Macadamia nut effects on cardiometabolic risk factors: a randomised trial

We sought to examine the effects of daily consumption of macadamia nuts on body weight and composition, plasma lipids and glycaemic parameters in a free-living environment in overweight and obese adults at elevated cardiometabolic risk. Utilising a randomised cross-over design, thirty-five adults with abdominal obesity consumed their usual diet plus macadamia nuts (~15 % of daily calories) for 8 weeks (intervention) and their usual diet without nuts for 8 weeks (control), with a 2-week washout. Body composition was determined by bioelectrical impedance; dietary intake was assessed with 24-h dietary recalls. Consumption of macadamia nuts led to increased total fat and MUFA intake while SFA intake was unaltered. With mixed model regression analysis, no significant changes in mean weight, BMI, waist circumference, percent body fat or glycaemic parameters, and non-significant reductions in plasma total cholesterol of 2⋅1 % (-4⋅3 mg/dl; 95 % CI -14⋅8, 6⋅1) and low-density lipoprotein (LDL-C) of 4 % (-4⋅7 mg/dl; 95 % CI -14⋅3, 4⋅8) were observed. Cholesterol-lowering effects were modified by adiposity: greater lipid lowering occurred in those with overweight v. obesity, and in those with less than the median percent body fat. Daily consumption of macadamia nuts does not lead to gains in weight or body fat under free-living conditions in overweight or obese adults; non-significant cholesterol lowering occurred without altering saturated fat intake of similar magnitude to cholesterol lowering seen with other nuts. Clinical Trial Registry Number and Website: NCT03801837 https://clinicaltrials.gov/ct2/show/NCT03801837?term = macadamia + nut&draw = 2&rank = 1.

Ultra-processed food intake and animal-based food intake and mortality in the Adventist Health Study-2

BACKGROUND

Both ultra-processed foods and animal-derived foods have been associated with mortality in some studies.

OBJECTIVES

We aimed to examine the association of 2 dietary factors (ultra-processed foods and animal-based foods), adjusted for each other, with all-cause mortality.

METHODS

The setting is an observational prospective cohort study in North America, recruited from Seventh-day Adventist churches, comprised of 95,597 men and women, yielding an analytic sample of 77,437 participants after exclusions. The exposure of interest was diet measured by FFQ, in particular 2 dietary factors: 1) proportion of dietary energy from ultra-processed foods (other processing levels and specific substitutions in some models) and 2) proportion of dietary energy from animal-based foods (red meat, poultry, fish, and eggs/dairy separately in some models). The main outcome was all-cause mortality. Mortality data through 2015 were obtained from the National Death Index. Analyses used proportional hazards regression.

RESULTS

There were 9293 deaths. In mutually adjusted continuous linear models of both dietary factors (ultra-processed and animal-based foods), the HR for the 90th compared with the 10th percentile of the proportion of dietary energy from ultra-processed food was 1.14 (95% CI: 1.07, 1.21, comparing 47.7% with 12.1% dietary energy), whereas for animal-based food intake (meats, dairy, eggs) it was 1.01 (95% CI: 0.95, 1.07, comparing 25.0% with 0.4% dietary energy). There was no evidence of interaction (P = 0.36). Among animal-based foods, only red meat intake was associated with mortality (HR: 1.14; 95% CI: 1.08, 1.22, comparing 6.2% with 0% dietary energy).

CONCLUSIONS

Greater consumption of ultra-processed foods was associated with higher all-cause mortality in this health-conscious Adventist population with many vegetarians. The total of animal-based food consumption (meat, dairy, eggs) was not associated with mortality, but higher red meat intake was. These findings suggest that high consumption of ultra-processed foods may be an important indicator of mortality.

Differences in DNA Methylation Patterns Between Vegans and Non-vegetarians in the AHS-2 Cohort (FS11-06-19)

Objectives

It is unclear how diets differing in content of animal products affect DNA methylation patterns. We sought to determine if DNA methylation patterns differed between vegans and non-vegetarians in the Adventist Health Study-2 (AHS-2) cohort.

