scholarly journals The Role of Choice in Weight Loss Strategies: A Systematic Review and Meta-Analysis

Nutrients ◽  
2018 ◽  
Vol 10 (9) ◽  
pp. 1136 ◽  
Author(s):  
Jill Leavy ◽  
Peter Clifton ◽  
Jennifer Keogh
Keyword(s):  
Systematic Review ◽  
Weight Loss ◽  
Dietary Intervention ◽  
Meta Analysis ◽  
American Psychological Association ◽  
Control Groups ◽  
Weight Loss Strategies ◽  
And Control ◽  
Weight Loss Strategy

Effective strategies to achieve weight loss and long-term weight loss maintenance have proved to be elusive. This systematic review and meta-analysis aims to explore whether the choice of weight loss strategy is associated with greater weight loss. An electronic search was conducted using the MEDLINE (Medical Literature Analysis and Retrieval System Online, or MEDLARS Online), EMBASE (Excerpta Medica database), CINAHL (Cumulative Index to Nursing and Allied Health Literature), and PsycINFO (Database of Abstracts of Literature in the Field of Psychology, produced by the American Psychological Association and distributed on the association’s APA PsycNET) databases for clinical trials and randomized controlled trials, investigating the role of choice in weight loss strategies. A total of nine studies were identified as meeting the pre-specified criteria. All of the studies included a ‘Choice’ or preference arm and a ‘No Choice’ arm or group who did not receive their preference as a control. A total of 1804 subjects were enrolled in these studies, with weight loss observed in both experimental and control groups of all studies, irrespective of dietary intervention, study duration, or follow-up length. Twelve interventions in nine trials were used for the meta-analysis, with results indicating a greater weight loss in the control groups, 1.09 ± 0.28 (overall mean difference in weight loss between groups ± standard error; p = 0). There was no significant effect of duration or attrition. In this meta-analysis, the choice of weight loss strategy did not confer a weight loss benefit.

P–625 Does endogenous progesterone play a role in unexplained infertility? A systematic review

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
C Raperport ◽  
E Chronopoulou ◽  
R Homburg ◽  
K Khan ◽  
P Bhide
Keyword(s):  
Systematic Review ◽  
Luteal Phase ◽  
Meta Analysis ◽  
Endometrial Receptivity ◽  
Unexplained Infertility ◽  
Receptor Expression ◽  
Control Groups ◽  
Significant Difference ◽  
And Control

