Royal Philips Electronics has released the BiPAP autoSV Advanced, its latest device for treating complicated sleep-disordered breathing patients.

The system is designed to effectively manage challenging sleep apnea cases. One example would be in those individuals who develop complex sleep apnea.

These individuals have apnea that develops into central sleep apnea only when continuous positive airway pressure (CPAP) is introduced, which is known as Cheyne-Stokes Respiration, a periodic breathing disorder. Because the apnea type changes from obstructive to central due to the introduction of CPAP, it is call complex sleep apnea.

When Respironics released the first bi-level positive airway pressure (BiPAP) device in the late 1980s, it made a impact for treating sleep apnea, a role it continues today.

BiPAP autoSV Advanced is Philips Respironics next generation servo ventilation (SV) device, which is updated to make patient management almost automatic, while optimizing therapy for complicated patients.

The BiPAP autoSV has the ability to manage the patient’s airway and assuring proper ventilation by continually monitoring and adjusting to the patients’ changing therapy needs.

A major advancement in BiPAP autoSV Advanced is an auto adjusting EPAP, utilizing at its core the clinically proven REMstar Auto titration algorithm.

With this addition, BiPAP autoSV Advanced enhances treatment by automatically distinguishing between obstructed and clear airway apneas and adapting pressure to patients’ needs as their conditions change due to weight, alcohol use, or lifestyle.

The automatic adjustment of EPAP simplifies titration and achieves efficacy at the minimum pressure levels.

BiPAP autoSV Advanced adds the proven Bi-Flex technology which assures patient comfort by providing pressure relief during exhalation and at critical transition points.

“Unlike standard CPAP and bi-level therapies, this highly developed system is specifically designed to take on challenges of managing complicated sleep apnea cases,” says Eli Diacopoulos, director of Respironics’ Global Product Marketing in Sleep Therapy.

“Combining our core technologies into one unit furthers our efforts to make the complex simpler to manage and assure the very best treatment possible for these patients,” Diacopoulos added.

Using advanced technologies from Respironics, such as Digital Auto-Trak, which matches the device’s air flow to the patient’s own breathing.

The clinically proven SV algorithm monitors peak flow and can rapidly normalize breathing patterns of patients with complex sleep apnea conditions with breath-to-breath adjustments of pressure support.

In the presence of central apneas, when care must be taken not to over- or under-ventilate a patient, the delivery of automatically calculated back-up breaths encourages spontaneous breathing at the patient’s own natural rate.

BiPAP autoSV Advanced also offers integrated heated humidification and built-in digital data storage.

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Philips Respironics has introduced the EasyLife nasal mask for the treatment of obstructive sleep apnea (OSA).

The EasyLife is a nasal mask that is used to deliver positive airway pressure (PAP) in the treatment of obstructive sleep apnea (OSA) for patients weighing more than 66 pounds.

It’s an alternative to traditional nasal masks with its dual-cushion design and patented Auto Seal technology.

With its patented Auto Seal technology and minimal number of parts, EasyLife is an extraordinarily easy mask for both health care professionals and patients to use.

The EasyLife nasal mask nearly eliminates the need for manual mask adjustments. Its innovative, lightweight design features a unique dual-cushion construction — the inner cushion creates an instant, self-adjusting seal, while the outer cushion provides comfortable support.

Because the forehead pad adjusts automatically, a number of traditional mask adjustments are nearly eliminated except for intuitive headgear adjustments.

The EasyLife mask has only four parts — mask frame, headgear, outer support cushion, and inner seal cushion — making the mask is easy to assemble and clean.

“Patients will appreciate its comfort and the way it maintains a seal throughout their nighttime movements,” said Gretchen Jezerc, director, U.S. Marketing, Sleep Disordered Breathing, Philips Home Healthcare Solutions. “It is truly a breakthrough in the patient interface market.”

The four available cushion sizes — small, medium, medium wide, and large — each fit one of two frames. To further simplify fitting and inventory management, FitPacks with two sizes of cushions are available.

DuoPacks with multiple cushions of the same size also are offered to support supply replacement initiatives for patients.

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A baby’s sleep position is the best predictor of a misshapen skull condition known as deformational plagiocephaly, which may cause flat spots to develop on an infant’s head, according to recently published findings.

Analyzing the largest database to date available, with more than 20,000 children, researchers found the number of babies who developed flat-headedness has dramatically increased since 1992.

