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Cochrane Database of Systematic Reviews

Intervenciones para la reducción de peso en la obesidad para mejorar la supervivencia de las pacientes con cáncer endometrial

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Información

DOI:
https://doi.org/10.1002/14651858.CD012513.pub2Copiar DOI
Base de datos:
  1. Cochrane Database of Systematic Reviews
Versión publicada:
  1. 01 febrero 2018see what's new
Tipo:
  1. Intervention
Etapa:
  1. Review
Grupo Editorial Cochrane:
  1. Grupo Cochrane de Cáncer ginecológico, neurooncología y otros cánceres

Copyright:
  1. Copyright © 2018 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

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Autores

  • Sarah Kitson

    Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK

  • Neil Ryan

    Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK

  • Michelle L MacKintosh

    Department of Obstetrics and Gynaecology, Manchester University NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, UK

  • Richard Edmondson

    Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK

    Department of Obstetrics and Gynaecology, Manchester University NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, UK

  • James MN Duffy

    Balliol College, University of Oxford, Oxford, UK

  • Emma J Crosbie

    Correspondencia a: Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK

    [email protected]

    Department of Obstetrics and Gynaecology, Manchester University NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, UK

Contributions of authors

All review authors contributed to the study conception and design.
Aquisition of data was undertaken by Sarah Kitson, Neil Ryan and Michelle MacKintosh
Analysis and interpretation were undertaken by Sarah Kitson, Neil Ryan, James Duffy, Richard Edmondson and Emma Crosbie.
Drafting of the manuscript was performed by Sarah Kitson, James Duffy, and Emma Crosbie and was reviewed by all authors.
The review update will be undertaken by Emma Crosbie.

Sources of support

Internal sources

  • Cochrane Review Support Programme, UK.

    Dr Emma Crosbie has been awarded funding via the Cochrane Review Support Programme to expedite the completion of this review which is a priority topic area.

External sources

  • National Institute for Health Research Clinician Scientist Fellowship, UK.

    Dr Emma Crosbie and Dr Sarah Kitson are funded through an National Institute for Health Research (NIHR) Clinician Scientist award (NIHR‐CS‐012‐009). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.

  • MRC, UK.

    Dr Neil Ryan is an Medical Research Council Doctoral Research Fellow (MR/M018431/1)

Declarations of interest

Sarah Kitson: None known.
Neil Ryan: None known.
Michelle Mackintosh: None known.
Richard Edmondson: None known.
James Duffy: None known.
Emma Crosbie: None known.

Acknowledgements

We would like to thank Jo Morrison (Co‐ordinating Editor) for clinical and editorial advice, Jo Platt (Information Specialist) for designing the search strategy and Gail Quinn, Clare Jess, and Tracey Harrison (Managing and Assistant Managing Editors), for their contribution to the editorial process.

Dr Emma Crosbie was awarded funding via the Cochrane Review Support Programme to expedite the completion of this review which is a priority topic area.

This project was supported by the National Institute for Health Research (NIHR), via Cochrane Infrastructure funding to the Cochrane Gynaecological, Neuro‐oncology and Orphan Cancer Group. The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the Systematic Reviews Programme, NIHR, National Health Service (NHS) or the Department of Health.

We would like to thank the referees for many helpful suggestions and comments, some of these include Rebecca Beeken, Evangelos Kontopantelis and Katharine Tylko‐Hill.

Version history

Published

Title

Stage

Authors

Version

2023 Mar 27

Interventions for weight reduction in obesity to improve survival in women with endometrial cancer

Review

Heather Agnew, Sarah Kitson, Emma J Crosbie

https://doi.org/10.1002/14651858.CD012513.pub3

2018 Feb 01

Interventions for weight reduction in obesity to improve survival in women with endometrial cancer

Review

Sarah Kitson, Neil Ryan, Michelle L MacKintosh, Richard Edmondson, James MN Duffy, Emma J Crosbie

https://doi.org/10.1002/14651858.CD012513.pub2

2017 Jan 17

Interventions for weight reduction in obesity to improve survival in women with endometrial cancer

Protocol

Sarah Kitson, James MN Duffy, Neil Ryan, Michelle L MacKintosh, Emma J Crosbie

https://doi.org/10.1002/14651858.CD012513

Differences between protocol and review

For the outcomes of overall and cancer‐specific survival insufficient data were available from published reports or correspondence with study authors to allow the calculation of hazard ratios. Instead, survival was treated as a dichotomous outcome and the risk ratio for survival was calculated in its place. Depending upon the assembled research, the study authors had planned to organise the data by population and, within the data categories, to explore the main comparisons of the review. Due to the small number of studies and participants included in the review this was not possible.