Abstract Study question Does endogenous progesterone play a role in unexplained infertility? A systematic review investigating the possibility of altered progesterone-mediated change leading to reduced endometrial receptivity in women with unexplained infertility. Summary answer The evidence suggests that many of the measurable actions of endogenous progesterone are reduced in women with unexplained infertility when compared with controls. What is known already Unexplained infertility is the diagnosis given to heterosexual couples who fail to conceive despite normal semen analysis, regular ovulation and patent tubes. The underlying pathology is likely to relate to embryonic failure to implant. Endometrial receptivity is largely mediated by luteal phase progesterone which controls many different molecular pathways involved in secretory transformation. It is possible that defective actions of progesterone could contribute to this condition. To date however, there is minimal published literature on the role of progesterone in unexplained infertility. We therefore felt it important to combine the results of all trials measuring progesterone-related outcomes in unexplained infertility. Study design, size, duration A systematic review was performed using standard Cochrane methodology. We searched Medline, Embase and CINAHL databases from inception to December 2020 and additionally hand-searched. The study was prospectively registered on Prospero (CRD42020141041). The search strategy was designed to identify all types of primary research published in English that investigated women with unexplained infertility and reported outcomes that relate to progesterone. Newcastle Ottawa Scoring and NHLBI assessment of bias scoring was performed. Participants/materials, setting, methods The study population was women with unexplained infertility. Included studies had no controls, fertile controls or controls with other diagnoses associated with subfertility. Outcomes were either upstream affecting progesterone production/release or receptor expression or downstream measuring results of progesterone-mediated processes. The results were summarised in a narrative review. Meta-analysis was not possible due to varying methodological heterogeneity. Main results and the role of chance 36 studies were included. No difference was found in 18 studies in progesterone levels (serum, peritoneal and salivary) between women with unexplained infertility and control groups. Despite this, 32 of the 36 included studies demonstrated a significant difference between progesterone-mediated outcomes in the unexplained infertile and control groups. 5 ultrasound studies all reported increased resistance and decreased flow on doppler studies of uterine, ovarian and spiral arteries and reduced endometrial and sub-endometrial perfusion. No significant difference was found in luteal phase endometrial thickness in 2 studies. Endometrial dating was reported by 11 studies. 8/11 studies reported significantly higher numbers (20–38%) of ‘out-of-phase’ endometrium in women with unexplained infertility compared with controls. Endometrial biopsy results measuring different cell adhesion molecules, monoclonal antibodies and other molecules involved in endometrial transformation as well as expression of responsible genes and steroid hormone receptors were included. All the progesterone-mediated outcome measures listed above were reduced in unexplained infertile women except β3 integrin which reported contradictory results and SGK1 expression which was reported in 1 study. This trend towards support for the hypothesis may be more important than any individual finding. The quality of the included studies was variable and hence the strength of the recommendations moderate. Limitations, reasons for caution The number of studies measuring each outcome was limited. The study quality varied from good to poor. Methodological heterogeneity between studies prevented meta-analysis. The strength of the study however comes from the originality of the research, the variety of included outcomes and that 32/36 papers reported results supporting the hypothesis. Wider implications of the findings: The findings of this systematic review support the need for larger, well designed research on this topic. If altered progesterone-mediated receptivity is implicated in unexplained infertility, it may be possible to offer other therapeutic interventions to improve outcomes as an alternative or adjunct to standard fertility treatment. Trial registration number NA

scholarly journals Dexmedetomidine Versus Propofol Sedation in Flexible Bronchoscopy: A Randomized Controlled Trial and a Systematic Review and Meta-Analysis

2022 ◽  
Author(s):  
Barak Pertzov ◽  
Boris Krasulya ◽  
Karam Azem ◽  
Yael Shostak ◽  
Shimon Izhakian ◽  
...  
Keyword(s):  
Systematic Review ◽  
Adverse Events ◽  
Controlled Trial ◽  
Meta Analysis ◽  
Flexible Bronchoscopy ◽  
Control Groups ◽  
Randomized Controlled ◽  
Study Results ◽  
Alpha2 Adrenoceptor ◽  
And Control

Abstract Background:Dexmedetomidine (DEX), is a highly selective alpha2 adrenoceptor (α2-AR) agonist, successfully used in various procedures including flexible bronchoscopy. Randomized controlled trials (RCTs) evaluating DEX sedation during bronchoscopy report equivocal results regarding respiratory and hemodynamic outcomes. Methods We conducted an RCT to evaluate the efficacy of dexmedetomidine compared to propofol for sedation during bronchoscopy. The primary outcome was desaturation events, secondary outcomes were transcutaneous Pco2 level, hemodynamic adverse events and physician and patient satisfaction. We have also conducted A systematic review and meta-analysis of all RCTs evaluating DEX sedation during flexible bronchoscopy, included current study results.ResultsOverall, 63 patients were included, 30 and 33 in the DEX and propofol groups, respectively. The number of desaturation events was similar between groups, median (IQR) 1 (0-1) and 1 (0-2) in the DEX and control groups, respectively (P=0.29). Median desaturation time was 1 (0-2) and 1 (0-3) minutes in the DEX and control groups, respectively (P=0.48). Adverse events included hypotension, 33% vs 21.1% in intervention and control groups, respectively (P=0.04), bradycardia, cough, and delayed recovery from sedation. Total adverse events were 22 and 7 in DEX and propofol groups, respectively (P=0.009). The pooled meta-analysis included 13 trials (1604 participants) showed a significantly lower rate of desaturation events in the DEX group (RR 0.67, 95% CI 0.57 to 0.79) with a significantly higher rate of hypotension and bradycardia events (RR 1.55, 95% CI 1.16 to 2.06 and RR 1.91, 95% CI 1.04 to 3.5, respectively)ConclusionDexmedetomidine sedation resulted in a significantly reduced rate of desaturation events in comparison to propofol, midazolam and fentanyl. However, it was also associated with a higher rate of hypotension and bradycardia.Trial registration : NCT04211298, registration date: 26/12/2019

