Journals Watch - Obesity, cancer pain and exercise

Too busy to read all the journals? Let Dr Tillmann Jacobi bring you up to date with the research.

Older obese patients should be encouraged to diet and exercise in order to improve physical function (Photograph: Life in View / Science Photo Library)
Older obese patients should be encouraged to diet and exercise in order to improve physical function (Photograph: Life in View / Science Photo Library)

Physical function in obese older adults
N Engl J Med 2011; 364:1218-29

Obesity exacerbates the age-related decline in physical function and causes frailty in older adults. This one-year RCT evaluated the independent and combined effects of weight loss and exercise on physical function in 107 obese adults over 65.

Participants were assigned to either a diet group, an exercise group, a diet and exercise group or a control group.

The primary outcome was change in score on the 'physical performance test'. Frailty, body composition, bone mineral density, specific physical functions and quality of life were secondary outcomes.

The findings suggest, perhaps not surprisingly, that a combination of weight loss and exercise greatly improves physical function compared with either intervention alone.

Genetic variability in opioid use for cancer pain
Pain 2011; doi:10.1016/j.pain.2011.01.040

This study deals with the interesting observation that cancer pain patients need variable opioid doses. There have been suggestions that opioid efficacy is related to genetic variability. However, the studies so far have had small samples and several newer candidate genes had not been studied in detail.

This study used a large cohort of 2,294 adult European cancer patients to examine genetic variability to doses of stronger opioids - morphine, oxycodone, fentanyl and others - and analysed 112 specific single nucleotide polymorphisms (SNPs) in genes with a putative influence on opioid mechanisms.

The patients were randomly divided into one development sample and one validation sample. Covariates such as gender, age and metastases were factored into the findings.

None of 112 SNPs in the 25 candidate genes showed significant associations with effective opioid dose in either group. These findings suggest that the different response to opioids in cancer patients is not linked to a specific genetic make-up.

Pharmacotherapy of eating disorders
Int J Neuropsychopharmacol 2011; 18: 1-19

The scientific evidence for efficacy and safety of pharmaco-therapy in patients with an eating disorder is not fully clear. This was the driver for this meta-analysis of all RCTs published between 1960 and 2010 for treatment of anorexia nervosa, bulimia nervosa or binge-eating disorder.

Medications used across the conditions included atypical antipsychotics, SSRIs and other antidepressants as well as zinc supplementation and anti- obesity medications. Between the different eating disorders there was little variation of outcomes with low recovery rates overall.

Treatment resistance seems particularly notorious in anorexia nervosa, where the effort should focus on renourishment plus psychotherapy.

Oxygen saturation values using pulse oximeters
Clin Nurse Spec 2011; 25: 71-4

Pulse oximeters are a very useful portable tool to assess oxygen saturation in a quick and non-invasive fashion. In some situations, such as on ICUs, patients may be physically restrained which can lead to circulation problems and evaluation of oxygen saturation from body parts with poor circulation can cause false results.

This small pilot study was conducted in the ICU of a university hospital in Turkey. Pulse oximeter values were measured simultaneously using finger sensors on restrained and unrestrained sides of the body in 30 patients. There was a significant difference between the results on both sides with reduced oxygen saturation on the restrained side.

Although this specific situation may not apply often in a general practice, it is a good reminder to check both sides of the body when assessing oxygen saturation levels.

Isoflavones and exercise in overweight women
Br J Nutr 2011;105(8): 1199-209

A previous pilot study indicated that isoflavones and exercise may have an additive effect on body composition and risk factors of cardiovascular disease in postmenopausal women. This RCT of 100 overweight-to-obese postmenopausal women assessed any combined effect of exercise and isoflavones. The four groups examined received either placebo; isoflavones; exercise and placebo or exercise and isoflavones.

The supplementation consisted of 70mg per day of isoflavones and exercise consisted of three weekly sessions of resistance training and aerobics. The outcome measures included fat mass, lean body mass, bone mineral density, lipid profile, fasting glucose, fasting insulin and insulin resistance. No interactions or synergistic effects were observed between isoflavones and exercise. Overall, exercise had better outcomes for patients than isoflavones.

Body dysmorphic disorder
Adv Psychiatr Treat 2011; 17: 142-9

Body dysmorphic disorder has been recognised as a mental disorder for many years, but acceptance of it has remained very mixed among the mental health community and health professionals. This leads to poor detection and incoherent treatment.

Furthermore there have been very few epidemiological studies and clinical trials to improve awareness and appropriate management. This article reviews the established diagnostic criteria for the disorder, its validity and also its relationship to other disorders such as obsessive compulsive disorder, anorexia nervosa, social phobia and various forms of somatisation disorders. There is also a helpful discussion about the aetiology and course of the illness as well as possible treatment approaches.

  • Dr Jacobi is a GP in York and a member of our team who regularly review the journals

Reflect on this article and add notes to your CPD Organiser on MIMS Learning

CPD IMPACT: EARN MORE CREDITS

 These further action points may allow you to earn more credits by increasing the time spent and the impact achieved.

  • Update the practice register of all adult patients with a BMI >25kg/m2 and look at ways to give simple advice on exercise.
  • Review patients with established eating disorders and look at previous or current pharmacological treatment. Think about the possible treatment options and have a discussion with each patient.
  • Discuss the use of pulse oximeters in a practice meeting and the importance of checking both sides of the body when assessing oxygen saturation levels.

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