Evaluating effect of acute or chronic use of antihypertensives on risk of falls in older adults. Data sources: Systematic search of primary research articles in CINAHL, Cochrane, EBM, EMBASE, and MEDLINE databases from January 1 2007 to June 1 2017. Study selection: Research studies of cohort, case-control, case-crossover, cross-sectional, or randomized controlled trial (RCT) design examining association between antihypertensives and falls in people older than 60 years were evaluated. Data synthesis: Twenty-nine studies (N = 1,234,667 participants) were included. Study quality was assessed using the Newcastle–Ottawa Scale (NOS). PRISMA and MOOSE guidelines were used for abstracting data and random-effects inverse-variance meta-analysis was conducted on 26 articles examining chronic antihypertensive use, with odds ratios (ORs) and hazards ratios (HRs) analyzed separately. Time-risk analysis was performed on 5 articles examining acute use of antihypertensives. Outcomes: Pooled ORs and HRs were calculated to determine the association between chronic antihypertensive use and falls. For time-risk analysis, OR was plotted with respect to number of days since antihypertensive commencement, change, or dose increase. There was no significant association between risk of falling and chronic antihypertensive medication use (OR = 0.97, 95% confidence interval [CI] 0.93–1.01, I² = 64.1%, P = 0.000; and HR = 0.96, 95% CI 0.92–1.00, I² = 0.0%, P = 0.706). The time-risk analysis demonstrated a significantly elevated risk of falling 0–24 hours after antihypertensive initiation, change, or dose increase. When diuretics were used, the risk remained significantly elevated till day 21. There is no significant association between chronic use of antihypertensives and falls in older adults. Risk of falls is highest on day zero for all antihypertensive medications.

Severely energy-restricted diets are used in obesity management, but their efficacy in people with class III obesity (body mass index ≥40 kg/m²) is uncertain. The aims of this systematic review and meta-analysis were to determine the effectiveness and characteristics of severely energy-restricted diets in people with class III obesity. As there was a lack of publications reporting long-term dietary interventions and randomised controlled trial designs, our original publication inclusion criteria were broadened to include uncontrolled study designs and a higher upper limit of energy intake. Eligible publications reported studies including adults with class III obesity and that assessed a diet with daily energy intake ≤5000 kJ for ≥4 weeks. Among 572 unique publications from 4 databases, 11 were eligible and 10 were suitable for meta-analysis. Our original intention was to classify comparison arms into short-term (1 year) interventions. Due to the lack of long-term data found, comparison arms were classified according to the commonalities in dietary intervention length among the included publications, namely dietary interventions of 4 weeks’ duration and those of ≥6 weeks’ duration. After a 4-week severely energy-restricted diet intervention, the pooled average weight loss was 9.81 (95% confidence interval 10.80, 8.83) kg, with a 95% prediction interval of 6.38 to 13.25 kg, representing a loss of approximately 4.1 to 8.6% of initial body weight. Diets ≥6 weeks’ duration produced 25.78 (29.42, 22.15) kg pooled average weight loss, with a 95% prediction interval of 13.77 to 37.80 kg, representing approximately 10.2 to 28.0% weight loss. Daily dietary prescriptions ranged from 330 to 5000 kJ (mean ± standard deviation 2260 ± 1400 kJ), and had wide variations in macronutrient composition. The diets were administered mostly via liquid meal replacement products. While the included publications had a moderate risk of bias score, which may inflate reported weight loss outcomes, the published data to date suggest that severely energy-restricted diets, delivered via diets of varying composition, effectively produce clinically relevant weight loss (≥10% of initial body weight) when used for 6 weeks or more in people with class III obesity.

Severely energy-restricted diets (SERDs) are an effective treatment for obesity, however, adherence to such diets is often perceived as poor by healthcare professionals. This investigation evaluated adherence to a 12-week SERD in participants with class II and III obesity. Reported food consumption was compared against individualised SERD prescriptions. Body weight measures were obtained at baseline, 12 and 52 weeks. The data were analysed in three groups (i) the entire cohort (n = 26), (ii) completers (n = 13) and (iii) non-completers (n = 13). SERD prescription elements included (i) the number of meal replacement products; (ii) total protein; (iii) total energy intake; (iv) level of dietary energy restriction; (v) vegetable serves; (vi) water serves, and (vii) how much physical activity was performed. A generalised repeated-measures mixed-effects model was used to investigate if adherence to the program elements individually, or collectively, influenced weight loss. Completers had an average (± SD) of 4549 ± 748 kJ energy intake per day, resulting in a mean energy restriction of 62% compared to the 69% prescribed, indicating a degree of non-adherence. The percent weight changes for completers and non-completers were −7.8 ± 4.7% and −1.6 ± 2.6% at 12 weeks, and −12.2 ± 12.1% and −1.8 ± 3.2% at 52 weeks, respectively. Complete dietary adherence to a SERD may not be necessary to achieve a clinically relevant weight loss of 12% at 52 weeks, if energy is restricted by at least 62% (~4600 kJ per day) relative to requirements.