GORD, BMI and breastfeeding

Too busy to catch up on the latest research? Let Dr Alison Glenesk update you on recent papers.

surgery for GORD
surgery for GORD

Laparoscopic anti-reflux surgery Arch Surgery 2008; 143: 482-7

Patients often look to GPs for advice regarding elective surgical procedures, even after speaking to their surgeon. This study should help in one area.

All patients who had undergone fundoplication surgery for gastro-oesophageal reflux disease in four USA centres between 1997 and 2006 were followed up with a questionnaire; the median time to follow-up being 60 months.

The response rate was quite low at 54 per cent. A total of 71 per cent were completely satisfied, although 43 per cent of the total had taken anti- reflux medication at some time since surgery. Only 1.2 per cent required the surgery to be repeated.

Patients with a BMI between 25 and 35 had the best outcomes, with those with a higher or lower BMI being less satisfied.

Authors emphasise the importance of patient selection and surgical technique, but make no comment on the 46 per cent who did not respond, leaving the results somewhat open to speculation.

BMI in children Acta Paediatr 2008; 97: 795-800
It is received wisdom that we, and particularly our children, are becoming a nation of couch potatoes, with increasing morbidity due to poor diet. This US study set out to find out which factors determine BMI.

A total of 122 girls and 146 boys aged 10 years were followed up for 18 months.

At entry and completion, height and weight were measured, with assessment by questionnaire of habitual physical activity, 'screen time' (TV, games and computer use) and dietary variables, mainly related to analysis of the type of drink habitually consumed.

Analysis then correlated these variables with BMI at baseline and follow up, and to look at change in BMI.

At entry, 10 per cent of both sexes were obese, with 17.8 per cent of boys and 14.8 per cent of girls overweight. BMI varied little over the study period, but more surprising was that correlation between BMI, exercise and diet was not significant.

Authors concluded that genetic factors were more important in BMI.

While this flies in the face of everyday experience, it should help us remember that obesity is a multifactorial condition.

Exercise counselling in older patients Arch Intern Med 2008; 168: 979-86
This study from the USA shows how a simple intervention can promote physical exercise with its resultant health gains in a group of elderly people.

A total of 224 men aged 60-85 years with some degree of physical impairment were randomised to an exercise or control group. The exercise group had baseline one- and five-month counselling sessions on walking and strength exercises with occasional brief follow-up calls from a nurse, and also kept an exercise diary. The control group had health education on a subject of their choice.

It was found that the exercise group walked much more and did more exercise than the control group, and the participants reported improved health and quality of life.

Breastfeeding and child cognitive development Arch Gen Psychiatry 2008; 65: 578-84
It is generally accepted that breastfeeding has a positive effect on subsequent intelligence. Most studies have been observational, however, this huge study of children from Belarus differs in being prospective. It sets to find out if prolonged and exclusive breastfeeding improves children's cognitive ability at age 6.5 years.

There were 17,046 children recruited to the cluster randomised trial between 1996 and 1997, from 31 maternity hospitals. A total of 7,108 were randomised to an 'active' group, in which prolonged and exclusive breastfeeding was encouraged, while the control group of 6,781 were given the standard post-natal advice.

The active group's breastfeeding rates were substantially higher at all times, though many in the control group also breastfed. There was no statistical difference in demographic data between the two groups.

After 6.5 years, the verbal, performance, and full scale IQ were respectively 7.5, 2.9 and 5.9 points higher in the active group.

These results, from such a large study, are very impressive, and should be very useful when discussing feeding methods with expectant mums.

Screening for type 2 diabetes BMJ 2008; 336: 1,180-5
Glucose tolerance testing has become a major growth area in our practice, and I wonder how much this benefits our patients.

This cost-effectiveness analysis was carried out on a hypothetical one-off basis on a population of 45-year-olds with risk factors for diabetes. The results appear to be roughly in line with current practice.

The four possible interventions were: screening for diabetes; screening for diabetes and impaired glucose tolerance followed by lifestyle advice or drugs; screening for diabetes and impaired glucose tolerance followed by pharmacological intervention, and no screening.

Screening for diabetes and impaired glucose tolerance was found to be most cost effective. As about 50 per cent of type-2 diabetics are as yet undiagnosed, and we know that lifestyle interventions can delay the onset of diabetes, this result makes intuitive sense.

As the accompanying editorial points out, however, questions such as feasibility, acceptability and affordability cannot be answered by a study such as this. Perhaps we need to wait for real trials on real patients.

Dr Glenesk is a GP trainer in Aberdeen and a member of our team who regularly review the journals

The quick study

  • Fundoplication surgery is a satisfactory treatment for gastro-oesophageal reflux disease.
  • BMI was not found to directly correlate with diet and exercise in growing children.
  • Exercise counselling, even in brief sessions, can improve mobility and quality of life in elderly patients.
  • Cognitive ability was seen to be better in children who had been breast fed for a prolonged period compared to those who had not.
  • Glucose tolerance testing with screening for diabetes was found to be cost effective in a population with risk factors for diabetes.

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