Sarah J Nolan

A systematic review and meta-analysis examining the effect of eating rate on energy intake and hunger

BACKGROUND Reductions in eating rate are recommended to prevent and treat obesity; yet, the relation between eating rate and energy intake has not been systematically reviewed, with studies producing mixed results. OBJECTIVE Our main objective was to examine how experimentally manipulated differences in eating rate influence concurrent energy intake and subjective hunger ratings. DESIGN We systematically reviewed studies that experimentally manipulated eating rate and measured concurrent food intake, self-reported hunger, or both. We combined effect estimates from studies by using inverse variance meta-analysis, calculating the standardized mean difference (SMD) in food intake between fast and slow eating rate conditions. RESULTS Twenty-two studies were eligible for inclusion. Evidence indicated that a slower eating rate was associated with lower energy intake in comparison to a faster eating rate (random-effects SMD: 0.45; 95% CI: 0.25, 0.65; P < 0.0001). Subgroup analysis indicated that the effect was consistent regardless of the type of manipulation used to alter eating rate, although there was a large amount of heterogeneity between studies. There was no significant relation between eating rate and hunger at the end of the meal or up to 3.5 h later. CONCLUSIONS Evidence to date supports the notion that eating rate affects energy intake. Research is needed to identify effective interventions to reduce eating rate that can be adopted in everyday life to help limit excess consumption.

Advertising as a cue to consume: a systematic review and meta-analysis of the effects of acute exposure to unhealthy food and nonalcoholic beverage advertising on intake in children and adults

BACKGROUND Several studies have assessed the effects of food and nonalcoholic beverage (hereafter collectively referred to as food) advertising on food consumption, but the results of these studies have been mixed. This lack of clarity may be impeding policy action. OBJECTIVE We examined the evidence for a relation between acute exposure to experimental unhealthy food advertising and food consumption. DESIGN The study was a systematic review and meta-analysis of published studies in which advertising exposure (television or Internet) was experimentally manipulated, and food intake was measured. Five electronic databases were searched for relevant publications (SCOPUS, PsycINFO, MEDLINE, Emerald Insight, and JSTOR). An inverse variance meta-analysis was used whereby the standardized mean difference (SMD) in food intake was calculated between unhealthy food advertising and control conditions. RESULTS Twenty-two articles were eligible for inclusion. Data were available for 18 articles to be included in the meta-analysis (which provided 20 comparisons). With all available data included, the analysis indicated a small-to-moderate effect size for advertising on food consumption with participants eating more after exposure to food advertising than after control conditions (SMD: 0.37; 95% CI: 0.09; 0.65; I(2) = 98%). Subgroup analyses showed that the experiments with adult participants provided no evidence of an effect of advertising on intake (SMD: 0.00; P = 1.00; 95% CI: -0.08, 0.08; I(2) = 8%), but a significant effect of moderate size was shown for children, whereby food advertising exposure was associated with greater food intake (SMD: 0.56; P = 0.003; 95% CI: 0.18, 0.94; I(2) = 98%). CONCLUSIONS Evidence to date shows that acute exposure to food advertising increases food intake in children but not in adults. These data support public health policy action that seeks to reduce childrens exposure to unhealthy food advertising.

Will smaller plates lead to smaller waists? A systematic review and meta-analysis of the effect that experimental manipulation of dishware size has on energy consumption

It has been suggested that providing consumers with smaller dishware may prove an effective way of helping people eat less and preventing weight gain, but experimental evidence supporting this has been mixed. The objective of the present work was to examine the current evidence base for whether experimentally manipulated differences in dishware size influence food consumption. We systematically reviewed studies that experimentally manipulated the dishware size participants served themselves at a meal with and measured subsequent food intake. We used inverse variance meta‐analysis, calculating the standardized mean difference (SMD) in food intake between smaller and larger dishware size conditions. Nine experiments from eight publications were eligible for inclusion. The majority of experiments found no significance difference in food intake when participants ate from smaller vs. larger dishware. With all available data included, analysis indicated a marginal effect of dishware size on food intake, with larger dishware size associated with greater intake. However, this effect was small and there was a large amount of heterogeneity across studies (SMD: −0.18, 95% confidence interval: −0.35, 0.00, I2 = 77%). Evidence to date does not show that dishware size has a consistent effect on food intake, so recommendations surrounding the use of smaller plates/dishware to improve public health may be premature.

