VP3- Chronic Diseases, IR, Epigenetics, Sleep Flashcards
Which of the following statements about the Appel DASH Diet study is most accurate?
A. This study showed that the DASH diet lowered blood pressure in those with HTN a similar amount as would beginning a medication.
B. The study used matched controls as a comparison to the DASH diet.
C. There were four arms in this randomized clinical trial.
D. Most blood pressure improvement occurred after two months of the intervention.
A.
This study showed that the DASH diet lowered blood pressure in those with hypertension a similar amount as would beginning a medication.
The study used a randomized parallel design with three arms (controls, fruit-and-vegetable diet, and DASH diet) rather than matched controls.
The fruit-and-vegetable diet was more effective than the control diet, and the DASH diet was > twice as effective as the fruit-and-vegetable diet.
The treatment effect in HTN subjects was -11 mmHg and -5.5 mmHg, roughly equivalent to starting a medication.
Most of the improvement occurred in the first two weeks
Which of the following statements is most accurate about the Lim Counterpoint study?
A. This study used a case-control design with matched controls.
B. The intervention used an ad libitum diet to improve fasting blood glucose and decrease triacylglycerol stores in the liver and pancreas.
C. The first-phase insulin response improved to almost equal that of the non-diabetic controls, while maximal insulin response improved and exceeded that of the controls.
D. Most improvement occurred in the final four weeks of the 8-week study.
C.
The first-phase insulin response improved to almost equal that of the non-diabetic controls, while maximal insulin response improved and exceeded that of the controls.
The study used a case-control design with non-diabetic controls (matched for age, gender and weight).
The intervention consisted of a total energy intake of ~600 kcal per day. This included 510 kcal per day liquid diet formula (comprised of 46.4% carbohydrate, 32.5% protein and 20.1% fat; vitamins, minerals and trace elements) supplemented with three portions of non-starchy vegetables.
The hypothesis tested was that beta cell failure and insulin sensitivity can be reversed with dietary restriction.
Most of the improvement occurred in the first week (not the last four weeks). Dietary restriction significantly reduced both fatty liver and fatty pancreas.
*Reversal of type 2 diabetes: normalization of beta cell function in association with decreased pancreas and liver triacylglycerol. Lim et al. Diabetologia. 2011 Oct;54(10):2506-14.
Which of the following statements about the Gregg LookAHEAD study is most accurate?
A. The intervention consisted of reducing caloric intake to 1,200 to 1,800 kcal per day, plus 175 minutes of physical activity.
B. The primary outcome was reversal of triacylglycerol in the pancreas.
C. This study used matched controls as a comparison group.
D. The intensive lifestyle intervention (ILI) was twice as effective as was the diabetes support and education (DSE).
E. Most of the improvement occurred in the last year of the intensive lifestyle intervention.
A.
The intervention consisted of reducing caloric intake to 1,200 to 1,800 kcal per day, plus 175 minutes of physical activity.
The hypothesis tested was that the intervention would produce partial or complete remission of diabetes (defined as: transition from meeting diabetes criteria to a prediabetes or nondiabetic level of glycemia; FPG <126 mg/dL (7mmol/L) and hemoglobin A1c <6.5% with no anti-hyperglycemic medication).
The study used a randomized parallel design with 2,241 people in the experimental group and 2,262 controls.
The prevalence of any remission was highest in the first year for the intensive lifestyle intervention.
The prevalence of remission was ~12% in the intensive intervention versus ~2% for the DSE in the first year, and ~7% versus 2% in the final year.
*Association of an Intensive Lifestyle Intervention with Remission of Type 2 Diabetes. Gregg et al. JAMA. 2012 Dec 19;308(23):2489-96.
Which of the following statements most accurately describes the findings of the Gregg LookAHEAD study?
A. A very low calorie diet and exercise did not make any significant difference in remission.
B. Insulin sensitivity remained the same for the intervention group and the controls.
C. Weight loss and physical activity reduced the incidence of type 2 diabetes in overweight individuals.
D. Partial or complete remission was many times greater with the intensive intervention (ILI) than the diabetes support and education (DSE), and weight loss and fitness were also greater.
E. Weight loss was essentially the same for the intervention group and the control group.
D.
Partial or complete remission was many times greater with the intensive intervention (ILI) than the diabetes support and education (DSE), and weight loss and fitness were also greater.
The prevalence or frequency of partial or complete remission was much greater for the intervention group than the DSE control group.
Insulin sensitivity was not an outcome and was not measured in this study.
The intensive intervention group lost more weight than the DSE group.
The intervention did not use a very low calorie diet, but the reduced calorie diet and exercise did result in more remission than did the DSE control.
The subjects in this study already had type 2 diabetes and the intervention was evaluated for treating and reversing diabetes, not for preventing it.
*Association of an Intensive Lifestyle Intervention with Remission of Type 2 Diabetes. Gregg et al. JAMA. 2012 Dec 19;308(23):2489-96.
Which of the following statements about the Lean DiRECT study is most accurate?
A. Weight loss was unrelated to the primary outcome of diabetes remission.
B. The primary outcomes were weight loss of ≥ 15 kg (33 lbs) and remission of diabetes (HbA1c < 6.5% and off of all antidiabetic medications).
C. The intervention used a dietary replacement for one meal to reduce caloric intake to ~850 kcal per day for three to five months.
D. This study used a cross-over study design.
B.
The primary outcomes were ≥ 15 kg (33 lbs) weight loss, and remission of diabetes (HbA1c < 6.5% off all antidiabetic medications).
The intervention included a total diet replacement phase with ~850 kcal per day.
Remission of diabetes was strongly associated with weight loss in a dose-response relationship.
The study used a randomized parallel design.
*Primary care-led weight management for remission of type 2 diabetes (DiRECT): an open-label, cluster-randomised trial. Lean ME et al, Lancet. 2018 Feb 10;391(10120):541-551. doi: 10.1016/S0140- 6736(17)33102-1. Epub 2017 Dec 5.
Which of the following statements most accurately describes the findings of the Lean DiRECT study?
A. Beta cell function improved in association with weight loss during the total dietary replacement phase.
B. Weight loss was about the same for the experimental and control groups, but the experimental group showed greater remission of diabetes.
C. The null hypothesis could not be rejected; the study had “negative” findings.
D. There was a very weak interaction between weight loss and diabetes remission, just as there was in the LookAHEAD study.
E. Forty-six percent of the experimental subjects experienced remission of their diabetes, 86% of subjects with ≥ 15 kg (33 lbs) weight loss experienced remission, but none of those who gained weight experienced remission.
E.
Forty-six percent of the experimental subjects experienced remission of their diabetes, 86% of subjects with ≥ 15 kg (33 lbs) weight loss experienced remission, but none of those who gained weight experienced remission.
Weight loss was much greater in the experimental group than in controls (-10 kg versus -1 kg, or -22 lbs versus -2.2 lbs).
There was a strong correlation between weight loss and diabetes remission in this study, but not in the LookAHEAD study.
Beta cell function was not measured and was not an outcome in this study.
The null hypotheses was rejected and the study had strongly “positive” findings.
Forty-six percent of all experimental subjects experienced remission, 86% of those who lost ≥ 15 kg (33 lbs) experienced remission, and none of those who gained weight experienced remission.
*Primary care-led weight management for remission of type 2 diabetes (DiRECT): an open-label, cluster-randomised trial. Lean ME et al, Lancet. 2018 Feb 10;391(10120):541-551. doi: 10.1016/S0140- 6736(17)33102-1. Epub 2017 Dec 5.
