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Weight Management Interventions for Adults With Idiopathic Intracranial Hypertension: A Systematic Review and Practice Recommendations

BACKGROUND AND OBJECTIVES: Idiopathic intracranial hypertension (IIH) is associated with obesity; however, there is a lack of clinical consensus on how to manage weight in IIH. The aim of this systematic review was to evaluate weight loss interventions in people with IIH to determine which intervent...

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Autores principales: Abbott, Sally, Chan, Fiona, Tahrani, Abd A., Wong, Sui Hsien, Campbell, Fiona E.J., Parmar, Chetan, Pournaras, Dimitri J., Denton, Amanda, Sinclair, Alexandra Jean, Mollan, Susan P.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Lippincott Williams & Wilkins 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10663033/
https://www.ncbi.nlm.nih.gov/pubmed/37813577
http://dx.doi.org/10.1212/WNL.0000000000207866
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author Abbott, Sally
Chan, Fiona
Tahrani, Abd A.
Wong, Sui Hsien
Campbell, Fiona E.J.
Parmar, Chetan
Pournaras, Dimitri J.
Denton, Amanda
Sinclair, Alexandra Jean
Mollan, Susan P.
author_facet Abbott, Sally
Chan, Fiona
Tahrani, Abd A.
Wong, Sui Hsien
Campbell, Fiona E.J.
Parmar, Chetan
Pournaras, Dimitri J.
Denton, Amanda
Sinclair, Alexandra Jean
Mollan, Susan P.
author_sort Abbott, Sally
collection PubMed
description BACKGROUND AND OBJECTIVES: Idiopathic intracranial hypertension (IIH) is associated with obesity; however, there is a lack of clinical consensus on how to manage weight in IIH. The aim of this systematic review was to evaluate weight loss interventions in people with IIH to determine which intervention is superior in terms of weight loss, reduction in intracranial pressure (ICP), benefit to visual and headache outcomes, quality of life, and mental health. METHODS: A systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and registered with PROSPERO (CRD42023339569). MEDLINE and CINAHL were searched for relevant literature published from inception until December 15, 2022. Screening and quality appraisal was conducted by 2 independent reviewers. Recommendations were graded using Scottish Intercollegiate Guidelines Network methodology. RESULTS: A total of 17 studies were included. Bariatric surgery resulted in 27.2–27.8 kg weight loss at 24 months (Level 1− to 1++). Lifestyle weight management interventions resulted in between 1.4 and 15.7 kg weight loss (Level 2+ to 1++). Bariatric surgery resulted in the greatest mean reduction in ICP (−11.9 cm H(2)O) at 24 months (Level 1++), followed by multicomponent lifestyle intervention + acetazolamide (−11.2 cm H(2)O) at 6 months (Level 1+) and then a very low-energy diet intervention (−8.0 cm H(2)O) at 3 months (Level 2++). The least ICP reduction was shown at 24 months after completing a 12-month multicomponent lifestyle intervention (−3.5 cm H(2)O) (Level 1++). Reduction in body weight was shown to be highly correlated with reduction in ICP (Level 2++ to 1++). DISCUSSION: Bariatric surgery should be considered for women with IIH and a body mass index (BMI) ≥35 kg/m(2) since this had the most robust evidence for sustained weight management (grade A). A multicomponent lifestyle intervention (diet + physical activity + behavior) had the most robust evidence for modest weight loss with a BMI <35 kg/m(2) (grade B). Longer-term outcomes for weight management interventions in people with IIH are required to determine whether there is a superior weight loss intervention for IIH.
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spelling pubmed-106630332023-11-21 Weight Management Interventions for Adults With Idiopathic Intracranial Hypertension: A Systematic Review and Practice Recommendations Abbott, Sally Chan, Fiona Tahrani, Abd A. Wong, Sui Hsien Campbell, Fiona E.J. Parmar, Chetan Pournaras, Dimitri J. Denton, Amanda Sinclair, Alexandra Jean Mollan, Susan P. Neurology Research Article BACKGROUND AND OBJECTIVES: Idiopathic intracranial hypertension (IIH) is associated with obesity; however, there is a lack of clinical consensus on how to manage weight in IIH. The aim of this systematic review was to evaluate weight loss interventions in people with IIH to determine which intervention is superior in terms of weight loss, reduction in intracranial pressure (ICP), benefit to visual and headache outcomes, quality of life, and mental health. METHODS: A systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and registered with PROSPERO (CRD42023339569). MEDLINE and CINAHL were searched for relevant literature published from inception until December 15, 2022. Screening and quality appraisal was conducted by 2 independent reviewers. Recommendations were graded using Scottish Intercollegiate Guidelines Network methodology. RESULTS: A total of 17 studies were included. Bariatric surgery resulted in 27.2–27.8 kg weight loss at 24 months (Level 1− to 1++). Lifestyle weight management interventions resulted in between 1.4 and 15.7 kg weight loss (Level 2+ to 1++). Bariatric surgery resulted in the greatest mean reduction in ICP (−11.9 cm H(2)O) at 24 months (Level 1++), followed by multicomponent lifestyle intervention + acetazolamide (−11.2 cm H(2)O) at 6 months (Level 1+) and then a very low-energy diet intervention (−8.0 cm H(2)O) at 3 months (Level 2++). The least ICP reduction was shown at 24 months after completing a 12-month multicomponent lifestyle intervention (−3.5 cm H(2)O) (Level 1++). Reduction in body weight was shown to be highly correlated with reduction in ICP (Level 2++ to 1++). DISCUSSION: Bariatric surgery should be considered for women with IIH and a body mass index (BMI) ≥35 kg/m(2) since this had the most robust evidence for sustained weight management (grade A). A multicomponent lifestyle intervention (diet + physical activity + behavior) had the most robust evidence for modest weight loss with a BMI <35 kg/m(2) (grade B). Longer-term outcomes for weight management interventions in people with IIH are required to determine whether there is a superior weight loss intervention for IIH. Lippincott Williams & Wilkins 2023-11-21 /pmc/articles/PMC10663033/ /pubmed/37813577 http://dx.doi.org/10.1212/WNL.0000000000207866 Text en Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License 4.0 (CC BY-NC-ND) (https://creativecommons.org/licenses/by-nc-nd/4.0/) , which permits downloading and sharing the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
spellingShingle Research Article
Abbott, Sally
Chan, Fiona
Tahrani, Abd A.
Wong, Sui Hsien
Campbell, Fiona E.J.
Parmar, Chetan
Pournaras, Dimitri J.
Denton, Amanda
Sinclair, Alexandra Jean
Mollan, Susan P.
Weight Management Interventions for Adults With Idiopathic Intracranial Hypertension: A Systematic Review and Practice Recommendations
title Weight Management Interventions for Adults With Idiopathic Intracranial Hypertension: A Systematic Review and Practice Recommendations
title_full Weight Management Interventions for Adults With Idiopathic Intracranial Hypertension: A Systematic Review and Practice Recommendations
title_fullStr Weight Management Interventions for Adults With Idiopathic Intracranial Hypertension: A Systematic Review and Practice Recommendations
title_full_unstemmed Weight Management Interventions for Adults With Idiopathic Intracranial Hypertension: A Systematic Review and Practice Recommendations
title_short Weight Management Interventions for Adults With Idiopathic Intracranial Hypertension: A Systematic Review and Practice Recommendations
title_sort weight management interventions for adults with idiopathic intracranial hypertension: a systematic review and practice recommendations
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10663033/
https://www.ncbi.nlm.nih.gov/pubmed/37813577
http://dx.doi.org/10.1212/WNL.0000000000207866
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