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Very low calorie diets
Question 1
Question 3
In the UK what percentage of the population is thought to be overweight (body
mass index [BMI] of 25–29.9 kg/m2) or obese (BMI 30 kg/m2 or more)?
For how long is a Very Low Calorie Diet typically used?
a.
6 weeks
a.
Over 30%
b.
8 weeks
b.
Over 35%
c.
12 weeks
c.
Over 40%
d.
16 weeks
d.
Over 45%
e.
24 weeks
e.
Over 50%
Answer c. The VLCD is typically used for 12 weeks, ending with a period
of conventional food re-introduction (e.g. for 12–14 weeks).
Answer e. In the UK, over 50% of adults are overweight (body mass index
[BMI] of 25–29.9 kg/m2) or obese (BMI 30 kg/m2 or more).
Question 2
Question 4
How many kcal/day are supplied by a Very Low Energy Diet?
a.
Less than 1,600kcal/day
b.
Less than 1,400kcal/day
c.
Less than 1,200kcal/day
d.
Less than 1,000kcal/day
e.
Less than 800kcal/day
Answer e. Dietary interventions include low-calorie diets (LCDs; 1,000–
1,200kcal/day for women and 1,200–1,600kcal/day for men), very low
calorie diets (VLCDs; including Very Low Energy Diets [VLED]; below 800kcal/
day) and Low Energy Liquid formula diets (LELD; above 800kcal/day).
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Up to how much can Very Low Calorie Diets cost?
a.
£15/week
b.
£30/week
c.
£45/week
d.
£60/week
e.
£90/week
Answer d. VLCDs cost up to £60–70 per week, so they may be unrealistic
for some people.
DTB CPD/CME accompanying Vol 50 | No 5 | May 2012
DTB CME/CPD | Produced in association with BMJ Learning
DTB CME/CPD
Answers
Very low calorie diets
Question 5
In a meta-analysis of six randomised controlled trials of Very Low Calorie Diets
(VLCD) and Low Calorie Diets, what was the long-term weight loss in patients
taking VLCD (at a mean of 1.9 years)?
a.
Approximately 12% of initial weight
b.
Approximately 10% of initial weight
c.
Approximately 8% of initial weight
d.
Approximately 6% of initial weight
e.
Approximately 4% of initial weight
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Answer d. A meta-analysis of six randomised controlled trials compared VLCDs
(400–608kcal/day for 8-24 weeks; total length of treatment 6-26 months;
maintenance programme not specified) with LCDs comprising conventional
foods (energy goals 1000–1800kcal/day); most studies enrolled patients with
a BMI of 35-40kg/m2. Attrition was around 22% (range 15-41%) for VLCD and
23% (range 0-52%) for LCD over a mean of 29 months. Short-term weight
loss (over a mean of 12.7 weeks on the diet) was greater with VLCD (16.1%
of initial weight vs. 9.7% with LCD, p=0.0001). Long-term weight loss (at a
mean of 1.9 years) was not significantly different (6.3% vs. 5.0% of initial
weight), with VLCD patients regaining 62% and LCD patients 41% of lost
weight. These results represent the best case scenario for both diets because
data were provided for treatment completers in five of the six studies.
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Answers
▼ Indacaterol for COPD
Question 1
Question 2
Mr AR is a 75 year old man with a history of wheeze and breathlessness. He suffers
from chest infections in the winter and has recently been discharged from hospital
following worsening of his symptoms. He has a forced expiratory volume in 1
second (FEV1)/forced vital capacity (FVC) ratio of <0.7 and a FEV1 of 55% predicted.
According to the grades of severity defined by the National Institute for Health
and Clinical Excellence (NICE) how severe is Mr AR’s chronic obstructive pulmonary
disease?
For people with COPD who remain breathless or have exacerbations despite taking
the combination of a long-acting bronchodilator (LABA) plus inhaled corticosteroid,
at what level of FEV1 does NICE recommends offering a long-acting antimuscarinic
agent (LAMA) in addition to the existing drugs?
a.
b.
a.
100-80%
b.
80-60%
Mild
c.
60-40%
Moderate
d.
40-20%
c.
Severe
e.
Any level
d.
Very severe
Answer e. For people with COPD who remain breathless or have
exacerbations despite taking the combination of a LABA plus inhaled
corticosteroid, offer a LAMA in addition, irrespective of their FEV1.
Answer b. The severity of airflow obstruction in COPD is assessed according
to reduction in forced expiratory volume in 1 second (FEV1). The grades
of severity (from mild to very severe) have been defined by the National
Institute for Health and Clinical Excellence (NICE) as shown in the table.
Table 1 Gradation of severity of airflow obstruction
Post-bronchodilator FEV1/
FVC
FEV1 % predicted
Stage 1 (mild)
<0.7
≥80%
Stage 2 (moderate)
<0.7
50–79%
Stage 3 (severe)
<0.7
Stage 4 (very severe)
<0.7
Question 3
Which one of the following improvements is regarded by NICE as not
providing “clinically important effects” in the management of COPD?
a.
a 100mL difference in FEV1
b.
10 unit improvement in the ‘transition dyspnoea index’
30–49%
c.
8 points improvement in St George’s Respiratory Questionnaire
<30% (or <50%
with respiratory
failure)
d.
10% relative risk reduction in hospitalisations
e.
30% relative risk reduction in exacerbations
Answer d. NICE has defined clinically important effects in COPD as
follows: a 100mL difference in FEV1; 1 unit improvement in the
‘transition dyspnoea index’ (TDI); 4 points improvement in St George’s
Respiratory Questionnaire (SGRQ); 20% relative risk reduction (RRR) in
hospitalisations; and 20% RRR in exacerbations.
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Answers
▼ Indacaterol for COPD
Question 4
In a clinical trial comparing indacaterol with salmeterol, by how much more did
indacaterol increase trough FEV1 at week 12 compared with salmeterol?
Question 5
According to the European Public Assessment Report (EPAR), which one of the
following unwanted effects “may be an issue hampering the clinical use of
the product if it affects treatment compliance or patients’ quality of life”?
a.
30mL
b.
60mL
a.
nausea
c.
90mL
b.
nasopharyngitis
d.
120mL
c.
headache
150mL
d.
post-inhalation cough
e.
upper respiratory tract infection
e.
Answer b. In one trial, involving 1,002 patients, indacaterol 150μg once daily
was compared with placebo and with salmeterol 50μg twice daily. Indacaterol
increased trough FEV1 at week 12 by 170mL more than placebo (p<0.001)
and by 60mL more than salmeterol (p<0.001).
Answer d. The EPAR noted that no major safety issues were identified
in trials of indacaterol, but that the most notable effect was postinhalation cough, which was generally mild and did not lead to any
patient discontinuing from the studies at the recommended doses.
Cough was reported by around 17–20% of patients and had an onset
within 15 seconds of inhalation and typically lasted for 5 seconds. The
EPAR comments that the frequency of post-inhalation cough may be an
issue hampering the clinical use of the product if it affects treatment
compliance or patients’ quality of life.
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This CME/CPD module is available for completion online via BMJ
Learning (learning.bmj.com) by subscribers to the online version of DTB.
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contact our Customer Services team on +44 (0)20 7383 6270 or email
support@bmjgroup.com. As well as allowing you to complete CME/CPD
modules online, an online subscription also gives you unlimited access
to the entire DTB archive back to volume 1, issue 1.
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