VLED and formula LED in the management of type 2 diabetes: defining the clinical need and research requirements

It has been known for many years that substantial weight loss, achieved by bariatric surgery or non-surgical means can mean normalise glucose tolerance. Recent RCT evidence indicates that >15 kg weight loss is necessary, to this and it may lead to near normalisation (doubling) of life expectancy. Less than 5% of patients achieve this through even the best, evidence-based medical weight management programme (Counterweight www.counterweight.org ). A weight loss of >15 kg is easily achievable by 8 weeks VLED/LELD in compliant patients, with little difference between 400-800 kcal/day, but weight maintenance after VLED has until recently been so poor that VLEDs are not, at present, recommended in clinical guidelines. However, mean weight loss close to >15 kg can be maintained 18-24 months using a variety of maintenance strategies. These include a structured reintroduction of foods linked to an education programme with behavioural strategies, intermittent VLED use and prescribable anti-obesity drugs (dexfenfluramine, orlistat, sibutramine). Most of these studies have been in non-diabetic subjects. A new “curative” paradigm in T2DM management, aiming to normalise glucose tolerance and health risks by achieving and maintaining >15 kg loss, as soon as possible after diagnosis, should be highly acceptable to patients, generating many additional QALYs. It is likely to be highly cost-effective by avoiding the current recommended, mainly palliative, model, using polypharmacy which provides an overall risk reduction of only 5-10%.. Clinical trials are on-going to establish the feasibility of delivering formula (LELD) and a maintenance programme to large numbers of patients within routine primary care. There is urgent need, to run similar studies in diabetic patients. New approaches to long-term (lifelong) maintenance of weight loss and a non-diabetic state may include anti-obesity drugs

Contemporary challenges to iodine status and nutrition: the role of foods, dietary recommendations, fortification and supplementation

Iodine deficiency (ID) in women of childbearing age remains a global public health concern, mainly through its impact on fetal and infant neurodevelopment. While iodine status is improving globally, ID is still prevalent in pregnancy, when requirements increase. More than 120 countries have implemented salt iodisation and food fortification, strategies that have been partially successful. Supplementation during pregnancy is recommended in some countries and supported by the WHO when mandatory salt iodisation is not present. The UK is listed as one of the ten countries with the lowest iodine status globally, with approximately 60 % of pregnant women not meeting the WHO recommended intake. Without mandatory iodine fortification or recommendation for supplementation in pregnancy, the UK population depends on dietary sources of iodine. Both women and healthcare professionals have low knowledge and awareness of iodine, its sources or its role for health. Dairy and seafood products are the richest sources of iodine and their consumption is essential to support adequate iodine status. Increasing iodine through the diet might be possible if iodine-rich foods get repositioned in the diet, as they now contribute towards only about 13 % of the average energy intake of adult women. This review examines the use of iodine-rich foods in parallel with other public health strategies, to increase iodine intake and highlights the rare opportunity in the UK for randomised trials, due to the lack of mandatory fortification programmes

Legibility of electroluminescent instrument panels investigated

Legibility studies of several EL /electroluminescent/ displays correlate reading time and accuracy with number size, stroke/width ratio, indicia size, pointer width, contrast, ambient illumination, and color background and and contrast. Human factor criteria established on non-EL displays may not apply to EL displays

Eating the elephant whole or in slices: views of participants in a smoking cessation intervention trial on multiple behaviour changes as sequential or concurrent tasks

Background: This paper explores smoking cessation participants’ perceptions of attempting weight management alongside smoking cessation within the context of a health improvement intervention implemented in Glasgow, Scotland. <p/>Methods: One hundred and thirty-eight participants were recruited from smoking cessation classes in areas of multiple deprivation in Glasgow and randomised to intervention, receiving dietary advice, or to control groups. The primary outcome of the study was to determine the % change in body weight. Semi-structured interviews were conducted with a purposive sample of 15 intervention and 15 control participants at weeks 6 (during the intervention) and 24 (at the end of the intervention). The current paper, though predominantly qualitative, links perceptions of behaviour modification to % weight change and cessation rates at week 24 thereby enabling a better understanding of the mediators influencing multiple behaviour change. <p/>Results: Our findings suggest that participants who perceive separate behaviour changes as part of a broader approach to a healthier lifestyle, and hence attempt behaviour changes concurrently, may be at comparative advantage in positively achieving dual outcomes. <p/>Conclusions: These findings highlight the need to assess participants’ preference for attempting multiple behaviour changes sequentially or simultaneously in addition to assessing their readiness to change. Further testing of this hypothesis is warranted

Iodine and pregnancy – a UK cross-sectional survey of dietary intake, knowledge and awareness

