Search

Familial hypercholesterolaemia (FH) is a dominantly inherited disorder present from birth that causes marked elevation in plasma cholesterol and premature coronary heart disease. There are at least 45,000 people with FH in Australia and New Zealand, but the vast majority remains undetected and those diagnosed with the condition are inadequately treated.To bridge this major gap in coronary prevention the FH Australasia Network (Australian Atherosclerosis Society) has developed a consensus model of care (MoC) for FH. The MoC is based on clinical experience, expert opinion, published evidence and consultations with a wide spectrum of stakeholders, and has been developed for use primarily by specialist centres intending starting a clinical service for FH. This MoC aims to provide a standardised, high-quality and cost-effective system of care that is likely to have the highest impact on patient outcomes.The MoC for FH is presented as a series of recommendations and algorithms focusing on the standards required for the detection, diagnosis, assessment and management of FH in adults and children. The process involved in cascade screening and risk notification, the backbone for detecting new cases of FH, is detailed. Guidance on treatment is based on risk stratifying patients, management of non-cholesterol risk factors, safe and effective use of statins, and a rational approach to follow-up of patients. Clinical and laboratory recommendations are given for genetic testing. An integrative system for providing best clinical care is described.This MoC for FH is not prescriptive and needs to be complemented by good clinical judgment and adjusted for local needs and resources. After initial implementation, the MoC will require critical evaluation, development and appropriate modification. © 2011 Elsevier Ireland Ltd.

Aims Two medication change protocols were tested, both based on haemoglobin A1c (HbA1c), with one protocol also accounting for hypoglycaemic events. The aim was to compare the two protocols during intermittent energy restriction (5:2 diet). Methods Forty-two adults with type 2 diabetes (HbA1c ≥ 7% [53 mmol/mol], BMI of ≥27 kg/m2) treated with sulphonylureas and/or insulin were recruited and randomised 1:1 to fixed or adjusted medication protocols. Participants experiencing hypoglycaemia during a 2-week usual diet period then followed the 5:2 diet for 2 weeks (2 non-consecutive very-low-calorie days [500–600 kcal] and 5 habitual eating days/week), following the allocated medication protocol. The primary outcome was to determine if the adjusted protocol was superior to the fixed protocol at reducing hypoglycaemic events during the 5:2 diet. Flash glucose monitoring was used throughout to detect hypoglycaemia. Results There was a significant difference in change in the number of hypoglycaemic events between fixed and adjusted protocols (−1.0 vs. −3.5; P = 0.04). Over 60% of participants on the adjusted protocol had no hypoglycaemic events. Conclusions This pilot study demonstrates the importance of assessing the risk of hypoglycaemia before starting a 5:2 diet and that the adjusted medication protocol is likely the best option for patients at risk. Clinical trial registry This study has been registered with the Australia New Zealand Clinical Trial Registry (ANZCTR) www.anzctr.org.au and given the registration number ACTRN12617000512325.

Aims: We investigated the effects of intermittent compared to continuous energy restrictionon glycaemic control in patients with type 2 diabetes mellitus. Methods: Adults (N = 137) with type 2 diabetes (mean [SD] HbA1c level, 7.3% (56 mmol/mol)[1.3%] [14.2 mmol/mol]) were randomised to one of two diets for 12 months. The intermittent group (n = 70) followed a 2100–2500 kJ (500–600 kcal) diet 2 non-consecutive days/week and their usual diet for 5 days/week. The continuous group (n = 67) followed a 5000–6300 kJ (1200–1500 kcal) diet for 7 days/week. Follow-up occurred at 24 months, 12 months after the completed intervention. The primary outcome was change in HbA1c and the secondary outcome was weight loss. Results: Intention-to-treat analysis showed an increase in mean [SEM] HbA1c level at 24 months in both the continuous and intermittent groups (0.4% [0.3%] vs 0.1% [0.2%]respectively; P = 0.32) (4.4 [3.3 mmol/mol] vs 1.1 [2.2 mmol/mol]; P = 0.32), with a between group difference of 0.3% (90% CI, 0.31 to 0.83%) (3.3 mmol/mol [90% CI, 3.2 to 9.1 mmol/mol]) outside the prespecified boundary of ± 0.5% (5.5 mmol/mol), so statistical equivalence was not shown. Weight loss was maintained (P < 0.001) at 3.9 kg [1.1 kg] in both groups at 24 months, with a between-group difference of 0.07 kg (90% CI, 2.5 to 2.6 kg) outside the prespecified boundary of ±2.5 kg. There were no significant differences between groups in body composition, fasting glucose levels, lipid levels, or total medication effect score at 24 months, which remained less than baseline. Conclusions: In this prospective analysis weight loss was maintained but despite this HbA1c increased to above baseline levels in both groups. Refereed/Peer-reviewed