Assessment of the quality of harms reporting in non-randomised studies and randomised controlled studies of topiramate for the treatment of epilepsy using CONSORT criteria

PURPOSE Treatment decisions should be informed by high quality evidence of both the potential benefit and harms of treatment alternatives. Randomised controlled trials (RCTs) provide the best evidence regarding benefits; however information relating to serious, rare and long-term harms is usually available only from non-randomised studies (NRSs). The aim of this study was to use a checklist based on the CONSORT (Consolidating Standards for Reporting Trials) extension for harms recommendations to assess the quality of reporting of harms data in both NRSs and RCTs of antiepileptic drugs, using studies of topiramate as an example. RESULTS Seventy-eight studies were included from an online search of seven databases. Harms data was extracted from each study using a 25-point checklist. The mean number of items met was 11.5 (SD 2.96) per study. Commercially funded studies met on average 12.7 items and non-commercially funded studies met 10.08 (p value < 0.001). RCTs met on average 13.0 items and NRSs met 10.8 (p = 0.001). Multi-centre studies and commercially funded studies met significantly more items than single centre and non-commercially funded studies respectively. There was no significant difference in the mean number of items met by studies that had included adult vs. child participants, or studies published pre- vs. post-CONSORT extension for harms in 2004. CONCLUSIONS Reporting of harms is significantly better in RCTs than in NRSs of TPM, but is suboptimal overall and has not improved since the publication of CONSORT extension for harms in 2004. There is a need to improve the reporting of harms in order to better inform treatment decisions.

Antiepileptic drug monotherapy for epilepsy: a network meta-analysis

This is the protocol for a review and there is no abstract. The objectives are as follows: To review the time to withdrawal, remission and first seizure of 10 antiepileptic drugs (carbamazepine, phenytoin, valproate, phenobarbitone, oxcarbazepine, lamotrigine, gabapentin, topiramate, levetiracetam, zonisamide) currently used as monotherapy in children and adults with partial onset seizures or generalised tonic-clonic seizures with or without other generalised seizure types.

The not so clean plate club: food self-served won’t always result in food eaten

In a recent article, Wansink and Johnson1 combined data from 14 studies and on the basis of this conclude that in adults ‘about 92% of self-served food is eaten’. On the basis of this they suggest that we can extrapolate how much food will have been eaten in previous studies that measured self-served portion size alone.

Physical exercise training for cystic fibrosis

Cystic fibrosis (CF) is the most common life-shortening autosomal recessively inherited disease in Caucasian populations [2]. Progressive respiratory disease in CF results in an abnormal ventilatory response to exercise which contributes to dyspnea and is a major limiting factor to exercise tolerance [3]. In addition, a sedentary lifestyle contributes to the progression of physical and functional impairment in CF [4], likely with the consequence of a reduced life expectancy as exercise capacity is linked to survival [5]. Exercise has received growing recognition among researchers and clinicians as treatment for chronic disease including CF lung disease [6,7]. In CF, exercise has the potential to improve airway clearance through a combination of hyperventilation, mechanical vibration, and improved sputum viscoelasticity thereby leading to facilitated and increased sputum expectoration [8,9]. Regular physical exercise improves exercise tolerance and slows progressive pulmonary function decline [4,10]. Until today, much of the knowledge on the effects of physical conditioning in CF originates predominantly from observational or small non-randomized and non-controlled studies. Therefore, a systematic review of evidence from randomised controlled trials (RCTs) on the effects of regular physical exercise training was required to critically evaluate potential beneficial effects on patient-relevant outcomes in CF.

The Use and Reporting of the Cross-Over Study Design in Clinical Trials and Systematic Reviews: A Systematic Assessment

Background Systematic reviews of treatment interventions in stable or chronic conditions often require the synthesis of clinical trials with a cross-over design. Previous work has indicated that methodology for analysing cross-over data is inadequate in trial reports and in systematic reviews assessing trials with this design. Objective We assessed systematic review methodology for synthesising cross-over trials among Cochrane Cystic Fibrosis and Genetic Disorders Group reviews published to July 2015, and assessed the quality of reporting among the cross-over trials included in these reviews. Methodology We performed data extraction of methodology and reporting in reviews, trials identified and trials included within reviews. Principal Findings We reviewed a total of 142 Cochrane systematic reviews including 53 reviews which synthesised evidence from 218 cross-over trials. Thirty-three (63%) Cochrane reviews described a clear and appropriate method for the inclusion of cross-over data, and of these 19 (56%) used the same method to analyse results. 145 cross-over trials were described narratively or treated as parallel trials in reviews but in 30 (21%) of these trials data existed in the trial reports to account for the cross-over design. At the trial level, the analysis and presentation of results were often inappropriate or unclear, with only 69 (32%) trials presenting results that could be included in meta-analysis. Conclusions Despite development of accessible, technical guidance and training for Cochrane systematic reviewers, statistical analysis and reporting of cross-over data is inadequate at both the systematic review and the trial level. Plain language and practical guidance for the inclusion of cross-over data in meta-analysis would benefit systematic reviewers, who come from a wide range of health specialties. Minimum reporting standards for cross-over trials are needed.

Inhaled Mannitol (Bronchitol) for Cystic Fibrosis

Sarah J. Nolan *, Judith Thornton , Clare S. Murray , Tiffany Dwyer 4 Department of Biostatistics, The University of Liverpool, Liverpool, UK Centre for Clinical Practice, National Institute for Health and Care Excellence, Manchester, UK Centre for Respiratory Medicine and Allergy, Institute of Inflammation and Repair, University of Manchester and University Hospital of South Manchester, Manchester, UK 4 Sydney Medical School, University of Sydney, Sydney, Australia