Keywords

MeSH

PICO

Population
Intervention
Comparison
Outcome

El uso y la enseñanza del modelo PICO están muy extendidos en el ámbito de la atención sanitaria basada en la evidencia para formular preguntas y estrategias de búsqueda y para caracterizar estudios o metanálisis clínicos. PICO son las siglas en inglés de cuatro posibles componentes de una pregunta de investigación: paciente, población o problema; intervención; comparación; desenlace (outcome).

Para saber más sobre el uso del modelo PICO, puede consultar el Manual Cochrane.

Study flow diagram.
Figuras y tablas -
Figure 1

Study flow diagram.

'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
Figuras y tablas -
Figure 2

'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.
Figuras y tablas -
Figure 3

'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.

Forest plot of comparison: 1 Lifestyle intervention versus. usual care, outcome: 1.3 Overall survival (24 months).
Figuras y tablas -
Figure 4

Forest plot of comparison: 1 Lifestyle intervention versus. usual care, outcome: 1.3 Overall survival (24 months).

Forest plot of comparison: 1 Lifestyle intervention versus. usual care, outcome: 1.4 Adverse events‐musculoskeletal.
Figuras y tablas -
Figure 5

Forest plot of comparison: 1 Lifestyle intervention versus. usual care, outcome: 1.4 Adverse events‐musculoskeletal.

Forest plot of comparison: 1 Lifestyle intervention versus. usual care, outcome: 1.13 Weight loss stratified by BMI (24 months) [kg].
Figuras y tablas -
Figure 6

Forest plot of comparison: 1 Lifestyle intervention versus. usual care, outcome: 1.13 Weight loss stratified by BMI (24 months) [kg].

Comparison 1 Lifestyle intervention versus. usual care, Outcome 1 Overall survival (6 months).
Figuras y tablas -
Analysis 1.1

Comparison 1 Lifestyle intervention versus. usual care, Outcome 1 Overall survival (6 months).

Comparison 1 Lifestyle intervention versus. usual care, Outcome 2 Overall survival (12 months).
Figuras y tablas -
Analysis 1.2

Comparison 1 Lifestyle intervention versus. usual care, Outcome 2 Overall survival (12 months).

Comparison 1 Lifestyle intervention versus. usual care, Outcome 3 Overall survival (24 months).
Figuras y tablas -
Analysis 1.3

Comparison 1 Lifestyle intervention versus. usual care, Outcome 3 Overall survival (24 months).

Comparison 1 Lifestyle intervention versus. usual care, Outcome 4 Adverse events‐musculoskeletal.
Figuras y tablas -
Analysis 1.4

Comparison 1 Lifestyle intervention versus. usual care, Outcome 4 Adverse events‐musculoskeletal.

Comparison 1 Lifestyle intervention versus. usual care, Outcome 5 Cancer‐specific survival (6 months).
Figuras y tablas -
Analysis 1.5

Comparison 1 Lifestyle intervention versus. usual care, Outcome 5 Cancer‐specific survival (6 months).

Comparison 1 Lifestyle intervention versus. usual care, Outcome 6 Cancer‐specific survival (12 months).
Figuras y tablas -
Analysis 1.6

Comparison 1 Lifestyle intervention versus. usual care, Outcome 6 Cancer‐specific survival (12 months).

Comparison 1 Lifestyle intervention versus. usual care, Outcome 7 Cancer‐specific survival (24 months).
Figuras y tablas -
Analysis 1.7

Comparison 1 Lifestyle intervention versus. usual care, Outcome 7 Cancer‐specific survival (24 months).

Comparison 1 Lifestyle intervention versus. usual care, Outcome 8 Weight loss (6 months).
Figuras y tablas -
Analysis 1.8

Comparison 1 Lifestyle intervention versus. usual care, Outcome 8 Weight loss (6 months).

Comparison 1 Lifestyle intervention versus. usual care, Outcome 9 Weight loss stratified by BMI (6 months).
Figuras y tablas -
Analysis 1.9

Comparison 1 Lifestyle intervention versus. usual care, Outcome 9 Weight loss stratified by BMI (6 months).

