Key Articles MORE Flashcards
Key article 1: Intensive lifestyle changes for reversal of coronary heart disease
Which of the following statements about the Lifestyle Heart Trial is correct?
A. The main outcome measures were adherence to intensive lifestyle changes, changes in coronary artery percent diameter stenosis, and cardiac events.
B. There were more than 2.5 times as many cardiac events per patient in the control group than in the experimental group.
C. There was a strong correlation between adherence and percent diameter stenosis after one year in a dose-response relationship .
D. There was no difference in the reported frequency of angina after one year between the two groups.
Correct answer = A (p2001)
B - more than twice as many (p2005)
C - 5 years not 1 year (p 2004)
D - The reported frequency of angina after one year decreased in the experimental group, but increased in the control group (p2004)
Key article 2: Reduction in the Incidence of Type 2 Diabetes with Lifestyle Intervention or Metformin (Diabetes Prevention Program)
Which of the following statements about the Diabetes Prevention Program trial is correct?
A. The reduction in incidence of diabetes was almost twice as effective in the lifestyle intervention group then in the metformin group.
B. Type 2 diabetes can be prevented or delayed in persons at high risk for the disease using metformin, but not lifestyle modification.
C. The reduction in HbA1c was similar in the lifestyle intervention group and the metformin group.
D. The intensive lifestyle intervention was more effective in younger participants than in older participants.
Correct answer = A
B - metformin and lifestyle modification are effective
C - reduction in HbA1c - lifestyle intervention > metformin
D - at least as effective in older participants as it was in younger participants
Key article 3: Effects of a Dietary Portfolio vs Lovastatin (2003)
Which of the following statements is the most accurate regarding the Dietary Portfolio study?
A. Participants lost the most weight in the dietary portfolio group.
B. The reduction in blood lipids in both the dietary portfolio and statin groups were significantly greater than the respective changes in the control group for LDL-C and LDL-C:HDL-C ratio.
C. There was no significant reduction in CRP in the dietary portfolio and statin groups relative to the control group.
D. The LDL-C reduced by 35% in the dietary portfolio group.
Correct answer = B
A - Participants lost a similar amount of weight in all 3 treatments (p506)
C - Statistically significant difference in CRP (p507)
D - 28.6% (p506)
Key article 4: PCI Compared With Exercise Training in Patients With Stable CAD
In regards to a study comparing PCI with exercise training in patients with stable CAD, which of the following statements is true?
A. The difference in costs between the two interventions was not statistically significant.
B. The exercise training group exercised on bicycle ergometer close to target heart rate (70% of maximal heart rate) for 20 minutes per day and participated in one 60-minute group training session of aerobic exercise per week.
C. Exercise training was more effective than PCI in improving symptom-free exercise tolerance.
D. Standard PCI intervention resulted in a higher event-free survival rate than with the 12-month exercise training program.
Correct answer = B
A - Training intervention was significantly more cost-effective ($3708 vs $6086) (p1376)
C - Both PCI and exercise training were equally effective in improving symptom-free exercise tolerance (p1376)
D - 12-month exercise training program resulted in a higher event-free survival rate than with standard PCI intervention (p1376)
Key article 5: Comparison of the Atkins, Ornish, Weight Watchers, and Zone Diets for Weight Loss and Heart Disease Risk Reduction
In a study examining weight loss and reduction in cardiac risk factors using 4 different diets, which of the following statements is not true?
A. Approximately 25% of participants in each diet group sustained a mean adherence level of at least 6 out of 10, which appeared to delineate a clinically meaningful adherence level.
B. All 4 diets resulted in modest statistically significant weight loss at 1 year with no statistically significant differences between diets.
C. For each diet, weight loss was significantly associated with changes in total cholesterol, CRP and insulin levels, regardless of diet type.
D. The amount of weight loss predicted the amount of improvement in several cardiac risk factors.
Correct answer = C
Not total cholesterol, but total/HDL cholesterol ratio (p50)
Key article 6: Changes in prostate gene expression in men undergoing an intensive nutrition and lifestyle intervention
In relation to a study examining changes in prostate gene expression following comprehensive lifestyle changes, which of the following statements is incorrect?
A. Total PSA did not change significantly, but the percent free PSA improved.
B. There were significant reductions in the psychological distress associated with prostate cancer.
C. There were significant reductions in both the mental health and physical health quality of life.
D. A set of RAS family oncogenes (RAN, RAB14, RAB8A) were downregulated.
Correct answer - C
Mental health QOL also improved. Physical health QOL was stable (p8371)
Key article 7: Effect of comprehensive lifestyle changes on telomerase activity and telomere length in men with biopsy-proven low-risk prostate cancer
In relation to a study examining the effects of comprehensive lifestyle changes on telomerase activity and telomere length in men with early-stage prostate cancer, which of the following statements is incorrect?
