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Benefits of Intermittent Fasting May Not be Timing

'Time-restricted' eating has become a popular weight-loss tactic, but a new clinical trial finds no benefits in adding it to old-fashioned calorie-cutting. -restricted eating is a form of intermittent fasting, in which people limit themselves to eating within a certain time window each day. And small studies have shown that limited eating windows - six hours being a popular one - can help people lose weight. In a new trial, researchers tested whether adding time restriction to traditional calorie-counting had any extra weight-loss benefits- the verdict was 'no". For the study, researchers recruited 139 patients with obesity. They all started a reduced-calorie diet, both study groups were instructed to cut their daily calories by 25%, with the support of an intensive program that involved health coaches and keeping daily food logs but half were randomly assigned to also take on time restriction - eating only between 8 a.m. and 4 p.m. each day.After one year, weight loss was similar between the two groups - as were their reductions in blood pressure, cholesterol and blood sugar. Those in the fasting group showed no greater weight loss, both groups lost an average of about 14 to 17 pounds over one year. They also lost body fat and trimmed a few inches from their waistlines, whether they used time restriction or not. But experts said the findings do not actually say much about the effectiveness of time-restricted eating, per se. No matter the method, caloric reduction seems to be the take away. While the time limits may not be the method for all, an accompanying editorial suggests if may be helpful for people with obesity who find the strategy appealing. However, they also caution that some groups should avoid time-restricted eating - including pregnant and breastfeeding women, people with a history of eating disorders, adults older than 70 and advise people with diabetes to talk to their doctors first, since they are on medications to manage their blood sugar.


Source: Liu, D et al, Calorie Restriction with or without Time-Restricted Eating in Weight LossN Engl J Med 2022; 386:1495-1504 DOI: 10.1056/NEJMoa2114833


Guidelines Recommended for Managing Anorexia in Pregnancy

Anorexia nervosa has an increased prevalence in women across childbearing years, with up to one in 200 pregnant women with the condition. It is typically associated with restricting or binging and purging behaviors, or both.


Pregnant women with anorexia are at greater risk of having a stillbirth, underweight baby or pre-term birth, yet there are no clear guidelines for how doctors should manage the condition. For women with anorexia nervosa, there is an increase in reported obstetric complications. A 2020 study from Canada reported that women with anorexia nervosa in pregnancy had 1.32 times the risk of pre-term birth, 1.69 times the adjusted risk of a baby with low birth weight, and 1.99 times the adjusted risk of stillbirth compared with women without anorexia nervosa in pregnancy. Additionally, risks from untreated or undertreated anorexia nervosa in pregnancy include psychological and psychosocial risks, including perinatal depression and anxiety


Recently, researchers have developed recommendations and principles for multidisciplinary management of anorexia nervosa in pregnancy. These recommendations include a focus on the specialist mental health, obstetric, medical, and nutritional care required to ensure optimal outcomes for women and their infants.


There are no current guidelines that include recommendations for anorexia nervosa in pregnancy. Research into managing the health of pregnant women in general has highlighted the importance of maternal antenatal nutrition, pregnancy weight gain, and the infant's birth weight as critical risk factors and vital intervention points for improving lifelong health including for areas such as heart disease, diabetes and obesity.


According to the study authors, anorexia nervosa might affect obstetric and neonatal outcomes through low calorie intake, nutritional and vitamin deficiencies, stress, fasting, low body mass (underweight and low weight gain during pregnancy), and problems with the function of the placenta.


The management of anorexia nervosa requires a multidisciplinary team approach with expertise across mental health, specialist medical care, and dietetics at a minimum; in pregnancy. The authors recommend., key experts include obstetricians (particularly experts who manage high-risk pregnancies), physicians with pregnancy expertise, dieticians who also have expertise in pregnancy nutrition requirements, pediatricians, and mental health clinicians with perinatal expertise.


Source: Galbally et al.Management of anorexia nervosa in pregnancy: a systematic and state-of-the-art review, The Lancet Psychiatry, Volume 9, Issue 5, 2022, Pages 402-412,


New American Heart Association Guidelines on Non Alcoholic Fatty Liver Disease

It is estimated that about one in four adults worldwide have nonalcoholic fatty liver disease (NAFLD), that occurs when abnormally elevated amounts of fat are deposited in the liver, sometimes resulting in inflammation and scarring. The prevalence of NAFLD is an estimate, given the challenges in diagnosing the condition.


Because NAFLD is often missed in routine medical screening, the new American Heart Association scientific statement raises awareness and understanding about its link to heart disease and outlines how to prevent and diagnose the condition. Lifestyle changes are the cornerstone of treatment for early NAFLD. Dietary recommendations include reducing fat intake, limiting the consumption of simple sugars and choosing more fiber-rich vegetables and whole grains. A Mediterranean-style diet is a dietary pattern recommended by a consortium of professional groups for the treatment of NAFLD and NASH. However, avoiding alcohol (also often part of the Mediterranean diet) is encouraged since even light alcohol intake can aggravate NAFLD and interfere with the liver's ability to heal.


Consultation with a dietitian may help people with NAFLD plan and maintain a healthful diet and lose weight, if needed. The statement cites research showing that losing 10% of body weight dramatically reduced liver fat and improved fibrosis, with lower levels of improvement with at least a 5% loss in body weight. Research also supports 20-30 minutes of physical activity per day to decrease liver fat and improve insulin sensitivity even in the absence of weight loss.


Medications may be needed to treat Type 2 diabetes, lower cholesterol or reduce weight. Weight loss surgery may be appropriate for some people because the resulting, marked weight loss can be an effective intervention for NAFLD. Optimal care may also involve consulting with a lipid specialist, endocrinologist or gastroenterologist.


Source: Duell, PB, et al. Nonalcoholic Fatty Liver Disease and Cardiovascular Risk: A Scientific Statement From the American Heart Association Arteriosclerosis, Thrombosis, and Vascular Biology. 2022;0:10.116


Dietary Supplements for Eye Conditions: What the Science Says

Findings from the Age-Related Eye Disease Studies (AREDS and AREDS2) suggest that dietary supplementation with antioxidant vitamins and zinc may slow the progression of age-related macular degeneration in people who have intermediate Age-related Macular Degeneration (AMD) and those who have late AMD in one eye. The AREDS2 trial found that adding lutein and zeaxanthin or omega-3 fatty acids to the original AREDS formulation (with beta-carotene) had no overall effect on the risk of late AMD. However, the trial also found that replacing beta-carotene with a 5-to-1 mixture of lutein and zeaxanthin may help further reduce the risk of late AMD. Data from other studies do not support using other dietary supplements, such as Ginkgo biloba and omega-3 fatty acids, for AMD.


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