Iodine is a key component of the thyroid hormones, which are critical for healthy growth, development and metabolism. The UK population is now classified as mildly iodine-insufficient. Adequate levels of iodine during pregnancy are essential for fetal neurodevelopment, and mild iodine deficiency is linked to developmental impairments. In the absence of prophylaxis in the UK, awareness of nutritional recommendations during pregnancy would empower mothers to make the right dietary choices leading to adequate iodine intake. The present study aimed to: estimate mothers' dietary iodine intake in pregnancy (using a FFQ); assess awareness of the importance of iodine in pregnancy with an understanding of existing pregnancy dietary and lifestyle recommendations with relevance for iodine; examine the level of confidence in meeting adequate iodine intake. A cross-sectional survey was conducted and questionnaires were distributed between August 2011 and February 2012 on local (Glasgow) and national levels (online electronic questionnaire); 1026 women, UK-resident and pregnant or mother to a child aged up to 36 months participated in the study. While self-reported awareness about general nutritional recommendations during pregnancy was high (96 %), awareness of iodine-specific recommendations was very low (12 %), as well as the level of confidence of how to achieve adequate iodine intake (28 %). Median pregnancy iodine intake, without supplements, calculated from the FFQ, was 190 μg/d (interquartile range 144–256μg/d), which was lower than that of the WHO's recommended intake for pregnant women (250 μg/d). Current dietary recommendations in pregnancy, and their dissemination, are found not to equip women to meet the requirements for iodine intake

Effects of moderate weight loss on anginal symptoms and indices of coagulation and fibrinolysis in overweight patients with angina pectoris

Objective: To evaluate the effects of moderate weight loss, in overweight patients with angina, on plasma coagulation, fibrinolytic indicies and pain frequency. Design: Single- stranded 12-week dietary intervention, an individualised eating plan with quantitative advice delivered by a dietitian. Target weight loss of 0.5 kg per week. Setting: Outpatient research clinic. Subjects: Fifty-four volunteers with angina pectoris were recruited. Five subjects withdrew, so 27 males, 22 females, mean body mass index (BMI) 29.3 (s.d. 4.3) kg/m(2) and age 60.3 (s.d. 6.5) y completed the intervention. Measurements: Body weight and frequency of anginal pain. Plasma fibrinogen, red cell aggregation (RCA), viscosity, factor VII activity, plasminogen activator inhibitor (PAI) activity, tissue plasminogen activator antigen (t-PA), plasma cholesterol, triglyceride and insulin. Results: After the 12-week dietary intervention period, mean body weight fell by 3.5 (s.d. 2.6) kg or 4.3% (P = 0.0001), range -11.7 to +1.7 kg. Mean angina frequency fell by 1.8 (s.d. 3.6) from 3.2 to 1.4 episodes/week (P = 0.009) and plasma cholesterol by 0.4 (s.d. 0.7) from 6.3 to 5.9 mmol/1 (P = 0.0001). HDL cholesterol and triglyceride were unchanged. Of the coagulation and fibrinolytic factors, factor VII activity and RCA were significantly reduced by 5 (s.d. 20), IU/dl (P = 0.04) and 1.3 (s.d. 1.3) arbitrary units (P = 0.014), respectively. Conclusions: A conventional dietetic intervention, resulting in 4% weight loss, offers the potential to reduce atherosclerotic and thrombotic risk, and to reduce pain frequency, in angina patients. Given the importance of this result in a public health context, these results indicate that this may be a fruitful area for future nutrition research

Binding Specificity and Causal Selection in Drug Design

Binding specificity is a centrally important concept in molecular biology, yet it has received little philosophical attention. Here I aim to remedy this by analyzing binding specificity as a causal property. I focus on the concept’s role in drug design, where it is highly prized and hence directly studied: From a causal perspective, understanding why binding specificity is a valuable property of drugs contributes to an understanding of causal selectionーof how and why scientists distinguish between causes, not just causes from non-causes. In particular, the specificity of drugs is precisely what underwrites their value as experimental interventions on biological processes

Scale-selective verification of rainfall accumulations from high-resolution forecasts of convective events

The development of NWP models with grid spacing down to 1 km should produce more realistic forecasts of convective storms. However, greater realism does not necessarily mean more accurate precipitation forecasts. The rapid growth of errors on small scales in conjunction with preexisting errors on larger scales may limit the usefulness of such models. The purpose of this paper is to examine whether improved model resolution alone is able to produce more skillful precipitation forecasts on useful scales, and how the skill varies with spatial scale. A verification method will be described in which skill is determined from a comparison of rainfall forecasts with radar using fractional coverage over different sized areas. The Met Office Unified Model was run with grid spacings of 12, 4, and 1 km for 10 days in which convection occurred during the summers of 2003 and 2004. All forecasts were run from 12-km initial states for a clean comparison. The results show that the 1-km model was the most skillful over all but the smallest scales (approximately <10–15 km). A measure of acceptable skill was defined; this was attained by the 1-km model at scales around 40–70 km, some 10–20 km less than that of the 12-km model. The biggest improvement occurred for heavier, more localized rain, despite it being more difficult to predict. The 4-km model did not improve much on the 12-km model because of the difficulties of representing convection at that resolution, which was accentuated by the spinup from 12-km fields