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Background: Previous literature shows possible benefits of whey protein supplementation in promoting weight loss. However, most studies do not have enough power to show beneficial effects on body composition and cardiovascular disease (CVD) risk factors. This meta-analysis evaluated effects of whey protein in individuals who are overweight and obese.Methods: We comprehensively searched the databases of MEDLINE, Embase, and Cochrane databases. The inclusion criteria were published randomized control trials (RCTs) comparing whey protein supplementation to placebo or controls in individuals who are overweight or obese. The primary outcome was the differences in the change in body composition (body weight, waist circumference, total fat mass, body lean mass). We also examined the changes in CVD risk factors as secondary outcomes. We calculated pooled mean difference (MD) with 95% confidence intervals (CIs) using a random effects model.Results: Nine RCTs were included in the meta-analysis. There was a significant reduction of body weight (MD = 0.56, 95% CI: 0.30-0.81), lean mass (MD = 0.77, 95% CI: 0.59-0.96), and fat mass (MD = 1.12, 95% CI: 0.77-1.47) favoring the whey protein group. There were improvements in multiple CVD risk factors including levels of systolic blood pressure, diastolic blood pressure, glucose, high-density lipoprotein, and total cholesterol (all p values <0.05).Conclusions: Whey protein supplementation seems to improve body weight, total fat mass, and some CVD risk factors in overweight and obese patients. Further studies regarding optimal dosage and duration of whey protein supplementation would be helpful to assess potential favorable effects in individuals who are overweight or obese. [ABSTRACT FROM AUTHOR]

Several major risk factors for osteoporosis have been identified. One of these risk factors is chronic inflammation. Several recent studies have supported the association between low bone mineral density (BMD) and nonalcoholic fatty liver disease (NAFLD), which comprises a spectrum of disorders involving liver inflammation. However, conflicting evidence regarding this association has been obtained thus far. We, therefore, conducted a meta-analysis of observational studies to show the association between NAFLD and BMD. The Cochrane Central Register of Controlled Trials, Cochrane Library, Medline, and Embase were searched from database inception to November 2014 for all observational studies evaluating the association between NAFLD or nonalcoholic steatohepatitis (NASH) and bone mass, BMD, or osteoporosis. All patients were ≥18 years of age and had no other cause of liver disease, osteoporosis, or pathological bone disease at baseline. Risk factors were NAFLD and NASH; control subjects were individuals without NAFLD. Eleven articles underwent full-length review. Data were extracted from five cross-sectional studies involving 1276 participants; 638 had NAFLD. The main meta-analysis showed no significant difference in BMD between patients with fatty liver disease and controls. Among all variables analyzed, body mass index had the strongest and most significant predictive effect on the difference in BMD. Controversy exists regarding the effect of BMD on NAFLD. Further studies are required to fully show this relationship. [ABSTRACT FROM AUTHOR]

Background/Aim: The relationship between gastroesophageal reflux disease (GERD) and nonalcoholic fatty liver disease (NAFLD) has been demonstrated in recent epidemiologic studies although the results were inconsistent. This meta-analysis was conducted to summarize all available data and to estimate the risk of NAFLD among patients with GERD. Materials and Methods: Comprehensive literature review was conducted using MEDLINE and EMBASE database from inception through November 2016, to identify studies that compared the risk of NAFLD among patients with GERD versus those without GERD. Effect estimates from each study were extracted and combined using the random-effect, generic inverse variance method of DerSimonian and Laird. Results: Eight studies (four cross-sectional studies and four case--control studies) with 31,322 participants met the eligibility criteria and were included in the meta-analysis. The risk of NAFLD among patients with GERD was significantly higher than those without GERD with the pooled odds ratio of 2.07 (95% confidence interval, 1.54-2.79). The statistical heterogeneity was high with an I2 of 87%. Conclusions: A significantly increased risk of NAFLD among patients with GERD was observed in this meta-analysis. [ABSTRACT FROM AUTHOR]

Background/Aims The correlation between the Bristol stool form scale (BSFS) and colonic transit time (CTT) has been reported in Western populations. Our study aims to study the relationship between BSFS, stool frequency, and CTT in Eastern patients with chronic constipation. Methods A total of 144 chronic functional constipation patients underwent colonic transit study by using radio-opaque markers, anorectal manometry, and balloon expulsion test. Stool diary including stool forms and frequency was recorded. Delayed CTT was defined as the retention of more than 20.0% of radio-opaque markers in the colon on day 5. Results Twenty-five patients (17.4%) had delayed colonic transit. Mean 5-day BSFS (OR, 0.51; 95% CI, 0.34-0.79; P = 0.021) and stool frequency (OR, 0.60; 95% CI, 0.44-0.83; P = 0.002) were independently associated with delayed CTT by logistic regression analysis. Mean 5-day BSFS (area under the curve [AUC], 0.73; 95% CI, 0.62-0.84; P < 0.001) and stool frequency (AUC, 0.75; 95% CI, 0.63- 0.87; P < 0.001) fairly predicted delayed CTT. The optimal mean 5-day BSFS of≤ 3 provided 68.0% sensitivity, 69.7% specificity, and 69.4% accuracy, and the optimal stool frequency≤ 2 bowel movements in 5 days provided 64.0% sensitivity, 83.1% specificity, and 84.0% accuracy for predicting delayed CTT. Conclusions Both stool form and frequency were significantly associated with delayed CTT. Stool frequency≤ 2 and BSFS 1-3 rather than BSFS 1-2 that was used in the Westerners could be used as surrogate for delayed CTT in Eastern patients with constipation. [ABSTRACT FROM AUTHOR]

