaction, time x IR status = 0.34). However, IR status did affect %BW lost when the type of carbohydrate was considered (p for interaction, time x IR status x diet = 0.04; Figure ). Post-hoc analysis revealed that within the refined grain group, IR participants lost less %BW than the IS participants (−4.14±0.4 vs. −5.84±0.5 %BW, adjusted p=0.04). On the whole grains diet, %BW lost was similar in the IS and IR groups. Conclusion: In conclusion, IR individuals lost less %BW than IS individuals on the hypocaloric refined grain diet. Limiting refined grains may improve the efficacy of traditional weight loss diets in IR individuals. Figure. %BW lost in IR and IS groups on refined grain diet, *p=0.04.

scholarly journals Adiposity, education and weight loss effort are independently associated with energy reporting quality in the Ontario Food Survey

2007 ◽  
Vol 10 (8) ◽  
pp. 803-809 ◽  
Author(s):  
Heather Ward ◽  
Valerie Tarasuk ◽  
Rena Mendelson
Keyword(s):  
Weight Loss ◽  
Food Insecurity ◽  
Multivariate Regression ◽  
Secondary Analysis ◽  
Primary Source ◽  
Reporting Quality ◽  
Personal Characteristics ◽  
Total Energy Expenditure ◽  
Regression Analyses ◽  
Men And Women

AbstractObjectivesTo examine the associations of adiposity, dietary restraint and other personal characteristics with energy reporting quality.Design/subjectsSecondary analysis of 230 women and 158 men from the 1997/98 Ontario Food Survey.MethodsEnergy reporting quality was estimated by ratios of energy intake (EI) to both basal metabolic rate (BMR) and total energy expenditure (TEE). Multivariate regression analyses were conducted to examine energy reporting quality between two dietary recalls and in relation to body mass index (BMI) with adjustment for potential confounders. Energy reporting quality was explored across categories of age, BMI, income, education, dieting status and food insecurity through analysis of variance (ANOVA).ResultsFrom the ANOVA, energy reporting quality was associated with BMI group, age category and weight loss for men and women, as well as with education among women (P < 0.05). The multivariate regression analyses indicated that energy reporting quality was positively associated with education and inversely associated with obesity and dieting. No associations were observed in relation to food insecurity or income (P>0.05). EI:BMR and EI:TEE on the first and second 24-hour recalls were positively related (P < 0.0001 for men and women). A higher proportion of variance in energy reporting quality was explained for women than for men (R2 = 0.19 and 0.14, respectively).ConclusionsStudies of diet and adiposity are probably hindered to some extent by BMI-related variation in energy reporting quality. Methods to address this issue are urgently needed if population surveys will continue to serve as the primary source of dietary intake data.

Conviction and Confidence for Dietary Changes Predict Early Weight Loss in a Lifestyle Modification Intervention

2011 ◽  
pp. P1-459-P1-459
Author(s):  
Marie-Eve Domingue ◽  
Jean-Patrice Baillargeon ◽  
Christine Brown ◽  
Vicki Lebrun ◽  
Marie-France Langlois
Keyword(s):  
Weight Loss ◽  
Lifestyle Modification ◽  
Dietary Changes ◽  
Early Weight Loss ◽  
Modification Intervention
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