Improving mental health following multiple disasters in Australia: a randomized controlled trial of the Skills for Life Adjustment and Resilience (SOLAR) programme

Background: The mental health impacts of climate change-related disasters are significant. However, access to mental health services is often limited by the availability of trained clinicians. Although building local community capability for the mental health response is often prioritised in policy settings, the lack of evidence-based programs is problematic. The aim of this study was to test the efficacy of the Skills for Life Adjustment and Resilience programme (SOLAR) delivered by trained local community members following compound disasters (drought, wildfires, pandemic-related lockdowns) in Australia.Method: Thirty-six community members were trained to deliver the SOLAR programme, a skills-based, trauma informed, psychosocial programme. Sixty-six people with anxiety, depression and/or posttraumatic stress symptoms, and impairment were randomised into the SOLAR programme or a Self-Help condition. They were assessed pre, post and two months following the interventions. The SOLAR programme was delivered across five 1-hourly sessions (either face to face or virtually). Those in the Self-Help condition received weekly emails with self-help information including links to online educational videos.Results: Multigroup analyses indicated that participants in the SOLAR condition experienced significantly lower levels of anxiety and depression, and PTSD symptom severity between pre - and post-intervention (T1 to T2), relative to the Self-Help condition, while controlling for scores at intake. These differences were not statistically different at follow-up. The SOLAR programme was associated with large effect size improvements in posttraumatic stress symptoms over time.Conclusion: The SOLAR programme was effective in improving anxiety, depression and posttraumatic stress symptoms over time. However, by follow-up the size of the effect was similar to an active self-help condition. Given the ongoing stressors in the community associated with compounding disasters it may be that booster sessions would have been useful to sustain programme impact.Trial registration: Australian New Zealand Clinical Trials Registry identifier: ACTRN12621000283875..

Comparing the unified protocol for transdiagnostic treatment of emotional disorders to prolonged exposure for the treatment of PTSD: Design of a non-inferiority randomized controlled trial

Background

Prolonged Exposure (PE), a trauma-focused therapy, is one of the most efficacious treatments available for PTSD. However, many people with PTSD do not lose their diagnosis following delivery of PE. The Unified Protocol (UP) for Transdiagnostic Treatment of Emotional Disorders is a non-trauma focused treatment that may offer an alternative treatment for PTSD.

Methods

This paper describes the study protocol for IMPACT, an assessor-blinded randomized controlled trial that examines the non-inferiority of UP relative to PE for participants who meet DSM-5 criteria for current PTSD. One hundred and twenty adult participants with PTSD will be randomized to receive either 10 × 90-min sessions of UP or PE with a trained provider. The primary outcome is severity of PTSD symptoms assessed by the Clinician Administered PTSD Scale for DSM-5 (CAPS-5) at post-treatment.

Discussion

While evidence-based treatments are available for PTSD, high levels of treatment dropout and non-response require new approaches to be tested. The UP is based on emotion regulation theory and is effective in treating anxiety and depressive disorders, however, there has been limited application to PTSD. This is the first rigorous study comparing UP to PE in a non-inferiority randomized controlled trial and may help improve clinical outcomes for those with PTSD.

Trial registration

This trial was prospectively registered with the Australian New Zealand Clinical Trials Registry, Trial ID (ACTRN12619000543189).

Familial hypercholesterolaemia: Experience of a tertiary paediatric lipid clinic

AIM

To review the experience of a dedicated paediatric multidisciplinary lipid clinic in the management of familial hypercholesterolaemia (FH) by studying the demographics, clinical presentations as well as statin therapy and outcomes.

METHODS

Retrospective database review of all patients under 18 years old seen in the lipid clinic at an Australian tertiary paediatric hospital between April 1999 and August 2017. Outcome measures collected included patient demographics, family history, lipid profile, age at treatment commencement, treatment outcomes and complications.

