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The 2 Week Diet Summary


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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...

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...

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,...

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...

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...

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)...

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 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...

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.

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.

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...

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.

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...

Variability in Micronutrient Requirements among Individuals

Put simply, each person has unique nutritional requirements. Depending on one's individual genetic makeup, striking variability can exist in the body's biochemistry. A nutrient intake sufficient for one person may be inadequate for another. For example, 2 mg day of vitamin B6 is adequate for good health in most people, yet some individuals with inherited defects in vitamin B6 metabolism need up to 30 to 100 times this amount.25 The absorption and daily requirement for calcium can vary four- to fivefold among healthy middle-aged women.26 Normal plasma concentrations for 1,25 (OH)2 vitamin D (the activated form of the vitamin) vary between 15 and 45 pg ml in healthy adults.9 In the 10 of the population who are heterozygous for the hemochromatosis gene (see pp. 68), dietary iron intakes that normally maintain health may be toxic in the long-term.27 Biochemical individuality also helps explain why different people react differently to dietary factors. For example, a high intake of salt...

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.

Personal and Social History

The Personal and Social History also conveys lifestyle habits that promote health or create risk such as exercise and diet, including frequency of exercise, usual daily food intake, dietary supplements or restrictions, and use of coffee, tea, and other caffeine-containing beverages and safety measures, including use of seat belts, bicycle helmets, sunblock, smoke detectors, and other devices related to specific hazards. You may want to include any alternative health care practices.

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*

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,...

Prevention Strategies

Investigators are beginning to address the possibility that the efficacy of cancer prevention strategies may depend on both genetic and environmental risk factors affecting specific individuals. Mutationsldeletion of the APC tumor suppressor gene, discussed earlier, causes intestinal tumor formation in both rodents and humans. Increasing levels of dietary fat increases intestinal tumor number in rodent models (100). However, mice with a defective APC gene develop tumors even on low-fat diets. Thus, dietary modifications may reduce carcinogenesis in individuals without, but may be ineffective in individuals with, certain genetic risk factors for specific cancers. Recently, several large randomized studies conducted in the United States have failed to detect any protective effect of dietary fiber increase or dietary fat decrease on colon polyp recurrence (101).

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.

Apl Differentiation Syndrome

The pathophysiology and treatment of RA syndrome or APL differentiation syndrome have recently been reviewed,45 46 and knowledge of the manifestations of this potentially fatal complication of induction therapy is essential to all clinicians who treat APL. The most common presenting symptoms47-49 are respiratory distress, fever, pulmonary infiltrates, weight gain, and pleural pericardial effusions. Less common signs and symptoms include renal failure, cardiac failure, hypotension, and bone pain. These symptoms can develop at virtually any time after presentation (and may be present before any therapy), but the median time to development is between weeks 1 and 2 after the start of induction.47-49 The differential diagnosis includes sepsis acute respiratory distress syndrome, as well as pulmonary hemorrhage, and the outcome can be fatal if the disorder is not recognized, diagnosed correctly, and properly treated. Treatment of RA syndrome is with corticos-teroids (given at the earliest...

Dna Damage And Repair

The sources of DNA damage are protean. Environmental agents may act as mutagens, thus increasing the likelihood of the occurrence of mutations. Known agents in this category include ultraviolet (UV) light (the major source being exposure to sunlight), ionizing radiation, cigarette smoke, and various carcinogens such as asbestos and possible dietary factors. Whereas exposure to environmental factors frequently can be reduced or minimized by behavioral modification, other sources of DNA alteration are unavoidable errors during DNA replication (which occur with each cell division), damage from by-products of normal cellular metabolism (including reactive oxygen species superoxide anions, hydroxyol radicals, and hydrogen peroxide derived from oxidative respiration), and products of lipid peroxidation. Other weak mutagens, such as thermally promoted hydrolysis of nucleotide residues by water, may occur under physiological conditions. Deamination results in base substitutions, such as the...

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...

