The therapeutic effect of fiber in treating obesity. Effect of a high-fiber diet vs a fiber-supplemented diet on C-reactive protein level. Dietary fiber and the glycemic index: a background paper for the Nordic Nutrition Recommendations 2012 Determinants of weight loss maintenance: a systematic review. [Effects of fiber administration in the prevention of gallstones in obese patients on a reducing diet. A clinical trial]. Effect of Psyllium Fiber Supplementation on C-Reactive Protein: The Trial to Reduce Inflammatory Markers (TRIM) Protocol for systematic reviews of determinants/correlates of obesity-related dietary and physical activity behaviors in young children (preschool 0 to 6 years): evidence mapping and syntheses Effect of alginate supplementation on weight loss in obese subjects completing a 12-wk energy-restricted diet: a randomized controlled trial. Calcium intake in health maintenance – a systematic review Effect of glucomannan on obese patients: a clinical study. Soy fiber improves weight loss and lipid profile in overweight and obese adults: a randomized controlled trial. Whole-body vibration training in obese subjects: A systematic review Effect of vitamin D supplementation on inflammation: protocol for a systematic review The Effects of Maternal Supplementation of Polyunsaturated Fatty Acids on Visual, Neurobehavioural, and Developmental Outcomes of the Child: A Systematic Review of the Randomized Trials Bias in Systematic Reviews? Systematic Reviews: Synthesis of Best Evidence for Clinical Decisions Effects of intentional weight loss in patients with obesity and heart failure: a systematic review. Dietary fiber supplementation for fecal incontinence: a randomized clinical trial. Effectiveness of parent‐centred interventions for the prevention and treatment of childhood overweight and obesity in community settings: a systematic review How Quickly Do Systematic Reviews Go Out of Date? A Survival Analysis Experiences with three different fiber supplements in weight reduction. Efficacy of vitamin D supplementation in depression in adults: a systematic review protocol The effectiveness of adherence intervention in a colon cancer prevention field trial.
This study provides preliminary data on the influence of ingestion of 15 g of dietary fiber daily for 4 weeks on weight change and serum iron concentrations in obese children . During two consecutive 4-week periods , subjects received either fiber/placebo supplements or placebo/fiber supplements . Initially , and after the fourth and eighth weeks , height , weight , and serum iron concentration were obtained . Diet records were maintained throughout the study . No significant differences ( p less than or equal to 0.05 ) were found in weight change , energy , iron , and crude fiber intakes and serum iron concentrations of the subjects between periods of fiber and placebo supplementation . However , mean weight loss of subjects ( 336 g ) was greater during fiber ingestion than during placebo ingestion ( 33 g ) . Due to the small sample size and the subjects ' poor compliance , further studies are needed , with a larger sample size , to determine the effectiveness of different fibers in the treatment of obesity BACKGROUND Diets high in fiber are associated with lower levels of inflammatory markers . This study examined the reduction in inflammation from a diet supplemented with fiber compared with a diet naturally high in fiber . METHODS R and omized crossover intervention trial of 2 diets , a high-fiber ( 30-g/d ) Dietary Approaches to Stop Hypertension ( DASH ) diet or fiber-supplemented diet ( 30 g/d ) , after a baseline ( regular ) diet period of 3 weeks . There were 35 participants ( 18 lean normotensive and 17 obese hypertensive individuals ) aged 18 to 49 years . RESULTS The study included 28 women and 7 men ; 16 ( 46 % ) were black , the remainder white . The mean ( SD ) fiber intake on baseline diets was 11.9 ( 0.3 ) g/d ; on the high-fiber DASH diet , 27.7 ( 0.6 ) g/d ; and on the supplemented diet , 26.3 ( 0.4 ) g/d . Overall , the mean C-reactive protein ( CRP ) level changed from 4.4 to 3.8 mg/L ( -13.7 % ; P = .046 ) in the high-fiber DASH diet group and to 3.6 mg/L ( -18.1 % ) in the fiber-supplemented diet group ( P = .03 ) . However , CRP levels decreased in the 18 lean normotensive participants in either intervention diet group ( 2.0 mg/L [ baseline ] vs 1.4 mg/L [ high-fiber DASH ] vs 1.2 mg/L [ supplemented ] ) ; P<.05 ) but did not change significantly ( 7.1 mg/L [ baseline ] vs 6.2 mg/L [ high-fiber DASH ] vs 6.5 mg/L [ supplemented ] ; P>.05 ) in obese hypertensive participants . Neither age nor race influenced the response of CRP levels to the diets . No evidence of a crossover effect was detected . CONCLUSIONS The results demonstrate that fiber intake of about 30 g/d ) from a diet naturally rich in fiber or from a supplement can reduce levels of CRP . Further research is needed to more clearly eluci date the differential effect seen in lean vs obese individuals and whether modification of dietary fiber may be helpful in modulating inflammation and its consequent cardiovascular consequences The aim of this study is to review recent data on dietary fiber ( DF ) and the glycemic index ( GI ) , with special focus on studies from the Nordic countries regarding cardiometabolic risk factors , type 2 diabetes , cardiovascular disease , cancer , and total mortality . In this study , recent guidelines and scientific background papers or up date s on older reports on DF and GI published between 2000 and 2011 from the US , EU , WHO , and the World Cancer Research Fund were review ed , as well as prospect i ve cohort and intervention studies carried out in the Nordic countries . All of the reports support the role for fiber-rich foods and DF as an important part of a healthy diet . All of the five identified Nordic papers found protective associations between high intake of DF and health outcomes ; lower risk of cardiovascular disease , type 2 diabetes , colorectal and breast cancer . None of the reports and few of the Nordic papers found clear evidence for the GI in prevention of risk factors or diseases in healthy population s , although association was found in sub-groups , e.g. overweight and obese individuals and suggestive for prevention of type 2 diabetes . It was concluded that DF is associated with decreased risk of different chronic diseases and metabolic conditions . There is not enough evidence that choosing foods with low GI will decrease the risk of chronic diseases in the population overall . However , there is suggestive evidence that ranking food based on their GI might be of use for overweight and obese individuals . Issues regarding methodology , validity and practicality of the GI remain to be clarified BACKGROUND Discerning the determinants of weight loss maintenance is important in the planning of future interventions and policies regarding overweight and obesity . We have therefore systematic ally synthesized recent literature on determinants of weight loss maintenance for individuals with overweight and obesity . METHODS With the use of the Preferred Reporting Items for Systematic Review s and Meta-Analyses statement , prospect i ve studies were identified from search es in PubMed and PsycINFO from 2006 to 2016 . We included articles investigating adults with overweight and obesity undergoing weight loss without surgery or medication .  