Description
Bias and Confounding
For this submission, you will write a two-page paper identifying any bias or confounding that may be present in your research. You will include at least one scholarly reference other than your textbook.
Within your paper, include the elements identified below.
- Identify and describe the measure of association or measure of the effect that you will use in your research based on your research population and research question.
- Determine if confounding is present, and explain your decision.
- Describe methods for controlling bias and confounding in the study design, and provide advantages and disadvantages of each.
Adhere to APA Style when constructing this assignment, and include in-text citations and references for all sources that are used. Please note that no abstract is needed.
This is part of the previous literature review that you helped me with before. You can use the same sources.
Unformatted Attachment Preview
Weight Management: Obesity to Diabetes
Marion J. Franz
U
Nutrition Concepts by Franz, Minneapolis,
MN
Corresponding author: Marion J. Franz,
MarionFranz@aol.com
https://doi.org/10.2337/ds17-0011
©2017 by the American Diabetes Association.
Readers may use this article as long as the work
is properly cited, the use is educational and not
for profit, and the work is not altered. See http://
creativecommons.org/licenses/by-nc-nd/3.0
for details.
VO LU M E 3 0 , N U M B ER 3 , SU M M ER 2 017
nfortunately, the prevalence of
obesity continues to escalate,
and solutions continue to be
evasive. In 2015, two-thirds of the
U.S. population was reported as being overweight or obese (1). Health
care professionals in the diabetes field
are well aware of the impact and consequences of obesity contributing to
the development of prediabetes and
type 2 diabetes. This article reviews
the role of weight management interventions across the continuum of
obesity to prediabetes to diabetes, beginning with management of obesity.
Readers are reminded that weight loss
is an outcome and not a weight management intervention. Interventions
include reduced energy intake, regular physical activity, education and
support, pharmacotherapy, and/or
metabolic (bariatric) surgery.
Weight Management of
Obesity
Moderate weight loss, defined as
a 5–10% reduction from baseline
weight, is associated with clinically
meaningful improvements in obesityrelated metabolic risk factors (2). A
5% weight loss has been shown to
improve pancreatic β-cell function
and the sensitivity of liver and skeletal muscle to insulin, with larger relative weight losses leading to graded
improvements in key adipose tissue
disturbances (3).
The American College of Cardiology/American Heart Association
Obesity Expert Panel recommends
that patients receive high-intensity
behavioral counseling, with ≥14 visits in 6 months (4). They report that
this type of comprehensive program
results in a mean weight loss of 5–8%
and that ~60–65% of patients lose
≥5% of initial weight (4). However,
weight regain is common after completion of such programs, and they
note that the most effective behavioral method for preventing weight
regain is continued support on an
every-other-week or monthly basis,
whether in person or by telephone.
Unfortunately, long-term counseling is not widely available. They also
note that it is challenging to persuade
patients to remain in counseling to
maintain a weight loss that is usually
smaller than they had desired (4). It is
important that all health profession-
149
FROM RESEARCH TO PRACTICE
■ IN BRIEF Evidence supports the effectiveness of nutrition therapy across
the continuum of diabetes management—obesity to prediabetes to diabetes.
For people who are overweight/obese or diagnosed with prediabetes, modest
weight loss is important. However, the goals of nutrition therapy for type
2 diabetes are improved glycemia, lipids, and blood pressure. To achieve
these goals, a reduced energy intake is essential. For some, reducing energy
intake may lead to weight loss, while for others, it may maintain weight loss
or prevent weight gain. Weight loss medications and metabolic surgery have
been shown to be effective weight loss therapies across the continuum.
FROM RESEARCH TO PRACTICE / THE ROLE OF WEIGHT MANAGEMENT IN DIABETES
als help educate the public regarding
the benefits of moderate weight loss.
The other treatment options for
overweight and obesity are weight
loss medications and metabolic
(bariatric) surgery. In 1-year trials,
total weight losses for three monopharmacotherapies (orlistat, lorcaserin, and liraglutide), whose effects are
mediated by different mechanisms,
ranged from 5.8 to 8.8 kg (5.8 to
8.8% of initial body weight) (2). In
1-year trials of two combination medications (phentermine-topiramate and
naltrexone-bupropion), whose effects
are on neural weight loss mechanisms, weight loss ranged from 6.2
to 10.2 kg (6.4–9.8% of initial body
weight) (2).
Mean weight losses of 16–32%
of baseline weight are produced by
metabolic surgery in patients with
severe obesity and may lead to disease remission, including remission
of type 2 diabetes (2). Limitations of
current metabolic surgeries include
high initial costs; at 1 year, risks of
short- and long-term complications;
and weight regain in ~5–20% of
patients (2). However, Roux-en-Y
gastric bypass and vertical-sleeve
gastrectomy are by far the most effective long-term treatments of severe
obesity. Unfortunately, only a small
fraction of patients who would benefit
from these three classes of treatment
(lifestyle intervention, weight loss
medications, and metabolic surgery)
actually receive them (2).
Of interest is a recent position statement from the American Association
of Clinical Endocrinologists and
American College of Endocrinology,
which recommends a new diagnostic term for obesity: adiposity-based
chronic disease, or ABCD (5). The
reason cited for the new term is
to avoid the stigma and confusion
related to the differential use and multiple meanings of the term “obesity.”
Weight Management of
Prediabetes
Readers of this article are likely aware
of the effectiveness of modest weight
150
loss for people with prediabetes.