Energy Distribution Among Nutrients

The choice of foods according to their energy value represents the basis for building-up the energy-controlled dietary regimens that are required under different conditions, such as reduction of body weight (in overweight or obese patients), increased energy demand during recovery from illness or surgery, or high-level physical activity 11,12 . Dietary fiber However, in addition to the importance of controlling the total amount of dietary energy, food choices should be directed towards a balanced distribution of energy among nutrient sources. Epidemiological and experimental studies have led to the establishment of correct energy distribution among carbohydrates, fats, and protein, in order to prevent the onset of chronic diseases and to assure the maintenance of a good nutritional and health status. In this view, in the USA, more than 20 years ago, a Senate Select Committee stated that the energy distribution compatible with good health and that should be reached by the American...

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.

Biochemical Parameters of Nutrition in the Elderly

And metabolism should be studied more closely. Vitamins that act as antioxidants appear to have a role in preventing coronary artery disease and cancer 53 . Current work is focusing on the actions of vitamins as related to immune function, the formation of cataracts, and the development of osteoporosis, all associated with ageing 53 . The Food and Nutrition Board, the Institute of Medicine, and the National Academy of Science and Health of Canada have recently developed a standard set of nutrient recommendations, known as dietary reference intakes (DRIs), which has added, with regard to vitamin intakes, the groups for ages 51-70 years and for 70 years and older 54 . These recommendations are listed in Table 3 54 .

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...

Overview of Carotenoid Function in the Skin

Epidemiological and experimental studies show that a high dietary intake of foods rich in carotenoids could protect against many diseases besides macular degeneration, including cancer (69-71), cardiovascular diseases, and numerous pathological conditions linked to damage by oxygen-based free radicals (72,73). In the skin, carotenoids function as antioxidants scavenging free radicals (74), singlet oxygen (75,76), and other harmful reactive oxygen species (77) that are all formed as a by-product of normal metabolism and by excessive exposure of skin to ultraviolet (UV) light or sunlight. As with the eye, it would be useful to know skin carotenoid levels rather than just serum levels or dietary intakes. Skin biopsies are invasive, and HPLC analysis poses special challenges since distributions can vary from body region to body region. Skin also has much lower concentrations of carotenoids, and it has considerable amounts of fibrous tissue that must be broken down prior to analysis. Peng...

Examination General Survey and Vital Signs

This chapter addresses skills and techniques needed for initial assessment as you begin the physical examination. Under Anatomy and Physiology you will find information on how to measure height, weight, and Body Mass Index (BMI), and guidelines for nutritional assessment. There is clinical information on the relevant health history, health promotion and counseling (The General Survey), and a preview of how to record the patient's overall appearance (The Vital Signs). The section on Techniques of Examination describes the initial steps of the physical examination preparing for the examination, conducting the general survey, and taking the vital signs.

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).

Psychosocial and Supportive Care

Honing social and interpersonal skills is an important developmental milestone during adolescence. Cancer treatment for these patients must accommodate this important developmental process. We have discharged a patient from the intensive care unit to allow her to attend her senior prom, and readmitted her when the party was over. Yet boundaries must be set, so that treatment effectiveness is not compromised to keep a social calendar. Certainly, cancer therapy causes practical problems in social arenas. Adolescent and young adult patients, who are developmentally dependent on peer-group approval, often feel isolated from peers by their experience the cancer patient's issues are illness and death, while their peers are consumed by lipstick and homework. All adolescents agonize over their personal appearance and hate to be singled out or to appear different. In adolescents with cancer, having to be isolated from peers and society by having a disease that makes them different and having...

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

Influence of Nutritional Status on Immune Response

A survey of the literature shows that most nutritional deficits lead to suppressed immune responses. This is not surprising, since anabolic and catabolic pathways in the immune system require the same sort of building blocks and energy sources as other physiological activities. Caloric restriction is another area of emerging interest, with important implications for human health. In general, moderate caloric restriction appears to have beneficial effects on longevity and disease resistance. However, these trends and generalisations must be approached with some caution 62 .

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 .

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.

Structure Activity Relationships

A-Melanotropin (a-MSH), was one of the first peptide hormones isolated from the pituitary gland (131-135). This hormone plays an important role in skin pigmentation. Other effects ascribed to this hormone include (l)regulation of the release of pituitary and peripheral hormones, such as somatostatin and corticotropin (2) sebotro-phic effects, adrenal steroidogenesis, immune response, cardiovascular and metabolic effects and (3) important roles in the CNS such as (a)control over learning, memory, motivation, sleep, sexuality, and food intake (associated with obesity) (b) effects on neurotransmission such as cholinergic and dopaminergic systems (c) neurochemical effects (d) hypothermic and antipyretic effects (e) effects on nerve regeneration and (f) interactions with other neuroactive compounds such as opiates.