Methods

DNA methylation was profiled using the Infinium Human Methylation 450 K BeadChip in white blood cells of 137 participants in the AHS-2 cohort classified as vegan (57) or non-vegetarian (80) based on validated diet history data. Linear regression models were generated to test associations between diet pattern and methylation, where the response variable represented methylation intensity for individual CpG sites. This was repeated for sites separated into gene regions or in relation to CpG islands. CpG methylation was also averaged across each gene. The permutation-identified null distribution, false discovery rate of Storey et al was used to adjust for multiple testing.

Results

A total of 53,809 individual CpG sites were estimated to be differentially methylated (non-null). Of these, with this small sample, we could individually identify only up to 5.5% (differing by gene region) at FDR <0.05. A vegan diet was associated almost exclusively with hypomethylation of individual CpG sites. Significant CpG sites numbered 2504 within CpG islands, 749 and 13 CpG sites 0–200 base pairs or 201–1500 base pairs upstream of the transcription start site (TSS200 and TSS1500), respectively, and 51 and 458 sites falling within the 5’ UTR and first exon, respectively. The greatest difference in methylation was observed for sites mapping to TSS200 and CpG islands, where methylation was 9.2% lower in vegans. No differences were found when CpG methylation was averaged to obtain a cumulative value for all sites (no FDR criterion) within each gene region. A total of 328 genes (averaging all methylation regions) were significantly hypomethylated in vegans relative to non-vegetarians at FDR <0.05. The greatest number of genes were hypomethylated when considering methylation of only CpG islands, followed by the TSS200, first exon, and TSS1500 regions.

Conclusions

Our findings suggest substantial differences in methylation of CpG sites and genes, particularly in regulatory regions, between vegans and non-vegetarians, with a preponderance of hypomethylation among vegans.

Funding Sources

National Institute of Health, National Cancer Institute, World Cancer Research Fund (UK).

Paracrine factors produced by bone marrow stromal cells induce apoptosis and neuroendocrine differentiation in prostate cancer cells

BACKGROUND

Preferential bony metastasis of human prostate cancer (PCa) cells contributes to disease mortality and morbidity. Local factors in bone stromal extracellular matrix microenvironment affect tumor growth through paracrine interactions between tumor and stromal cells.

METHODS

Using co-culture and medium transfer, we used several methods to assess interactions between PCa and bone stromal cells using three PCa cell lines: PC3, LNCaP, and the LNCaP derivative, C4-2B.

RESULTS

Co-culture of LNCaP and C4-2B cells with bone marrow stromal cell lines, HS27a and HS5, decreased cell number, as did culture with conditioned medium (CM) harvested from these two cell lines suggesting a soluble paracrine factor was responsible. PC3 cell growth was unaffected. CM harvested from bone stromal cell lines triggered apoptosis in LNCaP and C4-2B cell lines, but not in PC3 cells. Surviving C4-2B cells grown in bone stromal cell CM over several days were growth arrested, suggesting presence of a growth inhibitor. Apoptosis induced by CM was dose-dependent. Flow cytometry demonstrated that over a 5-day culture period in stromal cell CM, LNCaP, and C4-2B cell lines, but not PC3 cells, underwent greater apoptosis than parallel cultures in SF medium. The LNCaP and C4-2B cells showed morphology and biomarker expression consistent with transdifferentiation towards a neuroendocrine phenotype after exposure to stromal cell CM.

CONCLUSIONS

The reactive bone stromal microenvironment initially is hostile to PCa cells producing widespread apoptosis. Activation of transdifferentiation in a subset of apoptotic resistant cells may support phenotypic adaptation during disease progression in bone, eventually favoring lethal disease.

Review of Staphylococcus aureus infections requiring admission to a paediatric intensive care unit

AIMS

To review clinical features and outcome of children with severe Staphylococcus aureus sepsis (SAS) presenting to a paediatric intensive care unit (PICU) with particular focus on ethnicity, clinical presentation, cardiac involvement, and outcome.

METHODS

Retrospective chart review of patients coded for SAS over 10 years (October 1993 to April 2004).

