Alexis St.George

Independent Effects of Physical Activity in Patients with Nonalcoholic Fatty Liver Disease

Nonalcoholic fatty liver disease, characterized by elevated liver enzymes, central obesity, and insulin resistance, is becoming increasingly prevalent. The effects of changes in physical activity on the metabolic profile of this group have not been reported. We assessed at 3 months the impact of a behavior change‐based lifestyle intervention on physical activity and the effects of this change on the metabolic profile of people with fatty liver disease. In all, 141 participants with nonalcoholic fatty liver disease were prospectively enrolled into either a low‐ or moderate‐intensity lifestyle intervention or to a control group. Physical activity was assessed using a validated reporting tool and physical fitness was measured using the YMCA protocol on a cycle ergometer. Individualized counseling to increase physical activity was provided. Overall, 96% of participants attended the 3‐month follow‐up assessment. Participants in the moderate‐ and low‐intensity intervention groups were 9 times more likely to increase physical activity by an hour or more per week compared to controls. Patients increasing or maintaining their reported physical activity to ≥150 minutes/week, and those who increased their objective levels of fitness, had the greatest improvements in liver enzymes and other metabolic indices compared to those who were least active. This effect was independent of weight loss and was corroborated by an objective measure of fitness. There was no dose‐response effect on liver enzymes with incremental increases in physical activity above 60 minutes/week. Conclusion: Lifestyle counseling interventions are effective in improving physical activity behavior. Maintaining or increasing physical activity provides health benefits for patients with fatty liver, independent of changes in weight. (HEPATOLOGY 2009.)

Effect of a lifestyle intervention in patients with abnormal liver enzymes and metabolic risk factors

Background and Aim:  Non‐alcoholic fatty liver disease associated with insulin resistance is the most common cause of abnormal liver tests in clinical practice. To date, practical and effective strategies to improve the metabolic profile of this large group of patients have not been well characterised. We sought to assess the effect at 3 months of a behavior change‐based lifestyle intervention on the metabolic profile of patients characterised by elevated liver enzymes.

The pattern of complaints about Australian wind farms does not match the establishment and distribution of turbines: support for the psychogenic, 'communicated disease' hypothesis.

Background and Objectives With often florid allegations about health problems arising from wind turbine exposure now widespread, nocebo effects potentially confound any future investigation of turbine health impact. Historical audits of health complaints are therefore important. We test 4 hypotheses relevant to psychogenic explanations of the variable timing and distribution of health and noise complaints about wind farms in Australia. Setting All Australian wind farms (51 with 1634 turbines) operating 1993–2012. Methods Records of complaints about noise or health from residents living near 51 Australian wind farms were obtained from all wind farm companies, and corroborated with complaints in submissions to 3 government public enquiries and news media records and court affidavits. These are expressed as proportions of estimated populations residing within 5 km of wind farms. Results There are large historical and geographical variations in wind farm complaints. 33/51 (64.7%) of Australian wind farms including 18/34 (52.9%) with turbine size >1 MW have never been subject to noise or health complaints. These 33 farms have an estimated 21,633 residents within 5 km and have operated complaint-free for a cumulative 267 years. Western Australia and Tasmania have seen no complaints. 129 individuals across Australia (1 in 254 residents) appear to have ever complained, with 94 (73%) being residents near 6 wind farms targeted by anti wind farm groups. The large majority 116/129(90%) of complainants made their first complaint after 2009 when anti wind farm groups began to add health concerns to their wider opposition. In the preceding years, health or noise complaints were rare despite large and small-turbine wind farms having operated for many years. Conclusions The reported historical and geographical variations in complaints are consistent with psychogenic hypotheses that expressed health problems are “communicated diseases” with nocebo effects likely to play an important role in the aetiology of complaints.

Weight change in control group participants in behavioural weight loss interventions: a systematic review and meta-regression study

BackgroundUnanticipated control group improvements have been observed in intervention trials targeting various health behaviours. This phenomenon has not been studied in the context of behavioural weight loss intervention trials. The purpose of this study is to conduct a systematic review and meta-regression of behavioural weight loss interventions to quantify control group weight change, and relate the size of this effect to specific trial and sample characteristics.MethodsDatabase searches identified reports of intervention trials meeting the inclusion criteria. Data on control group weight change and possible explanatory factors were abstracted and analysed descriptively and quantitatively.Results85 trials were reviewed and 72 were included in the meta-regression. While there was no change in control group weight, control groups receiving usual care lost 1 kg more than control groups that received no intervention, beyond measurement.ConclusionsThere are several possible explanations why control group changes occur in intervention trials targeting other behaviours, but not for weight loss. Control group participation may prevent weight gain, although more research is needed to confirm this hypothesis.