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,...

Psychological Dependence

Psychological dependence can occur merely on a tablet or injection, regardless of its content, as well as to drug substances. Mild dependence does not require that a drug should have important psychic effects the subject's beliefs as to what it does are as important, e.g. purgative and diuretic dependence in people obsessed with dread of obesity. We are all physically dependent on food, and some develop a strong emotional dependence and eat too much (or the reverse) sexual activity, with its unique mix of arousal and relaxation, can for some become compulsive or addictive.

Neuropsychology Of Aged Rodents

Another pathway that may have a role in age-related cognitive decline is that of oxidative stress. Quinn and colleagues 91 examined the effects of a diet high in the antioxidant alpha-lipoic acid in Tg2576 mice, a transgenic model of the cerebral amyloidosis associated with Alzheimer's disease. Aged mice that received the antioxidant-enhanced diet for 6 months demonstrated improved performance in context fear conditioning and in Morris water maze performance compared to the normal-diet controls. Although beta-amyloid levels remained unchanged, these data suggest that chronic dietary manipulation can improve some aspects of learning and memory in aged populations.

Experimental Models for the Study of Carcinogenesis

Multistage carcinogenesis has also been observed for liver tissue. For example, Peraino et al.89 observed that a 3-week exposure of rats to AAF in the diet produced only a small number of hepatomas after several months, but if the animals were subsequently treated with phenobarbital for several months after carcinogen feeding was discontinued, a high incidence of hepatomas was noted. Similar results have been obtained by Kitagawa et al.,90 who fed rats a nonhepatocarcinogenic dose of 2-methyl-N,N-dimethyl-4-aminoazobenzene for 2 to 6 weeks, and then a dietary administration of phenobarbital for 70 weeks. By 72 weeks, many large hepatocellular carcinomas had developed in the phenobarbital-treated animals, whereas only a few small tumor nodules were observed in the rats not given phenobarbital. Thus, the action of phenobarbital appears to be analogous to that of TPA in the mouse skin system that is, it fixes the damage to cells induced by an initiating agent and causes a clone of cells...

Angiotensinogen Agt Gene

Different sites of expression of the components of the renin-angiotensin system (RAS) in the body. The classical systemic RAS in which angiotensinogen (AGT) is derived from the liver, renin from the kidney, and angiotensin-converting enzyme from lung is shown. Presence of different components of the RAS in a variety of tissues has led to the concept of local RAS. AGT expression is also detected in adipose tissue and is induced by obesity in some depots. Adipose tissue is becoming recognized as another potential tissue RAS. Fig. 1. Different sites of expression of the components of the renin-angiotensin system (RAS) in the body. The classical systemic RAS in which angiotensinogen (AGT) is derived from the liver, renin from the kidney, and angiotensin-converting enzyme from lung is shown. Presence of different components of the RAS in a variety of tissues has led to the concept of local RAS. AGT expression is also detected in adipose tissue and is induced by obesity in some...

Etiology and Pathogenesis 361 etiology

The increasing ratio of male to female cases across the three age groups 13 to 14 years, 15 to 19 years, and 20 to 24 years suggests that the onset of osteosarcoma and Ewing tumor may be associated with the adolescent growth spurt, which occurs earlier in females than in males. Dietary and hormonal factors may be relevant. The possibility of a viral etiology for osteosarcoma has also been considered, and SV40-like sequences have been detected in osteosarcoma tissue in several studies 60-63 . In the most recent of these studies, the frequency of SV40-like sequences in peripheral blood cells from osteosarcoma patients was compared with that in normal, healthy controls and was found to be substantially increased in the osteo-sarcoma patients 63 . Space-time clustering has been reported in childhood STS 64 . It would be of considerable interest to determine whether STS in adolescents and young adults exhibit space-time clustering.

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...

Starting and stopping use

Though they are as aware of the risks of smoking as men, women find it harder to stop they consistently have lower success rates. This trend crosses every age group and occupation. Women particularly dislike the weight gain. If the patient is heavily tobacco-dependent and severe anxiety, irritability, headache, insomnia and weight gain (about 3 kg) and tension are concomitants of attempts to stop smoking, an anxiolytic sedative (or (3-adrenoceptor blocker) may be useful for a short time, but it is important to avoid substituting one drug-dependence for another.