Background and aims: The relationship between dietary intake and carotid intima media thickness (IMT) and pulse wave velocity (PWV) in individuals with type 1 and type 2 diabetes has not been well studied. We investigated the association between dietary intake and common carotid artery intima media thickness (CCA IMT) and PWV in a cohort with type 1 and type 2 diabetes. Methods and results: A one-year randomised controlled trial was conducted to investigate the effect of improving dietary quality on CCA IMT. These subjects were followed up again approximately 12 months after the completion of the trial (i.e. approximately 24 month since baseline). The study cohort included 87 subjects that had dietary intake and CCA IMT measured at baseline and after a mean of 2.3 years' follow-up. PWV was measured in a subsample of this cohort. Age and baseline mean CCA IMT were strongly associated with mean CCA IMT at 24 months. After adjustment for age and baseline mean CCA IMT, baseline consumption of carbohydrate (r = −0.28; p = 0.01), sugars (r = −0.27; p = 0.01), fibre (r = −0.26; p = 0.02), magnesium (r = −0.25; p = 0.02) and the Alternate Health Eating Index (AHEI) score (r = −0.23; p = 0.03) were inversely associated with mean CCA IMT at 24 months. Mixed linear modelling showed an interaction between mean CCA IMT and AHEI at baseline (p = 0.024). Those who were in the highest AHEI tertile at baseline had greater CCA IMT regression at 24 months compared to those in the lowest tertile, after adjustment for baseline age, BMI, smoking pack years, time since diabetes diagnosis, and mean arterial pressure at baseline (mean −0.043 mm; 95% CI -0.084, −0.003; p = 0.029). Conclusions: In this prospective analysis greater diet quality at baseline, as measured by the AHEI, was associated with greater CCA IMT regression after approximately two years. This suggests that greater diet quality is associated with better longer term vascular health in individuals with type 1 and type 2 diabetes. Refereed/Peer-reviewed

Aims: Over the last 7 years there has been intense debate about the advice to reduce saturated fat and increase polyunsaturated fat to reduce CVD risk. The aim of this review was to examine systematic reviews and meta-analyses since 2010 on this topic plus additional cohort studies and interventions not included in these reviews. Data Synthesis: High saturated and trans fat intake (which elevates LDL like saturated fat) in the Nurses and Health Professional Follow-Up Studies combined is associated with an 8-13% higher mortality and replacement of saturated fat with any carbohydrate, PUFA and MUFA is associated with lower mortality with PUFA being more effective than MUFA (19% reduction versus 11%). With CVD mortality only PUFA and fish oil replacement of saturated fat lowers risk with a 28% reduction in CVD mortality per 5% of energy. Replacing saturated fat with PUFA or MUFA is equally effective at reducing CHD events and replacement with whole grains will lower events while replacement with sugar and starch increases events. Replacement of saturated fat with carbohydrate has no effect on CHD events or death. Only PUFA replacement of saturated fat lowers CHD events and CVD and total mortality. Replacing saturated fat with linoleic acid appears to be beneficial based on the Hooper Cochrane meta-analysis of interventions although other analyses with fewer studies have shown no effect. Conclusions: Reducing saturated fat and replacing it with carbohydrate will not lower CHD events or CVD mortality although it will reduce total mortality. Replacing saturated fat with PUFA, MUFA or high-quality carbohydrate will lower CHD events. Refereed/Peer-reviewed