Included articles were scored on their method ological quality , and a best- evidence synthesis was applied to summarize the results . RESULTS Our search result ed in 8,222 articles of which 67 articles were selected . In total , 124 determinants were identified of which 5 were demographic , 59 were behavioural , 51 were psychological/cognitive and 9 were social and physical environmental determinants . We found consistent evidence that demographic determinants were not predictive of weight loss maintenance . Behavioural and cognitive determinants that promote a reduction in energy intake , an increase in energy expenditure and monitoring of this balance are predictive determinants . CONCLUSION This review identifies key determinants in weight loss maintenance . However , more research regarding cognitive and environmental determinants of weight loss maintenance is needed to advance our knowledge on determinants of weight loss maintenance Nearly 30 % of the obese patients treated with hypoenergetic diets for weight reduction develop gallstone disease ( GD ) . Until the present time , the use of ursodeoxycholic acid ( UDA ) is the only available therapeutic measure to avoid the development of GD . Dietary fiber induce a bile acid synthesis . A double-blind clinical trial was conducted to compare the effect of rational diet plus UDA vs a rational diet supplemented with Psyllium plantago ( Pp ) for the prevention of GD in obese subjects undergoing a weight-reduction diet . Patients with a body mass index ( BMI = weight in Kg/square height in m ) of 30 Kg/m2 or more and with normal gallbladder and biliary tree ultrasound ( GBUS ) were included .  Weight-reduction diets were individually calculated for each patient according to their energy expenditure ( EE ) . Patients were r and omly and blindly assigned either to group I ( diet + 750 mg UDA + fiber placebo ) or group II ( diet + 15 g Pp+ UDA placebo ) . An anthropometric evaluation was performed to each patient before and after the two-month treatment , as well as resting EE by indirect calorimetry , GBUS and endoscopy for the determination of cholesterol crystals in duodenal bile . Weight reduction was similar in both groups ( group I = 6 + /- 2 Kg vs group II = 6 + /- 3 Kg ) . GD development was observed in one patient of group I ( 5.5 % ) and two patients of group II ( p > 0.05 ) . All patients with GD lost a minimum of 4 Kg during the study period . GD development did not correlate with the presence of crystals in the duodenal bile at the beginning of the study . Our results suggest a beneficial effect of a rational diet with fiber supplementation to prevent GD development in obese patients included in a weight reduction program PURPOSE Recent evidence supports a significant association between the intake of dietary fiber and levels of inflammatory markers . The objective of this study was to determine whether daily fiber supplementation would reduce levels of inflammatory markers . METHODS This study was a prospect i ve r and omized controlled trial at a single university medical center . Participants were overweight or obese adults with no history of heart disease . The intervention was psyllium supplementation at either 7 or 14 g/d for 3 months compared with no supplements in a control group . The main outcome measure was change in level of high-sensitivity C-reactive protein ( hsCRP ) concentration ; secondary outcomes included changes in interleukin-6 ( IL-6 ) levels , fibrinogen levels , and white blood cell ( WBC ) count . Protocol completers attended at least 2 visits and took more than 75 % of the prescribed fiber dose . RESULTS In this intent-to-treat analysis ( n = 158 ) , there were no significant differences between either of the 2 treatment groups and the control group in the amount of change in CRP , fibrinogen , or IL-6 levels or in WBC count ( P>.05 ) . In the analysis of protocol completers ( n = 132 ) , there also were no significant differences between the groups except for a small decrease in fibrinogen level in the high-fiber group ( −6 mg/dL [ −0.18 μmol/L ] compared with 13 mg/dL [ 0.38 μmol/L ] in the control group , P<.05 ) . CONCLUSION Psyllium fiber supplementation did not significantly reduce  CRP levels in overweight or obese individuals in this trial , and changes in other markers were not consistent . Further research is needed to determine whether other fibers or nutrients can reduce inflammatory markers Background The aim of these review s is to inform the design and content of interventions to reduce obesity in young children . The behaviors that are associated with obesity/overweight have been studied extensively ; however , the factors associated with these behaviors in young children ( 0 to 6 years ) have not been systematic ally review ed . Over the past few years the focus of obesity prevention has shifted to preschool children because of the high prevalence of obesity at school entry and recognition that habits formed in early life could track into adulthood . In order to develop effective interventions and change behavior , it is important to underst and the factors that are associated with those behaviors . For example , we need to underst and whether it would be more important to target the family , childcare setting s or the wider environment and identify the most effective way of changing these energy balance related behaviors . Methods / Design Quantitative ( intervention and observational ) and qualitative literature on determinants/correlates of fruit and vegetable intake , sugar sweetened beverage and other unhealthy diet intake , and physical activity and sedentary behaviors in young children will be systematic ally identified , mapped and review ed . A common search strategy ( no language or period restrictions ) will be used to identify papers from eight electronic data bases and this will be supplemented by h and - search ing . Next , studies in developed countries that examine the factors associated with these behaviors in children aged 0 to 6 years ( at baseline ) will be screened and mapped descriptively followed by in-depth data extraction , quality assessment and synthesis . Data from quantitative studies will be summarized using either forest plots or harvest plots and narrative synthesis , and qualitative studies using thematic analysis . Qualitative evidence will be integrated with the quantitative evidence , using a parallel synthesis approach , to provide a deeper underst and ing of effective strategies to influence these energy balance related behaviors . Discussion In addition to updating and mapping current research , these review s will be the first to comprehensively synthesize and integrate both the quantitative and qualitative evidence pertaining to determinants/correlates/barriers/facilitators of obesity related behaviors in this young age group ( 0 to 6 years ) with the aim of informing future interventions . Systematic review registration International Prospect i ve Register for Systematic Review s ( PROSPERO ) Registration number : BACKGROUND Acute studies with alginate-based preloads suggested that these strong gelling fibers may induce increased feelings of satiety and reduce energy intakes . However , the long-term efficacy and safety of alginate supplementation on body weight regulation are lacking . OBJECTIVE The primary aim of the study was to investigate the effects in subjects of alginate supplementation  in conjunction with  energy restriction ( -300 kcal/d ) on loss of body weight and fat and , second , on metabolic risk markers in comparison with in a placebo group . DESIGN In a parallel , double-blind , placebo-controlled study , we r and omly assigned 96 obese subjects to either an energy-restricted diet plus a placebo preload supplement or an energy-restricted diet plus an alginate-based preload supplement ( 15 g fiber ) . The preload was administered as a beverage 3 times/d before main meals for a period of 12 wk . RESULTS No differences in loss of body weight and fat between groups were shown in the intension-to-treat ( ITT ) analysis ( P > 0.1 ) . However , in the completer analysis ( n = 80 ) , we showed a greater weight loss with alginate ( 6.78 ± 3.67 kg ) than with the placebo ( 5.04 ± 3.40 kg ) ( P = 0.03 ) , which was mainly attributed to a reduction in the percentage of body