Comparison 1 Lifestyle intervention versus. usual care, Outcome 10 Weight loss (12 months).
Figuras y tablas -
Analysis 1.10

Comparison 1 Lifestyle intervention versus. usual care, Outcome 10 Weight loss (12 months).

Comparison 1 Lifestyle intervention versus. usual care, Outcome 11 Weight loss stratified by BMI (12 months).
Figuras y tablas -
Analysis 1.11

Comparison 1 Lifestyle intervention versus. usual care, Outcome 11 Weight loss stratified by BMI (12 months).

Comparison 1 Lifestyle intervention versus. usual care, Outcome 12 Weight loss (24 months).
Figuras y tablas -
Analysis 1.12

Comparison 1 Lifestyle intervention versus. usual care, Outcome 12 Weight loss (24 months).

Comparison 1 Lifestyle intervention versus. usual care, Outcome 13 Weight loss stratified by BMI (24 months).
Figuras y tablas -
Analysis 1.13

Comparison 1 Lifestyle intervention versus. usual care, Outcome 13 Weight loss stratified by BMI (24 months).

Comparison 1 Lifestyle intervention versus. usual care, Outcome 14 Adverse events‐diarrhoea.
Figuras y tablas -
Analysis 1.14

Comparison 1 Lifestyle intervention versus. usual care, Outcome 14 Adverse events‐diarrhoea.

Comparison 1 Lifestyle intervention versus. usual care, Outcome 15 Cardiovascular and metabolic event frequency (6 months).
Figuras y tablas -
Analysis 1.15

Comparison 1 Lifestyle intervention versus. usual care, Outcome 15 Cardiovascular and metabolic event frequency (6 months).

Comparison 1 Lifestyle intervention versus. usual care, Outcome 16 Cardiovascular and metabolic event frequency (12 months).
Figuras y tablas -
Analysis 1.16

Comparison 1 Lifestyle intervention versus. usual care, Outcome 16 Cardiovascular and metabolic event frequency (12 months).

Comparison 1 Lifestyle intervention versus. usual care, Outcome 17 Quality of life‐SF12 Physical Health component (6 months).
Figuras y tablas -
Analysis 1.17

Comparison 1 Lifestyle intervention versus. usual care, Outcome 17 Quality of life‐SF12 Physical Health component (6 months).

Comparison 1 Lifestyle intervention versus. usual care, Outcome 18 Quality of life FACT‐G (6 months).
Figuras y tablas -
Analysis 1.18

Comparison 1 Lifestyle intervention versus. usual care, Outcome 18 Quality of life FACT‐G (6 months).

Comparison 1 Lifestyle intervention versus. usual care, Outcome 19 Quality of life stratified by BMI (6 months FACT‐G).
Figuras y tablas -
Analysis 1.19

Comparison 1 Lifestyle intervention versus. usual care, Outcome 19 Quality of life stratified by BMI (6 months FACT‐G).

Comparison 1 Lifestyle intervention versus. usual care, Outcome 20 Quality of life FACT‐G (12 months).
Figuras y tablas -
Analysis 1.20

Comparison 1 Lifestyle intervention versus. usual care, Outcome 20 Quality of life FACT‐G (12 months).

Comparison 1 Lifestyle intervention versus. usual care, Outcome 21 Quality of life stratified by BMI (12 months FACT‐G).
Figuras y tablas -
Analysis 1.21

Comparison 1 Lifestyle intervention versus. usual care, Outcome 21 Quality of life stratified by BMI (12 months FACT‐G).

Summary of findings for the main comparison. Lifestyle intervention versus usual care compared to placebo for weight reduction in obesity to improve survival in women with endometrial cancer

Lifestyle intervention versus usual care compared to placebo for weight reduction in obesity to improve survival in women with endometrial cancer

Patient or population: weight reduction in obesity to improve survival in women with endometrial cancer
Setting: university hospitals in the USA
Intervention: Lifestyle intervention versus. usual care
Comparison: placebo

Outcomes

Anticipated absolute effects* (95% CI)

Relative effect
(95% CI)

№ of participants
(studies)

Certainty of the evidence
(GRADE)

Comments

Risk with placebo

Risk with Lifestyle intervention versus. usual care

Overall survival (24 months)

(Number of deaths from any cause)

100 per 1000

23 per 1000
(1 to 455)

RR 0.23
(0.01 to 4.55)