The increase coincides with the American Academy of Pediatrics launch of a “Back to Sleep” educational campaign that recommended parents place their infants on their backs to cut the risk of Sudden Infant Death Syndrome (SIDS).

The Arizona State University researchers’ findings were published in the December 2009 issue of the journal Pediatrics.

“We looked at a number of risk factors, but the largest cause was the sleep position of the baby,” said Brian Verrelli, an assistant professor in ASU’s School of Life Sciences and researcher in the Center for Evolutionary Functional Genomics at the Biodesign Institute.

The condition is thought to occur when babies spend too much time in one position. The research team found that sleep position, and specifically, head position, are linked to flat-headedness.

Babies who slept on their right-side or left-side tended to have right-side and left-side flat spots, respectively.

The study, “Risk Factors Associated With Deformational Plagiocephaly,” also found that boys were twice as likely as girls to have the condition (a nearly perfect 2-to-1 ratio) and also more common in firstborn infants, babies with low birth weight, in breech and transverse positions in the womb, and in multiple births, specifically fraternal twins.

The study was designed to statistically check the independent and interacting effects of biological and environmental risk factors that lead to deformational plagiocephaly, in an attempt to provide future guidance for clinical treatment.

The unprecedented size of the sample in our study allowed us to show potential factors, such as maternal prenatal conditions and low birth weight, that were previously unrecognized in smaller cohort studies.

“These other factors need to be explored further before we can begin to piece together the entire puzzle,” said Jessica Joganic, who was an ASU undergraduate student at the time. She is the lead author on the study.

However, independent of the biological and environmental factors, the findings showed that sleep position was the best predictor of deformational plagiocephaly, and one that could be addressed by altering behavior, according to Verrelli.

The research was part of Joganic’s undergraduate honors thesis as a student in ASU’s Barrett, the Honors College.

Joganic earned a bachelor’s degree in anthropology in 2008 from the School of Human Evolution and Social Change in ASU’s College of Liberal Arts and Sciences. She currently is pursuing a doctorate in physical anthropology at Washington University in St. Louis.

Also collaborating in the study, which appeared online this week, were John Lynch, an ASU evolutionary biologist, and Timothy Littlefield with Cranial Technologies, Inc., in Phoenix, which supplied the database of more than 20,000 children who were treated for deformational plagiocephaly between 1990 and 2007.

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New UK research, published recently in PLoS ONE, has not reproduced previous findings that suggested Chronic Fatigue Syndrome may be linked to a recently discovered virus.

The authors of the study, from Imperial College London and King’s College London, say this means that anti-retroviral drugs may not be an effective treatment for people with the illness.

An estimated three in 1000 people have Chronic Fatigue Syndrome (CFS), or myalgic encephalomyelitis (ME), experiencing severe physical and mental fatigue that is not alleviated by rest, together with other symptoms such as muscle pain, headache, joint pain, and depression.

Diagnosing CFS is difficult, as symptoms vary and there is no standard test. The fundamental cause of CFS is unknown and it is usually treated using rehabilitation techniques such as cognitive behavioral therapy or graded exercise therapy.

In October 2009, a group of U.S. scientists published research in the journal Science that suggested that a recently discovered virus called xenotropic murine leukaemia virus-related virus (XMRV) could be linked to CFS. In their study, 68 out of 101 patients with the illness and eight out of 218 healthy controls appeared to be infected with the virus.

However, in this study, researchers found no evidence that patients with CFS had the XMRV virus, after analysing tissue samples from 186 patients with CFS using sensitive molecular testing techniques.

This more recent analysis showed no molecular evidence for XMRV in any of the samples from CFS patients. The researchers say this means that anti-retrovirals should not be used to treat CFS, as they would be unlikely to have an effect on the symptoms.

Several labs in the U.S. now offer CFS patients treatments based on the earlier findings that linked the condition with XMRV.

Professor Myra McClure, one of the authors of the study from the Division of Medicine at Imperial College London, said: "Our research was carried out under rigorous conditions — we looked at samples from well-studied patients, and we used very sensitive testing methods to look for the virus. If it had been there, we would have found it. The lab in which we carried out the analysis had never housed any of the murine leukaemia viruses related to XMRV, and we took great care to ensure there was no contamination.”

"We are confident that our results show there is no link between XMRV and Chronic Fatigue Syndrome, at least in the UK. The U.S. study had some dramatic results that implied people with the illness could be treated with anti-retrovirals. Our recommendation to people with Chronic Fatigue Syndrome would be not to change their treatment regime, because our results suggest that anti-retrovirals would not be an effective treatment for the condition," added McClure.

