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Micronutrients in the Diets of Industrialized Countries

In the USA and Western Europe, agriculture and the food industry produce enough to feed the population and export large quantities of food. Despite this, many people are poorly nourished they are oversupplied with foods rich in fat, protein, sugar, and salt, and under-supplied with complex carbohydrates, fiber, vitamins, and minerals. Dietary surveys have repeatedly found that micronutrient deficiencies are widespread in the industrialized countries. For example Common dietary deficiencies of micronutrients in the USA and Western Europe* Common dietary deficiencies of micronutrients in the USA and Western Europe* Micronutrients in the Diets of Industrialized Countries

Dietary Records and Diaries

Ly prefer the record system even if the food intake can be influenced by this process to such a degree that the subject's original food pattern can be changed. It is better to record dietary intake over a period of three non-consecutive days with a ratio of 5 2 between working days and holidays 34 .

Dietary Requirements for the Elderly

Nutrition may act in different ways first, lifestyle and nutritional habits of adulthood may contribute to the age-related loss of tissue function second, chronic degenerative diseases, such as atherosclerosis and cancer, appear to be influenced by nutrition finally, since elderly people eat less, the intake of some nutrients may fall below the recommended dietary allowances (RDA) 39 . But, until now, most of the nutritional recommendations for the elderly have been derived by extrapolation from data of younger adults 32, 39 . The controversial point is the choice of two-thirds of the RDA as a cut-off value for determining insufficient intake 32 . This could be incorrect because the chronic disease widespread in geriatrics might interfere with the dietary intake for groups of elderly subjects 40 .

Nitrogen Metabolism and Dietary Protein Characteristics

Of essential amino acids generates the ineffective utilisation of dietary nitrogen. Furthermore, besides such an insufficient utilisation, it is important to assess the amount of dietary and intestinal nitrogen that is absorbed as free amino acids or dipeptides, or excreted in the faeces, urine or other routes. Finally, the assessment of the anabolic utilisation for protein synthesis is a key step to measure amino acid retention in the body. Other factors may affect nitrogen retention. Differences in the gastric emptying rate of dietary proteins may result in highly variable rates of amino acid absorption in the small intestine 45 . Also, differences in the rate of protein digestion and or absorption result in relevant differences in amino acid oxidation and postprandial nitrogen accretion 46 . In this regard, the concept of net postprandial protein utilisation (NPPU) has been proposed, which is calculated using true ileal digestibility and true 15N-labelled protein deami-nation...

Good Dietary Sources

Plant foods, unless they are enriched with the vitamin, contain no vitamin B12. Although our intestinal bacteria synthesize small amounts of vitamin B12-like compounds, these do not contribute to nutritional needs. Therefore, the only significant dietary sources are animal products meat, seafood, eggs, and milk products.5 Vitamin B12 is sensitive to heat and substantial amounts can be lost during food preparation for example, milk boiled for 2 minutes loses 30 of its vitamin B12.

Dietary Fatty Acids and Sodium Intake Cytokines LVH and CHF

Whereas male gender, obesity, heredity, and insulin resistance may explain some of the variance in LVH, hypertension (HBP) is generally regarded as the primary culprit. Thus, the risks associated with LVH and HBP are intimately linked. Recent data also suggested that low dietary intake of polyun-saturated fatty acids and high intake of saturated fatty acids, as well as HBP and obesity, at age 50 predicted the prevalence of LVH 20 years later. Although the source of saturated fatty acids is usually animal fat, the source of unsaturated fatty acids in that specific Scandinavian population and at that time was less clear and there was no adjustment for other potential dietary confounders such as magnesium, potassium, calcium, and sodium. Thus this study did not provide conclusive data regarding the dietary lipid determinants of LVH. However, it does suggest that dietary fatty acids may be involved in the development of LVH and that this diet-heart...

Minimum Clinical Priority Dietary Program

Despite the increased evidence that dietary prevention is critical in the post-AMI patient, many physicians (and their patients) remain rather poorly informed about the potential of diet to reduce cardiac mortality, the risk of new CHD complications, and the need for recurrent hospi-talization and investigation. There are many reasons for that, the main one probably being an insufficient knowledge of nutrition. For that reason (and knowing the resistance of many physicians to the idea that diet is important in CHD), we propose a minimum dietary program that every CHD patient, whatever his her medical and familial environment, should know and follow. This minimum Mediterranean diet should include the following taking capsules of n-3 fatty acids (for instance, a mix of alpha-linolenic acid and long chain n-3 fatty acids) is the best alternative option. Very importantly, the patients (and their physicians) should be aware that n-3 fatty acid supplementation will be even more...

Leptin and Diet Induced Obesity

After the discovery of leptin, the initial hypothesis that human obesity results from a deficiency in leptin has failed. Obese humans have high plasma leptin concentrations related to the size of adipose tissue, but this elevated leptin signal does not induce the expected response. This fact suggests that obese humans are resistant to the effects of endogenous leptin. The resistance is also shown by the lack of effect of exogenous administration to induce weight loss in obese patients 64 . Leptin resistance may be defined as reduced sensitivity or complete insensitivity to leptin action, as occurs for insulin in type 2 diabetes 57 . Human and rodent studies indicate that the major cause of this resistance arises from an inability of leptin to cross the blood-brain barrier 81 . The leptin transporter is a saturable system beyond a certain plasma leptin level, increased production by the growing fat mass would be futile. Furthermore, severe hyperleptinaemia might down-regulate the...

Overweight Obese Patients

Obesity is not a single disorder but a heterogeneous group of conditions with multiple causes, the outcome of an imbalance between energy intake and energy expenditure.12 Although genetic components are very important, the principal causes of the accelerating obesity problem worldwide are best explained by changing behaviors and environment. Obesity research areas are numerous and include studies of genetics, basic mechanisms that regulate body composition, optimal nutrition from prenatal age to late adulthood, lifestyle strategies to maintain healthy weight, and effective nutritional care following weight loss.

Definition of Overweight Obesity and Health Implications

Obesity specifically refers to an excess amount of body fat sufficient to harm health.2 Obesity is most commonly assessed by a single measure, the body mass index (BMI). Individuals with a BMI of 25-29.9kg m2 are considered overweight, while those with a BMI of 30 and above are considered obese (Table 25-1). Obesity is classified as moderate (class I), severe (class II), or extreme (class III) according to BMI (30-34.9,35-39.9 and 40kg m2, respectively). It is associated with a high risk of cardiovascular disease and type 2 diabetes which increases gradually as BMI increases.1,2 Waist circumference is increasingly recognized as a simple means of identifying abdominal obesity. A waist size greater than 102 cm for men and 88 cm for women, at least in Europid populations, markedly increases the risk of most weight-related illnesses. A moderately increased metabolic risk (including MetS) is already observed in individuals with waist circumference greater than 94 cm for men and 80 cm for...

Nutritional Prevention of Overweight Obesity in Childhood

- adequate maternal nutrition during pregnancy while avoiding excessive maternal weight gain and hyperglycemia and hypertriglyceridemia Major industrial concerns in food and drink production, manufacturing, retailing, and catering have targeted children. New policies to prevent overweight obesity require children to be protected at the most vulnerable and important stages in their development.

Influence of Qualitative Modification of Dietary Fats

There has been clear understanding for decades that dietary fat subtypes have very different effects on many metabolic variables of importance in the etiology of MetS.16,17 While the differing effects of saturated versus polyunsaturated fatty acids (PUFA) on cholesterol were identified decades ago, effects of dietary fats on plasma triglycerides have been recognized more recently. Plasma triglyceride levels are increased by some fats but decreased by n-3 PUFA. Furthermore, evidence for differential effects of fat subtypes on insulin action was published and consistent results were obtained in animal intervention and human cross-sectional and prospective studies. Animal studies have shown that increasing the percentage of calories from some, but not all, fats leads to impaired insulin action (insulin resistance) without the necessity of overconsumption of calories. Saturated fats are deleterious while n-3 PUFAs are protective. Monounsaturated fatty acids and n-6 PUFAs are also,...

Impact of Counseling on Dietary Behaviors

Because of the important differences across studies in outcome measures, study design, analysis strategy, and intervention techniques, it is difficult to reach definitive conclusions on the type of dietary counseling that is the most successful, even if some characteristics seem to improve the effectiveness of behavioral interventions in modifying dietary patterns. Ammerman et al.22 conducted an evidence-based review of existing literature on the efficacy of behavioral interventions in modifying dietary fat and fruit and vegetable intake. From 907 articles originally identified, the authors retained 92 independent studies meeting the research criteria (randomized controlled studies, not based on controlled diets, with at least a sample size of 40 subjects at follow-up). Intervention groups were similarly successful in reducing total fat (7.3 reduction in the percentage of total calories from fat) and saturated fat intakes, and in increasing fruit and vegetable intake (+0.6 servings...