Background/Aims: No medications have been approved for managing nonalcoholic fatty liver disease (NAFLD). Lifestyle intervention is the mainstay for its treatment. Hyperferritinemia, which appears to be associated with the severity of liver injury and insulin resistance, is frequently observed in patients with NAFLD. Patients and Methods: We conducted a systematic review and meta-analysis of the outcomes of four interventional trials regarding the effect of phlebotomy in patients with NAFLD versus the outcomes of NAFLD patients who did not undergo phlebotomy. Primary outcome was the pooled mean difference (MD) of the homeostasis model assessment of insulin resistance (HOMA-IR). The secondary outcomes were the changes in liver enzymes and the lipid profile. Results: Four interventional studies involving 438 participants were included in the meta-analysis. HOMA-IR was lower in patients who underwent phlebotomy, with an MD of 0.84 [95% confidence interval (CI) 0.01 to 1.67, I² = 72%]. Phlebotomy also significantly reduced the alanine aminotransferase (MD = 10.05, 95% CI 7.19-12.92, I² = 34%) and triglyceride (MD = 9.89, 95% CI 4.96-14.83, I² = 22%) levels and increased the high-density cholesterol level (MD = 3.48, 95% CI 2.03-4.92, I² = 18%). Conclusion: Phlebotomy decreased insulin resistance and liver transaminase levels in patients with NAFLD. In addition, it improved their lipid profile. [ABSTRACT FROM AUTHOR]

Background: Gallstone disease (GD) and nonalcoholic fatty liver disease (NAFLD) are common digestive disorders worldwide. Both conditions share certain risk factors including obesity, insulin resistance and diabetes. Several epidemiologic studies have reported the relationship between these two conditions.Aim: We conducted a systematic review and meta-analysis to characterize the association between GD and NAFLD.Methods: A comprehensive search of the databases MEDLINE and EMBASE was performed from inception through November 2015. The inclusion criterion was the observational studies' assessment of the association between GD and NAFLD in adult participants. Pooled odds ratio (OR) and 95 % confidence interval (CI) were calculated using a random-effects model.Results: Data were extracted from 12 observational studies (9 cross-sectional studies, 1 case-control study and 2 cohort studies). The pooled OR of NAFLD in patients who had GD was 1.55 (95 % CI 1.31-1.82). The statistical between-studies heterogeneity (I (2)) was 64 %. The association remained significant when limited to cohort studies with pooled OR 1.33 (95 % CI 1.14-1.55, I (2) = 0 %).Conclusion: Our meta-analysis demonstrated that GD is significantly associated with NAFLD. Further prospective studies exploring the underlying mechanism of this association should be pursued. [ABSTRACT FROM AUTHOR]

Background: Reports of mortality due to magnesium dysregulation in the critical care setting are controversial. We performed a systematic review and meta-analysis to evaluate the association between hypomagnesemia and mortality in patients admitted to the intensive care unit. Methods: Eligible studies assessing the association between hypomagnesemia or hypermagnesemia and mortality in the critical care setting were comprehensively searched in MEDLINE and EMBASE from their inception to September 2015. Inclusion criteria were published observational studies in adults who were admitted to the intensive or critical care setting with initial serum magnesium measurement. We used the definition of abnormal magnesium level defined by each study. Primary outcome was all-cause mortality. We performed meta-analysis using random-effects model and calculated pooled effect estimate of outcome comparing between hypomagnesemia and normal magnesium category. Results: From 30 full-text articles, 6 studies involving 1550 participants were included in the meta-analysis. There was a statistically significant higher risk of mortality in critically ill patients who had hypomagnesemia with RR of 1.90 (95% CI: 1.48-2.44, P<0.001, I²=63.5%). Risk for needing mechanical ventilation was also higher in the hypomagnesemia group with RR of 1.65 (95% CI: 1.12-2.43, P=0.01, I²=84%). Length of ICU stay was also higher in the hypomagnesemia group with mean difference of 4.1 days (95% CI: 1.16-7.04, P=0.01). Conclusion: The findings of this meta-analysis indicate hypomagnesemia is associated with higher mortality, the need of mechanical ventilation and also the length of ICU stay in patients admitted to ICU. [ABSTRACT FROM AUTHOR]