Dietary Intervention In Patients Research Articles

Dietary interventions in fibromyalgia: a systematic review

Fibromyalgia (FM) is a chronic non-degenerative disease, whose nutritional therapy seems controversial. This systematic review aimed to synthesize the knowledge about the effect of dietary interventions on patient-reported outcomes (PRO) and inflammation in patients with FM. Six electronic databases – PubMed, BioMed Central, Cochrane library, EMBASE, LILACS and ISI – were searched for clinical trials, in which a dietary intervention in patients with FM diagnosed was conducted. Quality of evidence assessment was measured in accordance with GRADE methodology. Seven clinical trials – 3 randomized controlled trials, 1 unrandomized clinical trial and 3 uncontrolled clinical trials were identified. Dietary approaches included gluten-free diet (n = 1), raw vegetarian diet (n = 2), low Fermentable oligo-, di- and monossacharides, alcohols and polyols (FODMAPs) diet (n = 1), hypocaloric diet (n = 2) and monosodium glutamate- and aspartame-free diet interventions (n = 1). The major PRO were pain and functional repercussion, with 5 out of 7 studies reporting an improvement. The progress in secondary outcomes was reported for fatigue (2/5 studies), sleep quality (2/3 studies), depression and anxiety (3/6 studies), quality of life (4/5 studies), gastrointestinal symptoms (1/2 studies) and inflammatory biomarkers (1/1 study). However, according to Cochrane Risk of Bias, these studies had poor statistical quality. Well-designed studies should be performed to investigate the dietary interventions effect on FM. Key messages Fibromyalgia (FM) is a chronic non-degenerative disease, whose nutritional therapy seems controversial but promising. Pain and functional repercussion in FM patients seem to improve with a hypocaloric diet, a raw vegetarian diet or a low FODMAPs diet, as much as quality of life, quality of sleep, anxiety and depression and inflammatory biomarkers. Existing studies in this subject are scarce and low quality, which does not allow conclusions to be drawn.

No effect of vitamin D administration plus dietary intervention on emerging cardiovascular risk factors in patients with metabolic syndrome

BackgroundPatients with metabolic syndrome (MetS) have low serum 25-hydroxyvitamin D (25(OH)VitD) levels. Low 25(OH)VitD has been associated with several emerging cardiovascular disease (CVD) risk factors, while VitD administration may ameliorate them. AimTo study the effect of 25(OH)VitD supplementation plus dietary instructions on novel CVD risk factors in MetS patients. MethodsThis is a pre-specified analysis of a previously published study. Patients with MetS (n = 50, 52 ± 10 years) were given dietary instructions and were randomized to receive either 25(OH)VitD, 2.000 IU/day p.o. (Suppl group) or nothing (No-Suppl group). Serum 25(OH)VitD, small dense low-density lipoprotein cholesterol (sdLDL), as well as lipoprotein-associated phospholipase A2 (LpPLA2) activity, leptin and adiponectin levels were measured at baseline and 3 months later. ResultsIn the Suppl group 25(OH)VitD levels increased by 90% [from 16.1 (3.3–35.1) to 30.6 (8.4–67.6) ng/mL, p = 0.001] and by 33.3% [from 9.9 (4.0–39.6) to 13.2 (3.5–36.8) ng/mL, p = NS] in the No-Suppl group. sdLDL serum levels, mean LDL size, LpPLA2 activity, leptin, adiponectin concentration and leptin to adiponectin ratio did not change significantly in both groups. ConclusionIn this small study the administration of 25(OH)VitD plus dietary intervention in patients with MetS were not associated with any significant change in various emerging CVD risk factors. (NCT01237769 ClinicalTrials.gov).

Dietary intervention in patients with age-related macular degeneration: protocol for a randomised controlled trial

IntroductionAge-related macular degeneration (AMD) is a leading cause of blindness. After smoking, nutrition is the key modifiable factor in reducing AMD incidence and progression, and no other preventative treatments are...