Dietary Recommendations

Weight Reduction Obesity has numerous adverse hemodynamic, cardiac structure and function effects, as well as a propensity for more ventricular arrhythmias. Almost one-third of morbidly obese patients have clinical evidence of HF and a significant increase in NYHA functional class can be achieved with weight reduction.31 On the other hand, it has been documented that obese chronic HF patients have similar or improved prognosis compared to normal or underweight patients32 although these results are subject to debate, a lower body weight is likely to be associated with heightened metabolic state, and an involuntary weight loss, as in the cardiac cachexia syndrome, is associated with a poor outcome.19 A liberalized fat intake is allowed for weight maintenance and adequate caloric intake in poorly nourished chronic HF patients, with normal or low levels of total and LDL cholesterol.

Experimental Models of Caloric Restriction and Applicability to Humans

The lifespan-extending and other beneficial effects of CR, such as anti-tumor effects and the maintenance of more youthful physiology, have been reported in many hundreds of experiments over the past 70 yr. Nonetheless, the question of relevance to humans remains and will go unanswered until definitive human data are obtained (2). There are, however, data from a number of sources that suggest that CR may be relevant to human aging. For example, based on his study of Spanish nursing home residents, Vallejo (3) concluded that reduced caloric intake was associated with a significant reduction in morbidity and that mortality also tended to be lower in the group provided the fewest calories. Caloric intake in residents of the Japanese island of Okinawa differs by 20-40 in adults and children, respectively, compared to the national average (4). Interestingly, Okinawa has a greater proportion of centenarians, a lower overall death rate, and fewer deaths due to vascular disease and cancer....

Relationship of Plasma Carotenoid Concentration to Dietary Intake and Supplementation

Many studies have examined the relationship between dietary intake (as assessed by food frequency questionnaires, 24-hour recalls, or other instruments) and plasma concentrations of carotenoids. In general, it is found that plasma concentrations are correlated with dietary intake, but rather weakly, e.g., correlation coefficients ranging between 0.26 and 0.58 (66-68). The problem is, of course, complicated by the fact that it is difficult to assess dietary intake accurately different instruments for assessing dietary intake do not correlate perfectly (67). Another great body of studies has assessed the impact of dietary supplementation with carotenoids on increasing plasma carotenoid concentrations again, it is clear that plasma concentrations can be increased by use of supplements, but the effect is subject to considerable individual variation (69). Dietary supplementation with large amounts of -carotene (90mg day for 3 weeks) results in enrichment of -carotene in all plasma...

Dietary Intake of Proteins in Patients with Cancer

The typical nutrient intakes of individuals with advanced cancer have not been widely studied. This would appear to be an important deficit, as it is obvious that no anti-cachexia strategy is likely to be entirely effective unless coupled with adequate intake of essential nutrients, including proteins, and any need for supplementation must necessarily be considered in the context of the level of intake. A couple of relevant citations on dietary intakes of cancer patients may be found in the recent literature. Fearon (2003) reported the typical protein and energy intake of patients with unresectable pancreatic cancer who completed 3-day dietary records 16 . On average, total energy intakes were 1500-1600 kcal day and protein intakes were 60-63 g protein day, to provide an overall protein energy

Caloric Restriction Mimetics

We first proposed the idea of CR mimetics in 1998 (10) and further expanded on this potential approach in a subsequent article in Scientific American (11). In our initial study, we reported that disruption of cellular glucose metabolism (e.g., glycolysis) using the glucose analogue 2-deoxy-D-glucose (2DG) fed in the diet to rats lowered body temperature and fasting insulin levels without significantly reducing food intake over a 6-mo period at the selected dose (10). The 6-mo duration of this study was insufficient to assess indices of biological aging or longevity, but did validate that it may be possible to mimic metabolic effects of CR without reducing food intake. A follow-up survival study in rats unfortunately indicated that the window between efficacy and toxicity was too narrow to make this particular compound useful. The concept of CR mimetics has been further validated in other experiments. For example, similarly to CR, 2DG has been shown to be neuroprotective in rodent...

Caloric Restriction

There are many theories on aging, and one of the most widely accepted is the gradual age-related accumulation of irreparable and irreversible cellular and molecular damage. One environmental manipulation that can alter the aging process is caloric restriction (CR). For example, the lifespan of rodents can be increased by approximately 50 when CR is initiated in young adulthood and maintained throughout life 95 . CR also decreases the incidence of systemic age-related diseases, including cancer, cardiovascular disease, and diabetes in a variety of animal models 96, 97 , making dietary restriction a plausible and relatively inexpensive preventive therapy to consider for aging human populations. CR also has profound behavioral and attentional effects 98 . Moreover, CR in rodents increases neurogenesis in the dentate gyrus 95, 99 and partially attenuates the effects of ischemia 100, 101 and of (MPTP) poisoning within substantia nigra dopaminergic neurons 95, 102 . Thus, CR is an ideal...

Caloric Restriction And Aging

Caloric restriction (30-40 reduction in total caloric intake without malnutrition) has been recognized for over 60 years (33) as a means to extend the life span in many species, including rodents and probably primates. Similar to the dauer pathway in C. elegans, caloric restriction increases stress resistance and postpones reproduction. Certain mutations in C. elegans affect the ability to eat ( eat mutants) and the rate of living, including feeding ( clk mutants). Genetic epistasis experiments indicate that mutations in eat and clk affect the same pathway (reviewed in Ref. 34). In contrast, the daf pathway is independent, because daf-2 clk-1 double mutants live longer than either single mutant. Which of these mutants most closely resembles caloric restriction (CR) is not clear. The mechanism of CR has not been elucidated, but one hypothesis is that is that it slows the production of toxic ROS, and thus decreases the accumulation of oxidative damage. Interestingly, some important...

Diet and Eating Habits at School

For children with recurrent abdominal pain, Walker noted that diet and eating habits may exacerbate symptoms (4). Available foods and schedules for school lunch may contribute to symptoms. Many children may not have sufficient time to ingest their food and use the bathroom in the amount of time provided for lunch. In other cases, the types of food and beverages may also increase gastrointestinal symptoms and result in abdominal distress. In such cases, parents can advocate for specialized diets. With the epidemic of obesity in children and adolescents and the resulting increased risk for other diseases (e.g., type 2 diabetes, cardiovascular problems), it would be appropriate for the school to advocate for good nutritional standards in promoting positive health behaviors.

What are the Dietary Protein Requirements of Cancer Patients

Dietary protein and amino acid requirements of cancer patients have never been formally determined, and we have argued elsewhere that this is an important deficit in the literature that would hopefully draw the attention of nutritional scientists with appropriate expertise 18 . Methods for the determination of human protein requirements continue to advance conceptually and technically, and the subset of these that are minimally invasive merit particular scrutiny for use, since patients with advanced malignancy may not tolerate extensive or invasive investigations. The indicator amino acid oxidation approach has been extensively developed for clinical use by Ball and co-workers 19,20 . This method is based on the principle that the oxidation of an indicator amino acid is high when a test amino acid is limiting for protein synthesis, and that indicator oxidation decreases to reach a low and constant value once amino acid requirements are met 19, 21 . Using this technique, breath and...

The Fate of Dietary Protein Nitrogen During the Postprandial Phase

Nitrogen Balance Study

The diurnal cycle of feeding and fasting is accompanied by concurrent changes in protein turnover. Protein feeding is necessary to replenish the body protein stores that would be wasted during fasting 21-24 . Because of this, nitrogen retention calculated on a daily basis is lower than that derived just from the postprandial phase 21 , and, conversely, dietary protein utilisation calculated as the daily gain is lower than the postprandial gain. Dietary proteins, once ingested, are digested in the gut and thereafter absorbed as either free amino acids or dipeptides 25 . The absorbed amino acids are subjected to a variable first-pass extraction by splanchnic organs (mainly the liver) 26-28 and then they travel as such through the extracellular spaces before being used by the cells, either for catabolism or for protein synthesis. A minor fraction of amino acids are excreted unmodified into the urine 29 . The acute nitrogen deposition during the postprandial phase is likely to be the most...

Ghrelin and Weight Loss in Obesity

Obesity is a chronic disease that is causally related to serious medical illnesses such as type 2 diabetes mellitus, hypertension, hyperlipidaemia, Based on evidence of the potent orexigenic action of ghrelin, its levels were at first expected to be increased in obesity. On the contrary, ghrelin levels turned out to be inversely related to body mass index. At present, the exact peripheral signals leading to a reduced ghrelin secretion in obesity have not yet been identified. The most likely hypothesis is that low ghrelin levels in obesity might represent a signal to the hypothalamic centres regulating food intake that energy stores are filled 34 . Ghrelin gene polymorphisms have been described by several groups linkage analysis studies, however, failed to prove a solid association between ghrelin and obesity 76,93,94 . While diet-induced human obesity, as well as polygenic (e.g. Pima Indians) or monogenic (e.g. MC4-R defect) causes of human obesity all present with low plasma ghrelin...