Background and aims Increased potassium intake is related to reduced blood pressure (BP) and reduced stroke rate. The effect of increased dietary potassium on endothelial function remains unknown. The aim was to determine the effect of increased dietary potassium from fruit and vegetables on endothelial function. Methods and results Thirty five healthy men and women (age 32 ± 12 y) successfully completed a randomised cross-over study of 2 × 6 day diets either high or low in potassium. Flow mediated dilatation (FMD), BP, pulse wave velocity (PWV), augmentation index (AI) and a fasting blood sample for analysis of Intercellular Adhesion Molecule-1 (ICAM-1), E-selectin, asymmetric dimethylarginine (ADMA) and endothelin-1 were taken on completion of each intervention. Dietary change was achieved by including bananas and potatoes in the high potassium and apples and rice/pasta in the low potassium diet. Dietary adherence was assessed using 6 day weighed food diaries and a 24 h urine sample. The difference in potassium excretion between the two diets was 48 ± 32 mmol/d ( P = 0.000). Fasting FMD was significantly improved by 0.6% ± 1.5% following the high compared to the low potassium diet ( P = 0.03). There were no significant differences in BP, PWV, AI, ICAM-1, ADMA or endothelin-1 between the interventions. There was a significant reduction in E-selectin following the high (Median = 5.96 ng/ml) vs the low potassium diet (Median = 6.24 ng/ml), z = −2.49, P = 0.013. Conclusion Increased dietary potassium from fruit and vegetables improves FMD within 1 week in healthy men and women but the mechanisms for this effect remain unclear. Clinical trial registry ACTRN12612000822886.

Abundant evidence over past decades shows that foods with added plant sterols and plant stanols lower serum LDL cholesterol concentrations. However, despite the overwhelming data, numerous scientific questions still remain. The objective of this paper is to summarize the considerations of 60 academic and industrial experts who participated in the scientific meeting in Maastricht, the Netherlands, on issues related to the health effects of plant sterols and plant stanols. The meeting participants discussed issues including efficacy profiling, heterogeneity in responsiveness, effects beyond LDL-C lowering, and food formulation aspects of plant sterol and stanol consumption. Furthermore, aspects related to the potential atherogenicity of elevated circulatory plant sterol concentrations were discussed. Until the potential atherogenicity of plant sterols is resolved, based on the results >200 clinical trials, the risk to benefit of plant sterol use is favorable. Evidence on these topics in plant sterol and plant stanol research was presented and used to reach consensus where possible. It was concluded that endpoint studies looking at plant sterol and plant stanol efficacy are needed, however, there was no clear opinion on the best marker and best design for such a study. Based on the current scientific evidence, plant sterols and plant stanols are recommended for use as dietary options to lower serum cholesterol. Refereed/Peer-reviewed

Aims Weight loss improves glycaemic control in type 2 diabetes mellitus (T2DM). However, as achieving and maintaining weight loss is difficult, alternative strategies are needed. Our primary aim was to investigate the effects of intermittent energy restriction (IER) compared to continuous energy restriction (CER) on glycated haemoglobin A1c (HbA1c). Secondary aims were to assess effects on weight loss, body composition, medication changes and subjective measures of appetite. Using a 2-day IER method, we expected equal improvements to HbA1c and weight in both groups. Method Sixty-three overweight or obese participants (BMI 35.2 ± 5 kg/m2) with T2DM (HbA1c 7.4 ± 1.3%) (57 mmol/mol) were randomised to a 2-day severe energy restriction (1670-2500 kJ/day) with 5 days of habitual eating, compared to a moderate CER diet (5000-6500 kJ/day) for 12 weeks. Results At 12 weeks HbA1c (−0.7 ± 0.9% P < 0.001) and percent body weight reduction (−5.9 ± 4% P < 0.001) was similar in both groups with no group by time interaction. Similar reductions were also seen for medication dosages, all measures of body composition and subjective reports of appetite. Conclusions In this pilot trial, 2 days of IER compared with CER resulted in similar improvements in glycaemic control and weight reduction offering a suitable alternative treatment strategy. Refereed/Peer-reviewed