Effect of combined vitamin D administration plus dietary intervention on oxidative stress markers in patients with metabolic syndrome: A pilot randomized study

Metabolic syndrome (MetS) patients can have low 25-hydroxyvitamin D 25(OH)VitD levels, which may be associated with increased oxidative stress. There is little data on the effect of 25(OH)VitD administration plus dietary intervention on oxidative stress markers in these patients. To study the effect of 25(OH)VitD administration plus dietary intervention on oxidative stress markers in MetS patients. This is a pre-specified analysis of a previously published study (NCT01237769 ClinicalTrials.gov). MetS participants (n=50, 52±10 years) were given dietary instructions and were randomized to 25(OH)VitD 2.000 IU/day p.o. (Suppl group) or no supplementation (No-Suppl group). Serum 25(OH)VitD, oxidized LDL (ox-LDL), paraoxonase activity (PON-1), arylesterase activity (ARYL) and urine 8-isoprostane (8-iso-PGF2a) levels were measured at baseline and after 3 months. MetS patients had low baseline 25(OH)VitD levels, which increased by 90% in the Suppl group [from 16.1 (3.3-35.1) to 30.6 (8.4-67.6) ng/mL, p=0.001] and by 33.3% in the No-Suppl group [from 9.9 (4.0-39.6) to 13.2 (3.5-36.8) ng/mL, p=NS] after intervention. Ox-LDL, PON-1 and ARYL did not change significantly at follow-up in both groups, except for urine 8-iso-PGF2a levels that decreased by 22.7% in the Suppl group [from 48.8 (26.8-137.1) to 37.7 (12.3-99.0) ng/mmol creatinine, p=0.015] and by 14.4% in No-Suppl group [from 45.8 (16.6-99.3) to 39.2 (13.3-120.1) ng/mmol creatinine, p=NS]. The reduction in 8-iso-PGF2a levels did not differ significantly between the 2 groups. The administration of 25(OH)VitD plus dietary intervention in patients with MetS was not associated with meaningful reductions in oxidative stress markers compared with dietary intervention alone.

Comparison of a Mediterranean to a low-fat diet intervention in adults with type 1 diabetes and metabolic syndrome: A 6–month randomized trial

Background and aimsThe metabolic syndrome (MS) is an emerging complication in patients with type 1 diabetes (T1D), with no preventive or therapeutic treatment reported yet. We wanted to compare the impact of two 6-month nutritional interventions, based on a Mediterranean (MED) or a low-fat diet, on waist circumference, anthropometric and metabolic outcomes in patients with both T1D and the MS. Methods and resultsParticipants were randomized into 2 intervention groups: 1) MED-diet or 2) low-fat diet. The 6-month study included 9 teaching sessions with a registered dietitian. Anthropometric (primary outcome: waist circumference), metabolic and nutritional assessments were performed at inclusion, 3 and 6-month. We used mixed effects models to assess the effects of both interventions. 28 participants were included (50.9 ± 10.3 years old) with a mean BMI of 30.7 ± 3.3 kg/m2 and a waist circumference of 105.5 ± 8.9 cm at inclusion. A trend towards a greater reduction of dietary fat intakes in the low-fat diet group was observed (P-interaction = 0.09). Waist circumference was reduced at 6-month in both groups (−3.5 cm low-fat; −1.5 cm MED-diet) with no significant difference between groups (P-interaction = 0.43). Body mass index also significantly decreased in both groups (−0.7 kg/m2 low-fat; −1.1 kg/m2 MED-diet; P-interaction = 0.56). No significant differences between groups were observed for other metabolic parameters. ConclusionsThis study suggests that a 6-month non-restrictive dietary intervention in patients with T1D and MS could contribute to weight management, without significant differences between interventions for anthropometric and metabolic parameters. Further studies should investigate the long-term benefits of these diets. Clinical trial registryNCT02821585 (https://clinicaltrials.gov/).

