The prevalence of obesity in the developed world is increasing. Approximately 23% of adult Canadians (5.5 million people) are obese. Obesity is associated with an increased risk of developing several comorbid diseases, ranging from cardiovascular diseases to cholelithiasis and nonalcoholic fatty liver disease. The etiology of obesity is multifactorial, involving a complex interaction among genetics, hormones and the environment. The available evidence and recommendations for nonpharmacological management of obesity, including dietary therapy, physical activity and behavioural therapy, in addition to pharmacotherapy are discussed. A brief discussion on endoscopic and surgical procedures is undertaken. Several antiobesity treatment options are available and may be indicated in appropriate situations. Selecting obesity therapy may be guided by body mass index measurements, comorbid illnesses and patient preference.

OBJECTIVE -Exposure to infections in infancy or childhood may be important in the pathogenesis of type 1 diabetes, but a protective role has also been suggested. We tested the hypothesis that increased early contact with infectious agents, measured by day care exposure, would decrease the risk of type 1 diabetes in childhood.RESEARCH DESIGN AND METHODS -We conducted a systematic review of casecontrol studies. Meta-analysis was performed to combine results, assess for heterogeneity, and explore variation in study design.RESULTS -Several generally well-designed case-control studies show a statistically significant protective effect of day care on type 1 diabetes. However, meta-analysis revealed too much heterogeneity to accept the overall synthesis results and none of the studies used prerecorded data. Day care does seem to have a protective effect in the subgroup of children who will be diagnosed with type 1 diabetes before the age of 5 years (odds ratio ϭ 0.6, 95% CI 0.5-0.8); however, this result is based on only two studies.CONCLUSIONS -Recall bias is one alternate explanation for these data; confirmation using prerecorded data is required. Such data could be prospectively measured in cohort studies of children at risk. We also suggest that information about day care attendance be measured in randomized trials of agents for the prevention of type 1 diabetes, as day care exposure could potentially modify the effect of the preventive agent.

The registry is a valid tool to assess several clinical parameters. On follow-up, HPN patients maintain good nutrition status while PN is reduced but do have a reduced quality of life.

This is a report of a patient with short-bowel syndrome secondary to recurrent surgeries for Crohn's disease who ultimately required small bowel transplantation in 1994. Eight years posttransplantation he developed recurrent Crohn's disease that was responsive to prednisone. From the perspective of advancing our understanding of Crohn's disease pathogenesis this case suggests that intestine-specific antigens may be more important than the classical MHC antigens for the development of Crohn's disease, since this man developed Crohn's disease in both the native intestine and also in the engrafted one.