After reading the U.S. study, clinical researchers from King’s College London sent blood samples from 186 CFS patients to the Imperial Retrovirology Laboratory team. King’s has been running an NHS service for CFS patients for nearly twenty years, and the previously stored samples came from patients had been fully investigated and examined, meaning that CFS was the correct diagnosis.

The Imperial scientists extracted the DNA from the samples and analyzed it using a sensitive technique, called Polymerase Chain Reaction (PCR), which can locate tiny fragments of virus DNA.

Scientists analyzed control samples of water at the same time to ensure there was no contamination. They also looked for a specific marker fragment of human DNA in the sample to make sure the technique was working.

The water controls contained no DNA, showing that the samples were not contaminated. All the test samples, from patients and healthy controls, contained the human DNA they looked for, suggesting the technique was working well.

Dr. Anthony Cleare, Reader in Psychiatric Neuroendocrinology, one of the authors of the study from the Chronic Fatigue Syndrome Clinic at King’s College London, said: "Chronic Fatigue Syndrome is a serious. and debilitating condition. It can also be extremely frustrating for people with the illness, as we have yet to identify its fundamental cause, or come up with any definitive treatments. The recent U.S. study generated real excitement among doctors and patients alike as it seemed to open up a new line of research. Unfortunately, we have not been able to replicate those findings."

"It is important to emphasise that today’s findings do not invalidate all previous. research, some of which has shown that CFS can be triggered by other infective agents, such as Epstein-Barr virus or Giardia parasites. As ever in science, no single study is conclusive and there are lots of other research groups working on this at the moment. We await their results with interest," added Professor Simon Wessely, another author of the study from the Chronic Fatigue Syndrome Clinic at King’s College London.

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Research published in the journal Clinical Science appears to have found a link between obstructive sleep apnea and non-alcoholic steatohepatitis.    

Dr Anne-Christine Piguet and colleagues from the University of Bern, Switzerland, kept mice for a week in low-oxygen atmospheres and found that it led to increased levels of fat and inflammation in their livers.    

Apnea means “without breath” and it occurs when the muscles in the airways behind the tongue relax in sleep, causing the person to snore and briefly, to stop breathing.    

Nonalcoholic steatohepatitis (NASH) is a common, often “silent” liver disease occurring in around 40 percent of the population. It resembles alcoholic liver disease, but occurs in people who drink little or no alcohol.    

The major feature in NASH is fat in the liver, along with inflammation and damage. NASH can be severe and can lead to cirrhosis, where the liver is permanently damaged and scarred and no longer able to work properly.    

Obesity predisposes patients to both fatty liver diseases and obstructive sleep apnea.    

To mimic the effects of low oxygen levels caused by the repeated obstruction of the upper airways in sleep apnea, the researchers kept mice in a low oxygen environment for seven days.    

After this time they were found to have more fat and inflammation in their livers compared to mice that had been kept in atmospheres with normal levels of oxygen.    

When the mice were exposed to low oxygen levels, the genes that controlled fat synthesis in the liver seemed to be more active while those that controlled fat breakdown demonstrated reduced activity.    

In addition, the mice exposed to low levels of oxygen became less sensitive to insulin. This is the mechanism by which the body regulates blood sugar and is a cause of diabetes. Metabolic disorders, such as diabetes and obesity, can cause complications in patients with NASH.    

Commenting on the finding, Piguet said, “Hypoxia (lack of oxygen) may be the link leading to accumulation of fat in the liver and progresses to non-alcoholic steatohepatitis, or NASH. Our findings show that it is important both to screen obese patients for obstructive sleep apnea to prevent it contributing to fatty liver disease and to treat those patients who already have NASH for hypoxia which may be making their condition worse.”    

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A study published today found adolescents with bedtimes that were set earlier by parents were significantly less likely to suffer from depression and to think about committing suicide, suggesting that earlier bedtimes could have a protective effect by lengthening sleep duration and increasing the likelihood of getting enough sleep.

Results show that adolescents with parental set bedtimes of midnight or later were 24 percent more likely to suffer from depression (odds ratio=1.24) and 20 percent more likely to have suicidal ideation (odds ratio=1.20) than adolescents with parental set bedtimes of 10 p.m. or earlier.

This association, published in the January 4, 2010 issue of the journal Sleep was appreciably attenuated by self-reported sleep duration and the perception of getting enough sleep.

