Separate influence of dietary carbohydrate and fibre on the metabolic control in diabetes

To clarify the separate influences of digestible carbohydrate and of dietary fibre on blood glucose control and serum lipoproteins, 14 diabetic patients (six Type 1 and eight Type 2) were submitted to three weight-maintaining diets for 10 days each: (1) low carbohydrate/low fibre diet with 42% carbohydrate and 20 g fibre; (2) high carbohydrate/low fibre diet (carbohydrate 53%, fibre 16 g); (3) high carbohydrate/ high fibre diet (carbohydrate 53%, fibre 54 g). In comparison with the low carbohydrate/low fibre diet, the 2-h post-prandial blood glucose and the daily blood glucose profile decreased significantly on the high carbohydrate/high fibre diet, without significant changes during the high carbohydrate/low fibre diet. The diet-induced modifications of blood glucose control were similar in both types of diabetic patients (two-way analysis of variance: F = 5.86, p less than 0.02 for dietary treatment and F = 2.09, NS for type of diabetes). Total and low-density lipoprotein cholesterol were also decreased after the high carbohydrate/high fibre diet in comparison with the low carbohydrate/low fibre diet (p less than 0.001 for both), while they were not significantly modified after the high carbohydrate/low fibre diet. Again the modifications of low density lipoprotein cholesterol induced by diet were similar in both types of diabetic patients (F = 10.02, p less than 0.005 for dietary treatment and F = 0.14 for type of diabetes, NS). High-density lipoprotein cholesterol was lower after the two test diets than after the low carbohydrate/low fibre diet.(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of oxprenolol and metoprolol on serum lipid concentration

The aim of the present study was to evaluate whether a reduction in HDL-cholesterol is peculiar to non cardioselective beta blockers or whether it is also produced by cardioselective beta 1-blockers. 16 patients with primary arterial hypertension on a balanced isocaloric diet were given oxprenolol 120 to 240 mg/day or metoprolol 100 to 200 mg/day in a random cross-over study. No significant change was observed after either treatment in fasting blood glucose, serum total cholesterol and triglycerides. HDL-cholesterol concentration was significantly decreased on metoprolol, from 41 to 36 mg/dl (p less than 0.05), while oxprenolol did not affect it at all. The difference might depend on intrinsic sympathomimetic activity which is possessed by oxprenolol and which metoprolol lacks.

Hypocholesterolaemic activity of suloctidil: double-blind, crossover short-term and long-term treatment trial

Two studies were carried out in patients with primary hyperlipidaemia to investigate the effect of suloctidil (200 mg 3-times daily) on serum cholesterol levels and other lipidaemic variables. The first study was a double-blind, crossover comparison of suloctidil and placebo in 23 patients. Patients were allocated at random to receive one or other treatment for 4 weeks, after a wash-out period of 4 weeks on placebo, and were then crossed over to the alternative medication for the following 4 weeks. Patients were kept on a controlled diet throughout the trial. In the second, long-term study, 28 patients were treated, after an initial washout period of 8 weeks on placebo, with suloctidil for periods of up to 1 year. As in the short-term trial, patients were maintained on a controlled diet. The results showed that suloctidil produced a statistically significant reduction in total serum cholesterol and serum triglycerides in the short-term and this reduction was maintained over the longer period of the second study. In addition, there was a concomitant and approximately proportional increase in HDL-cholesterol. Suloctidil was well tolerated and no serious side-effects were reported.

Characteristics of the association between salt intake and blood pressure in a sample of male working population in southern Italy

A possible association between dietary salt intake and blood pressure was investigated in an unselected sample of 188 healthy Neapolitan men. In univariate analysis diastolic pressure was positively correlated with age, body mass index and 24-h excretion of sodium, potassium and creatinine, but not with urine volume or sodium: potassium ratio. Systolic pressure was also related to age, body mass index and 24-h sodium, but to a lesser degree. As a high level of intercorrelation was apparent, multivariate analysis was also carried out. Body mass index was shown to be the variable having the largest influence on diastolic pressure variability: nevertheless a significant independent role was still found for 24-h urinary sodium when the latter was included in a regression along with body mass index, age, urine volume and potassium excretion. These results seem to support the possibility that dietary salt has a substantial influence on blood pressure levels.

Once a day indapamide therapy in hypertension. Effects on the heart and peripheral arterial circulation

Indapamide, a sulphonamide derivative, was prescribed for 8 weeks at low dose (2.5 mg once a day) to 14 hypertensive patients in order to investigate its effects on systolic and diastolic blood pressure (SBP, DBP), cardiac function and peripheral arterial resistance (PAR). During treatment we observed decreases in both SBP and DBP without any change in HR in the supine and standing positions and on exercise. As a result cardiac work was significantly reduced. Slight changes in pre-ejection period (PEP) and left ventricular ejection time (LVET) along with a more significant decrease in rate of rise of left ventricular pressure (DBP to PEP ratio) were observed during treatment. An increase in RBF and a decrease in PAR were also detected in the peripheral circulation. These findings may indicate that indapamide antagonizes the cardiovascular effects of catecholamines.

