May 22, 2003
May 22, 2003
Lung-Volume–Reduction Surgery for Severe Emphysema |
 |
|
||||
|
A Low-Carbohydrate Diet as Compared with a Low-Fat Diet in Severe Obesity Severely obese subjects with a high prevalence of diabetes and the metabolic syndrome were randomly assigned to either a low-fat or a low-carbohydrate diet. In this six-month study, an analysis including all subjects indicated that subjects on the low-carbohydrate diet lost more weight than those on the low-fat diet (mean [±SD] decrease, 5.8±8.6 kg vs. 1.9±4.2 kg; P=0.002) and had greater improvements in metabolic status. However, between-group differences were small for all variables. Future studies evaluating long-term cardiovascular outcomes are needed before a carbohydrate-restricted diet can be endorsed.
|
|
A Randomized Trial of a Low-Carbohydrate Diet for Obesity In a one-year trial, 63 obese men and women were assigned to either a low-carbohydrate, high-protein, high-fat diet or a conventional high-carbohydrate, low-fat diet. Participants who followed the low-carbohydrate diet had lost more weight at three and six months than those on the conventional diet, but the differences had abated by one year. The low-carbohydrate diet was associated with a greater improvement in some risk factors for coronary heart disease. Adherence to either diet was poor, and dropout rates were high. Longer and larger studies are still needed to determine the long-term safety and efficacy of low-carbohydrate, high-protein, high-fat diets.
|
||||
Cost Effectiveness of Lung-Volume–Reduction Surgery for Patients with Severe Emphysema On the basis of data from the National Emphysema Treatment Trial, the authors report that over a follow-up period of three years, as compared with medical therapy, lung-volume–reduction surgery cost $190,000 per quality-adjusted life-year gained. The investigators projected future survival and costs and estimated that surgery would cost $53,000 per quality-adjusted life-year gained over a period of 10 years. The long-term cost effectiveness of lung-volume–reduction surgery is not known, but it would compare favorably with other health care interventions only if the benefits were sustained beyond three years.
|
|
Restless Legs Syndrome A 45-year-old woman reports having had nightly insomnia for years. On further questioning, she reports having uncomfortable sensations in her legs when she lies down at night. She has a feeling of needing to move her legs, which is relieved only by getting up and walking around. How should this patient be evaluated and treated?
|
||||
Genetic Medicine and Obesity Common disorders, such as diabetes, asthma, and obesity, run in families but typically have a complex pattern of inheritance. The identification of the relevant genes has been notoriously difficult. A new study, designed to identify "obesity genes" in mice, used a combination of techniques that may help to identify genes that underlie other common disorders.
|
|
The Dilemma of Medicaid This Health Policy Report discusses recent causes of stress on the Medicaid program. Over the past year, Medicaid has faced more severe fiscal constraints related to state budget crises throughout the country. The Bush administration has proposed restructuring Medicaid to give states more flexibility in the design of their individual programs and establishing caps on federal matching funds available to the states.
|
||||
 |
||||||
|
||||||
HOME | SUBSCRIBE | SEARCH | CURRENT ISSUE | PAST ISSUES | COLLECTIONS | PRIVACY | TERMS OF USE | HELP | beta.nejm.org Comments and questions? Please contact us. The New England Journal of Medicine is owned, published, and copyrighted © 2009 Massachusetts Medical Society. All rights reserved. |
