Carbohydrate restriction in the morning increases weight loss effect of a hypocaloric Mediterranean type diet: a randomized, parallel group dietary intervention in overweight and obese subjects.

OBJECTIVE: The aim of this study was to examine the effect of carbohydrate restriction in the morning in the framework of a hypocaloric Mediterranean diet on weight loss and metabolic parameters. METHODS: Seventy overweight/obese individuals were randomized to two hypocaloric dietary regimens: one Mediterranean diet (Med-D) and one morning carbohydrate-restriction diet (MCR-D). Participants assigned to the MCR-D were permitted to consume a breakfast low in carbohydrate content, whereas typical Mediterranean morning meals were allowed in the Med-D group. Both diets were identical from midday on. Participants were followed over a period of 2 mo. RESULTS: Individuals in both groups achieved significant reductions in body weight, body mass index, waist circumference, and body fat mass. These reductions were more pronounced in the MCR-D than in the Med-D group (all P < 0.001). More participants in the MCR-D group achieved loss of 5% to 10% of body weight by the end of the first month, as well as 5% to 10% and >10% of body weight by the end of the second month (all P < 0.001). All participants achieved loss of ≥5% baseline body weight by the end of the intervention. Both groups achieved similar reductions in fasting serum glucose, glycated hemoglobin, and serum triacylglycerols as well as improvement in insulin sensitivity. Individuals in the Med-D group showed reductions in total and low-density lipoprotein cholesterol, whereas no such effect was observed in the MCR-D group. CONCLUSIONS: Integration of morning carbohydrate restriction into a Mediterranean-type hypocaloric diet resulted in greater weight loss while retaining metabolic benefits in glycemia-related parameters.

Management of anastrozole-induced bone loss in breast cancer patients with oral risedronate: results from the ARBI prospective clinical trial.

INTRODUCTION: The aim of this multicenter, phase III, prospective open label clinical trial was to investigate the effect of risedronate (R) on bone mineral density (BMD) in postmenopausal, early breast cancer (BC) patients scheduled to receive anastrozole (A). METHODS: Pre-treatment BMD of 213 patients with hormone receptor-positive BC was evaluated at lumbar spine (LS) and hip (HP). Patients were categorized according to their baseline BMD T-score as being at low, moderate and high risk of osteoporosis. Low risk patients received anastrozole only (A), moderate risk were randomized to anastrozole +/- risedronate (A+/-R) administration and high risk patients received anastrozole + risedronate (A+R). Anastrozole was given at a dosage of 1 mg/day while oral risedronate was given at 35 mg/week. BMD was then assessed at 12 and 24 months. All patients received daily supplements of calcium (1000 mg/day) and vitamin D (400 IU/day). RESULTS: At 24 months, in the moderate risk group, treatment with A+R resulted in a significant increase in BMD at LS and HP compared to treatment with A only (5.7% v -1.5%, Wilcoxon test P = 0.006, and 1.6% v -3.9% Wilcoxon test P = 0.037, respectively), while no significant difference was found at 12 months; 24.3% of the patients moved to normal BMD region. In the high risk group, a significant increase for LS was detected both at 12 and 24 months (6.3% and 6.6%, P < 0.001) but not for HP; BMD in 14% of patients improved to the osteopenic region. In the low risk group, a significant decrease of BMD was detected at 12 months for LS and HP (-5.3% P < 0.001 and -2.4% P < 0.001, respectively,); at 24 months, a significant decrease of BMD was detected only for LS (-2.5%, P < 0.001). However, 22% of patients became osteopenic and only 4% became osteoporotic. CONCLUSIONS: The addition of oral risedronate in post-menopausal breast cancer patients receiving anastrozole has a favorable effect on BMD. Patients with pre-treatment osteopenic to osteoporotic status should be treated with a combination of both therapies in order to avoid bone loss induced by aromatase inhibition. Patients with normal BMD before starting treatment with anastrozole have a very low risk to develop osteoporosis.

Improvement of facial appearance and nocturnal breathing with geniotomy (sliding genioplasty): report of two cases.

This article reports on two cases of nonobese female patients who presented in an orthodontic practice complaining of dental malocclusion and facial dysharmony. Because of the observed clinically and radiographically extreme mandibular retrognathia, they were referred for a sleep study and were found to have mild sleep apnea. Surgery in the form of advancement geniotomy was offered to relieve their retroglossal obstruction, improve their nocturnal sleep, and simultaneously address their facial esthetic concerns. Advancement geniotomy is useful for sleep apneic patients with exclusively retroglossal obstruction secondary to mandibular retrognathia.