Efficacy of Taurine Supplementation on Markers of Atherothrombosis and Atherogenesis Following Exercise Protocol Bruce Modified in Elderly Men with Myocardial Infarction

Introduction: Myocardial infarction (MI) is a leading cause of morbidity and mortality. Taurine, an essential amino acid, plays a critical role in cardiovascular function. The present study was accomplished to investigate the beneficial role of taurine on atherogenesis and atherothrombosis indexes in patients with MI. Materials & Methods: In this semi-experimental study, 16 cases, 50 to 60 years old suffering from myocardial infarction were randomly classified into two experimental (taurine supplement) and placebo groups. The subjects of the experimental group took 3 supplement capsules containing 500 mg of taurine before the 3 daily meals. The placebo group took 3capsules containing starch, at the same time as the experimental members. Plasma blood sampling was carried out on the subjects at baseline level and after the modified Bruce protocol with and without taurine supplements or placebo in the same conditions. Findings: There were no statistically significant differences in the general data, such as age, weight, BMI and Vo2max between the taurine supplement group and the control (P less-than 0.05). Taurine supplementation caused significant decrease in the LDL-C/HDL-C ، TC/HDL-C، TG/HDL-C and Plate/HDL-C ratios in the supplementation and placebo groups at baseline level as well as after exhaustive exercise with modified Bruce protocol. Discussion & Conclusion: Our investigation results confirm the significance of dietary intervention in patients with MI. Taurine may be an essential candidate to enrich nutrition supports for critically ill patients, although more researches seem necessary to get at a conclusive consideration.

EXPEDIENCY USING OF LOW-PROTEIN UKRAINIAN DISHES AND KETO/AMINO ACIDS IN THE TREATMENT OF CHRONIC KIDNEY DISEASE STAGE IV-V

Through the analysis of literature, the results of own research and development, 48-year-old experience in the nephrologìcal clinic outlines the dietary treatment of chronic kidney disease (CKD). Common issues with dietary interventions in CKD, optimal protein diet lowprotein quota must provide, culinary food processing of dietary interventions in patients with CKD. Particular attention is drawn to the use of Ukrainian low-protein dishes, which were developed by the author, and their combination with ketoacids including Ketosteril.

Dietary program and physical activity impact on biochemical markers in patients with type 2 diabetes: A systematic review

ObjectivesEvaluate the effectiveness of the implementation of independently or combined dietary and physical activity programs on the blood glucose values and lipid profile in patients with type 2 diabetes, including participants aged 60 years and over. DesignSystematic review. Data sourcePubMed/Medline database, with language restrictions. Papers published between 2010 and 2016 were included. Study selectionA total of 30 randomised controlled trials were included that focused on physical activity and dietary interventions in patients with type 2 diabetes mellitus and include participants aged 60 years and over. ResultsThe selected articles have shown that the implementation of physical activity programs (aerobic, resistance, flexibility and combined exercises), and programs based on a higher intake of vegetables, grains, legumes, fruits, unsaturated fatty acids, as well as consumption of foods with low glycaemic index, calorie restriction, intake of probiotics, vitamin D supplementation and educational sessions about diabetes improves blood glucose levels, as well as the lipid profile, in patients with type 2 diabetes. ConclusionsPhysical activity and dietary programs are fundamental in the treatment and metabolic control of type 2 diabetes mellitus.

Volatile Organic Compounds in Feces Associate With Response to Dietary Intervention in Patients With Irritable Bowel Syndrome

Dietary interventions are effective in management of patients with irritable bowel syndrome (IBS), although responses vary. We investigated whether fecal levels of volatile organic compounds (VOCs) associate with response to dietary interventions in patients with IBS. Adults who fulfilled the Rome III criteria for IBS were recruited to a 2x2 factorial randomized controlled trial. Patients were randomly assigned to a group counselled to follow a diet low in fructans, galacto-oligosaccharides, lactose, fructose, and polyols (low-FODMAP diet, n = 46) or a group that received placebo dietary advice (sham diet, n = 47) for 4 weeks. Patients from each group were also given either a multi-strain probiotic or placebo supplement. Response was defined as a reduction of 50 points or more on the validated IBS symptom scoring system. Fecal samples were collected from participants at baseline and end of the 4-week study period; VOCs were analyzed by a gas-chromatography sensor device. VOC profiles were determined using a pipeline involving wavelet transformation followed by feature selection based on random forest. A partial least squares classifier was constructed to classify VOC profiles by response and accuracies were determined using 10-fold cross-validation. Data from 93 patients who completed the study (63 female) were used in the final analysis. More patients responded to the low-FODMAP diet (37/46, 80%) than the sham diet (21/47, 45%) (P < .001), but there was no difference in response between patients given the probiotic (31/49, 63%) vs the placebo (27/44, 61%) (P = .850), with no interaction between the diet and supplement interventions. At baseline, VOC profiles contained 15 features that classified response to the low-FODMAP diet with a mean accuracy of 97% (95% CI, 96%-99%) and 10 features that classified response to probiotic with a mean accuracy of 89% (95% CI, 86%-92%). End of treatment models achieved similar predictive powers and accuracies. Fecal VOC profiling is a low cost, non-invasive tool that might be used to predict responses ofpatients with IBS to low-FODMAP diet and probiotics and identify their mechanisms of action. ISRCTN registry no:02275221.