fat ( P = 0.03 ) . In the ITT analysis , a larger decrease in systolic and diastolic blood pressure was shown in the placebo group than in the alginate group ( P < 0.05 ) . Plasma concentrations of glucose , insulin , C-reactive protein , and ghrelin , HOMA-IR , and lipid metabolism did not differ between treatment groups in the ITT analysis ( P > 0.1 ) . CONCLUSION These results suggest that alginate supplementation as an adjunct to energy restriction may improve weight loss in obese subjects who complete a 12-wk dietary intervention Background Calcium ( Ca ) is an essential nutrient for the human body . Despite lively research , there is uncertainty about Ca requirements in terms of desirable health outcomes including an upper intake level above which the potential for harm increases . Objectives The aim was to conduct a review to up date requirements and desirable or harmful health effects of Ca on the current scientific evidence . Methods We search ed Medline and Swemed from January 2000 to December 2011 and included all systematic review s that reported Ca supplementation or usual Ca intake on health outcomes . Meta-analyses , r and omized clinical trials and cohort studies were included in the second search between May 2009 and March 2011 and an additional search covering studies till the end of 2011 . This review concentrated on studies reporting independent effects of Ca , although a few recent trials report sole effects of Ca on health outcomes , most trials use Ca in combination with vitamin D vs. placebo . Results In total , we review ed 38 studies addressing the effects of Ca on bone , pregnancy-related outcomes , cancers , cardiovascular outcomes , obesity , and mortality .  There was a lot of heterogeneity in the study protocol s , which made it difficult to draw any strong conclusions . According to the literature , high Ca intake seems to have a small positive effect on bone mineral content ( BMC ) or bone mineral density ( BMD ) in children and postmenopausal women . We did not find any consistent evidence on the effects of Ca on bone health in premenopausal women or men . Also , the evidence that Ca supplementation reduces fracture incidence is scarce and inconsistent . Maternal diet may influence the peak bone mass of offspring but more studies are required . There was no overall effect of Ca intake on cancers . Ca was associated with a decreased risk of breast cancer and a slightly increased risk of prostate cancer in two of the three studies . No associations were found with other cancers . We found no consistent association between cardiovascular outcomes and  Ca  intake except for blood pressure . A small decrease of 2–4 mmHg in systolic blood pressure was found in pregnant and in hypertensive subjects with Ca supplementation . Review ed studies did not show consistent evidence relating Ca intake to either mortality or obesity . Conclusion Based on this evidence , there is no need to change the Nordic recommendations for Ca intake . However , due to heterogeneity in the studies it is difficult to interpret the results and provide single summary statement An eight-week double-blind trial was conducted to test purified glucomannan fiber as a food supplement in 20 obese subjects .  Glucomannan fiber ( from konjac root ) or placebo was given in 1-g doses ( two 500 mg capsules ) with 8 oz water , 1 h prior to each of three meals per d. Subjects were instructed not to change their eating or exercise patterns . Results showed a significant mean weight loss ( 5.5 lbs ) using glucomannan over an eight-week period . Serum cholesterol and low-density lipoprotein cholesterol were significantly reduced ( 21.7 and 15.0 mg/dl respectively ) in the glucomannan treated group . No adverse reactions to glucomannan were reported SCOPE Studies have suggested that food rich in dietary fiber may facilitate body weight loss , lower total and LDL-cholesterol levels , and reduce body fat . This study examined the effects of soy fiber ( SF ) on body weight , body composition , and blood lipids in overweight and obese participants . METHODS AND RESULTS Thirty-nine overweight and obese college adults ( 19 - 39 years of age ) were r and omly assigned to consume control biscuits or biscuits supplemented with SF for their breakfast for 12 wk ( approximately 100 g/day ) . There were significant differences in changes on body weight , BMI , and LDL-cholesterol ( LDL-C ) between the two groups after 12-wk intervention ( p < 0.05 ) . The changes of body weight , BMI , waist circumference , diastolic blood pressure , serum levels of total cholesterol , LDL-C , and glucose , body fat , and trunk fat of participants in SF group were observed significantly after 12 wk . CONCLUSION SF had favorable effects on body weight , BMI , and fasting LDL-C levels in overweight and obese adults . These effects may be beneficial in antiobesity and the improvement of hyperlipidemia and hypertension ( Clinical Trials.gov registration number-NCT01802840 ) Objective ( i ) to determine the outcomes of whole-body vibration training ( WBVT ) on obese individuals , and the intervention setting s producing such effects ; ( ii ) identify potential improper or harmful use of WBVT . Design Systematic review . Data sources Medline , Scopus , Web of Science , PEDro and Scielo until July 2018 . Eligibility criteria Full papers evaluating the effect of  WBVT on body composition , cardiovascular status and functional performance in obese adults . Papers with PEDro score<4 were excluded . Study appraisal and synthesis Risk of bias and quality of WBVT reporting were assessed with PEDro scale ( r and omized controlled trials ) or TREND checklist ( non-r and omized studies ) and a 14-items checklist , respectively . Weighted acceleration , daily exposure and Hedges ’ adjusted g were computed . Results We included 18 papers published 2010–2017 . Typical interventions consisted in three sessions/week of exercises ( squats , calf-raises ) performed on platforms vibrating at 25–40 Hz ( amplitude : 1–2 mm ) ; according to ISO 2631–1:1997 , daily exposure was “ unsafe ” in 7/18 studies . Interventions lasting ≥6 weeks improved cardiac autonomic function and reduced central /peripheral arterial stiffness in obese women ; 10 weeks of WBVT  produced significant weight/fat mass reduction , leg strength improvements as resistance training , and enhanced glucose regulation when added to hypocaloric diet . No paper evidence d losses of lean mass . Isolated cases of adverse effects were reported . Summary To date , WBVT is a promising adjuvant intervention therapy for obese women ; long-term studies involving larger cohorts and male participants are required to demonstrate the associated safety and health benefits . The therapeutic use of WBVT in the management of obese patients is still not st and ardised and should be supported by an extensive knowledge on the causality between vibration parameters and outcomes Introduction The extraskeletal role of vitamin D is being increasingly recognised . This has important clinical implication s , as vitamin D deficiency has reached epidemic proportions worldwide . Vitamin D has proposed anti-inflammatory properties , yet the role of vitamin D supplementation in reducing inflammation remains largely unknown . The purpose of this review is to investigate the impact of vitamin D supplementation on inflammation , and to identify relevant knowledge gaps in the field . Methods and analysis Medline , CINAHL , EMBASE and All EBM will be systematic ally search ed for r and omised controlled trials ( RCTs ) and systematic review s of RCTs , comparing vitamin D supplementation with placebo , usual care or other pharmacological or non-pharmacological interventions . One review er will assess articles for eligibility according to prespecified selection criteria , after which 2 independent review ers will perform