RESULTS

One hundred and eight patients (53 males) were seen in the lipid clinic. Eighty-five had low-density lipoprotein cholesterol (LDL-C) levels at or above the 75th percentile for sex prior to treatment. Of these, 75 had a first-degree relative with hypercholesterolaemia and/or early cardiac death. Four patients had clinical manifestations. Thirty-two patients (14 males) were started on statin therapy for likely FH. LDL-C levels reduced by 2.4 mmol/L (1.4 to 2.7) in boys and 1.9 mmol/L (0.8 to 2.8) in girls at 12 month follow-up. Five patients reported side effects requiring adjustment in therapy. Main reasons for not starting statin therapy in eligible patients were parental refusal and/or lost to follow up (77%).

CONCLUSION

A dedicated multidisciplinary lipid clinic is helpful for streamlining and monitoring management of paediatric FH. Clinical manifestations of FH are rare in children and may represent more severe form of FH or other lipid disorder. Statin therapy is efficacious and well tolerated but current recommended targets of treatment are difficult to attain. Greater awareness and coordinated services are required to overcome poor family engagement.

Fast track to health - Intermittent energy restriction in adolescents with obesity. A randomised controlled trial study protocol

BACKGROUND

Intermittent energy restriction (IER) has shown early success in adolescents with obesity, however efficacy trials are needed. This study aims to determine if IER results in lower body mass index (BMI) z-score after 52 weeks in metabolically unhealthy adolescents with obesity compared with continuous energy restriction (CER).

METHODS/DESIGN

This is a prospective, randomised, multi-centre trial conducted in tertiary care settings, with three phases: jumpstart (weeks 0-4); intensive intervention (weeks 5-16); continued intervention and/or maintenance (weeks 17-52). During the jumpstart phase, all participants follow a very low energy diet (∼800kcal/3350kJ/day), then transition to their allocated intervention: IER or CER. IER involves three energy-restricted days/week, consuming one-third of daily energy requirements (∼600-700kcal/2500-2950kJ/day), and four days/week of a healthy meal plan. The CER, which is current standard care, has individually tailored energy prescription based on age and sex (13-14years, 1430-1670kcal/6000-7000kJ/day; 15-17years, 1670-1900kcal/7000-8000kJ/day). The study will recruit 186 (93 per arm) treatment-seeking adolescents aged 13-17years with obesity and at least one metabolic co-morbidity. The primary outcome is change in BMI z-score at 52 weeks. Secondary outcomes are changes at 4, 16 and 52 weeks in: body composition; diet quality, food choices and food patterns; cardio-metabolic risk factors; physical activity and sedentary behaviour; sleep and psycho-behavioural measures.

DISCUSSION

This study challenges existing clinical paradigms that CER is the only method for weight management in metabolically unhealthy adolescents. If successful, IER may offer an alternate medical nutrition therapy approach for those seeking treatment in tertiary settings.

CLINICAL TRIAL REGISTRATION NUMBER

ACTRN12617001630303.

Can early weight loss, eating behaviors and socioeconomic factors predict successful weight loss at 12- and 24-months in adolescents with obesity and insulin resistance participating in a randomised controlled trial?

BACKGROUND

Lifestyle interventions in adolescents with obesity can result in weight loss following active intervention but individual responses vary widely. This study aimed to identify predictors of weight loss at 12- and 24-months in adolescents with obesity and clinical features of insulin resistance.

METHODS

Adolescents (n = 111, 66 girls, aged 10-17 years) were participants in a randomised controlled trial, the RESIST study, examining the effects of two diets differing in macronutrient content on insulin sensitivity. Eighty-five completed the 12-month program and 24-month follow-up data were available for 42 adolescents. Change in weight was determined by BMI expressed as a percentage of the 95th percentile (BMI95). The study physician collected socioeconomic data at baseline. Physical activity and screen time, and psychological dimensions of eating behavior were self-reported using the validated CLASS and EPI-C questionnaires, respectively. Stepwise multiple regressions were conducted to identify models that best predicted change in BMI95 at 12- and 24-months.

RESULTS

Mean BMI95 was reduced at 12-months compared with baseline (mean difference [MD] ± SE: -6.9 ± 1.0, P < 0.001) but adolescents had significant re-gain from 12- to 24-months (MD ± SE: 3.7 ± 1.5, P = 0.017). Participants who achieved greater 12-month weight loss had: greater 3-month weight loss, a father with a higher education, lower baseline external eating and parental pressure to eat scores and two parents living at home. Participants who achieved greater 24-month weight loss had: greater 12-month weight loss and a lower baseline emotional eating score.