scholarly journals Effect of Time-Restricted Feeding on Body Weight and Cardiometabolic Risks: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A8-A9
Author(s):  
Darin Ruanpeng ◽  
Sikarin Upala ◽  
Anawin Sanguankeo
Keyword(s):  
Systematic Review ◽  
Weight Loss ◽  
Fat Mass ◽  
Lean Mass ◽  
Meta Analysis ◽  
Control Diet ◽  
Intermittent Fasting ◽  
Randomized Controlled ◽  
Total Fat ◽  
And Control

Abstract Introduction: Time-restricted eating (TRE) or time-restricted feeding (TRF), a form of intermittent fasting (IF) when food consumption is restricted to a 4–12 hour window, poses unique possible health benefits that allow the nutrient to work in harmony with circadian rhythm. Whether TRF is effective in weight loss and cardiometabolic profile compare to usual diet is controversial. We conducted a meta-analysis of randomized control trials to investigate the weight and metabolic effects of TRF in humans. Methods: The systematic review was conducted according to the PRISMA guidelines. The literature search was conducted in MEDLINE, EMBASE, and CENTRAL from database inception to November 30, 2020. The search terms included time restricting feeding, time-restricted eating, periodic fasting, intermittent fasting, and periodic fasting. The eligibility criteria included a randomized controlled trial (RCT) comparing the effect of TRF as an intervention and control diet on weight and cardiometabolic risks in individuals with overweight (BMI 23–26.9 kg/m2 in Asian and 25–29.9 kg/m2 in others) or obesity (BMI≥27 kg/m2 in Asian and ≥30 kg/m2 in others) with study duration of at least 8 weeks. The primary outcome is the change in body weight between preintervention and postintervention. The secondary outcome is the change in total fat mass and lean mass, HDL, LDL, and triglycerides. Pool mean differences (MD) with 95% confidence interval (CI) were calculated for each outcome. Results: Four articles met the inclusion criteria and were included in this systematic review and meta-analysis. There were 511 participants with BMI 24 kg/m2 and above and aged between 18 and 65. TRF was defined as a 4–8 hours ad-lib unrestricted eating in 24 hours. The control diet was defined as ad-lib eating per usual habits. There was a significant improvement in weight and body composition in the TRF group. The mean weight loss was -2.08 kg (95% CI: -3.49 to -0.68) greater among TRF group. There was a significant total fat mass and lean mass loss in the TRF group with the MD of -1.29 kg (95% CI: -2.04 to -0.54) and -0.59 kg (95% CI: -1.15 to -0.03), respectively. There was no significant change in HDL, LDL, or triglycerides comparing between TRF and control diet. Conclusion: This systematic review and meta-analysis of RCT showed that TRF with no calories restriction resulted in significant decreased in weight, fat mass, and a slight decreased in total lean mass compared with control diet. Our findings support TRF as an effective lifestyle intervention for weight loss.