Aim: To conduct a systematic review and meta-analysis of clinical trials involving adults, to determine the effect of weight loss induced by energy restriction with or without exercise, anti-obesity drugs or bariatric surgery on measures of arterial stiffness and compliance. Methods: A systematic search of Pubmed, EMBASE, MEDLINE and the Cochrane Library was conducted to find intervention trials (randomised/non-randomised) that aimed to achieve weight loss and included the following outcome measures: cardio-ankle vascular index (CAVI), direct measures of area/diameter related to pressure change (including β-stiffness index, brachial or carotid artery compliance, aortic, carotid or brachial artery distensibility and strain), measures derived from peripheral pulse wave analysis (including augmentation index, augmentation pressure, distal oscillatory, proximal capacitive and systemic compliance) and pulse pressure. Data were analysed using Comprehensive Meta Analysis V2 using random effects analysis. Standardised mean difference (SMD) is reported with negative values indicating an improvement. Results: A total of 43 studies, involving 4231 participants, were included in the meta-analysis. Mean weight loss was approximately 11% of initial body weight. Weight loss improved CAVI (SMD -0.48; p = 0.04), β-stiffness index (SMD = -0.98; p = 0.001), arterial compliance (SMD = -0.61; p = 0.0001) and distensibility (SMD -1.10; p = 0.005), distal oscillatory compliance (SMD = -0.41; p = 0.03), proximal capacitive compliance (SMD -0.66; p = 0.009), systemic arterial compliance (SMD -0.71; p = 0.003) and reflection time (SMD -0.51; p = 0.001). Augmentation index, strain, augmentation pressure and pulse pressure were not significantly changed with weight loss. Conclusion: Weight loss induced by energy restriction improves some measures of arterial compliance and stiffness. Refereed/Peer-reviewed

Aim To investigate timing of protein ingestion relative to resistance exercise training (RT) on body composition, cardiometabolic risk factors, glycaemic control and resting energy expenditure (REE) during weight loss on a high-protein (HP) diet in overweight and obese patients with type 2 diabetes (T2DM). Methods Thirty-four men/women with T2DM (age 57 ± 7 years and body mass index 34.9 ± 4.2 kg m(-2) ) were randomly assigned to the ingestion of a HP meal (860 kJ, 21 g protein, 0.7 g fat, 29.6 g carbohydrate) either immediately prior to RT or at least 2 h following RT. All participants followed a 16-week, energy-restricted (6-7 MJ day(-1) ), HP diet (carbohydrate : protein : fat 43 : 33 : 22) and participated in supervised RT (3 day week(-1) ). Outcomes were assessed pre- and postintervention at 16 weeks. Results There was an overall reduction in bodyweight (-11.9 ± 6.1 kg), fat mass (-10.0 ± 4.4 kg), fat-free mass (-1.9 ± 3.1 kg), waist circumference (-12.1 ± 5.3 cm), REE (-742 ± 624 kJ day(-1) ), glucose (-1.9 ± 1.7 mmol l(-1) ), insulin (-6.1 ± 6.7 mU l(-1) ) and glycosylated haemoglobin (-1.1 ± 0.1%), p ≤ 0.01 time for all variables, with no difference between groups (p ≥ 0.41 group effect). Strength improved and cardiometabolic risk factors were reduced similarly in both groups; single repetition maximum chest press 11.0 ± 8.7 kg, single repetition maximum lat pull down 9.9 ± 6.0 kg, total cholesterol -0.6 ± 0.5 mmol l(-1) , high-density lipoprotein cholesterol -0.1 ± 0.2 mmol l(-1) , low-density lipoprotein cholesterol -0.3 ± 0.5 mmol l(-1) , triglycerides -0.6 ± 0.7 mmol l(-1) , blood pressure (systolic/diastolic) -13 ± 10/-7 ± 7 mmHg (p ≤ 0.04 time effect, p ≥ 0.24 group effect). Conclusion A HP, energy-restricted diet with RT was effective in improving glycaemic control, body composition, strength and cardiometabolic risk factors in overweight/obese patients with T2DM irrespective of altering the timing of protein ingestion relative to RT.