People with overweight or obesity
who received intensive lifestyle intervention in the Diabetes Prevention
Program (DPP) had a mean weight
loss of 5.6 kg at 2.8 years and a 58%
relative reduction in the risk of type
2 diabetes compared to a 31% risk reduction with metformin (6). Perhaps
most encouraging was the finding that
the incidence of type 2 diabetes remained 34% less than the incidence in
the control group at 10 years’ followup, even though the participants in
the intervention group had, on average, returned to close to their baseline
weight (7).
The American Diabetes Association (ADA) recommends that people
with prediabetes be referred to an
intensive behavioral lifestyle intervention modeled after the DPP (8). The
goal is to achieve and maintain a 7%
loss of initial weight and to increase
moderate-intensity physical activity
to at least 150 min/week. They also
state that technology-assisted tools,
including Internet-based social networks, distance learning, DVD-based
content, and mobile applications may
be useful elements of effective lifestyle
modification to prevent diabetes.
Combining lifestyle interventions to prevent type 2 diabetes is
reported to be helpful. Of interest
is a population-based cohort study
that examined lifestyle factors and
the risk of new-onset diabetes (9).
For all individuals, a healthy eating
pattern, participation in regular physical activity, maintenance of normal
weight, and moderate alcohol intake
were reported to lower the risk of
developing type 2 diabetes. However,
adherence to a combination of these
factors in this study was reported to
reduce that risk by as much as 84%
in women and 72% in men. Although
weight was one of the most important factors, the researchers noted that
even overweight individuals could
lower their risk of type 2 diabetes by
adopting other healthy lifestyle habits.
Medications such as metformin,
α-glucosidase inhibitors, orlistat,
glucagon-like peptide receptor agonists, and thiazolidinediones can
also prevent progression from prediabetes to diabetes (8). The ADA now
recommends that metformin should
be considered for prevention of diabetes in those with prediabetes and
especially for individuals with a BMI
≥35 kg/m2, those 12 months,
with continued support, decreases
ranged from 0.6 to 1.8%. Although
MNT interventions were effective
throughout the disease process, the
decreases in A1C were largest in
studies in which participants were
newly diagnosed and/or had baseline A1C levels >8.0%, for whom
decreases ranged from 0.5 to 2.0%.
A variety of MNT interventions,
including individualized nutrition
therapy, energy restriction, portion
control, sample menus, carbohydrate
counting, exchange lists, simple meal
plans, and a low-fat vegan diet, were
implemented and effective. However,
all MNT interventions resulted in
reduced energy intake.
Of importance, eating plans for
people with type 2 diabetes must be
based on their current food intake
and on the changes the individual is
willing and able to make to improve
blood glucose control and other
metabolic outcomes. Blood glucose
monitoring must then be used to
evaluate outcomes of lifestyle changes
on pre- and postmeal glucose levels.
It can then be determined whether
food/eating and activity changes have
achieved the target goals or whether
pharmacotherapeutic additions or
adjustments are needed. Because
medications—including insulin—
need to be combined with nutrition
therapy, weight gain often occurs;
thus, preventing this weight gain
becomes important. However, glycemic control must still take precedence
over concerns about weight.
Nutrition therapy for overweight
and obese individuals with type 2
diabetes therefore should focus pri-
marily on encouraging a healthy
eating pattern, with careful attention
to portion sizes and energy intake;
participation in regular physical
activity; and education and support
to improve metabolic outcomes. For
some, this may lead to weight loss,
while for others, it may maintain
weight loss or prevent weight gain.
Weight loss studies using the five
approved weight loss medications
have been conducted in people with
type 2 diabetes. Table 1 summarizes
the trials comparing weight loss
medication therapy to a placebo and
their 52- to 56-week weight loss and
A1C outcomes (19). When used as an
adjunct to lifestyle intervention, these
agents may help individuals sustain
weight loss for a longer period of time.
The weight loss resulting from the use
of the medications resulted in better
glycemic control, while reducing the
number and doses of glucose-lowering
medications and often lowering blood
pressure and improving lipids. The
ADA states that weight loss medications may be effective adjuncts to an
energy-reduced eating plan, physical
activity, and behavioral counseling
for selected individuals with type 2
diabetes and a BMI ≥27 kg/m2 (20).
It further recommends that, if an
individual’s response to weight loss
medications is .05
>.05
>.05
>.05
>.05
82.1 ± 10.6
28.5 ± 2.6
4.64 ± 0.35
5.8 ± 2.1
3.8 ± 1.6
1.23 ± 0.56
12 mo
CG
88.4 ± 12.6
32.6 ± 3.5
5.03 ± 0.32
7.6 ± 2.3
5.9 ± 1.4
3.32 ± 1.15
P
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Explanation & Answer
View attached explanation and answer. Let me know if you have any questions.
1
Bias and Confounding
Name;
Institution Affiliated;
Course;
Professor;
Date;
2
Bias and Confounding
Researchers often undertake various procedures to attain a successful study outcome.
There are basic research protocols that have to be adhered to, especially with the choice and
handling of the study participants. Other aspects include; choice of sample size and the
inclusion of research intervention. The concepts of bias and confounding are important in
research because of the effects of systematic error and confounding and their contribution to
the research outcome. The paper under review presents a discussion that identifies bias or
confounding that may be present in the research that is going to be undertaken.
The measure of Assoc...
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