Pharmacotherapy for Weight Management and Prevention of Diabetes

Weight reduction for the prevention of cardiovascular disease is an imperative in the current environment of epidemic obesity and metabolic syndrome. However, the failure rate is 70-95 within 1-2 years of weight loss. Weight loss is followed by a number of adaptations including decreased thyroid and immune function and changes in signaling in the central nervous system that result in weight regain. Thus, the treatment of obesity, which is the common denominator underlying the variable symptoms of the metabolic syndrome, remains a challenge in cardiovascular rehabilitation and prevention. Programs should emphasize a moderate weight loss of 5-10 that is achievable by lifestyle change, rather than dieting, and that is maintainable over time. Drugs may assist with this goal,but no studies that demonstrate a reduction in cardiovascular morbidity or mortality as a result of drug-assisted weight reduction have been done. Promisingly, treatment with a number of drugs may reduce the incidence...

Answers To Case 33 Obesity

Summary A 20-year-old obese female presents for a routine examination. Along with her abdominal obesity, she has irregular menstrual cycles, acanthosis nigricans, and hirsutism. Clinical issues to address Obesity and possible polycystic ovarian disease. Next steps in evaluation Calculate a body mass index (BMI), measure waist circumference, repeat blood pressure. Order laboratory tests to measure fasting glucose, lipids, thyroid-stimulating hormone (TSH), and liver enzymes. + Therapeutic options Assess her interest in losing weight. If she is interested, devise weight-loss goals and advise on diet and physical activity to achieve these goals. If she is not interested, advise on the health benefits of weight loss and address other risk factors. In either case, arrange follow-up. At subsequent visits, can consider adding pharmacotherapy therapy as an adjunct to diet and exercise. 1. Understand the etiology and pathogenesis of obesity 2. Know other comorbid conditions associated with...

The Difference between the Diet of Our Distant Ancestors and Our Diet Today

In the industrialized countries diets have changed remarkably over the past 100 years. This dietary shift, combined with an increasingly sedentary lifestyle, is a major cause of many common diseases-heart disease, osteoporosis, tooth decay, high blood pressure, and diabetes. These disorders, so prevalent now, were rare before the 20th century. For thousands of years, humans adapted to and thrived on a diet radically different from today's diet.19,20 Looking at the diet of our ancestors provides an insight into what foods and nutrients humans were genetically designed to consume for good health. Clearly, our modern diet is dramatically different to the diet our species was brought up on. Humans were not designed to thrive on a highly refined, micronutrient-depleted diet rich in simple sugars, animal fat, sodium, and food additives.

Mobilization of Fats from Dietary Intake and Adipose Tissue

Fatty acids are acquired readily in the diet and can also be made from carbohydrates and the carbon skeletons of amino acids. Fatty acids provide 30 to 60 of the calories in the diets of most Americans. For our caveman and cave-woman ancestors, the figure was probably closer to 20 . Dairy products were apparently not part of their diet, and the meat they consumed (from fast-moving animals) was low in fat. In contrast, modern domesticated cows and pigs are actually bred for high fat content (and better taste). However, woolly mammoth burgers and saber-toothed tiger steaks are hard to find these days even in the gourmet sections of grocery stores and so, by default, we consume (and metabolize) large quantities of fatty acids. The pathways for liberation of fatty acids from triacylglycerols, either from adipose cells or from the diet, are shown in Figures 24.2 and 24.3. Fatty acids are mobilized from adipocytes in response to hormone messengers such as adren-

Caloric Restriction And Erc Formation

Caloric restriction has been shown to extend the life span in a wide number of organisms (68-71). Growth on low glucose has been used as a model for caloric restriction in yeast and was found to extend the life span (72,73). Yeast are normally grown in medium containing 2 glucose. Growth on 0.1 glucose results in a 55 extension of the median life span (72) growth on 0.5 glucose results in a more modest 24 extension in the life span (73). In yeast, glucose activates the cAMP-dependent protein kinase pathway. Components of this pathway include the GTP GDP-binding proteins (Ras1 and Ras2 proteins), and a GTP-GDP exchange factor (Cdc25 protein) that interacts with the Ras proteins (74,75). Mutations in CDC25 and several other genes within the protein kinase A (PKA)-signalling pathway that decreased PKA activity have been found to extend the life span (73). Growth on low glucose does not further extend the life span of the long-lived cdc25 mutant, suggesting that low glucose and low PKA...

See also Biochemistry of Obesity

In mice, defects in the ob gene leads to mice with body weights as much as three times normal. The ob gene codes for a protein called leptin, which is normally synthesized in adipocytes and acts as a hormone, binding to a specific site in the brain. Obese mice lacking leptin eat as if perpetually starved. Conversely, injecting leptin into these mice causes them to lose weight dramatically. Obese humans, on the other hand, appear to contain high levels of leptin. Serotonin controls the feeling of fullness after eating. The anti-obesity drug fenfluramine was originally prescribed because it increases serotonin levels, thus curing appetite. It turned out, however, that fenfluramine also did but serious damage to the heart and has since been withdrawn from the market. Despite this setback, biochemical research on obesity is one of the most active current research frontiers.

Macronutrient Composition of the Diet

The macronutrient composition of a diet does not affect the rate of weight loss unless macronutrient manipulation influences total energy intake or expenditure. Nevertheless, changes in macro-nutrient composition of the diet have been tested in various clinical trials.8 A low-fat diet is considered the standard approach for the treatment of obesity. Based on several studies suggesting that there are benefits to restricting fat intake as well as calories, many programs also prescribe dietary fat goals to produce a 20-25 fat intake. High-fat diets are often highly palatable, but are energy dense and low in complex carbohydrates and water. Moreover, high-fat diets appear to be less satiating and the thermic effect of dietary fat is low, as compared to diets containing complex carbohydrates and or proteins. Thus, low-fat diets reduce the diet's energy density while maintaining satiety as a result of their high content of complex carbohydrate and protein. These characteristics lead to a...

Dietary Nutritional Factors

Dietary Fat High calorie intake has often been associated with an increased risk of prostate cancer. However, the interaction between various compounds (total fat, animal fat, saturated or un-saturated fatty acids, cholesterol, triglycerides, omega-3 fatty acids) is very complex (Wuermli Table 1 Data on dietary and nutritional factors according to evidence levels Table 1 Data on dietary and nutritional factors according to evidence levels Dietary fat, vitamin E, rye, soya, and phytoestrogens Conversion of vitamin D to the active form 1,25 dihydroxyvitamin D3 is suppressed by high consumption of dietary calcium (milk, cheese) (see also Sect. 2.3). Furthermore, low serum calcium levels stimulate the secretion of parathyroid hormone which promotes the conversion of vitamin D to calcitriol. From a clinical point of view, calcium has been found in excess levels to be associated with an increased rate of prostate cancer progression. Selenium, a trace element occurring predominantly as...

Positive Energy Balance Overweight and Obesity

When the energy balance is positive, the adipose organ prevalently undergoes an increment in its white component. White adipocytes become hypertrophic and subsequently hyperplastic (likely due to a close causal relationship). In fact, it has been suggested that adipocytes are unable to expand beyond a given maximum volume, or 'critical size', which is genetically determined and specific for each depot 77 . Adipocytes that have reached the critical size trigger an increase in cell number 78-80 . In a recent review, Hausman et al. 81 , after considering the evidence for this theory, conclude that not only paracrine factors, but also circulating factors as well as neural influences may play a large role in regulating adipose tissue development and growth. They suggest that in the development of obesity, enlarged fat cells produce and release proliferative paracrine factors as internal controllers of preadipocyte proliferation, and that their proliferative response is modulated by neural...

Nutrigenomics Research on Dietary Beef

A major component of many low-carbohydrate diets, such as the Atkins diet, is 95 lean ground beef, typified by a hamburger without the bun (56). Lean ground beef consists of 35 fat and 65 protein ( Kcal), in addition to 65 mg cholesterol and 55 mg sodium per 85 gram portion. The fat portion consists of approximately equal amounts of saturated and mono-unsaturated fats (FDA food label). Surprisingly, we could only find one previous study in which Drosophila were fed dietary beef (63), and one microarray study where mice were fed beef tallow (64). The Drosophila beef paper was published in 1979 and the title is Failure of irradiated beef and ham to induce genetic aberrations in Drosophila (63). The purpose of this paper was to allay the unjustifiable fear, which, unfortunately, is still common among the public, that irradiated food is carcinogenic in humans. In addition to the mouse microarray paper cited previously (64), several other laboratories also fed mice pure beef fat (tallow)...

Body Mass Index

A more recent approach to the evaluation of nutritional status refers to body mass index (BMI). It affords a more accurate measurement, as follows body weight (kg) height2 (m2). The reference table (Table 11) includes only five classes 0 20 kg m2, weight deficit N 20-24.9 kg m2, normal 1 25-29.9 kg m2, mild weight excess 2 30-39.9 kg m2, obesity 3 40 kg m2, severe obesity. Table 11. Body mass index values of the body classes Table 11. Body mass index values of the body classes Recently it has been proposed that the obesity threshold should be lowered to 25 kg m2, based on epidemiological studies showing an increase in all-cause, metabolic, cancer and cardiovascular morbidity when BMI is greater than or equal to 25. In normal adults in western countries, the mean is 24, in less developed countries it is 20-21, with a mean of 18 in some cases.