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.

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...

Bl22 Immunogenicity Plasma Levels And Toxicity In Hcl Patients

High levels of neutralizing antibodies were observed in patients 5, 9, and 12 after cycles 1, 1, and 5, respectively. Patient 5 had preexisting low levels of neutralizing antibodies prior to receiving BL22. Patient 2 had low levels of neutralizing antibodies after cycle 5. Plasma levels in patients with high disease burden increased greatly on subsequent cycles after patients responded. Dose-limiting toxicity in patient 5 included a cytokine release syndrome in patient 5 with fever, hypotension, bone pain, and weight gain (VLS) without pulmonary edema, which resolved within 3 days. Patients 8 and 13 had a completely reversible hemolytic uremic syndrome (HUS),

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

Inflammatory pathway in atherosclerosis biological basis of biomarkers in prediction and prognostication in

As data concerning the utility ofbiomarkers of inflammation in prospective cardiovascular risk prediction emerged, they appeared to fit into a pattern. One theoretical construct may help to systematize the biological basis ofbiomarkers ofinflammation in the cardiovascular arena (Fig. 4) (30). According to this hypothesis, a first wave ofprimary proinflammatory cytokines could arise from either vascular or extravascular sources (Fig. 4, top). Examples of primary proinflammatory cytokines include the soluble mediators IL-ip and tumor necrosis factor (TNF)-a. Intravascular sources could include the atheroma itself, a hotbed of inflammatory signaling, as already discussed. Extravascular sources could include foci of chronic infection, such as prostatitis, bronchitis, periodontal disease, or stasis or ischemic ulcers. Unfortunately, another potential source of extravascular inflammatory stimuli, visceral adipose tissue, will become more prominent owing to the currently increasing...

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 in Chronic Inflammation

With the tremendous increase in scientific knowledge about cytokines and their immune functions, it has also become clear that cytokines have systemic and local effects that are only partly related to their coordinating functions in the immune system. Thus, proinflammatory cytokines are the major endogenous mediators of anorexia and cachexia during chronic diseases. They have substantial hypermetabolic effects, which are at the core of the organism's fever reaction, and, last but not least, they are implicated in the metabolic disturbances and several other comorbidities of obesity, in particular by contributing to insulin resistance. This chapter summarises current knowledge of these effects it describes studies including different levels of scientific analysis, from the molecular through cellular to the systemic and behavioural levels, which reveal interesting features of the role of cytokines in these phenomena.

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...

Test Methodology 62 Creatinine Clearance

Creatinine clearance is an imperfect measure of glomerular filtration rate. The use of creatinine to estimate glomerular filtration rate is based upon three assumptions (1) creatinine is filtered through the glomerulus, (2) relatively low amounts of creatinine are reabsorbed through the nephron tubule, and (3) creatinine production is constant over time. Although creatinine can provide a rough estimate of glomerular filtration rate, error may be encountered. Such factors as increased tubular reabsorption of creatinine, reduced creatinine generation from muscle tissue, and dietary changes in nitrogenous compounds may affect creatinine clearance.

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...

Fish n3 Fatty Acids and SCD

That the protective effect of fish might be explained by a preventive action on ventricular fibrillation (VF), since no benefit was observed on the incidence of nonfatal acute myocardial infarction (AMI). This hypothesis was consistent with experimental evidence suggesting that n-3 polyunsaturated fatty acids (PUFA),the dominant fatty acids in fish oil and fatty fish, have an important effect on the occurrence of VF in the setting of myocardial ischemia and reperfusion in various animal models, both in vivo and in vitro.4 In the same studies, it was also apparent that saturated fatty acids are proarrhythmic as compared to unsaturated fatty acids. Using an elegant in vivo model of SCD in dogs, Billman and co-workers demonstrated a striking reduction of VF after intravenous administration of pure n-3 PUFA, including both the long chain fatty acids present in fish oil and alpha-linolenic acid, their parent n-3 PUFA occurring in some vegetable oils.4 These authors have found the mechanism...

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...