RESULTS

There were 58 patients identified with SAS over the 10 year study period; 55 were community acquired. This accounted for 4% of hospital admissions for SAS over this time; children with staphylococcal illness comprised 1% of all admissions to the PICU. Maori and Pacific children with SAS were overly represented in the PICU (81%) from a paediatric population where they contribute 21.6%. Musculoskeletal symptoms (79%) dominated presentation rather than isolated pneumonia (10%). An aggressive search for foci and surgical drainage of infective foci was required in 50% of children. Most children had multifocal disease (67%) and normal cardiac valves (95%); the few children (12%) presenting with methicillin resistant S aureus (MRSA) had community acquired infection. The median length of stay in the PICU was 3 (mean 5.8, SD 7.6, range 1-44) days. The median length of stay in hospital was 15 (mean 21, SD 22.7, range 2-149) days. Mortality due to SAS was 8.6% (95% CI 1.4-15.8%) compared with the overall mortality for the PICU of 6% (95% CI 5.3-6.7%). Ten children had significant morbidity after discharge.

CONCLUSIONS

Community acquired SAS affects healthy children, is multifocal, and has high morbidity and mortality, in keeping with the high severity of illness scores on admission. It is imperative to look for sites of dissemination and to drain and debride foci. Routine echocardiography had low yield in the absence of pre-existing cardiac lesions, persisting fever, or persisting bacteraemia.

Prevalence of human T-cell lymphotropic virus type 1 (HTLV-1) and HTLV-2 infection among Spanish drug users measured by HTLV-1 assay and HTLV-1 and -2 assay. HTLV-1 and HTLV-2 Spanish Study Group

The prevalence of human T-cell lymphotropic virus type 1 (HTLV-1) and HTLV-2 infection in 1992 and 1993 was determined by testing 2,152 specimens from injection drug users living in 11 geographic areas in Spain. Results obtained by an authentic HTLV-1 and -2 test were compared with those obtained by an HTLV-1 assay. HTLV infection was identified in 7 of 11 regions, with an overall prevalence of 2.5% (range, 0.4 to 11.5%). Fourty-four (81%) of 54 subjects were infected with HTLV-2; the viral strains in the remaining 10 subjects could not be serologically typed. Underestimation of HTLV infection because of the low sensitivities of HTLV-1 enzyme immunoassays for HTLV-2 antibody was relatively low (< 20%). Therefore, previous epidemiologic findings generated with HTLV-1 enzyme immunoassays appear to be reasonably accurate. Our results suggest that the rate of HTLV infection may have been increasing recently among Spanish drug users.

Visual discrimination of pigmented skin lesions

Three experiments explored human performance in discrimination of pigmented skin lesions from photographic slides. Experiment 1 showed that latent ability in identifying early melanoma was low, and some benign lesions tended to be falsely identified as serious. Performance overall did not decline when viewing time was reduced, suggesting that judgments could be made on the general appearance of lesions. Experiment 2 showed that enlargement of stimuli had no effect. Experiment 3 showed that performance was better with pictorial examples than with written descriptions for some classes of lesion, but for melanoma performance improved with longer viewing time when information was provided, suggesting that an opportunity to scrutinize could be beneficial. Guidelines to the public should distinguish melanoma from benign lesions and stress the importance of seeking prompt medical attention for suspicious lesions.

Visual discrimination of pigmented skin lesions

Three experiments explored human performance in discrimination of pigmented skin lesions from photographic slides. Experiment 1 showed that latent ability in identifying early melanoma was low, and some benign lesions tended to be falsely identified as serious. Performance overall did not decline when viewing time was reduced, suggesting that judgments could be made on the general appearance of lesions. Experiment 2 showed that enlargement of stimuli had no effect. Experiment 3 showed that performance was better with pictorial examples than with written descriptions for some classes of lesion, but for melanoma performance improved with longer viewing time when information was provided, suggesting that an opportunity to scrutinize could be beneficial. Guidelines to the public should distinguish melanoma from benign lesions and stress the importance of seeking prompt medical attention for suspicious lesions.

Supreme Court ruling supports right to fair Medicaid rates

Virginia Hospital Association should send a clear message to both the states and HCFA that Medicaid providers are entitled, as a matter of right, to challenge their Medicaid rates in federal courts on both substantive and procedural grounds. Accordingly, it is legally incumbent upon the states and HCFA to make the plan amendment process meaningful in terms of state submissions and HCFA's review and approval. Only direct provider participation can ensure this result.