F.A. van de Laar

The dieting dilemma in patients with newly diagnosed type 2 diabetes: Does dietary restraint predict weight gain 4 years after diagnosis?

OBJECTIVE To examine whether dieting--restriction of food intake for the purpose of weight control--suppresses or promotes excessive food intake and weight gain. DESIGN A 4-year follow-up study of a dietary intervention in a sample of 97 patients with newly diagnosed Type 2 diabetes. MAIN OUTCOME MEASURES Weight gain, change in body mass index (measured weight in kilograms divided by measured height squared), and intake of energy, as measured with a food frequency questionnaire, were assessed in relation to dietary restraint and tendency to overeat (emotionally or externally induced overeating), as assessed with the Dutch Eating Behaviour Questionnaire. RESULTS Tendency to overeat at diagnosis and not dietary restraint was associated with weight gain and intake of energy 4 years after diagnosis. CONCLUSION These findings suggest that the success of a dietary intervention can be predicted by a subjects tendency toward overeating. The possibility of matched treatment of obesity is discussed on the basis of the distinction between patients with a low versus a high tendency to overeat.

Eating behaviour and adherence to diet in patients with Type 2 diabetes mellitus

Aims  To assess restrained, emotional and external eating behaviour in patients newly diagnosed with Type 2 diabetes compared with the general population, and to assess the relationship of eating behaviour to changes in fat and energy.

Nutritional deficiency in general practice: a systematic review

Objective:Nutritional deficiency is an independent risk factor for mortality. Despite its clinical relevance, the prevalence in a primary care setting is poorly documented. We performed a systematic review of reported prevalence and clinical assessment of nutritional deficiency in general practice.Methods:From MEDLINE, Current Contents and EMBASE, we derived articles and checked the initially included ones for references on prevalence data. Of the eligible articles, we assessed the quality of research and results.Results:We finally included eight studies. The prevalence ranged from 0 to 13%. However, the study populations were heterogeneous and all studies contained methodological flaws, especially selection bias. In addition, the clinical assessment differed between studies.Conclusion:Literature on the prevalence of nutritional deficiency within general practice is rare and provides disputable prevalence assessments.Sponsorship:The Dutch Dairy Association, Zoetermeer.Objective:Nutritional deficiency is an independent risk factor for mortality. Despite its clinical relevance, the prevalence in a primary care setting is poorly documented. We performed a systematic review of reported prevalence and clinical assessment of nutritional deficiency in general practice.Methods:From MEDLINE, Current Contents and EMBASE, we derived articles and checked the initially included ones for references on prevalence data. Of the eligible articles, we assessed the quality of research and results.Results:We finally included eight studies. The prevalence ranged from 0 to 13%. However, the study populations were heterogeneous and all studies contained methodological flaws, especially selection bias. In addition, the clinical assessment differed between studies.Conclusion:Literature on the prevalence of nutritional deficiency within general practice is rare and provides disputable prevalence assessments.Sponsorship:The Dutch Dairy Association, Zoetermeer.

Limited evidence for effects of diet for type 2 diabetes from systematic reviews.

Objective:Systematic reviews are an appraised method to summarize research in a concise and transparent way, and may enable to draw conclusions beyond the sum of results of individual studies. We assessed the results, quality and external validity of systematic reviews on diet in patients with type 2 diabetes.Design, setting, subjects:We systematically searched for systematic reviews on nutritional interventions in patients with type 2 diabetes that used a reproducible search strategy in at least one major database that applied some form of quality assessment. We assessed quality and the external validity of the retrieved systematic reviews. Outcomes were defined as statistical meta-analyses or narrative results using a predefined and reproducible method.Results:Six systematic reviews met the inclusion criteria, investigating dietary interventions in general (n=3), chromium supplementation (n=1), fish-oil (n=1) or herbs and nutrition supplements (n=1). Quality assessment showed minimal/minor flaws in four cases and major/extensive flaws in two cases. All reviews had insufficient data needed to judge external validity. In reviews with minimal/minor flaws, we found beneficial effects of very-low-calorie diets and fish-oil supplements. However, the external validity of these results could not be assessed sufficiently.Conclusions:Systematic reviews largely failed to produce knowledge beyond the sum of the original studies. Furthermore, judgment of external validity was hampered in most cases owing to missing data. To improve the quality and usefulness of systematic reviews of dietary interventions, we recommend the application of more focused research questions, but with broader inclusion criteria, for example, the use of observational studies.Sponsorship:Internal funding Radboud University Nijmegen Medical Centre.

Prevalence of zebras in general practice: Data from the Continuous Morbidity Registration Nijmegen

Objective: To explore the prevalence of rare diseases in the Continuous Morbidity Registration (CMR) Nijmegen, and to discuss methodological difficulties in the study of rare diseases in general practice. Methods: We selected all diseases with a prevalence <0.5/1000 patients/year between 1986 and 2006 in the CMR, and we compared the results with rare diseases in the Orphanet database of rare diseases. Results: We retrieved 71 codes of rare diseases: 15 referred to trauma or intoxications; the remaining 51 could be subdivided into malignancies, specific infections, diseases of short duration, and chronic diseases. Twenty (36%) of these 56 diseases were also listed in the Orphanet database (mostly malignancies and chronic diseases). Conclusion: Although in the literature emphasis is placed on rare chronic diseases, the general practitioner is also confronted with many rare diseases of shorter duration. The CMR is not yet feasible for studying diseases with an extremely low prevalence.

Nutritional deficiency in Dutch primary care: data from general practice research and registration networks.

Objective:To explore incidence and prevalence rates of nutritional deficiency in adults in general practice.Methods:Six Dutch general practice research and registration networks supplied incidence and prevalence rates of nutritional deficiency by the International Classification of Primary Care (ICPC) or ‘E-list’ labels (‘loss of appetite, feeding problem adult, iron, pernicious/folate deficiency anaemia, vitamin deficiencies and other nutritional disorders, weight loss’). In case of disease-related nutritional deficiency, we asked whether this was labelled separately (‘co-registered’) or included in the registration of the underlying disease.Results:‘Iron deficiency anaemia’ had highest incidence (0.3–8.5/1000 person years), and prevalence rates (2.8–8.9/1000 person years). Nutritional deficiency was mostly documented in the elderly. In two networks ‘co-registration’ was additional, two only documented the underlying disease and two did not specify ‘co-registration’. No clear difference was found between networks considering the difference in ‘co-registration’.Conclusion:Nutritional deficiency is little documented in general practice, and generally is not registered separately from the underlying disease.