Association between serum amyloid A levels and cancers: a systematic review and meta-analysis

2018 ◽  
Vol 94 (1115) ◽  
pp. 499-507 ◽  
Author(s):  
Jielin Zhou ◽  
Jie Sheng ◽  
Yong Fan ◽  
Xingmeng Zhu ◽  
Qi Tao ◽  
...  
Keyword(s):  
Systematic Review ◽  
Serum Amyloid A ◽  
Meta Analysis ◽  
Serum Amyloid ◽  
Sensitivity Analyses ◽  
Cochrane Library ◽  
Control Groups ◽  
Amyloid A ◽  
Mean Differences ◽  
And Control

ObjectiveIncreased serum amyloid A (SAA) levels have been investigated in various human malignancies, but a consistent perspective has not been established to date. This study systematically reviewed the association between SAA levels and cancers.MethodsCochrane Library, PubMed and Embase were carefully searched for available studies. The following keywords were used in database searches: ‘serum amyloid A’, ‘SAA’, ‘cancer’, ‘tumour’, ‘carcinoma’, ‘nubble’, ‘knurl’ and ‘lump’. Pooled standard mean differences (SMDs) with corresponding 95% CIs were calculated using random-effects model analysis.ResultsTwenty studies, which contained 3682 cancer cases and 2424 healthy controls, were identified in this systematic review and meta-analysis. Our study suggested that the average SAA concentrations in the case groups were significantly higher than those in control groups (SMD 0.77, 95% CI 0.55 to 1.00, p<0.001). Subgroup analysis revealed that continent, age and cancer location were associated with SAA level differences between case groups and control groups. Sensitivity analyses showed the robustness and credibility of our results. In addition, we further stratified analyses for cancer stages and found that the concentrations of SAA increased gradually with the aggravation of cancer stages.ConclusionHigh circulating SAA levels were markedly associated with the developing risks of cancer, especially for participants from Asia, Oceania and Europe, or subject age more than 50, or locations in oesophageal squamous cell, ovarian, breast, lung, renal and gastric cancers. In addition, our study found that the concentrations of SAA increased with the severity of cancer stages.

scholarly journals The Role of Hydroxychloroquine in COVID-19 Treatment: A Systematic Review and Meta-Analysis

2020 ◽  
Vol 49 (10) ◽  
Author(s):  
Amir Shamshirian ◽  
Amirhossein Hessami ◽  
Keyvan Heydari ◽  
Reza Alizadeh-Navaei ◽  
Mohammad Ali Ebrahimzadeh ◽  
...  
Keyword(s):  
Systematic Review ◽  
Treatment Group ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Mesh Terms ◽  
Significant Difference ◽  
Mortality Difference ◽  
Meta Regression Analysis ◽  
And Control

Objective: A systematic review and meta-analysis was carried out to examine the role of hydroxychloroquine (HCQ) in the treatment of COVID-19. Methods: We performed a systematic search in PubMed, Scopus, Embase, Cochrane- Library, Web of Science, Google Scholar, and medRxiv pre-print databases using available MeSH terms for COVID-19 and hydroxychloroquine. Data from all studies that focused on the effectiveness of HCQ with or without the addition of azithromycin (AZM) in confirmed COVID-19 patients, which were published up to 12 September 2020, were collated for analysis using CMA v.2.2.064. Results: Our systematic review retrieved 41 studies. Among these, 37 studies including 45,913 participants fulfilled the criteria for subsequent meta-analysis. The data showed no significant difference in treatment efficacy between the HCQ and control groups (RR: 1.02, 95% CI, 0.81–1.27). Combination of HCQ with AZM also did not lead to improved treatment outcomes (RR: 1.26, 95% CI, 0.91–1.74). Furthermore, the mortality difference was not significant, neither in HCQ treatment group (RR: 0.86, 95% CI, 0.71–1.03) nor in HCQ plus AZM treatment group (RR: 1.28, 95% CI, 0.76–2.14) in comparison to controls. Meta-regression analysis showed that age was the factor that significantly affected mortality (P<0.00001). Conclusion: The meta-analysis found that there was no clinical benefit of using either HCQ by itself or in combination with AZM for the treatment of COVID-19 patients. Hence, it may be prudent for clinicians and researchers to focus on other therapeutic options that may show greater promise in this disease. Keywords: Azithromycin, coronavirus outbreaks, pandemic, SARS-CoV-2 disease

What is the Impact of Extracorporeal Shock Wave Lithotripsy on Semen Parameters? A Systematic Review and Meta-Analysis