Glycogen storage disease type III: diagnosis, genotype, management, clinical course and outcome.

Glycogen storage disease type III (GSDIII) is a rare disorder of glycogenolysis due to AGL gene mutations, causing glycogen debranching enzyme deficiency and storage of limited dextrin. Patients with GSDIIIa show involvement of liver and cardiac/skeletal muscle, whereas GSDIIIb patients display only liver symptoms and signs. The International Study on Glycogen Storage Disease (ISGSDIII) is a descriptive retrospective, international, multi-centre cohort study of diagnosis, genotype, management, clinical course and outcome of 175 patients from 147 families (86 % GSDIIIa; 14 % GSDIIIb), with follow-up into adulthood in 91 patients. In total 58 AGL mutations (non-missense mutations were overrepresented and 21 novel mutations were observed) were identified in 76 families. GSDIII patients first presented before the age of 1.5 years, hepatomegaly was the most common presenting clinical sign. Dietary management was very diverse and included frequent meals, uncooked cornstarch and continuous gastric drip feeding. Chronic complications involved the liver (hepatic cirrhosis, adenoma(s), and/or hepatocellular carcinoma in 11 %), heart (cardiac involvement and cardiomyopathy, in 58 % and 15 %, respectively, generally presenting in early childhood), and muscle (pain in 34 %). Type 2 diabetes mellitus was diagnosed in eight out of 91 adult patients (9 %). In adult patients no significant correlation was detected between (non-) missense AGL genotypes and hepatic, cardiac or muscular complications. This study demonstrates heterogeneity in a large cohort of ageing GSDIII patients. An international GSD patient registry is warranted to prospectively define the clinical course, heterogeneity and the effect of different dietary interventions in patients with GSDIII.Electronic supplementary materialThe online version of this article (doi:10.1007/s10545-016-9932-2) contains supplementary material, which is available to authorized users.

Nutritional support and dietary interventions for patients with ulcerative colitis: current insights

Ulcerative colitis (UC) demonstrates a remitting and relapsing course, and patients have long believed diet plays a role in their symptoms. Ad hoc removal of foods and food groups from the diet without strong evidence for therapeutic benefit places patients at risk for nutritional deficiencies. This review discusses the need for nutritional support in UC and the role of dietary modification in its management in humans. Current evidence suggests patients with UC are not nutritionally compromised during remission, but with increasing disease activity, nutritional status is worth monitoring, in particular through body composition assessment and investigation for anemia. There is no clear evidence for dietary modulation to relieve symptoms in UC. Neither enteral nutrition nor parenteral nutrition is efficacious for symptom control or mucosal healing. While early studies suggested avoidance of dairy foods, no recent work has replicated these results. A low intake of insoluble fiber is recommended during acute disease flares; however, the role of fiber in modulating the gut microbiota and their metabolites warrants further attention. Several studies have investigated polyunsaturated fatty acids for UC; however, current evidence is not supportive for either inactive or active disease. There is emerging evidence that curcumin supplementation may be a new dietary treatment option. Often, evidence for therapeutic diets is difficult to interpret due to the reporting of combined results for both Crohn's disease and UC. In general, there is no evidenced specific dietary advice for patients with UC other than to follow healthy eating guidelines. Further work should determine if diet as treatment efficacy lies in modification of dietary patterns, thereby investigating the synergistic relationship between foods and their components, rather than investigation of single foods/nutrients. Large randomized controlled trials investigating dietary modification for UC are needed.

Novel Diet, Drugs, and Gastric Interventions for Gastroparesis.

