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Reducing dietary fat has little effect on cardiovascular disease
Half a century ago it was suggested that dietary fat causes
heart disease and that reducing or modifying dietary fat intake will
keep us healthy. This theory is still a mainstay of population "healthy eating" strategies and individual risk reduction advice. On p 757 Hooper et al present a systematic review of randomised controlled trials of dietary fat reduction or modification (including 40 intervention arms, 1430 deaths, and 1216 cardiovascular events). The
review shows only modest reductions in cardiovascular events in those
remaining on diet for over two years. The authors found little evidence
for optimal intakes of total or individual fats.
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An increasing body of literature claims that exercise is
beneficial in the management of depression. A systematic review and meta-regression analysis of randomised controlled trials by Lawlor and
Hopker (p 763) shows that exercise may be efficacious in managing depressive symptoms in the short term but that the trials are of poor
quality and were mostly done in non-clinical volunteers. Better quality
research in this area is needed before the effectiveness of exercise in
clinical populations can be determined.
It is widely recognised that frequent attenders in all medical
settings account for a disproportionate amount of healthcare resources.
While many of these patients have chronic medical problems, others
present with complaints that remain unexplained after extensive investigation. Reid et al (p 767) reviewed the case notes of 361 frequent attenders in secondary care in one region of England in
1993-6. Over a fifth of secondary care consultations by this group
remained medically unexplained, with abdominal pain, chest pain,
headache, and back pain being particularly common. The authors suggest
that the identification and management of unexplained symptoms in
secondary care settings merits greater consideration.
Active coping strategies reduce depression in family caregivers.
Margallo-Lana et al (p 769) assessed whether this was also true in
professional staff caring for people with dementia. They measured
emotional wellbeing and the use of positive coping strategies in 161 staff working in private facilities and 64 working in NHS facilities.
They found that 20% of staff were psychologically distressed but there
was no significant difference between the two different settings.
However, they did confirm that coping strategies protect against
psychological distress and that nurses were more likely than care
assistants to use positive coping strategies.
Unmarried men have higher rates of cardiovascular disease and a
shorter life span than married men, perhaps because factors leading
people to remain unmarried are linked with susceptibility to
cardiovascular disease. Phillips et al asked whether, since small birth size is related to increased risk of cardiovascular disease, it could be associated with marital status (p 771). In a
retrospective, data linked study of 3577 Finnish men they found that
the odds ratio of marrying increased by 1.42 for each kilogram increase
in birth weight. Therefore, low birth weight was associated with a high
percentage of unmarried men. This was not the case for men who were
widowed, divorced, or separated.
Generic counselling is widely used as an alternative to antidepressants
in patients with depression in primary care. However, the two
treatments have not been directly compared. Chilvers et al (p 772)
conducted a randomised controlled trial of antidepressants and
counselling alongside a trial in which patients could choose their
method of treatment. The two methods were equally effective at 12 months' follow up, although antidepressants worked more quickly. Most
patients who had a choice opted for counselling, and these patients did
better than those randomised to counselling. The authors conclude that
patients with a strong preference should be allowed to have their
choice of treatment.
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