2016 ◽  
Vol 84 (1) ◽  
pp. 28-34
Author(s):  
Mohammad H. Radfar ◽  
Nasser Simforoosh ◽  
Mehdi Sotoudeh ◽  
Mehdi H. Ramezani ◽  
Mohammad J. Mollakoochakian ◽  
...  
Keyword(s):  
Systematic Review ◽  
Shock Wave ◽  
Confidence Interval ◽  
Shock Wave Lithotripsy ◽  
Meta Analysis ◽  
Sperm Concentration ◽  
Semen Parameters ◽  
Control Groups ◽  
Extracorporeal Shock Wave ◽  
And Control

Background Extracorporeal shock wave lithotripsy (ESWL) is an important tool for the management of urolithiasis. The effects of shockwaves on tissues are established. The aim of this meta-analysis is to evaluate the microscopic semen characteristics of young men before and after ESWL treatment for lower ureteral calculi. Methods Literature searches were performed following the Cochrane guidelines. We conducted a systematic review and meta-analysis that included six trials that investigated the effects of ESWL on semen parameters, including sperm concentration, motility, and hematospermia. Meta-analyses were performed using fixed and random-effects models with tests for publication bias and heterogeneity. Results Significant worsening was detected in sperm concentration and motility after ESWL between case and control groups (mean difference -17.23, 95% confidence interval -22.53 to -11.93, p<0.00001, mean difference -10.82, 95% confidence interval -18.56 to -3.07, p = 0.006). Rate of microscopic and macroscopic hematospermia was significantly higher after ESWL between case and control groups [risk ratio (RR) 40.00, 95% confidence interval 10.11-158.30, p<0.00001, RR 14.33, 95% confidence interval 2.82-72.90, p = 0.001]. All parameters recovered after 3 months. Conclusions This study showed sperm concentration, motility, and rate of hematospermia (microscopic and macroscopic) were affected by ESWL that was used for the treatment of lower ureteral stone. Long-term studies with a focus on male fertility (i.e., pregnancy rates) after ESWL are warranted.

scholarly journals The Use of Platelet-Rich Plasma for Treatment of Tenodesmic Lesions in Horses: A Systematic Review and Meta-Analysis of Clinical and Experimental Data

Animals ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. 793
Author(s):  
Chiara Montano ◽  
Luigi Auletta ◽  
Adelaide Greco ◽  
Dario Costanza ◽  
Pierpaolo Coluccia ◽  
...  
Keyword(s):  
Systematic Review ◽  
Platelet Rich Plasma ◽  
Meta Analysis ◽  
Inclusion Criteria ◽  
Control Groups ◽  
Definitive Evidence ◽  
Dichotomous Data ◽  
And Control ◽  
Risk Ratios

The use of platelet-rich plasma (PRP) to enhance tenodesmic lesion healing has been questioned over the years. The aim of this study was to evaluate current literature to establish the effectiveness of PRP for treating tenodesmic lesions through a systematic review, in accordance with the PRISMA guidelines, and a meta-analysis. Studies comparing PRP with placebo or other treatments for horses with tenodesmic injuries or evaluated PRP effect on tendon and ligament explants were included. Outcomes were clinical, ultrasound, histologic, molecular evaluation, and adverse effects. Two authors independently extracted data and assessed each study’s risk of bias. Treatment effects were evaluated using risk ratios for dichotomous data, together with 95% CI. Data were pooled using the random-effects model. The quality of the evidence for each outcome was assessed using GRADE criteria. Twenty-four trials met inclusion criteria for systematic review, while fifteen studies were included in the meta-analysis. Results showed no significant differences in the outcomes between PRP and control groups. Finally, there is no definitive evidence that PRP enhances tendons and ligaments healing. Therefore, there is a need for more controlled trials to draw a firmer conclusion about the efficacy of PRP as a treatment for tenodesmic lesions in the horse.

scholarly journals Radiologic Measurements in the Assessment of Patellar Instability: A Systematic Review and Meta-analysis