This review of the pathophysiologic basis for gastroparesis and recent advances in the treatment of patients with gastroparesis shows that there are several novel approaches to advance treatment of gastroparesis including diet, novel prokinetics, interventions on the pylorus, and novel forms of gastric electrical stimulation. The field of gastroparesis is likely to advance with further studies, with help from a guidance document from the Food and Drug Administration on gastroparesis, and with recent approval of the stable isotope gastric emptying test to ensure eligibility of participants in multicenter trials. Clinical experience and a formal, randomized, controlled trial provide insights on optimizing dietary interventions in patients with gastroparesis. This review addresses the biologic rationale of these different treatments, based on known physiology and pathophysiology of gastric emptying. The novel medications include the motilin agonist, camicinal; 5-HT4 receptor agonists, such as velusetrag; and the ghrelin agonist, relamorelin. New approaches target pylorospasm by stent placement, endoscopic pyloric myotomy, or laparoscopic pyloroplasty. These approaches offer the opportunity to achieve more permanent reduction of resistance to flow at the pylorus over the intrapyloric injection of botulinum toxin, which typically has to be repeated every few months if it is efficacious. A novel device, deployed in porcine stomach, involved per-endoscopic electrical stimulation. These promising approaches require formal, randomized, controlled trials and deployment in patients. The presence of concomitant antral hypomotility may be a significant factor in the responsiveness to interventions at the pylorus.

Nutrition support and dietary interventions for patients with lung cancer: current insights.

Malnutrition and weight loss are prevalent in patients with lung cancer. The impact of malnutrition on patients with cancer, and specifically in patients with lung cancer, has been demonstrated in a large number of studies. Malnutrition has been shown to negatively affect treatment completion, survival, quality of life, physical function, and health care costs. Emerging evidence is providing some insight into which lung cancer patients are at higher nutritional risk. In lung cancer patients treated with radiotherapy, stage III or more disease, treatment with concurrent chemotherapy and the extent of radiotherapy delivered to the esophagus appear to confer a higher risk of weight loss during and post-treatment. Studies investigating nutrition interventions for lung cancer patients have examined intensive dietary counseling, supplementation with fish oils, and interdisciplinary models of nutrition and exercise interventions and show promise for improved outcomes from these interventions. However, further research utilizing these interventions in large clinical trials is required to definitively establish effective interventions in this patient group.

Management of bile acid malabsorption using low-fat dietary interventions: a useful strategy applicable to some patients with diarrhoea-predominant irritable bowel syndrome?

This study evaluates the efficacy of low-fat dietary interventions in the management of gastrointestinal (GI) symptoms due to bile acid malabsorption. In total, 40 patients with GI symptoms and a 7-day (75)selenium homocholic acid taurine (SeHCAT) scan result of <20%, were prospectively recruited and then advised regarding a low-fat dietary intervention. Before and after dietary intervention, patients rated their GI symptoms using a 10-point numerical scale, and recorded their intake in 7-day dietary diaries. After dietary intervention, the median scores for all GI symptoms decreased, with a significant reduction for urgency, bloating, lack of control, bowel frequency (p ≥: 0.01). Mean dietary fat intake reduced to 42 g fat after intervention (p ≥: 0.01). Low-fat dietary interventions in patients with a SeHCAT scan result of <20% leads to clinically important improvement in GI symptoms and should be widely used.

Development and Testing of the Feasibility and Acceptability of a Tailored Dietary Intervention in Patients With Heart Failure

The aim of this study was to describe how to develop a theory-based tailored dietary intervention (TADI) and test its feasibility and acceptability in patients with heart failure (HF). The development team consisted of experts in HF, nutrition, and clinical trials. Four patients with HF and 3 additional experts reviewed intervention materials and provided feedback. The 5-session TADI was developed from this feedback and tested in 5 patients with HF (60% women; mean age, 55 years). Participation and intervention completion rates were collected for feasibility test. In addition, data on dietary adherence and the factors affecting dietary adherence were collected at baseline and after the intervention for feasibility test. Data on patient acceptability were collected at the end of sessions. Sixty percent of patients we approached expressed interest in this study. Five patients completed all of the sessions and follow-up data collection. Mean dietary sodium consumption decreased from 2.38 to 1.30 g/d. Among the factors affecting dietary adherence, skills showed the greatest increase. Patient acceptability scores for sessions 1, 2, 3, and 4 were 98%, 97%, 100%, and 100% of 100%, respectively. The TADI is ready for testing in larger sample studies to manage sodium intake.

