Miscellaneous Research Thread

This study on a high fat diet and favorable lipid changes in obesity has been doing the rounds

Lipid dynamics and cardiovascular risk profiles on carbohydrate- or saturated fat-based diets: secondary analysis of the CARBFUNC trial

Background​

Obesity involves complex changes in energy metabolism and increased cardiovascular disease (CVD) risk independently of low-density lipoprotein cholesterol (LDL-C). Diets high or low in carbohydrates or fats can be effective for reversing obesity, but their distinct effects on metabolic health and detailed lipid profiles may differentially impact overall CVD risk, particularly with large differences in saturated fatty acid (SFA) intake.

Methods​

In a 2-year randomised controlled trial, 193 males and females with obesity were assigned to 1) an acellular carbohydrate-based diet (A-HCLF, comparator arm), 2) a cellular carbohydrate-based diet (C-HCLF), or 3) a low-carbohydrate high-fat (LCHF) diet (75 energy percent fat, thereof 30 SFAs). As secondary outcomes of the trial, plasma lipids and lipoprotein particle subfractions were quantified by nuclear magnetic resonance spectroscopy assay, and coronary artery calcium score by CT imaging. Data were analysed by constrained linear mixed-effects modelling.

Findings​

Attrition was 74 (39%), 114 (59%), 128 (67%), 135 (70%), and 162 (84%) at 3, 6, 9, 12 and 24 months, respectively. Self-reported adherence ranged from 63 to 85% up to 12 months and 40–60% for the last 12 months. During the first 9–12 months, the LCHF group showed significantly greater reductions than the A-HCLF comparator and C-HCLF diets in very low-density lipoprotein particles (VLDLs), triacylglycerols (TAGs), remnant cholesterol, and the TAG/high-density lipoprotein cholesterol (HDL-C) ratio, alongside increases in HDL-C, total apolipoprotein A1 (apoA1), apoA1 in large HDL particles, LDL-C (attributed to large LDL particles), and the LDL-C/apolipoprotein B ratio. At 24 months, there were still greater reductions on the LCHF compared to the A-HCLF diet for TAGs, VLDL particles, remnant cholesterol, and the TAG/HDL-C ratio, as well as a greater increase in large LDL particles.

Interpretation​

In adults with obesity, an LCHF diet rich in SFA markedly lowered TAG-rich remnants and raised HDL-C and apoA1 compared to higher-carbohydrate diets, while shifting LDL toward larger particles without significantly increasing apoB or small LDLs—a pattern that may indicate greater lipid turnover.
 
On the lack of coding in electronic health journals. In this case the researchers looked for delirium, and fund that 9/10 cases in their selected HUNT cohort from Trøndelag county in Norway was not recorded in their hospital journals.

Population-based incidence rate of in-hospital delirium in older adults in Norway—a HUNT study
Background
Most studies of delirium occurrence are based on selected hospitalised populations or administrative data. We aimed to estimate the incidence rate of in-hospital delirium in older adults and to assess use of the International Classification of Diseases, 10th Revision (ICD-10) delirium code (F05) in electronic health records.

Methods
This population-based cohort study included 9956 participants aged ≥70 years from HUNT4 70+. Participants were followed from the date of study participation (2017–19) until 31 December 2023. In-hospital delirium was identified by retrospective chart review of all admissions during follow-up, using Diagnostic and Statistical Manual of Mental Disorders, fifth edition criteria. Incidence rates were estimated using the first delirium episode per participant, weighted for non-participation.

Results
During follow-up, 1507 participants (15.1%) experienced ≥1 in-hospital delirium episode. The weighted incidence rate was 33.1 (95% CI 31.5–34.9) per 1000 person-years and increased with age from 11.4 (age 70–74) to 109.0 (age ≥90) per 1000 person-years. Men had higher incidence rates than women across age groups. Among admissions with delirium, 11.9% had an ICD-10 discharge delirium diagnosis code (F05).

Conclusion
In-hospital delirium was common, increased markedly with age and was rarely captured by diagnostic coding. Low coding rates suggest that routine health-care data substantially underestimate delirium burden. Under-recognition of delirium may limit opportunities for follow-up in a group at high risk of adverse outcomes. With an ageing population, the burden of delirium is likely to increase for individuals and health-care systems. Our findings support systematic approaches to improve identification and management.
 
German and paywalled, putting it here.

[GER, Translated] Assessed, evaluated, excluded?, 2026, Yara Hofbauer

Begutachtet, beurteilt, ausgeschlossen?

Hofbauer, Yara
Der Beitrag untersucht die faktische Entscheidungsmacht medizinischer Sachverständiger bei der Gewährung existenzsichernder Sozialleistungen am Beispiel von ME/CFS. Ausgehend von den Besonderheiten medizinischer Tatsachenfeststellung analysiert er die Anforderungen an Qualität, Unabhängigkeit und Kontrolle von Sachverständigengutachten sowie die bestehenden Rechtsschutzmöglichkeiten. Dabei zeigt sich eine strukturelle Diskrepanz zwischen der formalen Entscheidungskompetenz von Sozialversicherungsträgern und Gerichten und dem tatsächlichen Einfluss medizinischer Expertise auf den Verfahrensausgang. Der Beitrag diskutiert diese Machtasymmetrie unter rechtsstaatlichen Gesichtspunkten und entwickelt Reformvorschläge für eine wissenschaftlich fundierte Begutachtung, wirksamere Kontrollmechanismen und effektiven Rechtsschutz.
Abstract
This article examines the de facto decision-making power of medical experts in the granting of subsistence-level social benefits, using the example of ME/CFS.

Based on the specific nature of medical fact-finding, it analyzes the requirements for the quality, independence, and oversight of expert opinions, as well as existing legal remedies. This reveals a structural discrepancy between the formal decision-making authority of social security institutions and courts and the actual influence of medical expertise on the outcome of the proceedings.

The article discusses this power asymmetry from the perspective of the rule of law and develops proposals for reform to ensure scientifically grounded assessments, more effective oversight mechanisms, and effective legal protection.

Web | DOI | Zeitschrift für kritik - recht - gesellschaft | Paywall

From Bluesky.
Machine translation:
Michael Stingl @neurostingl.bsky.social
Important article by @yarahofbauer.bsky.social showing why the situation regarding #MECFS assessments cannot be solved by expert training alone.

There is a structural problem regarding the distribution of power, uncertainty, and the risk of error within the welfare state.

A single examination is unsuitable for assessing impairment in ME/CFS.

This is a structural problem that must be rectified.

Because in reality, the current situation naturally creates doubts about the extent of the problem, going beyond the ignorance of individual assessors.

And these doubts currently fall 100% on those affected.

Another point raised is the lack of quality assurance—with one important aspect: does a biased attitude toward certain illnesses constitute partiality?

The current situation is that assessors possess significant decision-making power—with limited oversight.

And there is no real legal protection if those affected have no means of effectively refuting a flawed assessment.
Click to expand...
 
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