One in four Americans has a BMI of 30 or greater and is therefore considered to be obese. This crisis in obesity is the result you would expect when constant access to cheap, high-fat, energy-dense, unhealthful food is combined with lack of exercise. Nowhere is this relationship more clearly illustrated than it is in the case of the Pima Indians. This example illustrates the impact of lifestyle over genetics since the Pima of Arizona share many genes with their New Mexican cousins but have far less healthful lives due to their diet and lack of exercise. The example of the Pima Indians also shows that genes influence body weight, because the Pima of Arizona have higher rates of obesity and diabetes than other Americans whose lifestyle they share. (Genetics is discussed in Chapter 4.) Whether obesity is the result of genetics, diet, or lack of exercise, the health risks associated with obesity are the same. As your weight increases, so do your risks of diabetes, hypertension, heart...

Dietary Intake

Hypermetabolism can explain why some COPD patients lose weight despite an apparent normal to even high dietary intake. Nevertheless, it has been shown that dietary intake in weight-losing patients is lower than in weight-stable patients both in absolute terms and in relation to measured REE 50 . This is quite remarkable because the normal adaptation to an increase in energy requirements in healthy men is an increase in dietary intake. The reasons for a relatively low dietary intake in COPD patients are not completely understood. It has been suggested that they eat suboptimally because chewing and swallowing change the breathing pattern and decrease arterial oxygen saturation. Furthermore, gastric filling in these patients may reduce the functional residual capacity and lead to an increase in dyspnoea. Very intriguing is the role of leptin in energy homeostasis. This adipocyte- derived hormone represents the afferent hormonal signal to the brain in a feedback mechanism regulating fat...

Weight Gain

Normal, steady weight gain is a characteristic of a pregnancy that is progressing well. On average, a woman should gain approximately 0.45 kg week during the middle months of pregnancy, and about 0.4 kg week during the final 3 months. In well-nourished women, average total weight gain during pregnancy is about 10.5-12.5 kg.4 In the USA and Western Europe many mothers gain too much weight during pregnancy. This can harm both the baby and the mother. Excess weight gain increases the chance of having a larger baby, which can prolong labor and may reduce oxygen supply to the baby during delivery. In the mother, too much weight gain increases risk of developing high blood pressure during pregnancy and makes returning to the prepregnancy weight more difficult, increasing risk of later obesity.4

Dietary Conditions

Other dietary considerations are diets that have identical phosphate levels, protein levels, lipid levels, glycemic index, and so on, but vary in the source of these components. We have not yet performed experiments in Drosophila with these parameters controlled, but they are important considerations depending on the nutritional question being asked. For example, in mammalian models, intake of a low-phosphate diet stimulates transepithelial transport of inorganic phosphate (Pi) in the small intestine, which is associated with a change in the apical localization of NaPi cotransporters (69). A low-Pi diet can also lead to an increase in the level of vitamin D3 absorbed in the small intestine in mammals (69). Finally, depending on the goals of a particular nutrigenomics study, other considerations must also be made about the food components. One might want to consider glycemic index (GI), which is related to the speed in which nutrients are digested and absorbed, or glycemic load (GL),...

Diet Obesity

Diets high in fat increase risk of weight gain. Protein and carbohydrate each contain 4 kcal of energy per gram, whereas fat has 9 kcal per gram. Moreover, dietary fat is efficiently stored as body fat, while protein and carbohy Weight-loss diets should contain generous amounts of dietary fiber.3 Fiber adds nondi-gestible bulk, so that eating fiber-rich foods results in satiety with lower caloric intake, encouraging weight loss. Fruits, vegetables, whole grains, and legumes are fiber-rich foods that should be a part of diets for weight loss. Alcoholic drinks (beer, wine, and spirits) contain large amounts of calories for example, a medium-sized glass of dry wine contains about 120 kcal. Fig. 5.6 Relationship between mortality from all causes and body weight as defined by body mass index (BMI). Very low or very high BMIs correlate with increased early mortality risk.

The Role of Micronutrients in Prevention and Therapy

Reaching health effects beyond simple prevention of the classic deficiency diseases. He realized that many chronic illnesses occur when micronutrient deficiencies or imbalances cripple the body's biochemistry and metabolism.5 Although initially Pauling's ideas met with skepticism within the scientific community, time and the progress of scientific research have shown the value of his basic principles. Correcting deficiencies and imbalances by providing the missing nu-trients-often at levels greater than those normally found in the diet-has proved to be a powerful new therapeutic approach.6-8 Pauling termed this new medicine orthomolecu-lar medicine, which he defined as Approximately 45 essential micronutrients are necessary for life and must be supplied by the diet because they cannot be synthesized in the human body. Why are these substances so critical for health Micronutrients are basic components of every cell in the body. They serve as chemical messengers, building blocks, and...

Preface to the series

The business of dietary supplements in the Western World has expanded from the health store to the pharmacy. Alternative medicine includes plant-based products. Appropriate measures to ensure the quality, safety and efficacy of these either already exist or are being answered by greater legislative control by such bodies as the Food and Drug Administration of the USA and the recently created European Agency for the Evaluation of Medicinal Products, based in London. In the USA, the Dietary Supplement and Health Education Act of 1994 recognised the class of phytotherapeutic agents derived from medicinal and aromatic plants. Furthermore, under public pressure, the US Congress set up an Office of Alternative Medicine and this office in 1994 assisted the filing of several Investigational New Drug (IND) applications, required for clinical trials of some Chinese herbal preparations. The significance of these applications was that each Chinese preparation involved several plants and yet was...

Formularies Guidelines And Essential Drugs

Given the existing format of general practitioner notes and the limited time available for each consultation, it seems unlikely that detailed information will be recorded in the notes. A compromise is therefore inevitable. My suggestion is that doctors should make a point of recording the fact that they have warned patients about treatments which are potentially hazardous. Specific examples include the description of dietary precautions to be taken if a monoamine oxidase inhibitor has been prescribed and the issue of steroid treatment cards to patients given prednisolone. Similarly, it would be wise to record that a young woman given a retinoid for acne is taking adequate contraceptive precautions, or that a patient taking carbimazole for thyrotoxicosis had been warned to report to the surgery in the event of a severe sore throat.

Molecular Mechanisms of Transdifferentiation

Energy expenditure via activation of the orthosympathetic system is essential for the energy balance indeed, mice lacking all p receptors (1, 2 and 3), though not exhibiting changes in the amount of food intake or in motor activity, become precociously and massively obese 66 . These mice exhibit a complete and early transformation of BAT into WAT, in line with the observations that absence of BAT results in obesity and that ectopic UCP1 expression in WAT makes mice resistant to obesity. These data also agree with the finding that BAT activation and the white-to-brown transdifferentiation induced by administration of p3-AR agonists cure obesity. On the other hand, the mechanism by which mice lacking UCP1 fail to become obese is still obscure. Transgenic mice lacking the RIIp subunit (one of the subunits regulating AMPc-dependent pro-teinphosphokinase A, abundant in adipose tissues) overexpress RIa subunit, which involves increased sensitivity of proteinphosphokinase A to AMPc in WAT,...

Meat Beef Pork Lamb and Poultry

Meat is exceptionally rich in iron, zinc, and vitamins B6 and B12. Moreover, the micronu-trients in meat tend to be highly bioavailable. About 20 of the iron in meat is absorbed, compared to only 2-5 from most plant foods.23 In the average US diet, meat provides 70-75 of the total dietary zinc requirement and almost all of the vitamin B12 requirement. At the same time, meat is the major source of saturated fat and cholesterol in the diet of the industrialized countries. A high meat intake may increase the risk of heart disease, stroke, and colon cancer. A large study in the USA found that women who eat meat (beef, pork, or lamb) at least once a day are twice as likely to develop colon cancer as those with a lower meat intake.24 Women who regularly eat chicken or fish rather than red meat cut their risk by about 50 . Moderation when eating meat is the key eating too much is harmful, but occasional consumption of meat can provide important nutrients without adding too much fat to the...

Nutrition of the heart and myocardial protein turnover

The recent interest in healthy nutrition for the heart has almost exclusively focused on cholesterol because of its role in the development of coronary artery disease. There is little appreciation of the fact that, in terms of general descriptors of energy metabolism, heart muscle functions not simply as a conformer in response to substrate availability,65 but that substrate utilisation is controlled by the physiological demands on the system. Likewise, there is little appreciation of the fact that the heart stores endogenous substrates such as glycogen and triglycerides, and it does so in response to changes in the dietary state.66 67 In contrast to skeletal muscle, starvation increases the tissue content of both glycogen and triglycerides in heart muscle, an observation consistent with a biologist's definition of true hibernation .