Abnormalities of calcium metabolism in essential hypertension

Calcium metabolism has been investigated in patients with essential hypertension and normal renal function to evaluate the renal calcium handling and the reported increase in renal calcium loss. In 55 hypertensive and 55 sex- and age-matched healthy normotensive subjects creatinine clearance, serum total and ionized calcium, plasma parathyroid hormone and 24 h urinary excretion of calcium, sodium and cAMP were measured. In a subgroup of 20 hypertensive patients and 20 controls the fasting calcium excretion rate was also measured. Both 24 h and fasting calcium excretion rates were higher in the hypertensive group; so also were plasma parathyroid hormone and urinary cAMP. Serum total and ionized calcium levels were not different in the two groups. After intravenous calcium infusion (15 mg 3 h-1 kg-1) in seven hypertensive patients and controls, the hypertensive patients excreted more calcium at all serum calcium concentrations. These results support the hypothesis of primary renal calcium leak in essential hypertension. Enhanced urinary calcium excretion rate may cause compensatory parathyroid overactivity.

The relationship between blood glucose concentration and beat-to-beat variation in asymptomatic subjects

Very little is known about the presence of autonomic neuropathy in subjects with slight abnormalities of glucose metabolism. This study was carried out to investigate whether impaired glucose tolerance (IGT) is associated with abnormalities of beat-to-beat variation (BTBV). Sixty-two subjects, aged 40-59 years, with IGT (according to EASD criteria) and 124 normals, matched for age, sex and body mass index (BMI), were selected among the participants in a health examination survey and tested for BTBV. Among the possible factors influencing this test, sex did not shown any effect, while age and BMI were significantly and negatively correlated to BTBV in both groups. Glucose intolerance was not associated with any impairment of BTBV which was almost identical in the normal (15.8 +/- 6.3 beats/min) (mean +/- SD) and in the IGT group (16.7 +/- 7.0 beats/min). Similarly no significant difference was found in BTBV between subjects with constant IGT or normal results at OGTT, repeated on two occasions. All subjects were then stratified according to blood glucose values 2 h after an oral glucose load (after load): only those with blood glucose after load greater than 200 mg/dl displayed a significant decrease in BTBV (9.7 +/- 3.8 beats/min) compared to those found normal at the glucose tolerance test (p less than 0.025). They were also the only ones with an average HBa1 level significantly higher than in normal individuals (p less than 0.005). In conclusion, IGT is not associated with abnormalities of BTBV.

Evaluation of the hypocholesterolemic effect of vegetable proteins

The hypocholesterolemic effect of dietary vegetable proteins was studied by comparing egg-white protein and fava bean protein concentrate in one normal and seven hypercholesterolemic (six type II A, one II B) persons; five completed the crossover design. To maintain stable body weight, subjects were kept on an isocaloric diet (20% protein, 48% carbohydrate (CH), 32% fat, P/S = 2) for 1 month and then hospitalized for two consecutive 18-day periods while receiving an isocaloric diet of different composition (15% protein, 50% CH, 26% fat, P/S = 2). Women were provided 50 g and men 70 g daily of egg-white or fava bean protein concentrate during the two crossover periods. Hematocrit and fasting plasma or serum were analyzed every 3 days for glucose, insulin, uric acid, creatinine, total and low-density lipoprotein (LDL), very low-density lipoprotein (VLDL), and high-density lipoprotein (HDL) cholesterols, and for total and VLDL triglyceride. Dietary adequacy of both proteins was evaluated by measuring plasma concentration of prealbumin, transferrin, and retinol-binding globulin. Insulin and hematocrit did not show any change, nor did any other biochemical variables show significant differences when results were compared at the end of each crossover period. Compared with baseline, fasting plasma glucose significantly decreased on the fava bean diet. Serum total and LDL cholesterol decreased during both diets but were statistically significant only on the egg-white diet. Serum HDL cholesterol significantly decreased only on the fava bean diet. Serum total and VLDL triglyceride did not show any significant change. Labile plasma protein concentration was significantly reduced only on the fava bean diet. In conclusion, the fava bean diet did not show a significant effect on lowering serum total and LDL cholesterol. Such an effect was mild but significant on the egg-white diet, compared with baseline.

Serum lipid and lipoprotein profiles in childhood

Serum lipids and lipoproteins as well as other factors have been shown to be predictive of future symptomatic coronary heart disease in adult populations. Many epidemiologic data are available on serum lipids in adults in different populations; similar data in children indicate a large geographic variability between different populations and even among individuals of the same population, suggesting that both genetic and environmental factors are determinants of serum lipid concentrations. Serum cholesterol at birth and during childhood is carried predominantly by low-density lipoprotein (LDL) and high-density lipoprotein (HDL) whereas very low-density lipoprotein (VLDL) remains very low during the same period. Longitudinal studies show that serum cholesterol level decreases slightly with age in boys but not in girls; the decreasing trend is most evident between 10 and 14 years of age. LDL cholesterol follows the same trend. A continuous slight increase in serum total and VLDL triglyceride has been shown with age. HDL cholesterol seems to maintain a constant level with only slight variation with age. Moreover, LDL cholesterol has great consistency with future levels. Measurements made in children confirm that high levels of cholesterol may be present at early ages, suggesting the need for follow-up studies in young populations in order to evaluate whether hypercholesterolemia in childhood is predictive of future coronary events.