Wycherley TP, Brinkworth GD, Keogh JB, Noakes M, Buckley JD, Clifton PM. (Commonwealth Scientific and Industrial Research Organization, Food and Nutritional Sciences; School of Molecular and Biomedical Science, University of Adelaide; and Nutritional Physiology Research Centre and Australian Technology Network Centre for Metabolic Fitness, Sansom Institute for Health Research, University of South Australia). Long-term effects of weight loss with a very low carbohydrate and low fat diet on vascular function in overweight and obese patients. J Intern Med 2010; 267: 452–461. Objective. To compare the effects of an energy reduced very low carbohydrate, high saturated fat diet (LC) and an isocaloric high carbohydrate, low fat diet (LF) on endothelial function after 12 months. Design and Subjects. Forty-nine overweight or obese patients (age 50.0 ± 1.1 years, BMI 33.7 ± 0.6 kg m−2) were randomized to either an energy restricted (∼6–7 MJ), planned isocaloric LC or LF for 52 weeks. Body weight, endothelium-derived factors, flow-mediated dilatation (FMD), adiponectin, augmentation index (AIx) and pulse wave velocity (PWV) were assessed. All data are mean ± SEM. Results. Weight loss was similar in both groups (LC −14.9 ± 2.1 kg, LF −11.5 ± 1.5 kg; P = 0.20). There was a significant time × diet effect for FMD (P = 0.045); FMD decreased in LC (5.7 ± 0.7% to 3.7 ± 0.5%) but remained unchanged in LF (5.9 ± 0.5% to 5.5 ± 0.7%). PWV improved in both groups (LC −1.4 ± 0.6 m s−1, LF −1.5 ± 0.6 m s−1; P = 0.001 for time) with no diet effect (P = 0.80). AIx and VCAM-1 did not change in either group. Adiponectin, eSelectin, tPA and PAI-1 improved similarly in both groups (P

Background and aims: It is unclear whether high protein weight loss diets have beneficial effects on weight loss, abdominal fat mass, lipids, glucose and insulin compared to conventional low fat diets in subjects at increased risk of cardiovascular disease (CVD) because of elevated glucose and triglyceride concentrations. Our objective was to determine the effects of high protein (HP) compared to standard protein (SP) diets on CVD risk in obese adults. Conclusion Short-term high protein weight loss diets had beneficial effects on total cholesterol and triacylglycerol in overweight and obese subjects and achieved greater weight loss and better lipid results in subjects at increased risk of CVD. These observations provide further information regarding the utility of this dietary approach in effectively managing body weight and composition and reducing CVD risk in overweight and obese individuals. Methods and results: Data from three, 12 week, randomized parallel trials with subjects assigned to either HP or SP diet (5500-6500 kJ/day) were pooled. Weight, body composition (dual energy X-ray absorptiometry), lipids, insulin and glucose were measured before and after weight loss. Data from 215 subjects (49.9 ± 9.8 years, BMI 33.5 ± 3.7 kg/m2), 108 HP, 107 SP were analyzed. Weight loss (HP diet 7.82 ± 0.37 kg; SP diet 7.65 ± 0.39 kg, NS) and total fat loss were not different (HP 6.8 ± 4.3 kg; LP 6.4 ± 4.7 kg, NS on intention to treat analysis). The reduction in triacylglycerol (TAG) was greater on HP than SP 0.48 ± 0.07 mmol/L vs 0.27 ± 0.06 mmol/L, (P < 0.001). Subjects with TAG greater than the median (>1.54 mmol/L at baseline) lost more weight (HP 8.5 ± 0.6; SP 6.9 ± 0.6 kg, P = 0.01, diet by TG group), total (HP 6.17 ± 0.50 kg; SP 4.52 ± 0.52 kg, P = 0.007) and abdominal fat (HP 1.92 ± 0.17 kg; SP 1.23 ± 0.19 kg, P = 0.005) on HP. Total cholesterol (12 vs 6%, HP vs SP) and TAG (39 vs 20%, HP vs SP) decreased to a greater extent in these subjects (both P ≤ 0.05) on HP. Refereed/Peer-reviewed