CONCLUSIONS

Early weight loss is consistently identified as a strong predictor of long-term weight loss. This could be because early weight loss identifies those more motivated and engaged individuals. Patients who have baseline factors predictive of long-term weight loss failure may benefit from additional support during the intervention. Additionally, if a patient does not achieve early weight loss, further support or transition to an alternate intervention where they may have increased success may be considered.

TRIAL REGISTRATION

Australian New Zealand Clinical Trial Registration Number (ACTRN) 12608000416392 https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=83071.

Improved insulin sensitivity and body composition, irrespective of macronutrient intake, after a 12 month intervention in adolescents with pre-diabetes; RESIST a randomised control trial

Background

A higher protein to carbohydrate ratio in the diet may potentiate weight loss, improve body composition and cardiometabolic risk, including glucose homeostasis in adults. The aim of this randomised control trial was to determine the efficacy of two structured lifestyle interventions, differing in dietary macronutrient content, on insulin sensitivity and body composition in adolescents. We hypothesised that a moderate-carbohydrate (40-45% of energy), increased-protein (25-30%) diet would be more effective than a high-carbohydrate diet (55-60%), moderate-protein (15%) diet in improving outcomes in obese, insulin resistant adolescents.

Methods

Obese 10–17 year olds with either pre-diabetes and/or clinical features of insulin resistance were recruited at two hospitals in Sydney, Australia. At baseline adolescents were prescribed metformin and randomised to one of two energy restricted diets. The intervention included regular contact with the dietician and a supervised physical activity program. Outcomes included insulin sensitivity index measured by an oral glucose tolerance test and body composition measured by dual-energy x-ray absorptiometry at 12 months.

Results

Of the 111 adolescents recruited, 85 (77%) completed the intervention. BMI expressed as a percentage of the 95th percentile decreased by 6.8% [95% CI: −8.8 to −4.9], ISI increased by 0.2 [95% CI: 0.06 to 0.39] and percent body fat decreased by 2.4% [95% CI: −3.4 to −1.3]. There were no significant differences in outcomes between diet groups at any time.

Conclusion

When treated with metformin and an exercise program, a structured, reduced energy diet, which is either high-carbohydrate or moderate-carbohydrate with increased-protein, can achieve clinically significant improvements in obese adolescents at risk of type 2 diabetes.

Trial registration

Australian New Zealand Clinical Trail Registry ACTRN12608000416392. Registered 25 August 2008.

Effect of a prescriptive dietary intervention on psychological dimensions of eating behavior in obese adolescents

Background

Overweight adolescents are more likely to have dysfunctional eating behaviours compared to normal weight adolescents. Little is known about the effects of obesity treatment on the psychological dimensions of eating behavior in this population.

Objective

To examine the effects of a prescriptive dietary intervention on external eating (eating in response to food cues, regardless of hunger and satiety), emotional eating and dietary restraint and their relation to weight loss. Parental acceptability was also examined.

Method

This is a secondary study of a 12-month randomized trial, the RESIST study, which examined the effects of two diets on insulin sensitivity. Participants were 109 obese 10- to 17-year-olds with clinical features of insulin resistance. The program commenced with a 3-month dietary intervention using a structured meal plan, with the addition of an exercise intervention in the next 3 months and followed by a 6 month maintenance period.This paper presents changes in eating behaviors measured by the Eating Pattern Inventory for Children and parent rated diet acceptability during the first 6 months of the trial. As there was no difference between the diets on outcome of interest, both diet groups were combined for analyses.

Results

After 6 months, the proportion of participants who reported consuming more in response to external eating cues decreased from 17% to 5% (P = 0.003), whereas non- emotional eating increased from 48% to 65% (p = 0.014). Dietary restraint and parental pressure to eat remained unchanged. A reduction in external eating (rho = 0.36, P < 0.001) and a reduction in dietary restraint (r = 0.26, P = 0.013) were associated with greater weight loss at 3 and 6 months, respectively. Overall this approach was well accepted by parents with 72% of parents considered that their child would be able to follow the meal plan for the longer term.

