Academic Unit of Ophthalmology, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT.
BMJ. 2010 Jul 7;341:c2701. doi: 10.1136/bmj.c2701.
To observe intracranial pressure in women with idiopathic intracranial hypertension who follow a low energy diet.
Prospective cohort study.
Outpatient department and the clinical research facility based at two separate hospitals within the United Kingdom.
25 women with body mass index (BMI) >25, with active (papilloedema and intracranial pressure >25 cm H(2)O), chronic (over three months) idiopathic intracranial hypertension. Women who had undergone surgery to treat idiopathic intracranial hypertension were excluded.
Stage 1: no new intervention; stage 2: nutritionally complete low energy (calorie) diet (1777 kJ/day (425 kcal/day)); stage 3: follow-up period after the diet. Each stage lasted three months.
The primary outcome was reduction in intracranial pressure after the diet. Secondary measures included score on headache impact test-6, papilloedema (as measured by ultrasonography of the elevation of the optic disc and diameter of the nerve sheath, together with thickness of the peripapillary retina measured by optical coherence tomography), mean deviation of Humphrey visual field, LogMAR visual acuity, and symptoms. Outcome measures were assessed at baseline and three, six, and nine months. Lumbar puncture, to quantify intracranial pressure, was measured at baseline and three and six months.
All variables remained stable over stage 1. During stage 2, there were significant reductions in weight (mean 15.7 (SD 8.0) kg, P<0.001), intracranial pressure (mean 8.0 (SD 4.2) cm H(2)O, P<0.001), score on headache impact test (7.6 (SD 10.1), P=0.004), and papilloedema (optic disc elevation (mean 0.15 (SD 0.23) mm, P=0.002), diameter of the nerve sheath (mean 0.7 (SD 0.8) mm, P=0.004), and thickness of the peripapillary retina (mean 25.7 (SD 36.1) micro, P=0.001)). Mean deviation of the Humphrey visual field remained stable, and in only five patients, the LogMAR visual acuity improved by one line. Fewer women reported symptoms including tinnitus, diplopia, and obscurations (10 v 4, P=0.004; 7 v 0, P=0.008; and 4 v 0, P=0.025, respectively). Re-evaluation at three months after the diet showed no significant change in weight (0.21 (SD 6.8) kg), and all outcome measures were maintained.
Women with idiopathic intracranial hypertension who followed a low energy diet for three months had significantly reduced intracranial pressure compared with pressure measured in the three months before the diet, as well as improved symptoms and reduced papilloedema. These reductions persisted for three months after they stopped the diet.
观察遵循低能量饮食的特发性颅内高压女性的颅内压。
前瞻性队列研究。
英国两家不同医院的门诊和临床研究机构。
25 名 BMI（体重指数）>25、伴有活跃（视乳头水肿和颅内压>25cmH₂O）、慢性（超过三个月）特发性颅内高压的女性。已接受手术治疗特发性颅内高压的女性被排除在外。
第 1 阶段：无新干预措施；第 2 阶段：营养完整的低能量（热量）饮食（1777kJ/天（425kcal/天））；第 3 阶段：饮食后的随访期。每个阶段持续三个月。
主要结局是饮食后颅内压降低。次要措施包括头痛影响测试-6 的评分、视乳头水肿（通过视神经盘抬高和神经鞘直径的超声测量以及光学相干断层扫描测量的视乳头周围视网膜厚度来衡量）、Humphrey 视野平均偏差、LogMAR 视力和症状。在基线和三个月、六个月和九个月时评估了这些结果。在基线和三个月和六个月时通过腰椎穿刺来测量颅内压。
在第 1 阶段，所有变量均保持稳定。在第 2 阶段，体重显著减轻（平均 15.7kg（标准差 8.0kg），P<0.001）、颅内压（平均 8.0cmH₂O（标准差 4.2cmH₂O），P<0.001）、头痛影响测试评分（7.6（标准差 10.1），P=0.004）和视乳头水肿（视神经盘抬高（平均 0.15（标准差 0.23）mm，P=0.002）、神经鞘直径（平均 0.7（标准差 0.8）mm，P=0.004）和视乳头周围视网膜厚度（平均 25.7（标准差 36.1）µm，P=0.001））。Humphrey 视野平均偏差保持稳定，只有 5 名患者的 LogMAR 视力提高了一行。报告有耳鸣、复视和模糊等症状的女性人数减少（10 名 v 4 名，P=0.004；7 名 v 0 名，P=0.008；和 4 名 v 0 名，P=0.025）。饮食后三个月的重新评估显示体重没有明显变化（0.21kg（标准差 6.8kg）），所有结果均保持不变。
与饮食前三个月的颅内压相比，遵循低能量饮食三个月的特发性颅内高压女性的颅内压显著降低，症状也得到改善，视乳头水肿减轻。这些减少在停止饮食后持续了三个月。
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