37
(1 RCT)

⊕⊝⊝⊝
VERY LOW 1 2 3 4

Risk ratio for mortality calculated

Adverse events‐musculoskeletal

(Number of musculoskeletal adverse events reported)

0 per 1000

0 per 1000
(0 to 0)

RR 19.03
(1.17 to 310.52)

91
(2 RCTs)

⊕⊕⊝⊝
LOW 1 5 6 7

Unable to calculate assumed and corresponding risk as no events in control groups

Recurrence‐free survival (24 months)

(Number of cases of disease recurrence or death)

See comment

See comment

No RCTs reported this outcome

Cancer‐specific survival (24 months)

(Number of cancer‐related deaths)

See comment

See comment

not estimable

37
(1 RCT)

⊕⊝⊝⊝
VERY LOW 1 2 3 8

Unable to calculate risk ratio for mortality as no cancer related deaths reported in either arm of the study

Weight loss (12 months)

(Change in weight from baseline in kg; positive values = weight gain, negative values = weight lost)

The mean weight loss (12 months) was + 1.5kg12

MD 8.98 lower
(19.88 lower to 1.92 higher)

91
(2 RCTs)

⊕⊝⊝⊝
VERY LOW 1 2 9 10

Cardiovascular and metabolic event frequency (12 months)

(Number of strokes, myocardial infarctions and hospitalisations for heart failure)

See comment

See comment

93
(2 RCTs)

⊕⊝⊝⊝
VERY LOW 1 2 8 9

Unable to perform meta‐analysis as no events recorded in any study

Quality of life FACT‐G (12 months)

(Change in QOL on FACT‐G questionnaire from baseline; positive values = improved QOL, negative values = worsening QOL)

The mean quality of life FACT‐G (12 months) ranged from 0 to + 2 units13

MD 2.77 units higher
(0.65 lower to 6.20 higher)

89
(2 RCTs)

⊕⊝⊝⊝
VERY LOW 2 9 11

*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).

CI: Confidence interval; MD: mean difference; RR: Risk ratio;

GRADE Working Group grades of evidence
High certainty: We are very confident that the true effect lies close to that of the estimate of the effect
Moderate certainty: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect
Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect

1 Although participants, personnel and outcome assessors were not blinded to treatment group allocation this is unlikely to affect this specific outcome measure

2 Downgraded by one point as included study at high risk of attrition bias due to incomplete outcome reporting

3 Downgraded by one point due to indirect results (included study contained two patients who, in addition to receiving the intervention, underwent gastric bypass during follow‐up and were included in the final analysis)

4 Downgraded by one point due to imprecision as low event number in included study and wide confidence intervals

5 Downgraded by one point as two of the included studies were at high risk of attrition bias due to incomplete outcome reporting

6 Downgraded by one point due to imprecision as no events in control arms of included studies and wide confidence intervals

7 One of the included studies contained two patients who, in addition to receiving the intervention, had undergone gastric bypass during follow‐up. This was not felt to impact on the number of adverse musculoskeletal events experienced and, therefore, the study was not downgraded for this reason.

8 Downgraded by one point due to imprecision as no events in any study

9 Downgraded by one point due to indirect results (one of the included studies contained one patient, who by this time, had undergone a gastric bypass in addition to receiving the specific study intervention and was included in the final analysis)

10 Downgraded by one point due to imprecision as wide confidence intervals in all included studies, which cross the line of unity

11 Downgraded by one point due to high risk of performance and detection bias in all included studies. Participants, personnel and outcome assessors were unblinded to treatment group allocation, which may have affected the subjective results

12The assumed (control) risk is the median weight change from baseline among the control groups in the included studies

13The assumed (control) risk is the range of scores for change in QOL from baseline at 12 months in the control groups from the included studies, presented in preference to the median change score due to significant variation

Figuras y tablas -
Summary of findings for the main comparison. Lifestyle intervention versus usual care compared to placebo for weight reduction in obesity to improve survival in women with endometrial cancer
Table 1. Authors' responses to additional information request

Study

Principle Investigator contacted

Additional information requested

Answers provided

Allison 2016

Kelly Allison

Randomisation process

Blinding process

How was the study analysed?

Exclusion criteria

How was missing data dealt with?

Baseline characteristics

Duration of study intervention

Was a power calculation performed?

