The role of very-low-carbohydrate ketogenic diets (VLCKD) in the long-term management of obesity is not well established. The present meta-analysis aimed to investigate whether individuals assigned to a VLCKD (i.e. a diet with no more than 50 g carbohydrates/d) achieve better long-term body weight and cardiovascular risk factor management when compared with individuals assigned to a conventional lowfat diet (LFD; i.e. a restricted-energy diet with less than 30 % of energy from fat). Through August 2012, MEDLINE, CENTRAL, ScienceDirect, Scopus, LILACS, SciELO, ClinicalTrials.gov and grey literature databases were searched, using no date or language restrictions, for randomised controlled trials that assigned adults to a VLCKD or a LFD, with 12 months or more of follow-up. The primary outcome was body weight. The secondary outcomes were TAG, HDL-cholesterol (HDL-C), LDL-cholesterol (LDL-C), systolic and diastolic blood pressure, glucose, insulin, HbA 1c and C-reactive protein levels. A total of thirteen studies met the inclusion/exclusion criteria. In the overall analysis, five outcomes revealed significant results. Individuals assigned to a VLCKD showed decreased body weight (weighted mean difference 20·91 (95 % CI 2 1·65, 20·17) kg, 1415 patients), TAG (weighted mean difference 2 0·18 (95 % CI 20·27, 2 0·08) mmol/l, 1258 patients) and diastolic blood pressure (weighted mean difference 2 1·43 (95 % CI 22·49, 2 0·37) mmHg, 1298 patients) while increased HDL-C (weighted mean difference 0·09 (95 % CI 0·06, 0·12) mmol/l, 1257 patients) and LDL-C (weighted mean difference 0·12 (95 % CI 0·04, 0·2) mmol/l, 1255 patients). Individuals assigned to a VLCKD achieve a greater weight loss than those assigned to a LFD in the long term; hence, a VLCKD may be an alternative tool against obesity.Key words: Cardiovascular risk factors: Low-carbohydrate diets: Meta-analysis: Obesity: Weight loss Obesity continues to be a major worldwide health problem, despite the efforts of the medical community. At least 2·8 million adults die from obesity-related causes each year, and 65 % of the worldwide population lives in countries where obesity causes more deaths than underweight (1) . Although it is a difficult task, intensive lifestyle interventions can achieve weight loss that is sustained over the long term, as shown by the findings of a recent large clinical trial (2) .Diet is a cornerstone of any lifestyle intervention programme. The dietary plan that restricts energy and fat is the most common strategy, and based on it, several other dietary strategies have been proposed (3 -5) . The very-low-carbohydrate ketogenic diet (VLCKD) differs from these approaches. According to Accurso et al. A major concern regarding the prescription of the VLCKD is the adherence of the individuals assigned to it, since it promotes important lifestyle changes (7) . Given the importance of dietary counselling in weight loss, it is useful to investigate the effectiveness of different dietary therapies. A recent large randomised clinical trial, whic...

Advanced glycation end products (AGEs) are generated spontaneously in cells; however, under conditions of hyperglycemia and lipid peroxidation, their levels are higher than usual, which contribute to the development of diseases such as the nonalcoholic fatty liver disease (NAFLD). NAFLD is associated with oxidative stress (OS), which is linked to the transition of steatosis to steatohepatitis due to lipid peroxidation. The AGE-receptor interaction in hepatic stellate cells leads to an increase in reactive oxygen species and enhances the proliferation and activation of these cells, worsening liver fibrosis and disease progression. In this vicious cycle, there is production of (carboxymethyl)lysine, a biomarker for products of advanced glycation and lipid peroxidation, being a shared component between the two pathways. In this review, we aim to compile evidence to support the basic molecular mechanisms of AGEs and OS generation and their influence, independently or combined, on the evolution of NAFLD. The deeper understanding of the interrelations of AGEs + OS may help to elucidate the pathogenic pathways of NAFLD and to devise rational therapeutic interventions for this disease, with an expected positive impact on quality of life of patients.

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This study describes the nutritional status of 357 children (0-10 years) living in Fazenda Conceição, an area occupied by the "Landless Peasants' Movement" and recently expropriated for land reform purposes by the Brazilian National Institute for Land Settlement and Agrarian Reform. The prevalence of nutritional deficits (Z < -2 standard deviations from the NCHS median anthropometric standard) relating to body- weight-for-age, height-for-age, and body-weight-for-height were the following, respectively: 19.6%, 39.8%, and 2%, thus higher than the figures published recently for the rural areas of the State of Alagoas as a whole (8.4%, 22.7%, and 1.3%). These findings suggest that children are these affected by dwarfism. Despite this condition being widely acknowledged as one of the most visible manifestations of malnutrtion in developing countries, it is important to stress that the concentration of land tenure, an integral part of the income-concentrating development model adopted by Brazil, is also a major factor in determining such a health profile. There is thus an urgent need for policy-makers to reallocate resources for immediate intervention in such farm communities, in order to reduce the dire consequences of a situation of this magnitude.

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