Rectal NSAIDs are effective in the prevention of PEP in unselected patients.

Context Calorie restriction plus dietary advice is suggested as a preventive strategy for individuals with obesity and prediabetes, however, optimal diet is still debatable. We aimed to compare the effects of Mediterranean diet (MD) and Chinese diets high or low in plants on body weight and glucose homeostasis among high risk Chinese. Subjects and Methods In this parallel-arm randomized controlled trial, 253 Chinese adults aged 25-60 years with BMI ≥24.0 kg/m 2 and fasting blood glucose ≥5.6 mmol/L were randomly assigned to three isocaloric-restricted diets: MD (n = 84), a traditional Jiangnan Diet high in plants (TJD, n = 85), or a control diet low in plants (CD, n = 84). During the 6-month trial, a 5-weekday full feeding regimen was followed, along with mobile app-based monitoring. Abdominal fat measurement (magnetic resonance imaging), oral glucose tolerance test (OGTT), and continuous glucose monitoring (CGM) were conducted at baseline, 3- and 6-month. Results With a 25% calorie-restriction for 6 months, weight deduction was 5.72 kg (95% CI: 5.03, 6.40) for MD, 5.05 kg (4.38, 5.73) for TJD and 5.38 kg (4.70, 6.06) for CD (Ptime < 0.0001). No between-group differences were found for fasting glucose, insulin, and the Matsuda index from OGTT. Notably, CD had significantly longer time below range (glucose < 3.9 mmol/L) than MD [0.81% ( 0.21, 1.40), P = 0.024] and marginally longer time than TJD [0.56% (-0.03,1.15), P = 0.065], as measured by CGM. Conclusions With the 6-month isocaloric-restricted feeding, TJD and MD achieved comparable weight deduction and improved glucose homeostasis, whereas CD showed a higher risk for hypoglycemia.

Is rectal indomethacin ineffective in the prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis in the general population? Dear Editor We read with interest the meta-analyses by Feng et al. 1 and by Inamdar et al., 2 objecting to the use of rectal indomethacin for post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) prophylaxis in general patients and in 'average-risk patients', respectively, through analyzing the same six randomized controlled trials (RCT) where patients were unselected. Inamdar et al. 2 defined 'average-risk patients' as patients not meeting criteria for high-risk patients for PEP. However, five RCT in the meta-analysis included a proportion of highrisk patients. In another RCT for unselected patients, only patients undergoing successful ERCP within five attempts of cannulation were extracted, but patients with other risk factors could not be separated totally. Inconsistence between inclusion criteria and patients included made the results confusing to the readership. Feng et al. 1 corrected the inconsistency and made the first meta-analysis investigating the effectiveness of rectal indomethacin for PEP prophylaxis in the general population. However, the results may not be convincing for the following reasons. First, Freeman-Tukey transformation, a transformation to stabilize the variance in binomial distributions (one type of univariate distribution), 3 was mistakenly used in this bivariant meta-analysis. Second, relative risks (RR) are preferred in meta-analyses of RCT rather than odds ratio (OR), because OR might be nonÀintuitive in interpretation and can overestimate or underestimate RR in common events. 4 In this meta-analysis, the authors computed OR considering OR to be a close approximation of RR in rare events. However, they should mention this in the Methods and limitations. Third, some data were extracted by mistake and the correct ones are given in Table 1. Herein, we corrected the mistakes above and recalculated the results (Fig. 1), confirming the effectiveness of rectal indomethacin for PEP prophylaxis in general patients and further expanding the indication of this agent for patients receiving ERCP.