Conclusions

In the short to medium term, a prescriptive dietary intervention approach is a well-accepted and suitable option for obese adolescents with clinical features of insulin resistance. It may reduce external and emotional eating, led to modest weight loss and did not cause any adverse effect on dietary restraint.

Trial registration

Australian New Zealand Clinical Trial Registration Number (ACTRN) 12608000416392 https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=83071

Optimal macronutrient content of the diet for adolescents with prediabetes; RESIST a randomised control trial

CONTEXT

Prediabetes and clinical insulin resistance in adolescents are rapidly emerging clinical problems with serious health outcomes.

OBJECTIVE

The objective of this study was to determine the efficacy of 2 structured lifestyle interventions, both differing in diet macronutrient composition, on insulin sensitivity.

DESIGN

This study was a randomized controlled trial, known as Researching Effective Strategies to Improve Insulin Sensitivity in Children and Teenagers, in 2 hospitals in Sydney, Australia.

PARTICIPANTS

Participants included overweight or obese 10- to 17-year-olds with either prediabetes and/or clinical features of insulin resistance.

INTERVENTION

At baseline adolescents were prescribed metformin and randomized to a structured diet, which was either high carbohydrate or moderate carbohydrate with increased protein. The program commenced with a 3-month dietary intervention, with the addition of an exercise intervention in the next 3 months.

OUTCOMES

The outcomes included an insulin sensitivity, anthropometry, and cardiometabolic profile at 6 months.

RESULTS

One hundred eleven subjects (66 girls) were recruited and 98 subjects (58 girls) completed the 6-month intervention. After 3 months the mean insulin sensitivity index increased by 0.3 [95% confidence interval (CI) 0.2-0.4]. After 6 months the mean insulin (picomoles per liter) to glucose ratio (millimoles per liter) decreased by 7.2 [95%CI -12.0 to -2.3], body mass index, expressed as a percentage of the 95th centile, decreased by 9% (95% CI -3 to -15), but there was no significant change in the lipids. There were no significant differences in outcomes between the diet groups at any time point.

CONCLUSIONS

These results are in contrast with our hypothesis that adolescents randomized to the increased protein diet would have better outcomes. Further strategies are required to better address prediabetes and clinical features of insulin resistance in adolescents.

Researching Effective Strategies to Improve Insulin Sensitivity in Children and Teenagers - RESIST. A randomised control trial investigating the effects of two different diets on insulin sensitivity in young people with insulin resistance and/or pre-diabetes

BACKGROUND

Concomitant with the rise in childhood obesity there has been a significant increase in the number of adolescents with clinical features of insulin resistance and prediabetes. Clinical insulin resistance and prediabetes are likely to progress to type 2 diabetes and early atherosclerosis if not targeted for early intervention. There are no efficacy trials of lifestyle intervention in this group to inform clinical practice. The primary aim of this randomised control trial (RCT) is to determine the efficacy and effectiveness of two different structured lifestyle interventions differing in diet composition on insulin sensitivity, in adolescents with clinical insulin resistance and/or prediabetes treated with metformin.

METHODS/DESIGN

This study protocol describes the design of an ongoing RCT. We are recruiting 108 (54 each treatment arm) 10 to 17 year olds with clinical features of insulin resistance and/or prediabetes, through physician referral, into a multi-centred RCT. All participants are prescribed metformin and participate in a diet and exercise program. The lifestyle program is the same for all participants except for diet composition. The diets are a high carbohydrate, low fat diet and a moderate carbohydrate, increased protein diet.The program commences with an intensive 3 month dietary intervention, implemented by trained dietitians, followed by a 3 month intensive gym and home based exercise program, supervised by certified physical trainers. To measure the longer term effectiveness, after the intensive intervention trial participants are managed by either their usual physician or study physician and followed up by the study dietitians for an additional 6 months. The primary outcome measure, change in insulin sensitivity, is measured at 3, 6 and 12 months.

DISCUSSION

Clinical insulin resistance and prediabetes in the paediatric population are rapidly emerging clinical problems with serious health outcomes. With appropriate management these conditions are potentially reversible or at least their progression can be delayed. This research study is the first trial designed to provide much needed data on the effective dietary management for this cohort. This study will inform clinical practice guidelines for adolescents with clinical insulin resistance and may assist in preventing metabolic complications, type 2 diabetes and early cardiovascular disease.