Adolescents who reported they usually sleep for five or fewer hours per night were 71 percent more likely to suffer from depression (odds ratio=1.71) and 48 percent more likely to think about committing suicide (odds ratio=1.48) than those who reported getting eight hours of nightly sleep.

Participants who reported they "usually get enough sleep" were significantly less likely to suffer from depression (odds ratio=0.35) and suicidal ideation (odds ratio=0.71).

Lead author James E. Gangwisch, Ph.D., assistant professor at Columbia University Medical Center in New York, N.Y., said the results strengthen the argument that short sleep duration could play a role in the etiology of depression.

"Our results are consistent with the theory that inadequate sleep is a risk factor for depression, working with other risk and protective factors through multiple possible causal pathways to the development of this mood disorder," said Gangwisch.

"Adequate quality sleep could therefore be a preventative measure against depression and a treatment for depression," Gangwisch added.

Data were collected from 15,659 adolescents and their parents who had participated in the National Longitudinal Study of Adolescent Health (Add Health), a school-based, nationally representative, probability-based sample of U.S. students in grades seven to 12 in 1994 to 1996.

Seven percent of participants (1,050) were found to have depression using the Centers for Epidemiologic Study-Depression Scale, and 13 percent (2,038) reported they seriously thought about committing suicide during the past 12 months.

Depression and suicidal ideation were associated with later parental set bedtime, shorter sleep duration, self-perception of not getting enough sleep, female sex, older age and lower self-perception of how much parents care.

Fifty-four percent of parents reported their adolescent had to go to bed by 10 p.m. or earlier on weeknights, 21 percent reported setting a bedtime of 11 p.m., and 25 percent reported setting a bedtime of midnight or later.

Caucasians were more likely than adolescents of other racial/ethnic groups to have a parental set bedtime of 11 p.m.

Nearly 70 percent of adolescents reported going to bed at a time that complied with the weeknight bedtime that was set by their parents.

Adolescents reported going to bed only about five minutes later on average than their parental set bedtime.

The average adolescent-reported sleep duration was seven hours and 53 minutes, which contrasted sharply with the nine or more hours of nightly sleep the AASM recommends for adolescents.

Participants with a parental set bedtime of 10 p.m. or earlier reported they usually slept for an average of eight hours and 10 minutes, which was 33 minutes more than adolescents with a bedtime of 11 p.m. (seven hours, 37 minutes) and 40 minutes more than those with a bedtime of midnight or later (seven hours, 30 minutes).

With the exception of sleep durations of 10 hours or more per night, higher average self-reported sleep durations were associated with progressively earlier average bedtimes.

The authors reported there are a number of potential mechanisms by which chronic partial sleep deprivation could contribute to depression and suicidal ideation.

A lack of sleep may affect the modulation of emotional brain responses to aversive stimuli; produce moodiness that hinders the ability to cope with daily stresses and impairs relationships with peers and adults; and affect judgment, concentration and impulse control.

They also suggested that behavioral interventions that involve educating adolescents and their parents about healthier sleep hygiene practices and helping them modify maladaptive sleep habits could sever as primary preventative measures against depression and suicidal ideation.

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A recently published study shows dream-enacting behaviors are common in healthy, young adults, and the prevalence of specific behaviors differs between men and women.

Results indicate that 98 percent of subjects (486 out of 495) reported experiencing one of seven subtypes of dream-enacting behavior at least "rarely" in the last year.

The study was published in the December 1, 2009, issue of the journal Sleep, demonstrated the most prevalent behavior subtype was "fear," with 93 percent of participants reporting they had felt signs of fear in their body after awakening from a frightening dream.

Seventy-eight percent of participants reported they had awakened from an erotic dream to find that they were sexually aroused, and 72 percent of participants reported they had awakened from a happy dream and found they were actually smiling or laughing.

Each of the other four behavior subtypes was reported by more than 50 percent of participants: They awakened from a dream to find they were talking, crying, acting out an angry or defensive behavior, such as punching or kicking, or acting out other movements, such as waving or pointing.

Women reported more speaking, crying, fear and smiling/laughing than men, and men reported more sexual arousal.

Lead author and co-investigator Tore Nielsen, Ph.D., professor of psychiatry at the Université de Montreal in Canada, was surprised by the high prevalence of dream-enacting behavior.

Nielsen noted that more studies will need to be conducted to create a distinction between normal dream-enacting behavior and actions are associated with REM sleep behavior disorder (RBD).