Energy Values from the Food Composition Tables

Together, the monosaccharides + disaccharides + starch represent the available carbohydrates. Cellulose, hemicellulose, pectin, gums, and resistant starch* (collectively referred to as dietary fibre or unavailable carbohydrates) are not considered to have energetic value. However, unavailable, unaltered carbohydrates reach the colon, where they can be fermented by the local microflora, which consist of several genera of anaerobic microorganisms. These utilise dietary fibre to produce pyruvic acid, an important metabolic intermediate from which short-chain fatty acids (SCFA), i.e. acetic, propionic, and butyric acids, and other gases are produced (Fig. 2) 9 . Since the SCFA, produced at an estimated average amount of 380 mmol day, can be absorbed in the intestinal mucosa and metabolised to yield energy, an energetic value for dietary fibre of 1.5 Kcal g can be calculated 10 . In practice, however, since dietary fibre reduces the absorption of other energetic nutrients and increases...

Prevalence of Risk Factors for Heart Disease

Number of known risk factors associated with heart disease including smoking, sedentary lifestyle, and increased intake of dietary fat.3-5 Furthermore, South Africans have a high prevalence of overweight and obesity, with over 50 of women and more than 20 of men considered overweight by World Health Organization (WHO) standards (body mass index (kg m2) 25). Indeed, the World Health Survey 2003, published by the WHO, suggests that the prevalence of physical inactivity in South African adults is greater than 60 for both males and females. In fact, nearly 60 of all South African adults have at least one major reversible factor. Thus, the need for both secondary and indeed primary intervention initiatives including cardiac rehabilitation is large.

Basic Methods of the Aging Process

Besides basic methods for analysis of biological aging, many techniques have been recently developed for intervening in the aging process as an approach to determining the major factors that regulate and mediate biological aging. Caloric restriction is probably the most widely accepted approach to modulate life span and its application to the budding yeast, S. cerevisiae, is described in Chapter 9. Methods are detailed for determining the replicative life span of single yeast cells as well as for measuring the recombination frequency of the rDNA locus and the production of extrachromosomal rDNA circles that are a primary cause for aging in this yeast model. The fruit fly, Drosophila, is another popular model for studying age-related changes, and Chapter 10 describes nutrigenomic techniques that allow analysis of Drosophila larvae and adults fed control diets high in palmitic acid (a saturated fat), soy, or 95 lean ground beef. These methods incorporate microarray analyses that allow...

Mini Nutritional Assessment MNA

Items 38 and can be administered by a healthcare professional in less than 15 minutes. It involves a general assessment of health, a dietary assessment, anthropometric measurements, and a subjective self-assessment by the patient (Table 2). The results of the MNA test classify the patient as well nourished, at risk for malnutrition, or malnourished. The MNA test was shown to be 92-98 accurate. It is a simple, non-invasive, well-validated screening tool for malnutrition in elderly persons.

Overview of Carotenoid Function in the

It has long been recognized that carotenoids may have an important role in ocular physiology. As far back as the 18th century anatomists noted that the primate fovea, the region of the retina responsible for high-resolution visual acuity, displayed a deep yellow coloration that they termed the macula lutea or yellow spot (2). In 1945, George Wald studied organic extracts of primate macular tissue and determined that the macular yellow pigment had spectro-scopic and chemical features characteristic of xanthophyll carotenoids, ubiquitous plant derived carotenoids containing at least one oxygen atom along the core C40H56 isoprenoid carotene structure (3). Several decades later, Bone and Landrum preliminarily identified the macular carotenoids as lutein and zeaxanthin (4), and in a follow-up investigation, they were able to demonstrate the stereochemical nature of the macular pigment as a mixture of dietary (3R,3'R,6'R)-lutein, dietary (3R,3'R)-zeaxanthin, and nondietary (3R,30...

Atr Gene Polymorphisms And Hypertension

Among female hypertensives than in controls but no such difference was observed for men. Szombathy et al. (36) did not find any difference for this polymorphism in AT1R gene between normotensive controls and subjects with resistant essential hypertension, but high values of systolic BP were associated with the C allele in older and overweight patients. Moreover, Castellano et al. (37) found that BP values were lower in CC homozygotes in an Italian population these homozygotes also presented a lower incidence of family history of hypertension. Hypertension is a major risk factor for stroke, renal failure, and cardiovascular diseases. RAS gene polymorphism was studied in patients with cerebral white matter lesions assessed by brain magnetic resonance imaging these lesions represent a subclinical form of ischemic brain damage and hypertension is one of the most important factors for their development. Sierra et al. (43) showed that the presence of the ACE D allele may be a predisposing...

Chemical Contributions To Arthropod Dominance

FIGURE 3 Australian sawfly (Pseudoperga guerini). (Top) Female, guarding clutch of larvae recently emerged from her eggs. At this stage, the larvae are unable to fend for themselves when attacked. (Bottom) Older larvae, responding to disturbance by regurgitating droplets of oil from ingested eucalyptus. The droplets are potently deterrent to predators. The newly emerged larvae on left have not as yet accumulated sufficient dietary oil for defense. Bars 0.5 cm (Left), 1 cm (Right). FIGURE 3 Australian sawfly (Pseudoperga guerini). (Top) Female, guarding clutch of larvae recently emerged from her eggs. At this stage, the larvae are unable to fend for themselves when attacked. (Bottom) Older larvae, responding to disturbance by regurgitating droplets of oil from ingested eucalyptus. The droplets are potently deterrent to predators. The newly emerged larvae on left have not as yet accumulated sufficient dietary oil for defense. Bars 0.5 cm (Left), 1 cm (Right).

Environmental and host influences

No single rule or formula suffices for all cases. The dose may be established by scaling for body weight but this approach may overdose an obese child, for whom the ideal weight should calculated from age and height. Doses based on body surface area are generally more accurate, and preferably should take into account both body weight and height.33 The fact that the surface area of a 70 kg adult human is 1.8m2 (see p. 118) may then be used for adjustment, as follows

Regression of coronary artery disease as a result of intensive lipidlowering therapy in men with high levels of

BACKGROUND AND METHODS The effect of intensive lipid-lowering therapy on coronary atherosclerosis among men at high risk for cardiovascular events was assessed by quantitative arteriography. Of 146 men no more than 62 years of age who had apolipoprotein B levels greater than or equal to 125 mg per deciliter, documented coronary artery disease, and a family history of vascular disease, 120 completed the 2.5-year double-blind study, which included arteriography at base line and after treatment. Patients were given dietary counseling and were randomly assigned to one of three treatments lovastatin (20 mg twice a day) and colestipol (10 g three times a day) niacin (1 g four times a day) and colestipol (10 g three times a day) or conventional therapy with placebo (or colestipol if the low-density lipoprotein LDL cholesterol level was elevated). RESULTS The levels of LDL and high-density lipoprotein (HDL) cholesterol changed only slightly in the conventional-therapy group (mean changes, -7...

CD36 SHR and Insulin Resistance

Until recently, evidence for an in vivo role for CD36 in FA metabolism was indirect and relied on the pattern of tissue distribution and on alterations in CD36 expression with metabolic or pathologic states. CD36 expression is increased, for example, in mice fed a high-fat diet and in animal models of genetic obesity and diabetes 47-52 . In 1999, Aitman et al. suggested, based on genetic linkage studies, that CD36 deficiency may underlie defects of FA metabolism and insulin responsiveness in the spontaneously hypertensive rat (SHR), which is a well-studied rodent model of human syndrome X 107 . Based on in vitro studies implicating CD36 in FA transport, it was proposed that the primary genetic defect in SHR might be compromised tissue FA utilization, which would contribute to the pathogenesis of insulin resistance by producing secondary alterations in basal glucose metabolism. An SHR congenic strain was generated by replacing a small region of chromosome 4 containing the deletion...

Nestmate Recognition And Exclusion Of Foreigners

Cues derived from healthy queens with active ovaries are sufficient to label all workers in experimental colonies, while the workers' own discriminators become more important when their queen is infertile. As mentioned above, recent work suggests that the acquired recognition cues of Camponotus spp. workers may consist at least in part of colony-specific relative proportions of cuticular hydrocarbons (30, 31, 33). The queen is by no means the only source of shared extrinsic recognition cues. The discriminators produced by each worker may be transferred among them all, resulting in a gestalt or mixed label, as originally proposed by Crozier and Dix (36) and demonstrated, among others, in leptothoracine ants (37). In addition to heritable cues from other workers and or queens, variation originating in the diet or other environmental differences external to the colony also contributes to nestmate recognition in several ant genera (for review see refs. 2, 3, and 38).

Vitamin C Ascorbic Acid

Most animals are able to synthesize all the vitamin C they need from dietary sugars humans, along with other primates, are among the few species of animals unable to synthesize the vitamin.1 Vitamin C plays an important role in the body's ability to handle physiologic stress during infection, injury, or chronic disease. While most animals are able to increase synthesis of vitamin C during times of stress, humans' strict dependence on dietary sources of the vitamin increases risk of deficiency during stress periods.