data extraction and quality appraisal . Meta-analyses will be conducted where appropriate . Ethics and dissemination Formal ethical approval is not required as no primary data is collected . This systematic review will identify potential clinical implication s of vitamin D deficiency and supplementation , and will be disseminated through a peer- review ed publication and at conference meetings , to inform future research on the efficacy of vitamin D supplementation for inflammation and inflammatory diseases . PROSPERO registration number CRD42016037104 Polyunsaturated fatty acid ( PUFA ) use in pregnancy has been promoted as beneficial for visual and neurobehavioural development in the fetus . However , no systematic review of the r and omized trials has been conducted . The objective of this review was to evaluate potential advantages of this regiment by review ing all r and omized trials in pregnancy . Methods . Systematic review of r and omized controlled studies comparing cognitive and visual achievements among infants whose mothers were treated and untreated with PUFA during gestation . Results . Nine studies met the inclusion criteria , three focusing on  visual and six on neurobehavioural development . Due to differing outcome measurements in the infants , the studies could not be combined into a formal meta- analysis . Synthesizing the existing data , for both visual and neurobehavioural development , most studies could not show sustained benefits to infant cognition or visual development . Conclusion . At the present time a recommendation to change practice and supplement all expecting mothers with PUFA  to improve offspring vision or neurobehavioural function is not supported by existing evidence At an orthodontic meeting in recent years , a colleague recounted to me that when a presenter had finished their presentation on a systematic review , the person beside leaned over and said to my colleague ‘ not another systematic review where it ’s not possible to draw any firm conclusions ’ . So an element of frustration was clear based on the screening of a large volume of evidence to arrive at such a low point for a conclusion . This , however , is now a familiar outcome for many orthodontic systematic review s. In this short editorial , I have attempted to give a brief outline of the proposed benefits of systematic review s but more importantly , to highlight , some issues we all need to bear in mind in their regard . The increasing focus on evidence -based healthcare , including orthodontics , has shunned the narrative review and spawned the systematic review . Aim ing to identify , evaluate and summarize the findings of all relevant studies on a specific topic , its exacting systematic approach should minimize bias and provide conclusions based on reliable findings . Meta-analyses of r and omized clinical trials with low risk of bias are considered the highest level of evidence available for evaluating the effects of an intervention . Systematic review s are also important tools in setting the research agenda via their recommendations for future research and authors can alert research ers to the most pertinent outcomes in clinical practice . But systematic review s like any other study type are not without their variability , both in dentistry in general and specifically in orthodontics . Large differences have also been observed in the quality of reporting of several characteristics between Cochrane and non-Cochrane systematic review s. A key question that must be asked when looking at all Cochrane review s is whether the review has been undertaken in a way to avoid bias and whether the data and results from the included studies are valid . Conclusions may be distorted if bias is introduced to the review process at any stage . For example , incomplete search ing for all relevant studies may lead to publication bias ; there is strong association between publication and studies reporting significant or positive findings in medicine and also within orthodontics . With regard to studies included within the review , these need to be assessed to ensure that they are undertaken and reported in a manner that is free of bias ( systematic error ) . Outcome reporting bias ( ORB ) may also be relevant , e.g. in a study identified as relevant to a review , where data exist on the outcome of interest but only selected findings have been given based on the results . Although systematic review s have emphasized ‘ assessment of method ological quality ’ of included studies , the Cochrane h and book recommends a focus on ‘ risk of bias assessment ’ instead . The justifications are four-fold : it targets whether the results of included studies should be credible ; despite being carried out to the highest st and ards , a study may have risk of bias due to , e.g. impracticality/impossibility of blinding of participants / study personnel ; some quality markers , e.g. a power calculation is unlikely to directly affect risk of bias ; it overcomes ambiguity between quality of reporting and quality of the underlying research At the end of a long week in the office , you sink back into your chair , reflecting on some of the more memorable patients you cared for and counseled . Through gentle history taking , you discovered that urinary incontinence is the underlying cause of an elderly patient 's increasing social isolation . During a careful physical examination , you detected bruising on the torso of a woman with chronic headaches and began to explore the longst and ing abusive relationship between the woman and her alcoholic partner . You discontinued procainamide therapy in a 72-year-old man who had asymptomatic premature ventricular contractions after myocardial infa rct ion . To prevent bleeding from esophageal varices , you started -blocker therapy in a woman with long-st and ing cryptogenic cirrhosis and portal hypertension . In couples ' therapy , discussing the future quality of life of a middle-aged gay man with human immunodeficiency virus infection , you journeyed through emotionally intense dialogue about advance directives . You presented the risk factors for major and minor bleeding to a 39-year-old woman who was considering warfarin therapy because of recently diagnosed atrial fibrillation and valvular heart disease . You listened to , made diagnoses for , treated , advised , and comforted many patients . Yet there were some hiccoughs in your practice along the way . You stumbled while debating the pros and cons of breast cancer screening with a healthy 48-year-old woman who has been staying current with information on the Internet . You question ed the merits of a personalized walking program suggested to you by a motivated 66-year-old man with severe claudication . Explaining that you wanted to review the best current evidence on these issues , you resolved to address your uncertainties before these patients made their next office visits , in a week 's time . Sighing deeply , you acknowledge that you have little time to read . You subscribe to three journals , which you browse months after they arrive-either when your journal stack becomes precariously high or when your guilt is sufficiently motivational . You sometimes find the conclusions of individual articles conflicting or confusing . You know that some of the decisions and suggestions you made this week , specifically your decisions about stopping procainamide therapy and starting -blocker therapy and your advice about bleeding risks from anticoagulant therapy , were based on the best current research evidence [ 1 - 3 ] . On the other h and , your patients ' inquiries about breast cancer screening and exercise treatment for claudication highlight your need for a concise , current , rigorous synthesis of the best available evidence on each of these topics : in brief , a systematic review [ 4 , 5 ] . Incorporating