Lycopene Dietary Intervention

Heart failure (HF) is a condition of chronic exacerbations and injury resulting from an intricate relationship between biochemical and biological mechanisms. Inflammation can be a significant contributor in the pathophysiology of HF. Antioxidants may slow the progression of HF because of their ability to inhibit damaging inflammatory processes. The purpose of this study was to test a dietary intervention in patients with HF to assess the impact of lycopene on biomarkers of inflammation. Forty participants with HF were randomly assigned to 1 of 2 groups: lycopene intervention and usual care. The lycopene intervention group received 29.4 mg of lycopene intake per day by drinking an 11.5 oz serving of V8 100% vegetable juice for 30 days. We obtained serum lycopene, uric acid, C-reactive protein (CRP), and b-type natriuretic peptide to determine the impact of the intervention. Plasma lycopene levels increased in the intervention group compared with the usual care group (0.51 μmol/L to 0.76 μmol/L, P = .002; 0.56 μmol/L to 0.58 μmol/L). C-reactive protein levels decreased significantly in the intervention group in women and but not in men (P = .04). The preintervention CRP level for women was 5.9 ± 3.7 mg/dL and for men was 2.2 ± 2.1 mg/dL. The postintervention CRP level for women was 4.5 ± 3.6 mg/dL and for men was 2.4 ± 2.1 mg/dL. These findings suggest that the antioxidants in a 30-day intervention of V8 juice affect CRP levels in a sample of female patients with HF.

Dietary intervention in patients with gestational diabetes mellitus: a systematic review and meta-analysis of randomized clinical trials on maternal and newborn outcomes.

Diet is the cornerstone treatment of patients with gestational diabetes mellitus (GDM), but its role in maternal and newborn outcomes has been scarcely studied. The purpose of this study was to analyze the efficacy of dietary interventions on maternal or newborn outcomes in patients with GDM. A systematic review and meta-analysis of randomized clinical trials (RCTs) of dietary intervention in GDM or pregnancy with hyperglycemia was performed. MEDLINE, Embase, ClinicalTrials.gov, Cochrane, and Scopus were searched through to March 2014. The main evaluated maternal outcomes were proportion of patients using insulin and proportion of cesarean delivery; the newborn outcomes were proportion of macrosomia and hypoglycemia and newborn weight. From 1,170 studies, nine RCTs, including 884 women aged 31.5 years (28.7-33.2) with 27.4 weeks (24.1-30.3) of gestation, were eligible. We divided the RCTs according to the type of dietary intervention: low glycemic index (GI) (n = 4; 257 patients), total energy restriction (n = 2; 425 patients), low carbohydrates (n = 2; 182 patients), and others (n = 1; 20 patients). Diet with low GI reduced the proportion of patients who used insulin (relative risk 0.767 [95% CI 0.597, 0.986]; P = 0.039) and the newborn birth weight (weight mean differences -161.9 g [95% CI -246.4, -77.4]; P = 0.000) as compared with control diet. Total restriction and low carbohydrate diets did not change either maternal or newborn outcomes. A low GI diet was associated with less frequent insulin use and lower birth weight than control diets, suggesting that it is the most appropriate dietary intervention to be prescribed to patients with GDM.

Dietary Management of Diabetic Chronic Kidney Disease

Diabetic chronic kidney disease (diabetic nephropathy) is the most common cause for end-stage renal failure and is associated with increased cardiovascular morbidity and mortality. Multiple interventions, including good control of blood pressure, blood glucose, and lipids, have been shown to slow its progression. Dietary management is being considered an adjunct to retard the progression of diabetic nephropathy. Several animal and human studies have evaluated the rationale and potential benefits of using various dietary interventions in patients with diabetic nephropathy. We provide an overview of the current evidence supporting the use of dietary measures in the management of diabetic chronic kidney disease.

