Tuesday, March 27, 2007

Diet Atkins Efektif untuk Menurunkan Berat Badan

Seiring peningkatan insiden kelebihan berat badan dan obesitas muncul pula berbagai teori diet untuk menurunkan berat badan.

Untuk menilai efektifitas diet terhadap penurunan berat badan dan variabel metabolisme para ahli membandingkan 4 macam spektrum diet, mulai dari diet rendah karbohidrat tinggi lemak (Atkins) sampai diet tinggi karbohidrat rendah lemak.

Partisipan menjalankan diet yang ditentukan selama 12 bulan sambil dilakukan monitoring. Setelah 12 bulan ternyata kelompok diet Atkins mengalami penurunan berat badan yang paling besar dibanding diet yang lain. Demikian pula untuk profil lipid, persen lemak tubuh, rasio pinggang panggul, kadar insulin, kadar gula darah dan tekanan darah, kelompok diet Atkins lebih baik dibanding diet yang lain.

Sehingga dapat disimpulkan bahwa diet rendah karbohidrat tinggi protein dan lemak efektif untuk menurunkan berat badan, namun demikian benefit dan risiko jangka panjang masih memerlukan penelitian lebih lanjut.

Namun harus diingat bahwa penelitian ini dilakukan pada wanita premenopause di USA dengan pola diet yang memang rendah karbohidrat. Untuk populasi orang Indonesia hasilnya belum tentu sama.


Comparison of the Atkins, Zone, Ornish, and LEARN Diets for Change in Weight
and Related Risk Factors Among Overweight Premenopausal Women
The A TO Z Weight Loss Study: A Randomized Trial

Christopher D. Gardner, PhD; Alexandre Kiazand, MD; Sofiya Alhassan, PhD;
Soowon Kim, PhD; Randall S. Stafford, MD, PhD; Raymond R. Balise, PhD;
Helena C. Kraemer, PhD; Abby C. King, PhD

JAMA. 2007;297:969-977.

Context Popular diets, particularly those low in carbohydrates, have challenged current recommendations advising a low-fat, high-carbohydrate diet for weight loss. Potential benefits and risks have not been tested adequately.

Objective To compare 4 weight-loss diets representing a spectrum of low to high carbohydrate intake for effects on weight loss and related metabolic variables.

Design, Setting, and Participants Twelve-month randomized trial conducted in the United States from February 2003 to October 2005 among 311 free-living, overweight/obese (body mass index, 27-40) nondiabetic, premenopausal women.

Intervention Participants were randomly assigned to follow the Atkins (n =77), Zone (n = 79), LEARN (n = 79), or Ornish (n = 76) diets and received weekly instruction for 2 months, then an additional 10-month follow-up.

Main Outcome Measures Weight loss at 12 months was the primary outcome. Secondary outcomes included lipid profile (low-density lipoprotein, high-density lipoprotein, and non-high-density lipoprotein cholesterol, and triglyceride levels), percentage of body fat, waist-hip ratio, fasting insulin and glucose levels, and blood pressure. Outcomes were assessed at months 0, 2, 6, and 12. The Tukey studentized range test was used to adjust for multiple testing.

Results Weight loss was greater for women in the Atkins diet group compared with the other diet groups at 12 months, and mean 12-month weight loss was significantly different between the Atkins and Zone diets (P<.05). Mean 12-month weight loss was as follows: Atkins, -4.7 kg (95% confidence interval [CI], -6.3 to -3.1 kg), Zone, -1.6 kg (95% CI, -2.8 to -0.4 kg), LEARN, -2.6 kg (-3.8 to -1.3 kg), and Ornish, -2.2 kg (-3.6 to -0.8 kg). Weight loss was not statistically different among the Zone, LEARN, and Ornish groups. At 12 months, secondary outcomes for the Atkins group were comparable with or more favorable than the other diet groups.

