Introduction: Obesity is linked with uncontrolled, severe asthma. The Counterweight-Plus weight management programme (CWP) is an evidence-based, dietician-led, structured diet programme. Aim: To evaluate the effects of CWP versus usual care (UC) on asthma-related outcomes in a randomised, controlled trial in uncontrolled asthma associated with obesity. Methods: We randomised (1:1 CWP:UC) adults with uncontrolled asthma and body mass index (BMI) ≥30kg/m2. CWP: 12-week total diet replacement phase (800kcal/day low-energy formula); food reintroduction and weight loss maintenance up to week 52. Primary outcome: change in asthma control questionnaire (ACQ6) score over 16 weeks, adjusting for baseline using ANCOVA (intention-to-treat analysis). Secondary outcome: change in asthma quality of life questionnaire (AQLQ) score. Results: Of 36 participants screened, 35 were randomised and 33 attended 16-week follow-up (17 CWP, 16 UC). Mean (SD) ACQ6 at baseline was 2.6 (1.0) in CWP and 2.7 (1.1) in UC. Weight loss was greater with CWP than UC (mean difference -12.3kg; 95%CI -17.1, -7.5; p<0.001). ACQ6 improved more with CWP than UC (mean difference -0.69; 95%CI -1.37, -0.01; p=0.048). A greater proportion of participants had ≥0.5 improvement in ACQ6 (minimal clinically important difference) with CWP than UC (53% vs 19%; p=0.041). AQLQ improved more with CWP than UC (mean difference 0.76; 95%CI 0.18, 1.34; p=0.013). Conclusion: Weight loss, with a structured low-energy formula diet replacement programme, yields significant improvements in asthma control and quality of life over 16 weeks, compared to usual care, in adults with uncontrolled asthma associated with obesity.

The association of weight changes with cardiometabolic biomarkers in South Asians has been sparsely studied. We measured cardiometabolic biomarkers at baseline and after 3 years in the Prevention of Diabetes and Obesity in South Asians Trial. We investigated the effect of a lifestyle intervention on biomarkers in the randomized groups. In addition, treating the population as a single cohort, we estimated the association between change in weight and change in biomarkers. Complete data were available at baseline and after 3 years in 151 participants. At 3 years, there was an adjusted mean reduction of 1·44 kg (95% confidence interval (95% CI): 0.18–2.71) in weight and 1.59 cm (95% CI: 0.08–3.09) in waist circumference in the intervention arm as compared with the control arm. There was no clear evidence of difference between the intervention and control arms in change of mean value of any biomarker. As a single cohort, every 1 kg weight reduction during follow-up was associated with a reduction in triglycerides (−1.3%, P=0.048), alanine aminotransferase (−2.5%, P=0.032), gamma-glutamyl transferase (−2.2%, P=0.040), leptin (−6.5%, P<0.0001), insulin (−3.7%, P=0.0005), fasting glucose (−0.8%, P=0.0071), 2-h glucose (−2.3%, P=0.0002) and Homeostatic Model Assessment of insulin resistance (HOMA-IR: −4.5%, P=0.0002). There was no evidence of associations with other lipid measures, tissue plasminogen activator, markers of inflammation or blood pressure. We demonstrate that modest weight decrease in SAs is associated with improvements in markers of total and ectopic fat as well as insulin resistance and glycaemia in South Asians at risk of diabetes. Future trials with more intensive weight change are needed to extend these findings.

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OBJECTIVEHealth and lifestyle factors are associated with variations in serum testosterone levels in ageing men. However, it remains unclear how age-related changes in testosterone may be attenuated by lifestyle modifications. The objective was to investigate the longitudinal relationships between changes in health and lifestyle factors with changes in hormones of the reproductive endocrine axis in ageing men.DESIGNA longitudinal survey of 2736 community-dwelling men aged 40-79 years at baseline recruited from eight centres across Europe. Follow-up assessment occurred mean (±S.D.) 4.4±0.3 years later.RESULTSPaired testosterone results were available for 2395 men. Mean (±S.D.) annualised hormone changes were as follows: testosterone -0.1±0.95  nmol/l; free testosterone (FT) -3.83±16.8  pmol/l; sex hormone-binding globulin (SHBG) 0.56±2.5  nmol/l and LH 0.08±0.57  U/l. Weight loss was associated with a proportional increase, and weight gain a proportional decrease, in testosterone and SHBG. FT showed a curvilinear relationship to weight change; only those who gained or lost ≥15% of weight showed a significant change (in the same direction as testosterone). Smoking cessation was associated with a greater decline in testosterone than being a non-smoker, which was unrelated to weight change. Changes in number of comorbid conditions or physical activity were not associated with significant alterations in hypothalamic-pituitary-testicular (HPT) axis function.CONCLUSIONSBody weight and lifestyle factors influence HPT axis function in ageing. Weight loss was associated with a rise, and weight gain a fall, in testosterone, FT and SHBG. Weight management appears to be important in maintaining circulating testosterone in ageing men, and obesity-associated changes in HPT axis hormones are reversible following weight reduction.

CONTEXT Late-onset hypogonadism (LOH) has recently been defined as a syndrome in middle-aged and elderly men reporting sexual symptoms in the presence of low T. The natural history of LOH, especially its relationship to mortality, is currently unknown. OBJECTIVE The aim of this study was to clarify the associations between LOH, low T, and sexual symptoms with mortality in men. DESIGN, SETTING, AND PARTICIPANTS Prospective data from the European Male Aging Study (EMAS) on 2599 community-dwelling men aged 40-79 years in eight European countries was used for this study. MAIN OUTCOME MEASURE(S) All-cause, cardiovascular, and cancer-related mortality was measured. RESULTS One hundred forty-seven men died during a median follow-up of 4.3 years. Fifty-five men (2.1%) were identified as having LOH (31 moderate and 24 severe). After adjusting for age, center, body mass index (BMI), current smoking, and poor general health, compared with men without LOH, those with severe LOH had a 5-fold [hazard ratio (HR) 5.5; 95% confidence interval (CI) 2.7, 11.4] higher risk of all-cause mortality. Compared with eugonadal men, the multivariable-adjusted risk of mortality was 2-fold higher in those with T less than 8 nmol/L (irrespective of symptoms; HR 2.3; 95% CI 1.2, 4.2) and 3-fold higher in those with three sexual symptoms (irrespective of serum T; compared with asymptomatic men; HR 3.2; 95% CI 1.8, 5.8). Similar risks were observed for cardiovascular mortality. CONCLUSIONS Severe LOH is associated with substantially higher risks of all-cause and cardiovascular mortality, to which both the level of T and the presence of sexual symptoms contribute independently. Detecting low T in men presenting with sexual symptoms offers an opportunity to identify a small subgroup of aging men at particularly high risk of dying.

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This paper describes the first steps taken in Grampian Health Board to change hospital staff menus in order to provide meals higher in starchy carbohydrate and dietary fibre but lower in fat and sugar, as recommended in several recent reports. These changes are discussed with reference to the alterations made by the catering department. A nutrition education programme was used to promote these changes and the methods used for this are also described. An overall evaluation was carried out by means of a dietary intake questionnaire administered before and after the programme and the results of this show a significant decrease in fat intake and increases in carbohydrate and dietary fibre intakes.