background: Anti-Mullerian hormone (AMH) has been proposed as a clinical predictor of improvements in reproductive function following weight loss in overweight and obese women with polycystic ovary syndrome (PCOS). This study aimed to assess whether baseline and/or change in AMH levels with weight loss predict improvements in reproductive function in overweight and obese women with PCOS. methods: Fifty-two overweight and obese women with PCOS and reproductive impairment (age 29.8+ 0.8 years, BMI 36.5+ 0.7 kg/m 2 ) followed a 20-week weight loss programme. AMH, weight, menstrual cyclicity and ovulatory function were assessed at baseline and post-intervention. results: Participants who responded with improvements in reproductive function (n ¼ 26) had lower baseline AMH levels (23.5+ 3.7 versus 32.5+ 2.9 pmol/l; P ¼ 0.03) and experienced greater weight loss (211.7+ 1.2 versus 26.4+ 0.9 kg; P ¼ 0.001) compared with those who did not respond (n ¼ 26). Logistic regression analysis showed that weight loss and baseline AMH were independently related to improvements in reproductive function (P ¼ 0.002 and P ¼ 0.013, respectively). AMH levels did not change with weight loss in both responders and non-responders. conclusions: In overweight and obese women with PCOS and reproductive dysfunction, a 20-week weight loss intervention resulted in improvements in reproductive function but no change in AMH levels. Clinical Trials Registration Number: ACTRN12606000198527

Polycystic ovary syndrome (PCOS) is a common condition affecting reproductive-aged women with features including hyperandrogenism and menstrual irregularity frequently treated with hormonal steroidal contraceptives. Women with PCOS appear to have lower bone mineral density (BMD). While steroidal contraceptives may positively affect bone health, their effect on BMD in PCOS is not known. The aim of this study was to assess BMD in women with PCOS according to recent contraceptive use. A cross-sectional analysis of 95 pre-menopausal overweight or obese sedentary women with PCOS [age 29.4 ± 6.4 years, body mass index (BMI) 36.1 ± 5.3 kg/m2] who either recently took steroidal contraceptives (ceased 3 months prior) or were not taking steroidal contraceptives was conducted. Clinical outcomes included BMD, anthropometry, insulin, glucose, reproductive hormones, dietary intake and vitamin use. BMD was significantly lower for women who used contraceptives compared to those who did not (mean difference 0.06 g/cm2 95 % confidence interval −0.11, −0.02, p = 0.005). In regression models, lower BMD was independently associated with contraceptive use (β = −0.05, 95 % CI −0.094, −0.002, p = 0.042), higher testosterone (β = −0.03, 95 % CI −0.05, −0.0008, p = 0.043) and lower BMI (β = 0.006, 95 % CI 0.002, 0.01, p = 0.007) (r 2 = 0.22, p = 0.001 for entire model). We report for the first time that overweight and obese women with PCOS with recent steroidal contraceptive use had lower BMD in comparison to non-users independent of factors known to contribute to BMD. Whether this observation is directly related to steroidal contraceptive use or other factors requires further investigation.