Therapeutic interventions

Conclusive evidence that lowering hsCRP levels leads to a reduction in clinical cardiovascular events in primary prevention settings is not available. Nevertheless, many behavioral and pharmacological interventions that reduce cardiovascular event rates are associated with lower hsCRP levels. Behavioral interventions in this category include smoking cessation, weight loss, increased physical activity, and dietary modification (see ref. 6 for a review). Pharmacological interventions are reviewed in the following sections. Because a patient's compliance with recommended interventions depends in part on his or her perception of absolute disease risk and because the addition of hsCRP testing to existing risk algorithms provides an improved prediction tool, a major rationale for hsCRP screening is to help motivate at-risk individuals to adopt healthier lifestyles and to comply with prescribed drug therapies.

Deficiency in Specific Micronutrients

As discussed above, an important practical point is that deficiencies in specific micronutrients can actually cause CHF, or at least aggravate it. The prevalence of these deficiencies among patients with CHF (and post-infarction patients) is unknown. Whether we should systematically search for them also remains unclear. In particular, we do not know whether the association of several borderline deficiencies that do not individually result in CHF may result in CHF, especially in the elderly. For certain authors, however, there is sufficient evidence to support a large-scale trial of dietary micronutrient supplementation in CHF. restrict our comments only to human data, things can be summarized as follows. Cases of hypocal-cemia-induced cardiomyopathy (usually in children with a congenital cause for hypocalcemia) that can respond dramatically to calcium supplementation have been reported. Hypomagnesemia is often associated with a poor prognosis in CHF, and correction of the magnesium...

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

Plasma Leptin Concentration

Plasma leptin concentrations correlate with adiposity, being high in obesity and decreasing after weight loss. Elevation of serum leptin in obesity appears to result from both increased fat mass and increased leptin release from larger adipocytes 42 . However, leptin levels are not constant in blood. They are considered to be pulsatile, with a frequency of about one pulse every 45 min 32 . In healthy subjects, circulating leptin concentrations exhibit a diurnal pattern, with a nadir in the mid-morning and a late-night nocturnal peak 5, 43 . The diurnal leptin pattern is dependent on insulin responses to meals and is therefore influenced by meal timing 44 and dietary macronutrient composition 45 .

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 .

Leptin and Congenital Leptin Deficiency

Congenital leptin deficiency due to mutations in the leptin gene or receptor is a rare, but treatable, cause of severe early-onset obesity and various endocrine disturbances in both rodents and humans 74, 75 . According to the lypostatic theory, a state of 'perceived starvation' might exist in these subjects and results in a chronic stimulation of excessive food intake 39 . Leptin therapy has shown to have dramatically beneficial effects on weight, fat mass and appetite, hyperinsulinaemia and lipid levels, as well as on neuroendocrine phe-notypes and immune functions in these subjects 76, 77 . Leptin treatment blunts the changes in circulating thyroid hormone and corticosterone levels that are normally associated with food deprivation. It has been suggested that the inhibition of thyroid hormone secretion may have evolved to limit energy expenditure and prevent protein catabolism during starvation 78 . The effect of leptin on circulating thyroid hormone can be explained at least in...

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 Correlation

Hypokalemia is caused by renal loss such as renal tubular acidosis, hyperaldos-teronism, hypercortisolism, and certain diuretics. Potassium can also be decreased due to gastrointestinal dietary deficit or loss from severe vomiting, diarrhea, nasogastric suctioning, laxatives, and malabsorption. A cellular shift in cases of insulin overdose and alkalosis can also cause hypokalemia.23

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...

Allergy diets and pollutants

To date, none of the diets promoted for the relief of CFS symptoms and to combat Candida has been substantiated by clinical research (Morris and Stare 1993). Some studies have made remarkable claims for the effectiveness of dietary supplements in CFS, but these results have not been replicated in subsequent randomised trials (see Wessely, Hotopf and Sharpe 1998 for review). Further, reports of food intolerance are not always substantiated by objective data. In a study of patients with chronic fatigue, no laboratory differences were found between patients who did and did not report food intolerance (Manu, Matthews and Lane 1993b). Rather, food allergies were positively associated with a general tendency to report physical complaints. Evidence of psychological disorder or distress has also been related to unsubstantiated food allergies in the general population (Parker et al. 1991). Consequently, the lack of consistency between symptoms and objective evidence of allergies makes the...

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