Research Evidence into Clinical Decision Making The foregoing scenario is familiar to practitioners . In a typical week , we encounter patients with diverse problems ; exercise numerous clinical , interpersonal , and technical skills ; and make many decisions . The factors that affect these decisions and their outcomes are complex . For instance , each patient has unique sociodemographic characteristics , cultural circumstances , and personal preferences . Each physician has unique knowledge , experiences , and values . Moreover , practitioners and their patients make decisions within the context of a rapidly changing health care system that influences the availability , accessibility , and cost of diagnostic tests and therapies [ 6 ] . Timely , useful evidence from the biomedical literature should be an integral component of clinical decision making . If one treatment has been shown to be better than another , we need to know , so that we can recommend the treatment to the appropriate patients . The worldwide effort to develop new tests and treatments , and to determine their usefulness , has never been stronger , and our patients and their families expect us to be fonts of the knowledge that results from this effort [ 7 ] . Unfortunately , it is easy for current best research evidence to pass us by [ 8 ] . We may lack the time , motivation , and basic skills needed to find , critically appraise , and synthesize information , all of which we must do if we are to integrate the results of original studies into our practice . Fortunately , several potent methods are emerging that can greatly enhance our ability to interpret and apply research evidence ; foremost among them is the systematic review . This article begins a series in Annals that will examine systematic review s in detail and explore their many applications . Systematic review s represent the best chance that most practitioners will have to underst and and accurately apply the key signals arising from the robust and increasingly productive search for solutions to medical problems . A properly conducted systematic review faithfully summarizes the evidence from all relevant studies on the topic of interest , and it does so concisely and transparently . What Is a Systematic Review ? Systematic review s are scientific investigations in themselves , with pre-planned methods and an assembly of original studies as their subjects . They synthesize the results of multiple primary investigations by using strategies that limit bias and r and om error [ 9 , 10 ] . These strategies include a comprehensive search of all potentially relevant articles and the use of explicit , reproducible criteria in the selection of articles for review . Primary research design s and study characteristics are appraised , data are synthesized , and results are interpreted . When the results of primary studies are summarized but not statistically combined , the review may be called a qualitative systematic review . A quantitative systematic review , or meta- analysis , is a systematic review that uses statistical methods to combine the results of two or more studies . The term overview is sometimes used to denote a systematic review , whether quantitative or qualitative . Summaries of research that lack explicit descriptions of systematic methods are often called narrative review s. Review articles are one type of integrative publication ; practice guidelines , economic evaluations , and clinical decision analyses are others . These other types of integrative articles often incorporate the results of systematic review s. For example , practice guidelines are systematic ally developed statements intended to assist practitioners and patients with decisions about appropriate health care for specific clinical circumstances [ 11 ] . Evidence -based practice guidelines are based on systematic review s of the literature , appropriately adapted to local circumstances and values . Economic evaluations compare both the costs and the consequences of different courses of action ; the knowledge of consequences that are considered in these evaluations is often generated by systematic review s of primary studies . Decision analyses quantify both the likelihood and the valuation of the expected outcomes associated with competing alternatives . Differences between Systematic and Narrative Review s All review s , narrative and systematic alike , are retrospective , observational research studies and are therefore subject to systematic and r and om error . Accordingly , the quality of a review - and thus its worth-depends on the extent to which scientific review methods have been used to minimize error and bias . This is the key feature that distinguishes traditional narrative review s from systematic review s ( Table 1 ) . If a review is prepared according to the steps outlined in the right column of Table 1 , it is more likely to be systematic and to provide unbiased conclusions . If review methods approximate those found in the middle column of Table 1 , the article is more likely to be a narrative review , and the conclusions are less likely to be based on an unbiased summary of all relevant evidence . Table 1 . Differences between Narrative Review s and Systematic Review s Systematic review s are generated to answer specific , often narrow , clinical questions in depth . These questions can be formulated explicitly according to four variables : a specific population and setting ( such as elderly out patients ) , the condition of interest ( for example , hypertension ) , an exposure to a test or treatment ( such as pharmacologic management ) , and one or more specific outcomes ( such as cardiovascular and cerebrovascular events and mortality ) [ 12 ] . Thus , an example of a well-formulated , clinical ly relevant question is , Does pharmacologic treatment of hypertension in the elderly prevent strokes and myocardial infa rct ions or delay death ? If the question that is driving the review is not clear from the title , abstract , or introduction , or if no methods section is included , the paper is more likely to be a narrative review than a systematic review [ 13 ] . Most narrative review articles deal with a broad range of issues related to a given topic rather than addressing a particular issue in depth [ 9 ] . For example , a narrative review on diabetes ( such as that which might be found in a textbook chapter ) might include sections on the physiology and pathophysiology of carbohydrate , lipid , and protein metabolism ; the epidemiology of and prognosis associated with diabetes ; diagnostic and screening approaches ; and preventive , therapeutic , rehabilitative , and palliative interventions . Thus , narrative review s may be most useful for obtaining a broad perspective on a topic ; they are less often useful in furnishing quantitative answers to specific clinical questions . Narrative review s are appropriate for describing the history or development of a problem and its management . Narrative review s may better describe cutting-edge developments if research is scant or preliminary or if studies are very limited by flawed design or execution [ 13 ] . They may be particularly useful for discussing data in light of underlying theory and context . Narrative review s can draw analogies and can conceptually integrate two independent fields of research , such as OBJECTIVE Obesity is an independent risk factor for the development of heart failure , and the two commonly co-exist . The European Society of Cardiology does not provide guidance regarding weight loss strategies in heart failure . The aim of this study was to systematic ally review the evidence for outcomes following intentional weight loss in patients with heart failure and obesity . METHOD A systematic review of English articles was undertaken using data bases PubMed , Embase and CENTRAL . R and omized