Results‐overall survival, adverse events, recurrence‐free survival, cancer‐specific survival, weight loss from baseline, cardiovascular and metabolic event frequency, change in quality of life from baseline

Funding source

Conflicts of interest

"The coordinating center used a computer generated algorithm to produce the randomization envelopes for each clinical site, with the general parameters of randomizing 1:1:1 across the three conditions. The envelopes are then chosen sequentially as each participant was enrolled."

"There was no blinding. The outcome assessments were conducted by study coordinators and trained medical personnel (for blood draws, DEXA). The coordinators knew which condition the participants were in, but other medical personnel were not informed."

"Given we only had pre‐post assessment data and our main analyses used paired t‐tests and correlations, we were unable to do intention‐to treat analyses."

"Exclusion criteria included: age less than 18, current or recent participation in a weight loss program or use of weight loss medications; uncontrolled serious medical or psychiatric condition(s) that would affect the patient’s ability to participate in the interventional study; invasive malignancy other than EC or non‐melanoma skin cancer which required active treatment currently or within the last 5 years, or current pregnancy."

"Given the pre‐post assessment design, were excluded participants for variables that were not completed."

See Characteristics of included studies. Data on co‐morbidities, performance status and type of endometrial cancer were not provided.

" 6 months"

"No ‐ From the grant: The purpose will be to provide estimates for the size of an intervention effect achievable by the experimental intervention in order to power and justify a grant application for a full‐scale trial of a weight loss program in women with endometrial cancer. With a sample size of 30 participants per group, the true difference in mean weight loss between the groups can be estimated with a 95% confidence interval size of ±0.50σ, where σ is the population standard deviation of weight loss, assumed in this calculation to be the same in each of the two intervention groups and the control group. We will assess the comparability of variance across the groups and do exploratory analyses of possibly variance‐stabilizing transformations. Because this is a pilot study to derive parameters to design an appropriately‐powered study, hypothesis testing is not a primary goal of the statistical analysis of the data, although p‐values will be calculated."

See Data and analyses. No data provided on adverse events, recurrence‐free and cancer‐specific survival

"Cross‐TREC study funded by NCI U54‐CA155850 – University of Pennsylvania; U54 CA155626 – Harvard University; U54 CA155496CC – Washington University; U01 CA116850 – Fred Hutchinson Cancer Research Center."

None declared

McCarroll 2014

Michele McCarroll

Single‐ or multi‐centre study?

Reasons for non‐attendance at follow‐up visits

Methods of group allocation concealment

Prospectively published protocol?

Results‐overall survival, adverse events, recurrence‐free survival, cancer‐specific survival, weight loss from baseline, cardiovascular and metabolic event frequency, change in quality of life from baseline

Single centre

None provided

"Physician counseling was standardized. Clinical guidelines for professionals on the identification, evaluation, and treatment of overweight and obesity in adults, according to the NIH should include dietary therapy, behavior therapy, and an increase in physical activity. They recommend that the clinician and the patient devise goals and a treatment strategy for weight loss with periodic weight checks. A guideline for physicians consisting of a laminated 3 x 5 card was given to all treating physicians as a reminder of patient teaching points. Due to the interventions performed by the study team (dietitian, Physical therapist, psychologist, etc.), they were able to know who was in each group."

"No"

See Data and analyses

von Gruenigen 2009

Michele McCarrroll

Single‐ or multi‐centre study?

Reasons for non‐attendance at follow‐up visits

Methods of group allocation concealment

Prospectively published protocol?

Results‐overall survival, adverse events, recurrence‐free survival, cancer‐specific survival, weight loss from baseline, cardiovascular and metabolic event frequency, change in quality of life from baseline

Single centre

None provided

"Physician counselling was standardized. Clinical guidelines for professionals on the identification, evaluation, and treatment of overweight and obesity in adults, according to the NIH should include dietary therapy, behavior therapy, and an increase in physical activity. They recommend that the clinician and the patient devise goals and a treatment strategy for weight loss with periodic weight checks. A guideline for physicians consisting of a laminated 3 x 5 card was given to all treating physicians as a reminder of patient teaching points. Due to the interventions performed by the study team (dietitian, Physical therapist, psychologist, etc.), they were able to know who was in each group."