Exercise Effects on Lipids and Weight

The beneficial effects of exercise on a variety of lipid and lipoprotein variables are seen most clearly in short-term studies with a large amount of high-intensity exercise. Kraus and coworkers34 examined a total of 111 sedentary, overweight men and women with mild-to-moderate dyslipidemia. They were randomly assigned to participate for 6 months in a control group or for approximately 8 months in one of three exercise groups high-amount-high-intensity exercise, the caloric equivalent of jogging 20 miles (32km) per week at 65-80 of peak oxygen consumption low-amount-high-intensity exercise, the equivalent of jogging 12 miles (19.2km) per week at 65-80 of peak oxygen consumption or low-amount-moderate-intensity exercise, the equivalent of walking 12 miles (19.2km) per week at 40-55 of peak oxygen consumption. In a program of 6 months of endurance training, on average, only a 4 decline in body weight (100 vs. 96kg) and a decrease in body mass index by 1.1 (29.1 vs. 28.0) were observed,...

Evolution and progression of atherosclerotic lesions in coronary arteries of children and young adults

Clone Evolution Cancer

This paper describes a large series of coronary histology data from 565 human subjects who died between full-term birth and 29 years of age. At the time of this study, there was controversy regarding the extent of atherosclerosis in the young and at what age dietary interventions to reduce atherosclerosis should be instituted. The left main, proximal left anterior descending and proximal circumflex arteries were analysed. Based on the findings of this series, a classification system was developed to characterize development of atherosclerotic lesions. Type 1 lesions consist of isolated macrophage foam cells in the proteoglycan layer with no extracellular lipid or vascular smooth muscle cells. These lesions were seen in some infants as early as the first week of life and appeared to be decreased after the first year. Type II lesions are fatty streaks composed of layers of cells with lipid droplet-inclusions. More macrophages are present than type I lesions. These lesions were noted...

Protection against Infections

The connective tissue will close again right after the cell has passed through, using the compensating mechanisms that repair the tissue. This repair is assured by the optimal production of collagen molecules that require a sufficient supply of vitamin C and other cell factors in the diet.

Scientific Foundations

To get diabetes, high blood pressure, heart attacks, and stroke. (Together, high blood pressure, heart attacks, and stroke are called cardiovascular disease.) A person having less than 1 milligram of C-reactive protein per liter of blood (1 mg L) is at low risk for cardiovascular disease. A person with 1 to 3 mg L has average risk. If a person has more than 3 mg L, they have high risk. Smoking, lack of exercise, and being overweight increase C-reactive protein in the blood.

Essential Chemical Elements

Criteria (1) A physiological deficiency appears when the element is removed from the diet (2) the deficiency is relieved by the addition of that element to the diet and (3) a specific biological function is associated with the element.2 Table 1.1 indicates the approximate percentages by weight of selected essential elements for an adult human.

Generality of Results

When a dependent variable changes just because it is being measured, the effect is called reactive measurement. Reactive measurement limits the generality of a treatment (or intervention) to situations where the dependent variable is being measured or counted. For example, a person in a weight-control program (treatment) may lose weight just because he or she is weighed daily by a researcher. Daily weighing may focus attention on being overweight, and the program is only effective under these conditions. In Ayllon's experiment, the patient could have observed the nurses counting the ever-increasing number of towels, and the satiation procedure would be limited to this kind of situation. Reactive measurement is unlikely, however, since the nurses were counting during baseline, treatment, and the return to baseline. Also, the decline in towel hoarding following the satiation procedure is gradual rather than sudden, suggesting measurement of the number of towels did not limit the effects...

Use in Prevention and Therapy

Regular intake of laxatives to treat constipation may actually worsen symptoms by causing depletion of body potassium. Reducing laxative use, increasing dietary potassium and fiber intake, and increasing exercise can produce more regular bowel habits. Cardiac arrhythmias. Potassium depletion (often together with magnesium depletion) produced by diuretic therapy and or low dietary intake can increase the risk of arrhythmias. People with heart disease and those taking thiazide or 'loop' diuretics should be sure to obtain adequate dietary potassium.

Individual substances

Tenamfetamine ('ecstasy', MDMA methylenedioxy-methamphetamine) is structurally related to mescaline as well as to amphetamine. It was originally patented in 1914 as an appetite suppressant and has recently achieved widespread popularity as a dance drug at 'rave' parties (where it is deemed necessary to keep pace with the beat and duration of the music popular names reflect the appearance of the tablets and capsules and include White Dove, White Burger, Red and Black, Denis the Menace). Tenamfetamine stimulates central and peripheral a-and p-adrenoceptors thus the pharmacological effects are compounded by those of physical exertion, dehydration and heat. In susceptible individuals (poor metabolisers who exhibit the CYP450 2D6 polymorphism) a severe and fatal idiosyncratic reaction may occur with fulminant hyperthermia, convulsions, disseminated intravascular coagulation, rhabdomyolysis, and acute renal and hepatic failure. Treatment includes activated charcoal, diazepam for...

Fatty Acids and Phospholipids

Research on cis-trans isomerization (CTI) of lipid double bonds focused both on the conversion that occurs in some bacteria enzymatically and on trans isomers that are present in mammalian cells after a dietary supplementation of chemically modified fats 3,4 . It is known that cis trans isomeric mixtures of fats result from vegetable and fish oils manipulated through partial hydrogenation or deodoriza-tion processes that are frequently utilized in the food industry. Nutritional and epidemiological studies revealed some harmful effects of these unnatural lipids for human health. However, it must be pointed out that in the chemical manipulation of oils the structures of trans fatty acid residues consist of geometrical and positional isomers with unshifted and shifted double bonds compared with the natural cis compounds. With the name trans lipids we indicate these unnatural geometrical and positional isomers. It has to be mentioned for clarity that there

Consequences of Altered Glucose Metabolism Oxidative Stress

Oxidative stress is defined as an imbalance between oxidants and antioxidants in favour of the oxidants. The oxidants, also termed ROS, are present as a normal product of aerobic metabolism but can be produced at elevated rates under pathophysiological conditions. They are intermediate compounds derived from the univalent reduction of molecular oxygen (by electrons and protons), characterised by a spared electron in the external orbital, which confers them a particular instability (anion superoxide O2- hydroxyl radical OH-) or compounds such as hydrogen peroxide (H2O2), which react with oxidable functional groups. Anion superoxide and hydrogen peroxide are poorly reactive but in the presence of the transitional form of some metals, such as Fe3+, they generate the more reactive hydroxyl radical. These compounds are partially useful but potentially toxic, so the body is provided with several systems to counteract their activity. These systems include antioxidants produced in the body,...

Summary on Preventive Cardiology in Athletes

A review on the prevalence of physical activity (PA) and sedentary behaviors shows that many young people are active, but this declines with age.27 Even though it is not possible to determine objectively whether there has been a decline in physical activity in recent years in young people, a substantial number are not sufficiently active for health benefits. Furthermore, current trends in juvenile obesity are a cause for concern, in that data on energy intake and body mass indirectly suggest that young people have reduced their energy expenditure.28

Comprehension Questions

12.3 A 19-year-old gymnast active in national competition is brought to your office by her mother because the daughter's menses have ceased for the last 3 months. Prior to this, she was always regular. She denies excess dieting, although she does work out with her team 3 hours daily. On examination, her body mass index (BMI) is 20 kg m2 and is completely normal. Which laboratory test should be ordered first

Preanalytic Variability

Although most studies have shown no relationship between age and serum CRP concentration (7,14) (Fig. 2), at least two studies have reported a slight increase in CRP concentrations with age (15,16). This increase might be owing to the higher incidence of obesity that is associated with aging (15). In the Women's Health Study that included 15,770 participants, only a slight association of CRP with age was seen median CRP concentrations for individuals 45-54, 55-64, 65-74, and 75 yr of age were 1.31, 1.89, 1.99, and 1.52 mg L, respectively (17).

Cytokines and Insulin Resistance

In addition to their well-known anorectic and hypermetabolic effects, cytokines appear to be involved in obesity-related disorders such as insulin resistance and vascular diseases 65 . Epidemiological findings support the hypothesis that the metabolic syndrome, type II diabetes and cardiovascular diseases have an inflammatory component mediated by cytokines 66, 67 . Thus, overweight and obese children as well as adults TNF-a was among the first substances to be implicated in fat cell insulin resistance 68 . Adipose tissue TNF-a expression is increased in obese subjects, and TNF-a may limit an increase in adipocyte size by inhibiting lipoprotein lipase (LPL) and increasing insulin resistance 68 . A p55 TNF-a receptor-mediated phosphorylation of serine residues on the insulin receptor substrate-1 (IRS-1) appears to be an important mechanism for the induction of insulin resistance by TNF-a 69, 70 . The genetic deficiency of TNF-a or TNF-a signalling resulted in improved insulin...