The actions are characterized by abnormal behaviors emerging during rapid eye movement (REM) sleep that cause injury or sleep disruption, Nielsen further noted.

“Normal episodes are usually extremely mild, for example, briefly jerking an arm or leg while waking up from a nightmare, once or twice a year," said Nielsen. "This is far different from RBD cases, which are typically very intense, and might involve repeatedly flailing an arm or a leg or smashing into something in the middle of a dream, not waking up easily from it, with occurrences several times a month."

A total of 1,140 first-year undergraduate students who were enrolled in introductory psychology courses voluntarily participated in the study, with approximately two-thirds of them being female. All participants completed several questionnaires concerning personality and dreaming.

To determine the type of questions best for eliciting reports of dream-enacting behavior, students were divided into three groups. Group one (mean age 19.9 years) was provided with general questions concerning dream-enacting behaviors; group two (mean age 20.1 years) received the same questions, though this group received examples; and group three (mean age 19.1 years) received questions describing specific behavior subtypes.

The prevalence of dream-enacting behavior increased with increasing question specificity (35.9 percent in group one, 76.7 percent in group two and 98.2 percent in group three).

According to the authors, the findings suggest dream-enacting behaviors are common in the general population but are difficult for subjects to identify if detailed descriptions of the behaviors are not given.

The study distinguished the dream-enacting behavior of speaking out loud some of the words of a dream about talking from somniloquy, which was defined as speaking or making sounds during sleep without clear recall of an accompanying dream.

Acting out the movements of a dream was distinguished from somnambulism, which was defined as moving or walking during sleep without clear recall of a dream.

Almost 61 percent of subjects in group three reported experiencing somniloquy at least "rarely" in the last year, and 40.9 percent reported somnambulism.

The authors speculate there is a possibility of personality trait involvement and a genetically determined predisposition for frequent dream-enacting behaviors. It remains unknown whether the dream-enacting behaviors of healthy subjects may predict future RBD symptoms.

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Sleep apnea is common in kidney transplant patients and it is associated with an increased risk of high blood pressure, heart disease, and stroke, according to a study published in the Clinical Journal of the American Society Nephrology (CJASN).

Researchers found that kidney transplant patients are just as likely to have this sleep disorder as dialyzed kidney disease patients who are on the transplant waiting list.

Both types of patients who have sleep apnea should be considered at high risk for developing serious heart-related complications.

Cardiovascular disease is the most common cause of death in individuals who receive kidney transplants, and doctors monitor transplant recipients for high blood pressure, or hypertension, and other signs of heart trouble, according to the study’s findings, which were published online.

Obstructive sleep apnea occurs when an individual stops breathing momentarily during sleep due to obstruction of the airway and has been linked to hypertension.

Miklos Zsolt Molnar, M.D., Ph.D., of the Semmelweis University, in Budapest, Hungary, along with his colleagues studied the prevalence of sleep apnea in kidney transplant patients and the effects the condition had on their cardiovascular risk.

The study included 100 transplant recipients. The researchers found that moderate-to-severe sleep apnea occurred in one of every four individuals. This rate was similar to that seen in a group of dialyzed kidney disease patients who were waiting for a transplant.

Kidney transplant patients with sleep apnea were more than twice as likely to be taking three or more anti-hypertensive drugs as patients without the sleep disorder, but still displayed higher blood pressure than patients who slept normally.

As seen in the general population, being obese increased patients’ risk of developing sleep apnea. When risk scores were calculated to predict patients’ risk of developing heart disease or experiencing a stroke, kidney disease patients who had sleep apnea had twice the risk as patients without apnea.

"We propose that sleep apnea is a new risk factor for hypertension and cardiovascular events in kidney transplanted patients," said Molnar.

“Physicians should screen transplant patients for obstructive sleep apnea and offer appropriate treatment," the authors wrote.

This study was supported by grants from the National Research Fund (OTKA) (TS-049785, F-68841), the Hungarian Kidney Foundation, and the Foundation for Prevention in Medicine.

Study co-authors include Alpar Sandor Lazar, PhD, Anett Lindner, MD, Katalin Fornadi, MD, Maria Eszter Czira, MD, Andrea Dunai MD, Rezso Zoller, MD, Andras Szentkiralyi, MD, Laszlo Rosivall, MD, PhD, Dsc, Marta Novak, MD, PhD, Istvan Mucsi, MD, PhD (Semmelweis University, Budapest, Hungary), and Colin Michael Shapiro, FRCPC, MBBS, PhD (University of Toronto, Canada).