2021 ◽  
Vol 9 (5) ◽  
pp. 232596712199317
Author(s):  
Alex E. White ◽  
Peters T. Otlans ◽  
Dylan P. Horan ◽  
Daniel B. Calem ◽  
William D. Emper ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Systematic Review ◽  
Patellar Instability ◽  
Cruciate Ligament ◽  
Meta Analysis ◽  
Tibial Tubercle ◽  
Trochlear Groove ◽  
Resonance Imaging ◽  
Control Groups ◽  
And Control

Background: Numerous diagnostic imaging measurements related to patellar instability have been evaluated in the literature; however, little has been done to compare these findings across multiple studies. Purpose: To review the different imaging measurements used to evaluate patellar instability and to assess the prevalence of each measure and its utility in predicting instability. We focused on reliability across imaging modalities and between patients with and without patellar instability. Study Design: Systematic review; Level of evidence, 4. Methods: We performed a systematic review of the literature using the PubMed, SCOPUS, and Cochrane databases. Each database was searched for variations of the terms “patellar instability,” “patellar dislocation,” “trochlear dysplasia,” “radiographic measures,” “computed tomography,” and “magnetic resonance imaging.” Studies were included if they were published after May 1, 2009, and before May 1, 2019. A meta-analysis using a random effects model was performed on several measurements, comparing instability and control groups to generate pooled values. Results: A total of 813 articles were identified, and 96 articles comprising 7912 patients and 106 unique metrics were included in the analysis. The mean patient age was 23.1 years (95% CI, 21.1-24.5), and 41% were male. The tibial tubercle–trochlear groove (TT-TG) distance was the most frequently included metric (59 studies), followed by the Insall-Salvati ratio and Caton-Deschamps index (both 26 studies). The interobserver intraclass correlation coefficients were excellent or good for the TT-TG distance and Insall-Salvati ratio in 100% of studies reporting them; however, for the Caton-Deschamps index and Blackburne-Peel ratio, they were excellent or good in only 43% and 40% of studies. Pooled magnetic resonance imaging values for TT-TG distance ( P < .01), Insall-Salvati ratio ( P = .01), and femoral sulcus angle ( P = .02) were significantly different between the instability and control groups. Values for tibial tubercle–posterior cruciate ligament distance ( P = .36) and Caton-Deschamps index ( P = .09) were not significantly different between groups. Conclusion: The most commonly reported measurements for evaluating patellar instability assessed patellar tracking and trochlear morphology. The TT-TG distance was the most common measurement and was greater in the patellar instability group as compared with the control group. In addition, the TT-TG, tibial tubercle–posterior cruciate ligament, and patellar tendon–trochlear groove distances were highly reproducible measurements for patellar tracking, and the Insall-Salvati ratio had superior reproducibility for assessing patellar height.

scholarly journals The Role of Hydroxychloroquine in COVID-19 Treatment: A Systematic Review and Meta-Analysis

2020 ◽  
Author(s):  
Amir Shamshirian ◽  
Amirhossein Hessami ◽  
Keyvan Heydari ◽  
Reza Alizadeh-Navaei ◽  
Mohammad Ali Ebrahimzadeh ◽  
...  
Keyword(s):  
Systematic Review ◽  
Treatment Group ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Mesh Terms ◽  
Significant Difference ◽  
Mortality Difference ◽  
Meta Regression Analysis ◽  
And Control