controlled trials and observational studies reporting outcomes following intentional weight loss by lifestyle , surgical or pharmacotherapy intervention in patients with obesity and heart failure were included . RESULTS Four r and omized controlled trials and seven observational studies were identified . Two r and omized controlled trials used  diet and exercise  as an intervention , one used diet alone and one used a pharmacological intervention ( orlistat ) . All but one reported significant weight loss . Two reported improvement in exercise capacity and quality of life . One reported improvement in New York Heart Association functional class in heart failure with preserved ejection fraction . The observational studies , five of which reported on outcomes following bariatric surgery , despite being small , heterogeneous and high risk of bias , suggested a trend in improvement of left ventricular function , quality of life and exercise capacity following weight loss . CONCLUSION Weight loss is achievable with lifestyle intervention in those with heart failure and obesity and may result in improvements in New York Heart Association classification , quality of life and exercise capacity Dietary fiber supplements are used to manage  fecal incontinence ( FI ) , but little is known about the fiber type to recommend or the level of effectiveness of such supplements , which appears related to the fermentability of the fiber . The aim of this single-blind , r and omized controlled trial was to compare the effects of three dietary fiber supplements ( carboxymethylcellulose [ CMC ] , gum arabic [ GA ] , or psyllium ) with differing levels of fermentability to a placebo in community-living individuals incontinent of loose/liquid feces . The primary outcome was FI frequency ; secondary outcomes included FI amount and consistency , supplement intolerance , and quality of life ( QoL ) . Possible mechanisms underlying supplement effects were also examined . After a 14-day baseline , 189 subjects consumed a placebo or 16 g total fiber/day of one of the fiber supplements for 32 days . FI frequency significantly decreased after psyllium supplementation versus placebo , in both intent-to-treat and per- protocol mixed model analyses . CMC increased FI frequency . In intent-to-treat analysis , the number of FI episodes/week after supplementation was estimated to be 5.5 for Placebo , 2.5 for Psyllium , 4.3 for GA , and 6.2 for CMC . Only psyllium consumption result ed in a gel in feces . Supplement intolerance was low . QoL scores did not differ among groups . Patients with FI may experience a reduction in FI frequency after psyllium supplementation , and decreased FI frequency has been shown to be an important personal goal of treatment for patients with FI . Formation of a gel in feces appears to be a mechanism by which residual psyllium improved FI Background Worldwide in 2000 , 10 % of children aged five to 17 years were reported as being overweight with an additional 2‐3 % being obese . Overweight and obesity in childhood can adversely impact on both physical and psychological health . The rise in the prevalence of childhood obesity is a complex issue but widely recognised contributors include increased energy intake , decreased levels of physical activity and greater time spent in sedentary pursuits . A large number of environmental and cultural factors have also been identified as contributing to the problem . Evidence to support an optimal approach to treating childhood obesity is limited with many studies showing only modest results at best in the long‐term . However , the importance of family‐based treatment that combines diet , physical activity and behavioral components has been acknowledged in a recent Cochrane Systematic Review . It has also been suggested that interventions offered in the community setting may help overcome barriers to participation , by making programs more accessible and allowing the targeting of specific sub‐groups of the population . Objectives The objective of this review was to identify the effectiveness of parent‐centred interventions implemented in the community setting in modifying eating and physical activity behaviors or weight‐related outcomes of children . Inclusion criteria Types of participants This review considered studies that included free‐living children of pre‐school , primary and secondary school age and /or their parents/guardians aged > 18 years . Types of intervention(s)/phenomena of interest Intervention programs were required to have a parental component , to target eating and /or exercise behaviors for the prevention or treatment of obesity , and child weight status reported . Types of studies All intervention studies were included in the review including : r and omized controlled trials ( RCTs ) ; non‐r and omized controlled trials , longitudinal studies , cohort ( both retrospective and prospect i ve ) , case control and time series studies which had been conducted in a community setting . Types of outcomes This review considered studies that included overweight/obesity related outcomes , eating behavior outcomes , physical activity behaviour outcomes , and sedentary behavior outcomes and constructs . Search strategy A literature search of community‐based parent‐centred intervention studies to promote nutrition and physical activity for the prevention and treatment and of childhood overweight and obesity was performed in eight electronic data bases dating from 1975 to April 2009 . Method ological quality Studies were critically appraised for method ological quality using st and ardized tools . Data collection Data was extracted by one review er using a st and ardized data extraction form developed by the research ers and checked for accuracy and consistency by a second review er . Data synthesis Data in relation to setting , methodology , intervention components and effect on weight , dietary intake and physical activity was extracted , and described in a narrative synthesis . Where possible a meta‐ analysis was undertaken . Results Of the home‐based interventions , five of nine studies reported statistically significant changes in anthropometric outcomes post intervention . Of the 10 studies in the before and after school care setting , seven reported a significant decrease in a weight‐related outcome post intervention , with only one reporting an increase . Conclusions Results from the review support the after‐school setting as the most promising for community intervention setting for targeting parents as agents of change within child obesity prevention and treatment programs . Implication s for practice At this stage , interventions to support parents should target the after‐school environment as opposed to being conducted in the home , summer camps , leisure centers or churches . Targeting a decrease in energy intake and sweetened beverages in parallel with increasing number of daily steps and decreasing screen time use . Implication s for research Future studies of high quality are needed across the full range of community setting s. Given that currently most of the higher quality RCTs and the studies showing positive impacts of weight change are in the after‐school setting , further studies in this area using similar method ologies to those already published will facilitate future meta‐analyses in this area Context Clinicians rely on systematic review s for current , evidence -based information . Contribution This survival analysis of 100 meta-analyses indexed in ACP Journal Club from 1995 to 2005 found that new evidence that substantively changed conclusions about the effectiveness or harms of therapies arose frequently and within relatively short time periods . The median survival time without substantive new evidence for the meta-analyses was 5.5 years . Significant new evidence was already available for 7 % of the review s