SYSTEMATIC ASSESSMENT OF AN EPIDEMIOLOGIC STUDY Title: Practical dietary calorie management, body weight control and energy expenditure

of diabetic patients in short-term hospitalization Author(s): Nakajima Y, Sato , Sudo !, et al" Volume: #$%&' P !es: (()-&$ Ye r: *+#+ ,ink to article- https-..www"jstage"jst"go"jp.article.jat.#$.&.#$/0)+&./pdf INT"ODUCTION: "e#ie$ o% liter ture 1he re2iew of this literature is ade3uate so that the reader can understand that the study was an attempt to in2estigate how dietary management using the diet therapy recommended by 4apan 5iabetes 6ssociation %45S', 4apan 6therosclerosis Society %46S', and 4apan Society for the Study of 7besity %46SS7' affected body weight %89' reduction and energy expenditure in obese and normal weight type-* diabetic patients" " tio& le 1he rationale behind this study appears to be that despite se2eral studies on calorie restriction, it is unclear how much calorie intake is re3uired for weight control and diabetic treatment in a patient:s daily life" 1he next logical step would be to determine the efficacy of dietary approaches to weight control and diabetic management" '()otheses or O*+e,ti#es 1he article states that the aim of this study is to in2estigate how dietary management using the diet therapy recommended by 45S, 46S, and 46SS7 affected body weight %89' reduction and energy expenditure in obese and normal weight type-* diabetic patients" STUDY DESIGN AND MET'ODS Desi!&: A&s$er s m &( o% the %ollo$i&! Ge&er l ))ro ,h: 5escripti2e testing was used s )ossi*le:

Le#el o% me sureme&t: i&-i#i-u l or e,olo!i, l. 6n indi2idual le2el of measurement was used S)e,i%i, -esi!&: 1his was a case-control study"

Po)ul tio& t "is/: 1he population from which the study sample was selected was men and women aged *+-$; years admitted for diabetic control to Nippon !edical School <ospital from *++(-*++;" S m)li&! Metho- &- S m)le Si0e: 1here was no specification as to how the study sample was selected or what sampling method was used" 1he resulting sample size was #== patients %;0 men and (# women'" Sele,tio& &- E1,lusio& Criteri %or Stu-( Grou): >riteria used in selecting the sample were inpatient admittance for diabetic control" ?xclusion criteria included poor compliance with dietary management, proliferati2e retinopathy which limited physical acti2ity, macroalbuminuria %urinary albumin excretion e3ual to or greater than 0++mg.day', e2idence of li2er or endocrine disease, recent myocardial infarction, or cerebral 2ascular disease, unstable angina pectoris, heart failure, infectious disease, and carcinoma" De)e&- &t # ri *le: 1he dependent 2ariable in this study was body weight %89' reduction and energy expenditure in obese and normal weight type-* diabetic patients" 1he participants were checked for height, 89, and waste circumference on the first morning of admission and upon completion of the experiment @espiratory gas exchange was measured using indirect calorimetry" @?? %kcal.min' was calculated using 9eir:s formula- @??A0"; x B7* %oxygen consumption, #.min' C #"# x B>7* %carbon dioxide production, #.min' @D was assessed in the morning %fasting at +;++ h' and the afternoon %postprandial state at #(++ h' using the formula @DAB>7*.B7* ?nergy ?xpenditure %??' %kcal.min' measurement was assessed in the morning %fasting at +;++ h' and the afternoon %postprandial state at #(++ h' predict the daily energy expenditure"

I&-e)e&-e&t V ri *le1he independent 2ariable in this study was the diet therapy recommended by 45S, 46S, and 46SS7 which began for all of the participants on the day of admission" 1otal dietary calories are calculated using the formula *(-0( kcal.kg E89.day where Edeal 8ody 9eight %E89' is defined as the weight that e3uals ** times the s3uare of the height" 1he diet contained *+F calories from fat, *(F from protein, and ((F from carbohydrate" Physical acti2ity was kept within each patient:s usual intensity without specific exercise programs" Pote&ti l Co&%ou&-i&! or E%%e,t2Mo-i%(i&! V ri *le: >ontrolled by study design %by matching, randomization, etc"'CG 6ge 8!E Hender @D !edications, insulin Physical acti2ity >ontrolled by analysis 1here was no clarification of what was controlled by analysis" Not controlled 8ody composition changes related to body weight loss I&%orm tio& 3i s Co&trolle- *( Stu-( Desi!&1his study did not specify what measures, if any, were used to pre2ent or minimize bias" "ESULTS Missi&! D t : >ompliance or completion rate were not specified in this article" M +or Fi&-i&!s: #" Significant decrease in serum lipids in both the obese and normal weight groups %pI+"+++# in both groups'

*" 89 and 8!E decrease significantly greater in obese group 0" Significant decrease in waist circumference in obese group %pI+"+++#' =" @?? significantly greater in obsess group %pI+"+++#' (" 5aily energy expenditure significantly greater in obese group %pI+"+++#' &" Jcalorie %difference between energy intake and energy expenditure' significantly greater in the obese group $" En the obese group, J89 was significantly related with calorie Co&trol %or Co&%ou&-i&!: 5ata were analyzed using computer software 4!P $"+"# and expressed as a mean S?, but methods were not specified" St tisti, l A& l(sis: >omparisons of changes in body weight and differences in laboratory data between obese and normal-weight groups were studied using a t-test" Pearson:s correlations between continuous 2ariables were used for analysis of association" 6 multi2ariate regression model was used to determine the most statistically significant predictor of body weight reduction" P-2alues of I+"+( were considered significant which is considered appropriate" DISCUSSIONS AND CONCLUSIONS I&ter& l V li-it(: 1he reader drew the same conclusions from the results as the authors: howe2er there may ha2e been a sampling error as there was no mention of randomized selection or of the study being double blind" 1he article acknowledges that @?? change after discharge was not measured" 1hese problems are considered serious enough to jeopardize the internal 2alidity of the studyK E1ter& l V li-it(: 5o to the 3uestionable internal 2alidity, the reader does not belie2e that the results of this study ha2e external 2alidity" Co&siste&,( $ith Other Stu-ies: 1he authors did not attempt to integrate the results of this study with those of pre2ious studies" Theoreti, l Im)ort &,e o% "esults: 1he results of this study suggest that the 45S, 46S, and 46SS7 diet therapy recommendations may be effecti2e in body weight %89' reduction and energy expenditure in obese and normal weight type-* diabetic patients"

Pr ,ti, l Im)ort &,e o% "esults: Endi2iduals or agencies should not do anything differently as a result of this study" Further Stu-(: 1he authors of this article do not make any suggestions for further researchL howe2er, the reader suggests that further research be conducted to determine the effecti2eness the 45S, 46S, and 46SS7 diet therapy recommendations on weight control and diabetic treatment in a patient:s daily life"