[Report of a clinical case of tuberculous L/S spondylitis with radiologic and C.T. documentation]

A case of tuberculous spondylitis is presented and various aspects of its diagnosis are discussed. Stress is laid on the importance of radiology and CT in the diagnosis of this disease, and the monitoring of its progress.

Increased blood flow to lower limbs after plasma exchange in two patients with familial hypercholesterolemia

Leg blood flow was measured before and 1 and 7 days after plasma exchange by venous occlusion plethysmography in a 9-year-old girl with homozygous familial hypercholesterolemia and in a 41-year-old man with heterozygous familial hypercholesterolemia. In the first patient the plasma cholesterol level was reduced from 890 mg/dl to 532 mg/dl and 666 mg/dl 1 and 7 days after plasma exchange. In the second patient plasma cholesterol decreased from 596 mg/dl to 342 mg/dl and 480 mg/dl, respectively. Leg arterial flow increased from 8.5 ml/min/l of leg volume to 19.1 and 19.5 ml/min/l in the first patient and from 6.6 ml/min/l to 18.0 and 21.8 ml/min/l in the second. No change was observed in haematocrit and total globulin concentration, which are known to play an important role in blood viscosity and flow. It is concluded that plasma exchange, possibly by decreasing plasma cholesterol concentration in patients with familial hypercholesterolemia, is associated with improved arterial flow to lower limbs and it is suggested therefore that some beneficial effect might be found also in other vascular beds.

Nitrogen loss and urinary creatinine excretion during fasting in massive obesity

Six (5 f, 1 m) massively obese, otherwise healthy subjects, were submitted for 4 weeks to a very-low-calorie diet (VLCD): 80 kcal, 335 kJ = 2.6 g N/day (17 g protein, 0 CHO and fat). Daily urinary creatinine excretion (UCE) and weekly nitrogen loss (NL) were determined during the whole period of treatment. Both NL and UCE decreased from the second week of treatment indicating a progressive sparing effect on lean body mass (LBM). A positive correlation (r = 0.991, P less than 0.001) was observed between mean daily UCE and NL, indicating that NL during prolonged fasting in obesity is possibly influenced by the lean body mass of the individual.

Obesity and cardiac function

We studied 10 obese volunteers, mean age 36.5 +/- 10.3 years, who weighed 123.56 +/- 28.7 g and were 69.96 +/- 22.5 kg overweight. The subjects did not have diabetes, arterial hypertension or signs of cardiac and respiratory failure or disease and all underwent right- and left-heart catheterization. cardiac output and stroke volume were high, according to increased oxygen consumption and to the degree of obesity. Ventricular end-diastolic and atrial pressures ranged from normal to high and correlated with body weight, signs of volume overloading and reduced left ventricular (LV) compliance. The mean pulmonary artery pressure was elevated and correlated well with weight, pulmonary resistance being normal; mean aortic pressure did not correlate with weight, and systemic arterial resistance tended to have a negative correlation. The LV function curve showed impaired ventricular function, particularly for the heaviest subjects, in whom Vmax and the ratio of the stroke work index to LV end-diastolic pressure were reduced. These indexes correlated well with each other and both correlated negatively with the degree of obesity. In contrast, maximal dP/dt was normal and did not correlate with excess weight. These observations show that depressed LV function is already present in relatively young obese people, even if they are free from signs of cardiopathy and other associate diseases. The degree of impairment of heart function seems to parallel the degree of obesity.

Analytical fractionation of human liver microsomal fractions: localization of cholesterol and of the enzymes relevant to its metabolism

1. The submicrosomal distribution of three enzymes concerned in cholesterol metabolism, and of free and esterified cholesterol, was determined in human liver by analytical isopycnic centrifugation on sucrose gradients. 2. The distribution profile and median density of acyl-CoA:cholesterol O-acyltransferase was similar to that of RNA, showing that this enzyme is confined largely to the ribosome-rich membranes of the endoplasmic reticulum. The distribution profiles and median densities of 3-hydroxy-3-methylglutaryl-CoA reductase and cholesterol 7 alpha-mono-oxygenase showed that both enzymes are confined to the smooth, ribosome-poor, endoplasmic reticulum. 3. Most of the free cholesterol in the microsomal preparations was present in smooth membranes from the Golgi apparatus and in vesicles from plasma-membrane fragments. The distribution of esterified cholesterol was multimodal and extended throughout the whole gradient.