A. After 5 years, relative telomere length had increased in the lifestyle intervention group and decreased in the control group; the difference between the two groups was significant.
B. The median change in telomerase activity at 5 years was significantly higher in the intervention group than in the control group.
C. There was a correlation between the degree of adherence to the lifestyle changes and the extent of change in relative telomere length.
D. Participants in the lifestyle intervention group made more lifestyle changes than those in the control group.
Correct answer = B
The median change in telomerase activity at 5 years did not differ significantly between the two groups (p5)
Key article 8: Reversal of type 2 diabetes: normalisation of beta cell function in association with decreased pancreas and liver triacylglycerol
In a study testing to see if calorie restriction can reverse type 2 diabetes, which of the following statements is incorrect?
A. The total energy intake was about 600kcal/day.
B. Following the intervention, participants gained 3.1 ± 1.0kg body weight over 12 weeks; their HbA1c also increased.
C. Over the 8 weeks of dietary energy restriction, beta cell function increased towards normal and pancreatic fat decreased.
D. In the first 7 days of the reduced energy intake, fasting blood glucose and hepatic insulin sensitivity fell to normal, and intrahepatic lipid decreased by 30%.
Correct answer = B
HbA1c did not change
Key article 9: Association of an Intensive Lifestyle Intervention With Remission of Type 2 Diabetes (Look AHEAD study)
In reference to a trial studying long-term intensive lifestyle intervention and remission of type 2 diabetes, which of the following statements is FALSE?
A. The absolute prevalence of complete remission was high: 26% for ILI vs 2% for DSE at year 1.
B. Participants in the ILI group lost significantly more weight than DSE participants at year 1 and at year 4
C. Participants in the ILI group had greater increase in fitness at both year 1 and at year 4
D. ILI participants were significantly more likely to experience any remission (partial or complete)
Correct answer = A
The absolute prevalence of complete remission was low, ranging from 1.3% for ILI vs 0.1% for DSE at year 1 to 0.7% for ILI vs 0.2% for DSE in year 4 (p2492)
Key article 10: Effect of Low-Fat vs Low-Carbohydrate Diet on 12-Month Weight Loss in Overweight Adults and the Association With Genotype Pattern or Insulin Secretion (DIETFITS)
In a study comparing a healthy low-fat diet with a healthy low-carbohydrate diet, which of the following statements is correct?
A. The healthy low-fat diet group showed more favourable changes in HDL cholesterol.
B. The healthy low-carbohydrate group showed more favourable changes in LDL cholesterol.
C. The dietary intake of fats and carbohydrates was poorly differentiated between the two diet groups.
D. There was no significant difference in 12-month weight loss between the HLF and HLC diets.
Correct answer = D
A - The healthy low-fat diet group showed more favourable changes in LDL cholesterol. (p677)
B - The healthy low-carbohydrate group showed more favourable changes in HDL cholesterol and triglycerides. (p677)
C - The dietary intake of fats and carbohydrates was well differentiated between the two diet groups. (p676)
Key article 11: Primary Care-Led Weight Management for Remission of Type 2 Diabetes (DiRECT)
A trial in primary care setting showed that intensive weight management could achieve remission of type 2 diabetes. Which of the following regarding this trial is incorrect?
A. Diabetes remission was recorded in 68 (46%) participants in the intervention group and no participants in the control group.
B. At 12 months, weight loss of 15 kg or more was recorded in 36 (24%) participants in the intervention group and no participants in the control group.
C. For all 298 participants, diabetes remission was achieved by no participant who did not lose weight at 12 months.
D. Anti-hypertensive drugs had been withdrawn in 38 (48%) of 80 participants who had taken them at baseline in the intervention group, and in no participants in the control group.
Correct answer = A
Diabetes remission was recorded in 68 (46%) participants in the intervention group and six (4%) participants in the control group (p545)
Key article 13: From Diabetes Care to Diabetes Cure - The Integration of Systems Biology, eHealth, and Behavioral Change
In an article reviewing the holistic management of type 2 diabetes, which of the following statements is incorrect?
A. Lifestyle intervention can bring about significant improvements in risk factors for cardiovascular disease in T2D patients, as indicated by a meta-analysis of studies.
B. Fasting, including caloric energy restriction and different intermittent fasting regimes, has been shown effective in weight loss, improving insulin sensitivity, and decreasing cardiovascular risk in both non-diabetic and diabetic subjects.
C. There is no role for medication in the management of type 2 diabetes as medications do not address the root cause of type 2 diabetes and will thus not cure the patient.
D. The use of mobile app-based interventions has been shown to yield a clinically significant
HbA1c reduction among adults with type 2 diabetes.
Correct answer = C
In a fully integrated approach to cure of T2D, lifestyle and medication should (sometimes) be combined. (p8)