Reaching 'an audience that you would never dream of speaking to': influential public health researchers' views on the role of news media in influencing policy and public understanding

While governments and academic institutions urge researchers to engage with news media, traditional academic values of public disengagement have inhibited many from giving high priority to media activity. In this interview-based study, the authors report on the views about news media engagement and strategies used by 36 peer-voted leading Australian public health researchers in 6 fields. The authors consider their views about the role and importance of media in influencing policy, their reflections on effective or ineffective media communicators, and strategies used by these researchers about how to best retain their credibility and influence while engaging with the news media. A willingness and capacity to engage with the mass media was seen as an essential attribute of influential public health researchers.

How the factoid of wind turbines causing ‘vibroacoustic disease’ came to be ‘irrefutably demonstrated’

Objective : In recent years, claims have proliferated in cyberspace that wind turbines cause a large variety of symptoms and diseases. One of these, “vibroacoustic disease” (VAD) is frequently mentioned. The aim of this study is to examine the quality of the evidence on how VAD came to be associated with wind turbine exposure by wind farm opponents.

Effects of lifestyle intervention on soluble CD163, a macrophage activation marker, in patients with non-alcoholic fatty liver disease

Abstract Objective: Liver macrophages play an important role in the pathogenesis of non-alcoholic fatty liver disease (NAFLD). Soluble CD163 (sCD163), a macrophage-specific biomarker, reflects disease activity in the range of liver diseases. The impact of lifestyle intervention on sCD163 in adult NAFLD patients has not been investigated. Material and methods: We assessed 126 NAFLD patients participating in a lifestyle intervention study for sCD163 concentrations at baseline, after the three-month intervention period, and at long-term follow-up after 12 and 24 months. Results: The median sCD163 concentration at baseline was 2.59 mg/L (IQR = 1.78–3.63 mg/L). There was a significant decrease in sCD163 from baseline to three months follow-up (−0.64 mg/L, p < .001) with no difference between the four study groups (p = .6). At 12 and 24 months follow-up, the sCD163 concentrations had returned to baseline level (p = .3 and p = .1). Baseline sCD163 correlated with liver biomarkers and metabolic variables. There was a significantly greater decrease in sCD163 in patients who had a decrease in alanine aminotransferase (ALT) compared with patients with unchanged or increased ALT (−0.76 mg/L vs. −0.41 mg/L, p = .02), and in patients with a decrease in HOMA-IR compared with individuals with no decrease (−0.86 mg/L vs. −0.55 mg/L, p = .03). Conclusion: sCD163 is associated with markers of liver necro-inflammation and glucose homoeostasis in NAFLD. Participation in a lifestyle intervention programme resulted in a significant reduction in sCD163. Our data support the utility of sCD163 as a biomarker for monitoring the efficacy of therapeutic interventions in NAFLD.

Comprehensive sector-wide strategies to prevent and control obesity: what are the potential health and broader societal benefits? A case study from Australia

AIM Several countries have recently established multistakeholder strategies to prevent or control overweight and obesity; however, studies have not yet been done on their effectiveness and likely impact. This studys objectives were to (i) explore sector-wide benefits and impacts likely to accrue from implementing an obesity prevention strategy in the Australian state of New South Wales; (ii) discuss the wider implications of the findings for research and practice; and (iii) strengthen the case for sustained implementation of a comprehensive, intersectoral approach. METHOD A case study approach, including evidence reviews and illustrative epidemiological models, was used to show potential benefits from meeting selected targets and objectives specified in the strategy. RESULTS For adults, improved health outcomes potentially include reductions in all-cause mortality, cardiovascular disease, type 2 diabetes, various cancers, osteoarthritis, infant mortality and healthcare costs. Potential benefits beyond the health sector involve disability payments, absenteeism, worker productivity, workplace injuries and insurance claims. For children and adolescents, improved health outcomes potentially include metabolic risk factors, dental health, prehypertension/hypertension, cardiovascular disease risk factors, depression, rates of mortality in hospitalised children, bullying and otitis media. CONCLUSION Sector-wide health, social and economic benefits from successful implementation of multisector obesity prevention strategies are likely to be substantial if specified targets are achieved. Epidemiological modelling described in this paper for selected examples provides illustrative rather than comprehensive evidence for potential benefits. Process evaluation of the extent of implementation of these multisectoral strategies, together with the accumulated data on intervention effectiveness, will determine their potential population health benefit. Quantifying the health and social benefits that are likely to accrue if comprehensive sector-wide obesity prevention and control strategies are established can strengthen advocacy for their sustained implementation.

Diabetes: T2DM—will tertiary prevention solve the problem?

Gregg et al. demonstrate small but significant remission rates for type 2 diabetes mellitus (T2DM), achieved through an intensive lifestyle tertiary prevention trial. This finding reinforces existing evidence from intensive secondary prevention trials. But can these programmes be translated into the community with similar effects, or is primary prevention required to reduce the epidemic of T2DM?