Objective: A systematic review and meta-analysis was carried out to examine the role of hydroxychloroquine (HCQ) in the treatment of COVID-19. Methods: We performed a systematic search in PubMed, Scopus, Embase, Cochrane- Library, Web of Science, Google-Scholar, and medRxiv pre-print databases using available MeSH terms for COVID-19 and hydroxychloroquine. Data from all studies that focused on the effectiveness of HCQ with or without the addition of azithromycin (AZM) in confirmed COVID-19 patients, which were published up to 12 September 2020, were collated for analysis using CMA v.2.2.064. Results: Our systematic review retrieved 41 studies. Among these, 37 studies including 45,913 participants fulfilled the criteria for subsequent meta-analysis. The data showed no significant difference in treatment efficacy between the HCQ and control groups (RR: 1.02, 95% CI, 0.81–1.27). Combination of HCQ with AZM also did not lead to improved treatment outcomes (RR: 1.26, 95% CI, 0.91–1.74). Furthermore, the mortality difference was not significant, neither in HCQ treatment group (RR: 0.86, 95% CI, 0.71–1.03) nor in HCQ+AZM treatment group (RR: 1.28, 95% CI, 0.76–2.14) in comparison to controls. Meta-regression analysis showed that age was the factor that significantly affected mortality (P<0.00001). Conclusion: The meta-analysis found that there was no clinical benefit of using either HCQ by itself or in combination with AZM for the treatment of COVID-19 patients. Hence, it may be prudent for clinicians and researchers to focus on other therapeutic options that may show greater promise in this disease. Keywords: Azithromycin, coronavirus outbreaks, pandemic, 2019-nCoV disease

scholarly journals Association between characteristics of behavioural weight loss programmes and weight change after programme end: systematic review and meta-analysis

BMJ ◽  
2021 ◽  
pp. n1840
Author(s):  
Jamie Hartmann-Boyce ◽  
Annika Theodoulou ◽  
Jason L Oke ◽  
Ailsa R Butler ◽  
Peter Scarborough ◽  
...  
Keyword(s):  
Systematic Review ◽  
Weight Loss ◽  
Financial Incentives ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Rate Of Change ◽  
Initial Weight ◽  
Control Groups ◽  
Initial Weight Loss ◽  
Meal Replacements

AbstractObjectiveTo determine if the characteristics of behavioural weight loss programmes influence the rate of change in weight after the end of the programme.DesignSystematic review and meta-analysis.Data sourcesTrial registries, 11 electronic databases, and forward citation searching (from database inception; latest search December 2019). Randomised trials of behavioural weight loss programmes in adults with overweight or obesity, reporting outcomes at ≥12 months, including at the end of the programme and after the end of the programme.Review methodsStudies were screened by two independent reviewers with discrepancies resolved by discussion. 5% of the studies identified in the searches met the inclusion criteria. One reviewer extracted the data and a second reviewer checked the data. Risk of bias was assessed with Cochrane’s risk of bias tool (version 1). The rate of change in weight was calculated (kg/month; converted to kg/year for interpretability) after the end of the programme in the intervention versus control groups by a mixed model with a random intercept. Associations between the rate of change in weight and prespecified variables were tested.ResultsData were analysed from 249 trials (n=59 081) with a mean length of follow-up of two years (longest 30 years). 56% of studies (n=140) had an unclear risk of bias, 21% (n=52) a low risk, and 23% (n=57) a high risk of bias. Regain in weight was faster in the intervention versus the no intervention control groups (0.12-0.32 kg/year) but the difference between groups was maintained for at least five years. Each kilogram of weight lost at the end of the programme was associated with faster regain in weight at a rate of 0.13-0.19 kg/year. Financial incentives for weight loss were associated with faster regain in weight at a rate of 1-1.5 kg/year. Compared with programmes with no meal replacements, interventions involving partial meal replacements were associated with faster regain in weight but not after adjustment for weight loss during the programme. Access to the programme outside of the study was associated with slower regain in weight. Programmes where the intensity of the interaction reduced gradually were also associated with slower regain in weight in the multivariable analysis, although the point estimate suggested that the association was small. Other characteristics did not explain the heterogeneity in regain in weight.ConclusionFaster regain in weight after weight loss was associated with greater initial weight loss, but greater initial weight loss was still associated with reduced weight for at least five years after the end of the programme, after which data were limited. Continued availability of the programme to participants outside of the study predicted a slower regain in weight, and provision of financial incentives predicted faster regain in weight; no other clear associations were found.Study registrationPROSPERO CRD42018105744.

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