at the time of publication and became available for 23 % within 2 years . Implication Clinical ly important evidence that alters conclusions about the effectiveness and harms of treatments can accumulate rapidly . The Editors Systematic review s have become increasingly common in recent years ( 1 ) and are recommended by many as the best sources of evidence to guide both clinical decisions ( 2 ) and health care policy ( 3 ) . For systematic review s to fulfill these roles , their findings must remain relatively stable for at least several years or effective mechanisms must exist for alerting end users to important changes in evidence . Yet , surprisingly little research has assessed the extent to which systematic review s become out of date or the rate at which this occurs ( 47 ) . Some organizations , such as the Cochrane Collaboration , recommend updating systematic review s every 2 years , but few empirical data guide this or other recommendations about updating . We sought to determine how quickly systematic review s meet explicitly defined criteria for changes in evidence of sufficient importance to warrant updating . We also sought to identify predictors of survival time , the time to such important changes in evidence . Survival time might vary depending on many factors , including the type of question posed by the original review ( for example , therapeutic or diagnostic ) , the types of studies included ( for example , r and omized trials or observational studies ) , and whether the systematic review provided quantitative synthesis . To limit such variation , we focused on systematic review s of r and omized , controlled trials that evaluated therapeutic benefit or harm by providing quantitative synthesis ( meta- analysis ) for at least 1 outcome . Methods Study Design and Sample We used a quasi-r and om process ( alphabetical sort order by author ) to select 100 systematic review s that were indexed in ACP Journal Club with an accompanying commentary between January 1995 and December 2005 ( with a search date no later than 31 December 2004 to ensure at least 1 full year for new evidence to appear ) . We chose this sampling frame because ACP Journal Club selects systematic review s that meet explicit quality st and ards and are deemed directly relevant to clinical practice ( 8) . We regarded the sample size of 100 as sufficiently large to achieve suitably narrow confidence intervals and to permit evaluation of up to 5 potential predictors of survival . Eligibility Criteria Eligible review s evaluated the benefit or harm of a specific drug , class of drug , device , or procedure ( invasive procedure or surgery ) and included r and omized or quasi-r and omized , controlled trials . We excluded evaluations of alternative and complementary medicines because the stability of review s of such therapies might differ substantially from review s of conventional therapies . We required that review s provide a point estimate and 95 % confidence interval for at least 1 outcome in the form of a relative risk , odds ratio , or absolute risk difference for binary outcomes and weighted mean differences for continuous outcomes . We excluded meta-analyses of individual-patient data , meta-regressions , and indirect meta-analyses because of the difficulty of determining whether new data would alter previous quantitative results . Two team members independently assessed eligibility , with disagreements resolved by consensus involving a third review er . When more than 1 review on the same topic was identified , only the earliest was included . Search ing For each review , search es for new trials included identifying new systematic review s on the same topic , su bmi tting relevant content terms to the Clinical Queries function in Ovid , applying the Related Articles function in PubMed to the 3 largest and the 3 most recent trials in the original review ( up to 6 trials in total ) , and using Scopus ( www . scopus .com/ scopus /home.url ) to identify new r and omized trials that cited the original review . When these search strategies yielded no eligible new trials , we conducted more comprehensive electronic search es and review ed relevant chapters in such sources as Clinical Evidence and UpTo Date to ensure that we had not missed new trials . Team members who had background s in both medicine and clinical research screened citations retrieved by the preceding methods to identify trials that would have met the inclusion criteria in the original review . Retrieved articles were screened in chronological order to ascertain quantitative or qualitative signals for the need for updating . The review protocol stopped when any criteria for updating were met . Each systematic review was discussed in detail , with the final statussignal for updating was or was not detectedadjudicated by consensus ( Figure 1 ) . Figure 1 . Overall process for determining updating status . ACP Journal Club Signals for the Need to Up date Systematic Review s In design ing criteria for comparing new findings with those in a previous review , we adapted methods used by other investigators to address similar problems with comparing 2 sets of results relating to the same question ( 913 ) , such as r and omized and nonr and omized studies of the same intervention . These investigators identified conflicting findings among different publications using a combination of quantitative thresholds for differences in effect magnitude and qualitative judgments about the language used to describe the results . We have similarly conceptualized quantitative and qualitative signals of potential changes in evidence that are sufficiently important to warrant updating previous systematic review s. Quantitative Signals Quantitative signals consisted of a change in statistical significance or relative change in effect magnitude of at least 50 % . We restricted these changes to those involving 1 of the primary outcomes of the original review or any mortality outcome . We also ignored trivial changes in statistical significance when the original and up date d meta-analytic results both had P values between 0.04 and 0.06so that quantitative signals of changes in evidence would represent robust indicators of the need to up date previous review s. Quantitative signals were detected by combining data from eligible new trials with the previous results using a fixed-effects approach . Use of fixed-effect models allowed pooling of the new trials with the previous meta-analytic result , as opposed to having to obtain original data from all of the included trials in each of 100 systematic review s. Although r and om-effects models are usually preferred to avoid spurious precision in the face of heterogeneity , our goal was to detect potential changes in evidence that would warrant a formal up date , not produce exact estimates of the up date d results . Qualitative Signals Qualitative signals included new information about harm sufficient to affect clinical decision making , important caveats to the original results , emergence of a superior alternate therapy , and important changes in certainty or direction of effect . Qualitative signals were detected by using explicit criteria for comparing the language in the original review with descriptions of findings in new systematic review s that addressed the same topic , pivotal trials , clinical practice guidelines , or recent editions of major textbooks ( for example , UpTo Date ) . Pivotal trials were defined as trials that had a sample size at least 3 times larger than that of the previous largest trial or were published in 1 of the 5 highest-impact general medical journals ( The New Engl and Journal of Medicine , Lancet , Journal of the American Medical Association , Annals of Internal Medicine , and the British Medical Journal ) . We defined 2 levels of importance for qualitative signals : potentially