ABSTRACT In two studies of hypertensive patients the relationship between β‐blocker‐induced CNS side‐effects and the nightly urinary secretion of melatonin was analysed. In one group ( n =10) placebo, atenolol (mean dose 86 mg/day) or propranolol (mean dose 305 mg/day) were given in a double‐blind, randomised design. In the other ( n = 13) 100–400 mg metoprolol was given daily (mean dose 197 mg). After 4 weeks of treatment all β‐blockers reduced melatonin excretion, but the effect was significant only for metoprolol. Sleep disturbance records revealed more disturbed nights in the metoprolol group compared with the propranolol and the atenolol groups, even when the difference in age between the groups was controlled for. In the metoprolol group a significant relationship ( p <0.05) was found between the fall in melatonin and the percentage of disturbed nights. Severe CNS side‐effects, such as nightmares, occurred only in patients treated with metoprolol (21%), which in all cases were accompanied by low levels of melatonin. Our data suggest that the CNS side‐effects during β‐blockade are related to a reduction of melatonin levels.
Abstract. Objectives . To evaluate the efficacy of a structured very low calorie diet (VLCD) weight reduction/weight maintenance behaviour programme on weight maintenance in obese patients (BMI ≥ 30 kg/m 2 ). Design . Prospective, randomized, controlled intervention trial. Setting . University out‐patient obesity clinic. Subjects . A total of 114 obese patients from the waiting list were invited to participate in the structured weight reduction/weight maintenance programme lasting for 64 weeks. Sixty patients agreed to participate. Intervention . All 60 patients were placed on a Cambridge 330 kcal day ‐1 diet during the first 12 weeks. Fifty‐two were subsequently randomized to either a well balanced hypocaloric diet (1600 kcal day ‐1 ), of which 220 kcal were provided by two sachets of Cambridge diet (group 1), or the same energy provided by the same principal diet (group 2) during the following 52‐week weight maintenance period. Main outcome measures . During the VLCD period, the mean body weight decreased significantly from 112.4 ± 19.8 to 91.6 ± 17.7 kg ( P < 0.0001). Seventy‐one per cent of the weight loss was fat. During the weight maintenance period the average body weight increased significantly in group 1: 8.0 ± 8.2 vs. 12.3 ± 9.7 kg in group 2 ( P < 0.0001). After the 64‐week treatment period the mean body weight in group 1 was 93.7 ± 18.1 kg and significantly lower compared to 109.9 ± 23.8 kg in group 2 ( P = 0.008). Compliance was high: 87% completed the VLCD period and 75% completed the whole 64‐week treatment programme. Conclusion . Very low calorie diet as part of the dietary allowance during the weight maintenance programme partly prevents weight regain. This finding can be translated into practical treatment recommendations.
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