Aim: Evidence from epidemiological studies suggests that higher consumption of dairy products may be inversely associated with risk of type 2 diabetes and other components of the metabolic syndrome, although the evidence is mixed. Intervention studies that increase dairy intake often involve lifestyle changes, including weight loss, which alone will improve insulin sensitivity. The aim of this review was to examine weight stable intervention studies that assess the effect of an increased intake of dairy products or dairy derived supplements on glucose metabolism and insulin sensitivity. Conclusions: In adults, four of the dairy interventions showed a positive effect on insulin sensitivity as assessed by Homeostasis Model Assessment (HOMA); one was negative and five had no effect. As the number of weight stable intervention studies is very limited and participant numbers small, these findings need to be confirmed by larger trials in order to conclusively determine any relationship between dairy intake and insulin sensitivity. Data synthesis: An electronic search was conducted using MEDLINE, EMBASE, the Cochrane Database and Web of Science for randomised controlled trials altering only dairy intake in humans with no other lifestyle or dietary change, particularly no weight change, and with measurement of glucose or insulin. Healthy participants and those with features of the metabolic syndrome were included. Chronic whey protein supplementation was also included. Ten studies were included in this systematic review. Refereed/Peer-reviewed

Background and aims: Endothelial dysfunction, as assessed by flow mediated dilatation (FMD) is an early event in atherosclerosis and an independent predictor of cardiovascular events. The effect of potassium supplementation on endothelial function and blood pressure (BP) in the postprandial state is not known. The aim of this study was to assess endothelial function using FMD in healthy volunteers. Methods and results: Thirty-two normotensive volunteers received a meal with 36 mmol potassium (High K) and a control 6 mmol potassium (Low K) meal on 2 separate occasions in a randomized order. FMD and BP were measured while participants were fasting and at 30, 60, 90 and 120 min after the meal. There was a postprandial decrease in FMD in both groups. FMD decreased overall less after the High K meal compared to the Low K meal (meal effect p < 0.05). Both meals produced a postprandial decrease in BP at 30 min which returned to baseline levels by 120 min. No significant differences in BP were observed between meals. FMD and systolic BP were negatively correlated at 90 (r = −0.54–0.55, p < 0.01) and 120 min (r = −0.42–0.56, p < 0.01) after both meals. Conclusions: A high potassium meal, which contains a similar amount of potassium as 2.5 serves of bananas, can lessen the postprandial reduction in brachial artery FMD when compared to a low potassium meal. Refereed/Peer-reviewed

This study has been registered with the Australia New Zealand Clinical Trial Registry (ANZCTR) and given the registration number ACTRN12612000197831. Effective strategies are needed to help individuals lose weight and maintain weight loss. The primary aim of this study was to investigate the effect of intermittent energy restriction (IER) compared to continuous energy restriction (CER) on weight loss after 8 weeks and weight loss maintenance after 12 months. Secondary aims were to determine changes in waist and hip measurements and diet quality. In a randomized parallel study, overweight and obese (body mass index [BMI] ≥ 27 kg m−2) women were stratified by age and BMI before randomization. Participants undertook an 8-week intensive period with weight, waist and hip circumference measured every 2 weeks, followed by 44 weeks of independent dieting. A food frequency questionnaire was completed at baseline and 12 months, from which diet quality was determined. Weight loss was not significantly different between the two groups at 8 weeks (−3.2 ± 2.1 kg CER, n = 20, −2.0 ± 1.9 kg IER, n = 25; P = 0.06) or at 12 months (−4.2 ± 5.6 kg CER, n = 17 −2.1 ± 3.8 kg IER, n = 19; P = 0.19). Weight loss between 8 and 52 weeks was -0.7 ± 49 kg CER vs. −1 ± 1.1 kg IER; P = 0.6. Waist and hip circumference decreased significantly with time (P