invalidating changes in evidence , which would make one no longer want clinicians or policymakers to base decisions on the original findings ( such as a pivotal trial that characterized treatment effectiveness in terms opposite of those in the original systematic review ) , and major changes in evidence , which would affect clinical decision making in important ways without invalidating the previous results ( such as the identification of patient population s for whom treatment is more or less beneficial ) . Major changes also included differing characterizations of effectiveness that were less extreme than those for potentially invalidating signals but that would still affect clinical decision making ( for example , a change from possibly beneficial to definitely beneficial ) . Of importance , such characterizations as possibly effective , probably effective , and promising , were all categorized as possibly effective . Thus , qualitative signals for changes in evidence captured substantive differences in the characterization of treatment effects , not merely semantic differences . Full definitions for each of the specific signals can be found at www.ohri.ca/UpdatingSystRevs . Data Collection For each review , we characterized the clinical content area , eligibility criteria for included trials , definitions of reported outcomes , number of included trials and participants , meta-analytic result for each outcome , identification of statistical heterogeneity , and excerpted quotations of the authors ' characterizations of the main results . We also abstract ed whether a given outcome was explicitly identified as 1 of the primary or main outcomes . We discounted identification of more than 3 such outcomes as inconsistent with the BACKGROUND Fiber supplements added to a caloric diet have additional effects on weight reduction in overweight subjects . The aim of this study was to compare the effect of various commercial fiber supplements ( glucomannan , guar gum and alginate ) on weight reduction in healthy overweight subjects . MATERIAL / METHODS One hundred and seventy six men and women were included to receive either active fiber substance or placebo in r and omized placebo-controlled studies . The fiber supplements consisted of the viscous fibers glucomannan ( Chrombalance ) , glucomannan and guar gum ( Appe-Trim ) and glucomannan , guar gum and alginat ( Glucosahl ) . RESULTS All fiber supplements plus a balanced 1200 kcal diet induced significantly weight reduction more than placebo and diet alone , during a five week observation period . However , there were no significant differences between the different fibers in their ability to induce weight reduction , which was approximately 0.8 kg/week ( 3.8 + /- 0.9 , 4.4 + /- 2.0 , 4.1 + /- 0.6 in the Chrombalance , Appe-Trim and Glucosahl group , respectively ) . CONCLUSIONS Glucomannan induced body weight reduction in healthy overweight subjects , whereas the addition of guar gum and alginate did not seem to cause additional loss of weight Background The role of vitamin D in management of depression is unclear . Results from observational and emerging r and omized controlled trials ( RCTs ) investigating the efficacy of vitamin D in depression lack consistency - with some suggesting a positive association while others show a negative or inconclusive association . Methods / Design The primary aim of this study is to conduct a systematic review of RCTs to assess the effect of oral vitamin D supplementation versus placebo on depression symptoms measured by scales and the proportion of patients with symptomatic improvement according to the authors ’ original definition . Secondary aims include assessing the change in quality of life , adverse events and treatment discontinuation . We will conduct the systematic review and meta- analysis according to the recommendations of the Cochrane H and book for Systematic Review s of Interventions . We will search the Cochrane Central Register of Controlled Trials ( CENTRAL ) , MEDLINE ( 1966 to present ) , EMBASE ( 1980 to present ) , CINAHL ( 1982 to present ) , PsychINFO ( 1967 to present ) and Clinical Trials.gov . Unpublished work will be identified by search ing two major conferences : the International Vitamin Conference , the Anxiety Disorders and Depression Conference , while grey literature will be acquired by contacting authors of included studies . We will use the r and om-effects meta- analysis to synthesize the data by pooling the results of included studies . Discussion The results of this systematic review will be helpful in clarifying the efficacy of vitamin D supplementation and providing evidence to establish guidelines for implementation of vitamin D for depression in general practice and other relevant setting s. Study registration Unique identifier : CRD42013003849 BACKGROUND Adherence interventions were implemented in a 1-year community-based colon cancer prevention clinical trial ( n = 110 ) using wheat bran fiber and calcium dietary supplements . The adherence promotion strategy was guided by a theoretical model . METHODS The adherence intervention contains both a generalized portion given to all participants and an individualized portion given to marginal ( 50 - 74 % intake ) and low ( under 50 % intake ) adherers . A regression model was employed to assess the effectiveness of the interventions both at the first intervention and at subsequent times . RESULTS The Health Behavior in Cancer Prevention Model-based adherence promotion intervention was associated with retention of participants , both during the run-in period and after r and omization ( P = 0.05 ) ; and maximization of the percentage of the 13.5-g recommended fiber supplement consumed during the trial ( 92.5 % ) . The positive effects of the adherence intervention  were greater with first-time nonadherers and the control group than with the experimental group . The high-fiber group had notably more biological GI effects from the increased fiber intake , more preexisting comorbidities , and lower perceived cognitive and physical health status . CONCLUSIONS R and omized participants had excellent adherence overall . Retention rates in the trial were better than would be expected without the adherence intervention , especially among those participants who may have been at higher risk for dropping out of the study . This suggests that a systematic , theoretically based adherence strategy should be further tested in clinical trial setting s in which lower adherence is a problem
RESULTS The present study indicated that the efficacy of various fiber supplements on losing weight is variable .
Several mechanisms related to physicochemical properties of fibers such as solubility , fermentability and viscosity rates can be involved in their anti-obesity effects .
Dextrin , Mannan ( gum Arabic ) and pectin-rich fiber ( lupin kernel ) with no dietary interventions indicated a reduction in body weight and energy intake , while from clinical point of view , their effects were not considerable .
Overall , findings indicated that the efficacy of fiber supplements on obesity management is dependent on their contents and physicochemical properties .
It seems that fiber supplements with no weight-loss interventions did not have considerable antiobesity effects .
BACKGROUND Previous trials have reported beneficial effects of isolated and complex fiber supplements in obesity treatment .
However , recommending fiber supplements in obese subjects remains controversial .
To the best of our knowledge , no systematic review has up date d the data on the effects of fiber supplements on obesity since 2010 and the need exists for a systematic review on this topic .
Accordingly , a systematic review was undertaken to summarize the efficacy of different types of fiber supplements as a complementary treatment for weight management .