No

See Data and analyses

Figuras y tablas -
Table 1. Authors' responses to additional information request
Comparison 1. Lifestyle intervention versus. usual care

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Overall survival (6 months) Show forest plot

2

99

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

2 Overall survival (12 months) Show forest plot

1

59

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

3 Overall survival (24 months) Show forest plot

1

37

Risk Ratio (M‐H, Random, 95% CI)

0.23 [0.01, 4.55]

4 Adverse events‐musculoskeletal Show forest plot

2

91

Risk Ratio (M‐H, Random, 95% CI)

19.03 [1.17, 310.52]

5 Cancer‐specific survival (6 months) Show forest plot

2

99

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

6 Cancer‐specific survival (12 months) Show forest plot

1

59

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

7 Cancer‐specific survival (24 months) Show forest plot

1

37

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

8 Weight loss (6 months) Show forest plot

3

131

Mean Difference (IV, Random, 95% CI)

‐1.88 [‐5.98, 2.21]

9 Weight loss stratified by BMI (6 months) Show forest plot

2

101

Mean Difference (IV, Random, 95% CI)

‐3.11 [‐9.32, 3.10]

9.1 BMI <40 kg/m2

2

63

Mean Difference (IV, Random, 95% CI)

‐3.18 [‐10.29, 3.93]

9.2 BMI >/40 kg/m2

2

38

Mean Difference (IV, Random, 95% CI)

‐2.89 [‐15.65, 9.88]

10 Weight loss (12 months) Show forest plot

2

91

Mean Difference (IV, Random, 95% CI)

‐8.98 [‐19.88, 1.92]

11 Weight loss stratified by BMI (12 months) Show forest plot

2

90

Mean Difference (IV, Random, 95% CI)

‐5.23 [‐11.59, 1.12]

11.1 BMI <40 kg/m2

2

55

Mean Difference (IV, Random, 95% CI)

‐4.08 [‐11.20, 3.04]

11.2 BMI >/40 kg/m2

2

35

Mean Difference (IV, Random, 95% CI)

‐9.76 [‐23.84, 4.32]

12 Weight loss (24 months) Show forest plot

1

25

Mean Difference (IV, Random, 95% CI)

‐18.26 [‐38.73, 2.21]

13 Weight loss stratified by BMI (24 months) Show forest plot

1

25

Mean Difference (IV, Random, 95% CI)

‐25.84 [‐81.40, 29.72]

13.1 BMI <40 kg/m2

1

13

Mean Difference (IV, Random, 95% CI)

2.12 [‐20.82, 25.06]

13.2 BMI >/40 kg/m2

1

12

Mean Difference (IV, Random, 95% CI)

‐54.58 [‐80.97, ‐28.19]

14 Adverse events‐diarrhoea Show forest plot

2

91

Risk Ratio (M‐H, Random, 95% CI)

4.53 [0.23, 90.51]

15 Cardiovascular and metabolic event frequency (6 months) Show forest plot

3

131

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

16 Cardiovascular and metabolic event frequency (12 months) Show forest plot

2

93

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

17 Quality of life‐SF12 Physical Health component (6 months) Show forest plot

1

30

Mean Difference (IV, Random, 95% CI)

‐2.29 [‐7.34, 2.76]

18 Quality of life FACT‐G (6 months) Show forest plot

2

95

Mean Difference (IV, Random, 95% CI)

2.51 [‐5.61, 10.64]

19 Quality of life stratified by BMI (6 months FACT‐G) Show forest plot

2

95

Mean Difference (IV, Random, 95% CI)

4.69 [1.39, 7.99]

19.1 BMI <40 kg/m2

2

60

Mean Difference (IV, Random, 95% CI)

4.01 [‐5.48, 13.51]

19.2 BMI >/40 kg/m2

2

35

Mean Difference (IV, Random, 95% CI)

4.18 [‐0.13, 8.49]

20 Quality of life FACT‐G (12 months) Show forest plot

2

89

Mean Difference (IV, Random, 95% CI)

2.77 [‐0.65, 6.20]

21 Quality of life stratified by BMI (12 months FACT‐G) Show forest plot

2

89

Mean Difference (IV, Random, 95% CI)

2.83 [0.15, 5.50]

21.1 BMI <40k g/m2

2

56

Mean Difference (IV, Random, 95% CI)

2.90 [‐0.40, 6.20]

21.2 BMI >/40 kg/m2

2

33

Mean Difference (IV, Random, 95% CI)

2.68 [‐1.90, 7.26]

Figuras y tablas -
Comparison 1. Lifestyle intervention versus. usual care