Background: Meta analysis of short term trials indicates that a higher protein, lower carbohydrate weight loss diet enhances fat mass loss and limits lean mass loss compared with a normal protein weight loss diet. Whether this benefit persists long term is not clear. Methods and results: We selected weight loss studies in adults with at least a 12 month follow up in which a higher percentage protein/lower carbohydrate diet was either planned or would be expected for either weight loss or weight maintenance. Studies were selected regardless of the success of the advice but difference in absolute and percentage protein intake at 12 months was used as a moderator in the analysis. Data was analysed using Comprehensive Meta analysis V2 using a random effects analysis. As many as 32 studies with 3492 individuals were analysed with data on fat and lean mass, glucose and insulin from 18 to 22 studies and lipids from 28 studies. A recommendation to consume a lower carbohydrate, higher protein diet in mostly short term intensive interventions with long term follow up was associated with better weight and fat loss but the effect size was small-standardised means of 0.14 and 0.22, p = 0.008 and p < 0.001 respectively (equivalent to 0.4 kg for both). A difference of 5% or greater in percentage protein between diets at 12mo was associated with a 3 fold greater effect size compared with

Aims: To review: 1) the correlation between individual dietary components and carotid intima media thickness (cIMT); 2) the relationship between dietary patterns and cIMT; 3) the effect of dietary interventions on cIMT progression. Conclusions: A Mediterranean style dietary pattern, which is high in fruits, wholegrains, fibre and olive oil and low in saturated fat, may reduce carotid atherosclerosis development and progression. However further research from randomised controlled trials is required to understand the association between diet and cIMT and the underlying mechanisms. Data synthesis: An electronic search for epidemiological and intervention trials investigating the association between dietary components or patterns of intake and cIMT was performed in PUBMED, EMBASE and the Cochrane Library. Epidemiological data shows that a higher intake of fruit, wholegrains and soluble fibre and lower consumption of saturated fat in favour of polyunsaturated fat is associated with lower cIMT. In people at high risk of cardiovascular disease >93 g/day of fruit is associated with lower cIMT. Lower cIMT has also been observed when >0.79 serves/day of wholegrains and >25 g/day of fibre, predominately in the soluble form is consumed. Saturated fat is positively associated with cIMT, for every 10 g/day increase in saturated fat cIMT is 0.03 mm greater. Olive oil is inversely associated with cIMT, with a benefit seen when >34 g/day is consumed. While there are many epidemiological studies exploring the association between dietary intake and cIMT there are few intervention studies. Intervention studies show that a Mediterranean diet may reduce cIMT progression, especially in those with a higher cIMT. Refereed/Peer-reviewed

Introduction: Sustainability of healthy lifestyle behaviours following participation in a research-based supervised lifestyle intervention programme is often poor. This study aimed to document factors reported by overweight and obese individuals with Type 2 diabetes as enhancing or impeding sustainability of lifestyle behaviours following participation in such a programme. Methods: Thirty patients who completed a 16-week research-based supervised lifestyle intervention programme, incorporating a structured energy restricted diet with or without supervised resistance-exercise training underwent a semi-structured qualitative interview about their experiences in maintaining programme components after 1 year. Results: Participants maintained 8.8 ± 8.9 kg of the 13.9 ± 6.6 kg weight loss achieved with the research-based supervised lifestyle intervention programme. Only 23% of participants indicated continuation of the complete diet programme. Desire for ‘variety’ (33%) and increased portion size (27%) were the most commonly reported reasons for discontinuation. Participants who undertook supervised exercise training during the programme indicated access to appropriate programmes/facilities (38%), more affordable gym membership (21%) and having a personal trainer/motivator (17%) would have facilitated exercise continuation. Conclusion In overweight and obese individuals with Type 2 diabetes, success of the research-based supervised lifestyle intervention programme was perceived as being primarily due to high levels of professional support and supervision, the discontinuation of which subsequently presented difficulties. The interview data provide insight into what people experience following the completion of a research-based intensive lifestyle intervention programme and suggest that programmes assembled for research purposes with the emphasis on compliance may not necessarily promote sustainable change. Refereed/Peer-reviewed