PTH-109 Management Of Bile Acid Malabsorption (bam) With Low Fat Dietary Interventions

IntroductionBAM is the unrecognised cause for loose stool for 500,000 people in the UK. It is increasingly recognised as a potential cause of distressing gastrointestinal (GI) symptoms after cancer treatment....

Research in brief

Two multicentre, double-blind, randomised, placebo-controlled studies report that the DPP4 inhibitors alogliptin (n=5380) and saxagliptin (n=16 492) are effective anti-diabetes drugs and do not increase the risk of cardiovascular events in patients with type 2 diabetes. After a median follow-up of 18 months in the alogliptin study and 2·1 years in the saxagliptin study, the occurrence of the primary endpoint—a composite of cardiovascular death, myocardial infarction, or ischaemic stroke—was not increased by the drug treatment compared with placebo in either study. Moreover, the drug-treated patients had better glycaemic control than did those given placebo. These data provide important insights into the safety and efficacy of these drugs for patients with type 2 diabetes who have a high cardiovascular risk. The richness of gut microbiota could be associated with metabolic disease and might predict responsiveness to dietary interventions in patients with obesity, suggest two new studies. In one study, low microbial richness in the gut (<480 000 bacterial genes) was associated with increased adiposity, insulin resistance, dyslipidaemia, and inflammation in 292 Danish individuals, 169 of whom had obesity. Patients with obesity and low microbial richness were prone to metabolic disease and tended to gain more weight than those with obesity and high microbial richness. In the second study, an association was found between low richness of gut microbiome (<480 000 bacterial genes) and response to dietary interventions in 38 obese and 11 overweight individuals. 6-week diet-induced weight loss followed by 6-week weight-maintenance improved microbial richness, adiposity, and circulating cholesterol concentrations in patients with low microbial richness at baseline. However, diet was less effective at improving inflammation in these patients. Altogether, these data highlight the importance of a healthy gut microbiome for metabolic health, and indicate that the level of microbial richness could be a predictive marker for treatment of patients with obesity and related complications. Adherence to long-term medical treatment is a major challenge for patients with cardiovascular disease. A fixed-dose combination drug of aspirin, a statin, and two blood pressure-lowering drugs has now been reported to increase long-term treatment adherence and to improve cardiovascular benefits compared with standard care. 2004 patients in India and Europe were randomly assigned to the combination treatment or to standard care for a median of 15 months. At the end of the study, 86·3% of those receiving the combination were adherent to treatment vs 64·7% of those on standard care. Combination treatment also resulted in greater improvement of systolic blood pressure and low-density cholesterol concentration than did standard care; these differences were small, albeit statistically significant. These results are encouraging and further research will help elucidate the effect of combination treatment on cardiovascular outcomes. Researchers now suggest that assessment of the risk of thyroid cancer based on ultrasound imaging could reduce the number of unnecessary biopsies for patients with a low risk of cancer. In a retrospective case-control study, 8806 patients underwent ultrasound imaging between 2000 and 2005 at the University of California, San Francisco (CA, USA). During this time, 105 patients were diagnosed with thyroid cancer. Thyroid nodules were found in 96·9% of patients with thyroid cancer and in 56·4% of those not diagnosed with cancer, indicating that nodules were common in most patients who were screened. Interestingly, the nodules associated with thyroid cancer had only three ultrasound characteristics in common (microcalcifications, an entirely solid composition, and size of more than 2 cm). The investigators state that if one ultrasound feature is used to prompt biopsy, 56 biopsies would be done per cancer diagnosed, whereas, if two characteristics were required, this number would be reduced to 16 and the risk of cancer would be very low in those for whom biopsy is deferred. New research shows that children and adolescents with type 1 diabetes could have an increased risk of multiple sclerosis). In a cohort study, data from 5653 patients with type 1 diabetes collected from January 1995, to October 2012, in 248 German and Austrian centres were analysed for multiple sclerosis. Regression analyses showed that the prevalence of multiple sclerosis was higher in paediatric and adolescent patients with type 1 diabetes compared with published data for German and mid-European prevalence. Additional risk factors for multiple sclerosis included thyroid antibodies (in men only), and being born in spring or summer. The role of environmental factors in the risk for co-occurrence of multiple sclerosis and type 1 diabetes should be further investigated.