Clinical Approach

Amenorrhea can ensue for 2 to 3 months after a term delivery breast-feeding may inhibit hypothalamic function and lead to a greater duration of amenorrhea. However, in a nonlactating woman in whom menses does not resume by 12 weeks after delivery, then pathology must be suspected. Overall, the most common cause of amenorrhea in the reproductive years is pregnancy. Hence, a pregnancy test is the appropriate initial test. If the patient does not have a history of postpartum hemorrhage, pursuit of hypothalamic causes, such as hypothyroidism or hyperprolactinemia, often is fruitful. If the patient is somewhat obese or has a history of irregular cycles, then a diagnosis of polycystic ovarian syndrome (PCOS) would be entertained. Findings consistent with PCOS include a positive progestin withdrawal bleed (vaginal bleeding after ingestion of a progestin, such as medroxyprogesterone acetate or Provera). PCOS is characterized by estrogen excess without progesterone, obesity, hirsutism, and...

Saturated Fatty Acids Oleic Acid trans Fatty Acids and n6 Fatty Acids

Regarding the other dietary fatty acids, animal experiments have clearly indicated that a diet rich in saturated fatty acids is associated with a high incidence of ischemia- and reperfusion-induced ventricular arrhythmia, whereas PUFAs of either the n-6 or n-3 family reduce that risk.4 Large (but not all) epidemiological studies have shown consistent associations between the intake of saturated fatty acids and CHD mortality.1 However, the SCD endpoint is usually not analyzed in these studies. In addition, a clear demonstration of a causal relationship between dietary saturated fatty acids and SCD would require the organization of a randomized trial, which is not ethically acceptable. Thus, besides the effect of saturated fatty acids on blood cholesterol levels, the exact mechanism ) by which saturated fats increase CHD mortality remain unclear. If animal data, demonstrating a proarrhythmic effect of saturated fatty acids, are confirmed in humans, the first thing to do in order to...

Safety assessment of food additives

Table 7.1 Toxicology testing recommendations for food contact substances based on dietary concentration (DC) and corresponding estimated daily intake (EDI) values. Note that the cumulative exposures are based on non-biocidal chemicals biocidal tiers are one-fifth the cumulative dietary concentration (CDC) and cumulative estimated daily intake (CEDI) values expressed

Adrenoleukodystrophy ABCD1ALD

The X-linked adrenoleukodystrophy (ALD) is an inherited peroxisomal disorder caused by mutations in ABCD1 (Tab. 3.2), resulting in progressive neurological dysfunction, occasionally associated with adrenal insufficiency 180 . ALD is characterized by the accumulation of unbranched saturated fatty acids with a chain length of 24-30 carbons, particularly hexacosanoate (C26), in the cholesterol esters of brain white matter and in adrenal cortex and in certain sphingolipids of brain 15, 107 . It took a long period of research for the causative defect to be identified and therapies for ALD to be developed these include the famous approach developed by the Odone family of dietary treatment with oleic and erucic acids (glyceryl trierucate and trioleate oil), known as Lorenzo's oil 181, 182 . Adrenoleukodystrophy belongs to a group of defects in peroxisomal -oxidation 183 . The first step in the oxidation of very-long-chain fatty acids (VLCFA) involves their activation by conversion into CoA...

Leptin and Energy Expenditure

Increasing evidence from human studies suggests that leptin predominantly influences the human energy balance through appetite changes, but it appears not to be involved in regulating energy expenditure 72 . None of the expected factors, such as resting metabolic rate, total diurnal energy expenditure or dietary-induced thermogenesis, was related to blood leptin concentrations 73 .

The Carbohydrate Monounsaturated Fat Balance

Result in increased energy intake and weight gain. Therefore, when weight reduction is the major goal in a diabetic patient reducing monounsatu-rated fat intake is preferred, thus increasing the relative carbohydrate intake. When the metabolic profile of the diabetic patient is the major concern, reducing carbohydrate intake is recommended, increasing the relative monounsaturated fat intake.

Clinical Decision Making

Nevetheless, more data are needed before specific responses to elevated levels of CRP other than control of obesity, treatment of diabetes and dyslipidemia, and exercise can be recommended. Until such time, measurement of CRP may be useful to provide additional independent information with respect to risk in situations in which the patient's risk appears intermediate or is uncertain using traditional tools, or in which the patient is insufficiently motivated to follow established preventive strategies. CRP may be of value for triage of patients with suspected ACS in the emergency department (Fig. 6), particularly when biomarkers of necrosis are normal. In addition, elevated levels of CRP in patients with ACS might also identify those who warrant particularly close follow-up and aggressive postdischarge therapy, such as increased dose of statin, length of clopidogrel therapy, or addition of angiotensin-converting enzyme inhibitors or ARBs in nondiabe-tic, nonhypertensive patients with...

Function and Regulation of ABC Transporters in Lipid Transport

Due to the strong interest in the primary drug-transporting ABC proteins, other aspects of cellular functions, such as lipid homeostasis, of this large transporter superfamily has been for long time remained unknown and unappreciated. The first implication that ABC proteins could participate in lipid binding and or transport came from mdr2 knockout mice, which displayed a complete absence of phospholipids from bile and as a consequence developed liver disease 194 . Subsequently, the translocation of phospholipids by the human homolog MDR3 (ABCB4) was demonstrated 61, 62, 195, 196 . Only a few years later, the identification of the sterol-responsiveness of ABCA1 40 and of other ABC family members 41 had paved the way for the identification of the gene defect in HDL deficiency 6-8 , which was a major clue in proving the importance of ABC transporters in macrophage cholesterol efflux. In a similar manner, the discovery of the genetic defect in 5-sitosterolemia has identified ABCG5 and...

Objectives in the Management of Overweight Obese Subjects

The goals of obesity treatment have changed dramatically in the past two decades. Where once the Table 25-1. WHO classification of adult categories of body mass index (BMI) Table 25-1. WHO classification of adult categories of body mass index (BMI) goal was the reduction to ideal weight, the new goal is the attainment of a healthier weight.2 Interestingly, modest weight loss as low as 5-10 of initial body weight can reduce or eliminate disorders associated with obesity, especially MetS components and type 2 diabetes.6 The proposed explanation is that 5-10 weight loss is sufficient to induce a 30 reduction in visceral adipose tissue, an entity closely linked to various metabolic disturbances. Thus, initially, the target of a weight loss program should be to reduce body weight by about 10 . Individuals will generally want to lose more weight than this but it should be remembered that even a 5 weight reduction in those who are overweight or obese lessens the risk of complications such as...

General Recommendations

The primary approach for achieving weight loss, in the vast majority of cases, is therapeutic lifestyle change, which includes a reduction in energy intake and an increase in physical activ-ity.1,2,4 There is no evidence to suggest that specific components of the diet (carbohydrate, fat, protein, vitamins, and micronutrients) influence the ways in which food energy is absorbed or used up. Therefore, the main dietary method for reducing weight is to reduce the total amount of calories consumed, and this is best achieved by a reduction in the amount of fat from the diet and calories from soft drinks. A moderate decrease in caloric balance (500-1000 kcal day) will result in a slow but progressive weight loss. For most patients, weight loss diets should supply at least 10001200 kcal day for women and 1200-1600kcal day for men. Many different diets have been proposed for the treatment of overweight obesity.7 These dietary

Reduction in Energy Content

The Expert Panel on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults1 recommended a 500 to 1000kcal day deficit for obese persons, which will initially result in a weekly weight loss of 0.5 to 1kg. It is often difficult, however, to accurately determine a patient's daily energy requirements. Therefore, calorie intake guidelines for a weight loss diet have been suggested based between 1000 and The results from clinical trials may not reflect the experience in clinical practice because these trials involved subjects who volunteered for a weight loss study and often included formal behavior modification as part of the study protocol. An LCD usually causes an 8 loss of body weight at 6 months of treatment while the use of a VLCD usually produces a weight loss of 15 to 20 within 4 months. However, this initial greater weight reduction associated with VLCD results from water loss (especially during the first few days or weeks) and an undesirable reduction in...

Clinical Correlation

The liver, represented in Figure 7-1, is a large, bilobed, complex organ receiving a large amount of blood and nutrients from the gastrointestinal system in order to convert nutrients from the diet into usable or storage forms. It also is a key organ in conversion of toxins for their removal, and in production of bile, an important fluid to aid in the emulsification of dietary fats prior to their absorption. The liver also contains Kupffer cells as well as tissue lymphocytes and fibroblasts, key contributors in immune defenses.

Supportive Approaches

Although all popular hypocaloric diets have proven to reduce body weight and several cardiac risk factors at one year, overall dietary adherence rate is rather low.8 More research is needed to identify practical techniques to increase dietary adherence. The use of low energy-dense foods may be another effective approach for treating obesity. The energy density of a diet is defined as the calories present in a given weight of food. A food's energy density is directly correlated with its fat content and inversely correlated with its water content. Energy intake during a meal is partially regulated by the weight of ingested food and is inversely correlated with energy density.

