In the key statement of their important review article, Kesztyüs and colleagues express the following demand: “Further research regarding the treatment of abdominal obesity is urgently needed.” I hope they mean studies with clinically relevant endpoints (mortality, morbidity) and not merely studies with surrogate outcomes—for example, “reduction of abdominal obesity,” as one might deduce from the conclusions of their article.
This uncertainty may also be related to the fact that the authors seem to be confused about their terminology. Erroneously, they mention “pharmaceutical trials,” “pharmaceutical interventions,” and “pharmacological interventions.”
Pharmaceutical trials investigate the quality (identity, ingredients, purity, and so on) of a medical drug. Efficacy and harmlessness are, however, determined in clinical-pharmacological (phase I) and clinical (phase II–IV) trials.
Terminology problems are not merely a formality, as is shown by a further comment relating to a study reported by Tuomilehto et al. (2), in which the waist circumference of obese participants with prediabetes decreased by 4.4 cm and their relative risk of developing type 2 diabetes fell by 58%.
Kesztyüs et al., however, mentioned “a 58% reduction in the incidence of type 2 diabetes mellitus.” Since the incidence relates to the onset of an event—that is, the absolute risk—58% shrinks to 12% (control group 23%, intervention group 11%).
Unclear terminology is not trivial but can contribute to misunderstandings.
Prof. Dr. med. Frank P. Meyer
|1.||Kesztyüs D, Erhardt J, Schönsteiner D, Kesztyüs T: Treatment options for abdominal obesity in adults—a meta-analysis and systematic review of randomized controlled trials. Dtsch Arztebl Int 2018; 115: 487–93 VOLLTEXT|
|2.||Tuomilehto J, Lindström J, Eriksson JG, et al.: Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med 2001; 344: 1343–50 CrossRef MEDLINE|