Journals watch: Fizzy drinks, rapid weight loss in obesity and coeliac disease

Too busy to read all of the journals? Dr Tillmann Jacobi selects the latest papers of interest to GPs.

Study results linked sugary fizzy drinks to accelerated cellular ageing (iStock)

Fizzy drinks and cellular ageing

Am J Public Health 2014; doi: 10.2105/AJPH.2014.302151

This cross-sectional study looked at the possible direct impact of sugar-sweetened fizzy drinks on cellular health.

This was based on the concept that leucocyte telomere length maintenance is an important part of healthy cellular ageing, but can be disrupted by a number of dietary influences.

The diet of a sample of 5,309 healthy US adults aged 20-65 years with no history of diabetes or cardiovascular disease was assessed by a 24-hour dietary recall. Leucocyte telomere length was assayed from DNA specimens.

Associations between the two were examined using multivariate linear regression for the outcome of log-transformed telomere length.

After adjustment for sociodemographic and health-related characteristics, sugar-sweetened fizzy drink consumption was associated with shorter telomeres, indicating accelerated cellular ageing.

This was not the case for diet drinks or non-carbonated sugary drinks. Consumption of 100% fruit juice was marginally associated with longer telomeres. Is it the type of sugar or the fizz that makes some drinks unhealthy?

Rapid weight loss in obesity

Lancet Diabetes Endocrinol 2014; doi: 10.1016/S2213-8587(14)70200-1

It is widely believed that rapid intentional weight loss in obesity is much more likely to lead to quick regain of weight (the yo-yo effect), or to worsen the long-term perspective of weight control, compared with a more gradual steady weight loss.

This two-phase intervention study in Australia randomised 204 obese adults to either a 12-week rapid weight loss programme on a very low calorie diet (450-800kcal per day) or a 36-week gradual weight loss programme.

Of participants on the rapid weight loss programme, 81% managed to lose at least 12.5% of their body weight to enter phase two of the study, compared with only 50% in the gradual weight loss group.

At follow-up after 144 weeks, most of the participants had regained most of the weight (10.3kg in the rapid weight loss group versus 10.4kg in the gradual weight loss group).

The findings showed that rapid weight loss was more effective initially, but regaining weight was just as common in both groups.

Development of coeliac disease

N Engl J Med 2014; 371: 1295-303

It remains unclear if there is a particularly vulnerable phase in childhood which might trigger the onset of gluten intolerance in children at increased familial risk, and if this might be influenced by the age when gluten is introduced into their diet.

This study of 832 newborns with a first-degree relative with established coeliac disease analysed the outcomes of earlier (at six months) or later (at 12 months) introduction of gluten. An initially higher proportion of children with early introduction, who showed autoimmunity (16% versus 7%, P = 0.002) and overt coeliac disease (12% versus 5%, P = 0.01), when compared with the later introduction group, levelled out at the age of five, and at the age of 10, the type of human leucocyte antigen (high risk versus normal risk) appeared overall more relevant than any variables.

This finding suggests that later introduction of gluten in at-risk children merely postpones the eventual onset of coeliac disease.

Tailored hand exercises for RA

Lancet 2014; doi: 10.1016/S0140-6736(14)60998-3

Although there have been considerable advances in the control of symptoms and joint damage in rheumatoid arthritis (RA) using disease-modifying biologics and other drug regimens, there have been only limited reviews of the evidence of other interventions, such as tailored hand exercises, on function and quality of life in patients with RA.

This multicentre, parallel-group trial involving 490 patients with RA in the UK examined the effectiveness and cost-effectiveness of tailored hand exercises in addition to usual care, when patients had been on a stable drug regimen for at least three months.

While other factors remained stable, improvements in overall hand function after 12 months were 3.6 points (95% CI 1.5-5.7) with the Michigan Hand Outcomes Questionnaire in the usual care group and 7.9 points (6-9.9) in the exercise group (mean difference between groups 4.3, 95% CI 1.5-7.1; P = 0.0028) and there were no serious adverse events associated with the treatment.

This low-cost intervention (£156 per patient) resulted in significant positive outcomes.

Emollient therapy may prevent atopic dermatitis

J Allergy Clin Immunol 2014; 134(4): 818-23 and 824-30.e6

Many studies regarding interventions for atopic dermatitis (AD) have focused on allergen avoidance or other interventions (for example, probiotics), with very unconvincing results.

However, daily emollient therapy, which is easy and low cost, may help to prevent or correct abnormal skin barrier function, which could be essential in the pathophysiology of AD.

These two studies have shown encouraging results. First, 124 newborns in the US and the UK at high risk of AD were randomised to daily emollient therapy or usual infant skincare started by the age of three weeks.

After six months, 43% of infants in the control group versus 22% in the emollient group had AD (RR reduction = 50%).

A similar study set up in Japan randomised 118 very high-risk children to daily treatment with an emollient or usual skincare starting in the first week of life. This showed AD development in approximately 32% fewer neonates in the emollient group than in the control group at 32 weeks.

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

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

  • Discuss sugary fizzy drinks in well person consultations or reviews of patients with established cardiovascular conditions.
  • Advise a sample of your obese patients to try a diet that feels 'right' for them, rather than suggesting one particular approach.
  • Enquire about physiotherapy and occupational therapy approaches for patients with RA, to ensure referrals can be dealt with effectively.

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