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Low-Energy Diets and Prolonged QT Intervals-Reply

Arthur J. Moss, MD
JAMA. 1987;257(12):1601-1602. doi:10.1001/jama.1987.03390120063019.
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In Reply.—  The letter by Frank et al is appreciated. It highlights a somewhat unsettled area regarding the complex relationship between obesity, rapid-weight-reduction diets, QT-interval prolongation, and unexpected sudden death. Several articles have been published that have documented the occurrence of sudden cardiac death in obese persons on very-low-energy liquid protein diets.1-4 In ten of the 17 deaths reported, electrocardiograms were recorded during the period of dieting. Nine (90%) of these ten patients had unequivocal QT prolongation, with a QTc of greater than 0.45 s. In the population study referenced by Frank et al,5 a QTc of greater than 0.45 s occurred in only 1.7% of their obese patients. The available scientific data indicate that very-low-energy diets can be deadly, especially in a subset of patients who develop QT prolongation during rapid weight loss. The hypothesis that rapid weight loss results in acquired QT prolongation with

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