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In This Issue of Archives of Internal Medicine
January 25, 2010

In This Issue of Archives of Internal Medicine

Arch Intern Med. 2010;170(2):120. doi:10.1001/archinternmed.2009.482

DASH Diet and Cardiovascular Biomarkers

The ENCORE (Exercise and Nutrition Interventions for Cardiovascular Health) study compared the DASH (Dietary Approaches to Stop Hypertension) diet alone or combined with a weight management program with usual diet controls in 144 overweight or obese, unmedicated outpatients with high blood pressure. Results showed significant blood pressure reductions in participants receiving the DASH diet compared with the usual diet, as well as greater improvements in cardiovascular biomarkers of risk including flow-mediated dilation of the brachial artery, baroreflex sensitivity, and left ventricular mass. The addition of exercise and weight loss to the DASH diet resulted in even larger blood pressure reductions, greater improvements in vascular and autonomic function, and reduced left ventricular mass.

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Resistance Training and Executive Functions

A number of large prospective cohort studies have suggested that physical activity plays a protective role in lowering the risk of cognitive impairment and dementia. Intervention studies have shown that aerobic exercise training enhances brain and cognitive function. Whether resistance training has similar benefits on cognitive function in seniors has received little investigation. In this trial, Liu-Ambrose et al found that 12 months of once-weekly or twice-weekly resistance training benefited the executive cognitive function of selective attention and conflict resolution in women aged 65 to 75 years, while simultaneously improving muscular function. In addition, the authors found that enhanced selective attention and conflict resolution was significantly associated with increased gait speed. Improved gait speed is a predictor of substantial reduction in mortality, and executive functions are robust cognitive predictors of functional status in seniors.

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Nonsurgical Weight Loss for Extreme Obesity in Primary Care Settings

Patients with a BMI higher than 40 (calculated as weight in kilograms divided by height in meters squared) are encountered regularly in most primary care practices. Surgery for obesity is not always an option for them, yet little is known about medical weight management in this population. The Louisiana Obese Subjects Study (LOSS) is a novel “pragmatic clinical trial” reported in this issue. The study randomized 390 individuals with a BMI of 40 to 60 to usual care or an intensive medical intervention that used guideline-based obesity management. Primary care practices were given brief training in the intensive intervention. Among all randomized, at 2 years, 31% in the intervention group achieved greater than 5% sustained weight loss and 21% achieved greater than 10%, compared with 9% and 3%, respectively, in the usual care group. Primary care practices should not be nihilistic about trying to manage obesity in extremely obese patients. The study demonstrates that, with brief training, primary care practices can help a subset achieve sustained modest weight loss and prevent weight gain.

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Physical Activity at Midlife in Relation to Successful Survival in Women at Age 70 Years or Older

This study evaluated physical activity at age 60 years in relation to successful survival at 70 years and older in 13 535 women who participated in the Nurses' Health Study. Of these women, 1456 (10.8%) met the criteria of achieving successful survival, which was defined as being free of 11 major chronic diseases and having no physical, cognitive, and mental limitations. After controlling for a wide array of lifestyle and dietary covariates, total physical activity levels were associated with increased odds of achieving successful survival. Moreover, independent of vigorous physical activity, energy expenditure from walking, as well as walking pace, was associated with elevated odds of maintaining an overall health status in these women, with a strength similar to that for total physical activity. Findings from this study support the potential beneficial effects of physical activity on maintaining an optimal health status at older ages.

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A Randomized Trial of a Low-Carbohydrate Diet vs Orlistat Plus a Low-Fat Diet for Weight Loss

This trial randomly assigned 146 overweight or obese outpatients to intensive group counseling using either a low-carbohydrate, ketogenic diet (LCKD) or orlistat combined with a low-fat diet (O + LFD). A high percentage of LCKD (79%) and O + LFD (88%) participants completed measurements at 48 weeks. Weight loss was similar for the LCKD (expected mean change, −9.5% or −11.4 kg) and O + LFD (−8.5% or −9.6 kg) (P=.60 for comparison). Participants who attended 80% or more of group sessions lost considerably more weight (LCKD [n=26], −14.9%; O + LFD [n=27], −13.9%). The LCKD had a more beneficial impact than O + LFD on systolic (−5.9 vs 1.5 mm Hg) and diastolic (−4.5 vs 0.4 mm Hg) blood pressures (P < .001 for both comparisons), while antihypertensive medications were reduced in 47% of LCKD and 21% of O + LFD participants. The 2 interventions resulted in similar improvements in serum lipid profiles and diabetes-related measures.

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