Conclusions In this study, premenopausal overweight and obese women assigned to follow the Atkins diet, which had the lowest carbohydrate intake, lost more weight and experienced more favorable overall metabolic effects at 12 months than women assigned to follow the Zone, Ornish, or LEARN diets. While questions remain about long-term effects and mechanisms, a low-carbohydrate, high-protein, high-fat diet may be considered a feasible alternative
recommendation for weight loss.

Trial Registration clinicaltrials.gov Identifier: NCT00079573

Tuesday, March 20, 2007

Suplemen Antioksidan Meningkatkan Mortalitas

Suplemen antioksidan yang mengandung salah satu atau kombinasi dari
selenium, betakaroten, vitamin A, vitamin E dan vitamin C, banyak digunakan
untuk pencegahan berbagai penyakit.

Para ahli ingin mengetahui efek suplementasi antioksidan terhadap mortalitas
(kematian) penggunanya dengan melakukan meta-analisis.

Hasil penelitian ternyata penggunaan betakaroten, vitamin A dan vitamin E
dapat meningkatkan mortalitas. Sedangkan untuk vitamin C dan Selenium perlu
penelitian lebih lanjut.

Dengan demikian dapat disimpulkan bahwa pemberian suplementasi vitamin
sekalipun perlu hati-hati karena dapat membawa efek yang tidak diinginkan.

Mortality in Randomized Trials of Antioxidant Supplements for Primary and
Secondary Prevention

JAMA. 2007;297:842-857.
Goran Bjelakovic, MD, DrMedSci; Dimitrinka Nikolova, MA; Lise Lotte Gluud,
MD, DrMedSci; Rosa G. Simonetti, MD; Christian Gluud, MD, DrMedSci

Context Antioxidant supplements are used for prevention of several diseases.


Objective To assess the effect of antioxidant supplements on mortality in
randomized primary and secondary prevention trials.

Data Sources and Trial Selection We searched electronic databases and
bibliographies published by October 2005. All randomized trials involving
adults comparing beta carotene, vitamin A, vitamin C (ascorbic acid),
vitamin E, and selenium either singly or combined vs placebo or vs no
intervention were included in our analysis. Randomization, blinding, and
follow-up were considered markers of bias in the included trials. The effect
of antioxidant supplements on all-cause mortality was analyzed with
random-effects meta-analyses and reported as relative risk (RR) with 95%
confidence intervals (CIs). Meta-regression was used to assess the effect of
covariates across the trials.

Data Extraction We included 68 randomized trials with 232 606 participants
(385 publications).

Data Synthesis When all low- and high-bias risk trials of antioxidant
supplements were pooled together there was no significant effect on
mortality (RR, 1.02; 95% CI, 0.98-1.06). Multivariate meta-regression
analyses showed that low-bias risk trials (RR, 1.16; 95% CI, 1.05-1.29) and
selenium (RR, 0.998; 95% CI, 0.997-0.9995) were significantly associated
with mortality. In 47 low-bias trials with 180 938 participants, the
antioxidant supplements significantly increased mortality (RR, 1.05; 95% CI,
1.02-1.08). In low-bias risk trials, after exclusion of selenium trials,
beta carotene (RR, 1.07; 95% CI, 1.02-1.11), vitamin A (RR, 1.16; 95% CI,
1.10-1.24), and vitamin E (RR, 1.04; 95% CI, 1.01-1.07), singly or combined,
significantly increased mortality. Vitamin C and selenium had no significant
effect on mortality.

Conclusions Treatment with beta carotene, vitamin A, and vitamin E may
increase mortality. The potential roles of vitamin C and selenium on
mortality need further study.

Author Affiliations: The Cochrane Hepato-Biliary Group, Copenhagen Trial
Unit, Center for Clinical Intervention Research, Copenhagen University
Hospital, Rigshospitalet, Copenhagen, Denmark (Drs Bjelakovic, L. L. Gluud,
Simonetti, and C. Gluud and Ms Nikolova); Department of Internal Medicine,
Gastroenterology and Hepatology, University of Nis, Nis, Serbia (Dr
Bjelakovic); and Divisione di Medicina, Ospedale V. Cervello, Palermo, Italy
(Dr Simonetti).