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Stay Awake at the Wheel with Cumberland Farms
Free Coffee for New Year’s Eve Revelers

From 5 p.m. on December 31, 2009 until 5 a.m. on January 1, 2010, all Cumberland Farms locations will be offering free, piping-hot Farmhouse Blend coffee for the third year in a row.

Cumberland Farms encourages drivers to take advantage of this free community service. The National Highway Traffic Safety Association reports a spike in auto accidents during this holiday.

A combination of caffeine and naps is one of the best ways to help fight drowsiness, a leading cause of accidents, according to the group.

“We encourage drivers to have fun and stay safe and alert this holiday season,” said Ari Haseotes, president of Cumberland Farms. “Offering free coffee on New Year’s Eve is one way for us to let our customers know we care about them.”

The free coffee is available at all Cumberland Farms stores across the Northeast and Florida except for those with Dunkin Donuts service.

About Cumberland Farms

Rooted in a family-farm heritage today’s Cumberland Farms also has a long heritage of giving back to the communities where it operates. For more information about a Cumberland Farms near you, please visit us at www.CumberlandFarms.com.

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For obese men, a dramatic weight loss can be an effective way to improve moderate to severe sleep apnea, scientists at the Swedish medical university Karolinska Institute report. Those with severe sleep apnea when the study began benefited most from weight loss.

"Our findings suggest that weight loss may be an effective treatment strategy for sleep apnea in obese men," says Kari Johansson, one of the researchers involved in the study.

Sleep apnea — the temporary cessation of breathing during sleep — is a relatively common but under-diagnosed disease. Five or more such events per hour is considered a disease.

Untreated, sleep apnea is associated with increased risk of heart attacks and strokes, increased risk of high blood pressure, an increased risk of involvement in traffic accidents, among other health issues.

Moderate and severe sleep apnea also increases the risk of premature death. It has long been known that people with overweight or obesity are more likely to develop the disease, and that men are more affected than women.

In a randomized study published in the British Medical Journal, researchers at Karolinska Institute examined if weight-loss can help to cure moderate and severe sleep apnea.

The study included 63 obese men (BMI between 30 and 40) between the ages of 30 and 65. The participants had moderate to severe sleep apnea as measured by the AHI (apnea-hypopnea) index.

All participants had symptom alleviation treatment through CPAP — continuous positive airway pressure — which produces more normal breathing patterns during sleep.

The participants were randomly assigned to two groups, one of which underwent an intense weight-loss program, the other served as a control group, for a period of nine weeks.

The results of the study show that the weight loss group lost 19 kilos on average after nine weeks and more than halved the number of apnea events.

None of the treated patients had severe sleep apnea, half had only mild sleep apnea and one in six could be declared healthy. The researchers also noted that the effect of the weight loss program was greatest in patients with severe sleep apnea.

To achieve significant weight loss, the treatment group were put on a very low calorie diet (VLCD), which gave them an initial energy input of 554 kcal per day for seven weeks followed by a 14-day successive increase up to 1,500 kcal per day at week nine.

The control group maintained their normal dietary habits during the nine week study period, but was afterwards offered a VLCD program.

After the VLCD period, the participants were also invited to take part in a year’s behavioral change program to help them maintain their weight loss.

"We often use VLCD in the form of a low calorie powder as part of the treatment of obese patients with a serious co-morbidity, such as sleep apnea," says Johansson.

"The powder is mixed with water and replaces every meal of the day, which gives a rapid loss of weight. It’s also a good way of boosting the patients’ motivation," she added.

The researchers stress that the VLCD diet is not a general solution to weight problems, but something mainly to be used in the first phase of a long-term treatment program.

To keep the weight off, patients need to work hard to improve their dietary and exercise habits, usually with the aid of a long-term behavior modification program.

Drugs can also be used in the post-weight loss phase to further improve weight loss maintenance.

Cambridge Manufacturing Company Limited partially funded the current study. The company markets the Cambridge Diet, the low-calorie powder used in the study. The company had no influence on the study, the analyses or the collation of the results. Examples of similar VLCD products marketed by other companies are Nutrilett, Naturdiet and Allevo.

The researchers who conducted the study work at the Obesity Unit, Karolinska University Hospital, Huddinge, and the Clinical Epidemiology Unit, Karolinska Institute.

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