Objectives in the Management of Individuals with MetS

Patients with MetS have a 1.5- to 3-fold increase in the risk of coronary heart disease and stroke.3 The NCEP ATP III guidelines emphasize the importance of treating patients with MetS to prevent CVD.14 The association between MetS and CVD raises important questions about the underlying pathological process(es), especially for designing targeted therapeutic interventions. Cardiovascular risk reduction in individuals with MetS should include at least three levels of intervention (1) control of obesity and lack of physical activity (2) control of insulin resistance and (3) control of the individual components of MetS, especially hypertension and atherogenic

Effects of Weight Loss on MetS Components

Although obesity is thought to be the main predisposing factor for MetS, how it relates to insulin resistance is not precisely established. Abdominal obesity was identified as being particularly associated with several of the components of MetS,2 3 and weight gain has been shown to be strongly correlated with MetS.12 Although the precise answer to the question whether it is nature (genetic) or nurture (environment) is not known, it seems that it is probably both, to some extent. Nevertheless, it is clear that the current epidemic of obesity, and as a correlate of MetS, is related to modern lifestyles that emphasize overconsump-tion of high-caloric food and lack of physical activity.1,2 Effective for long-term weight loss are reduced-energy diets, consisting of a 500- to 1000-calorie day reduction. A realistic goal for weight reduction is to reduce body weight by 7-10 over a period of 6 to 12 months. Numerous studies have shown that significant improvement of several abnormalities of...

Influence of Carbohydrate Type and Content

The optimal types and amounts of carbohydrates in the diet remain controversial.18 It is now well established that low-fat, high-carbohydrate diets not only lower HDL and raise triglycerides but also generally produce higher postprandial glucose and insulin responses. However,metabolic consequences of carbohydrates depend not only on their quantity but also on their quality. The glycemic response of a given carbohydrate load depends on the food source, which has led to the development of the glycemic index, ranking foods by their ability to raise postprandial blood glucose levels.19 In addition, effects on blood glucose and lipid metabolism by carbohydrate-rich foods depend on fiber content and type. Controlled feeding studies have found benefits of whole grains on insulin sensitivity and glucose and lipid metabolism compared with refined grains. In addition, several epidemiological studies found that diets rich in whole grains may protect against CVD, stroke, and type 2 diabetes....

Insulin and Diabetes Mellitus

Whereas the metabolic disorders in type 1 diabetes may be explained by a lack of insulin, the basis for the metabolic abnormalities in type 2 diabetes is unclear but may be the end result of several defects in insulin action. Type 2 diabetes appears to develop in patients with acquired (diet- or obesity-related) and genetically programmed insulin resistance, when the pancreatic beta-cells are no longer able to produce extra insulin to counteract the effects of resistance 6 .

From Recommendations to Practice

Despite the worldwide consensus on nutritional recommendations in cardiovascular prevention, their application in everyday life is far from optimal. Western countries are facing a significant increase in obesity, metabolic syndrome, and diabetes directly linked to unhealthy dietary and sedentary habits. However, studies are still needed to orientate strategies dealing with this multifac- Table 26-1. Comparison of dietary counseling between European and North American Guidelines Dietary recommendations Saturated fat Polyunsaturated fat Monounsaturated fat Carbohydrate Fiber Total fat Protein Cholesterol Total calories

Which Health Professionals

Although dietitians are specially trained to provide dietary advice, other health professionals such as registered nurses, general practitioners, or cardiologists may also provide it. Even if dietitians seem the best qualified, the effects of dietary advice given by a dietitian compared with another health professional, and occasionally through the use of self-help resources, are debated. In a Cochrane Review involving 12 studies,11 participants receiving advice from dietitians experienced greater reduction in blood cholesterol than those receiving counsel only from doctors (0.25 vs. 0.12mmol L) however, there were no significant changes between dietitian and self-help resources. Compared to counselors the dietitians obtained greater weight reduction (5.8 vs. 2.69kg). There was no evidence that dietitians provided better outcomes than nurses. However, due to the limited number of trials, these results should be interpreted with caution. Nevertheless, the presence of a dietitian in a...

Thyroid Disorders Thyrotoxicosis

Weight gain occasional, usually younger patient with mild disease, weight gain may occur when caloric intake exceeds metabolic demand 18 . Anorexia, rather than hyperphagia, occurs in about one-third of elderly TS patients and contributes to the picture of apathetic TS 22 .

Organizational Issues

The settings for nutritional counseling differ widely from one country or region to another, depending on the local health network. Nutrition services may be implemented in hospitals, in cardiology units, or cardiac rehabilitation centers, delivering inpatient or outpatient nutritional programs. Lifestyle counseling, especially concerning diet, in coronary patients is underused for many reasons. Lack of time is the first cause mentioned in cardiology wards, which are focused more and more on emergencies and interventional cardiology. Moreover, the patient's length of stay is decreasing and it is difficult to expect that physicians and staff nurses will be able to give substantial dietary advice. In general practice, despite the widespread diffusion of guidelines encouraging doctors to promote healthy eating and exercise among high-risk patients, less than half of such patients are given lifestyle advice. Beyond the lack of time due to the increasing patient volume, other factors may...

What Does the Patient Have Medical and Nutritional Status

The question What does the patient have includes medical diagnosis and risk stratification, type of metabolic abnormality (dyslipi-demia, diabetes, overweight) and the associated risk factors which may have an influence on the dietary counseling (smoking, hypertension, sedentariness). Dietary intake, as an index of atherogenic-ity and thrombogenicity, must be measured before counseling, as in most of western Europe more than 40 of energy derives from fat, far from the recommendations that only 20-30 of energy should be derived from lipid intakes. The major problem of dietary intake assessment is that no method is the universal gold standard. Usually, three types of questionnaires are used

Using rates of amino acid flux to determine wholebody protein turnover

Where Q is the rate of amino acid turnover in plasma (or the flux), S is the rate of incorporation of the amino acid into protein, C is the rate of amino acid oxidation (or catabolism), B is the rate of amino acid release from protein breakdown and I is the rate of exogenous intake of an amino acid (typically from the diet). In cases where subjects are studied in postabsorptive state, I 0 and Q B. Q and C are experimentally determined from the dilution of the infused tracer (e.g. 1-13C leucine) and the rate of production of expired 13CO2 respectively S is then calculated by solving the equation, i.e. S Q - C.

Nutritional Counseling Sessions

Moreover, nutritional counseling sessions should involve the cultural context of attitudes to food in each country.21 A study conductedin 1999 in four countries (US, Japan, Belgium, and France) dealt with beliefs about the diet-health link, worries about food, the tendency to associate foods with nutritional versus culinary contexts, the healthiness of one's own diet the group associating food most with health and least with pleasure were US citizens. In contrast, the French were the most culinary oriented and the least health oriented, mainly among men. However, paradoxically, despite their knowledge about diet and health, the US group did not classify themselves as healthy eaters.

Practical Modalities Key Points

- Dietary counseling is a part of the therapeutic education of coronary patients, and nutritional education diagnosis is the first step for tailored dietary advice. - A patient's nutritional diagnosis includes not only medical status and assessment of dietary intake, but also socioeconomic factors, psychological context (readiness to change, locus of control) and level of knowledge.

N M OBrien and T P OConnor

Dental caries involves metabolism of sugars by oral microorganisms including Streptococcus mutans to acids that gradually dissolve tooth enamel. It is now recognised that a number of dietary factors and nutrient interactions can modify the expression of dental caries. The cariogenic potential of food is influenced by its composition, texture, solubility, retentiveness and ability to stimulate saliva flow. A considerable body of research has been conducted on the cariostatic effects of cheese. Early work demonstrated that the incorporation of dairy products into the diet greatly decreased the development of dental caries in rats. Later work indicated that if enamel is treated with milk in vitro and subsequently washed, the solubility of the enamel is greatly reduced. This effect was attributed to the high levels of calcium and phosphate in milk or to the protective effects of casein. It has also been reported that both casein and whey proteins significantly reduced the extent of...

Redesign Of Clinical Research

Include only patients with your target disease, but ensure that they vary in age, gender, race, size, obesity, diets, habits, activities, smoking, ethanol use, concomitant ills, and use of concomitant prescription, over-the-counter, illicit, and health products. Consider a multidimensional grid representing values of each of these patient variables and disperse your patients widely in this space of patient characteristics.

Other Laboratory Test Results That Correspond With Liver Disorders

Beta Gamma Bridging

Since the majority of proteins found in plasma are synthesized by the liver from amino acids, including serine protease coagulation factors, prothrombin time, serum albumin, and serum protein electrophoresis results can be used to indicate declining liver function. For example, serum albumin decreases and prothrombin time becomes prolonged with liver failure. Protein levels also reflect other disorders, such as those in which essential amino acids are not provided by the diet or in which proteins are lost by the kidneys or gastrointestinal tract.

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