TRIAL REGISTRATION

Australian and New Zealand Clinical Trials Registration Number ACTRN12608000416392.

Tamoxifen and epigallocatechin gallate are synergistically cytotoxic to MDA-MB-231 human breast cancer cells

High concentrations of specific catechins [epigallocatechin gallate (EGCG), epigallocatechin (EGC) and epicatechin gallate (ECG)] inhibit the proliferation of many different cancer cell lines. The aim of this work was to determine if low concentrations of catechins with and without 4-hydroxytamoxifen (4-OHT) co-treatment would cause significant cytotoxicity in estrogen receptor-positive (ERalpha+) and -negative (ERalpha-) human breast cancer cells. Therefore, MCF-7, T47D, MDA-MB-231 and HS578T cells were incubated with EGCG, EGC or ECG (5-25 microM) individually and in combination with 4-OHT for 7 days. Cell number was determined by the sulforhodamine B cell proliferation assay. As single agents, none of the catechins were cytotoxic to T47D cells, while only EGCG (20 microM) elicited cytotoxicity in MCF-7 cells. Additionally, no benefit was gained by combination treatment with 4-OHT. ERalpha- human breast cancer cells were more susceptible as all three catechins were significantly cytotoxic to HS578T cells at concentrations of 10 microM. In this cell line, combination with 4-OHT did not increase cytotoxicity. However, the most striking results were produced in MDA-MB-231 cells. In this cell line, EGCG (25 microM) produced a greater cytotoxic effect than 4-OHT (1 microM) and the combination of the two resulted in synergistic cytotoxicity. In conclusion, low concentrations of catechins are cytotoxic to ERalpha- human breast cancer cells, and the combination of EGCG and 4-OHT elicits synergistic cytotoxicity in MDA-MB-231 cells.

Use of quetiapine in bipolar disorder: a case series with prospective evaluation

Quetiapine, a new atypical antipsychotic, was added to ongoing treatment of bipolar I outpatients (n=15) for symptoms of illness (mood lability, irritability, psychosis and/or difficulty sleeping). All evaluations were prospectively obtained, with the majority of patients (n=9) showing much or very much improvement on the Clinical Global Impression for Bipolar Disorder (CGI-BP). Somatic complaints were limited. Mean (SD) duration before changes in medication regimens was 134 (100) days. Studies of the use of quetiapine in maintenance treatment of bipolar disorder are warranted.

Salivary cortisol levels in children adopted from romanian orphanages

Six and a half years after adoption. 6- to 12-year-old children reared in Romanian orphanages for more than 8 months in their first years of life (RO. n = 18) had higher cortisol levels over the daytime hours than did early adopted (EA, < or = 4 months of age, n = 15) and Canadian born (CB, n = 27) children. The effect was marked, with 22% of the RO children exhibiting cortisol levels averaged over the day that exceeded the mean plus 2 SD of the EA and CB levels. Furthermore, the longer beyond 8 months that the RO children remained institutionalized the higher their cortisol levels. Cortisol levels for EA children did not differ in any respect from those of CB comparison children. This latter finding reduces but does not eliminate concerns that the results could be due to prenatal effects or birth family characteristics associated with orphanage placement. Neither age at cortisol sampling nor low IQ measured earlier appeared to explain the findings. Because the conditions in Romanian orphanages at the time these children were adopted were characterized by multiple risk factors, including gross privation of basic needs and exposure to infectious agents, the factor(s) that produced the increase in cortisol production cannot be determined. Nor could we determine whether these results reflected effects on the limbic-hypothalamic-pituitary-adrenal axis directly or were mediated by differences in parent-child interactions or family stress occasion by behavioral problems associated with prolonged orphanage care in this sample.

Effect of foot and ankle position on tarsal tunnel compartment pressure

Tarsal tunnel intracompartment pressures were determined in 10 fresh-frozen normal human adult cadaver specimens. With the foot and ankle held in mild plantarflexion and neutral eversion-inversion, mean tarsal tunnel pressure was minimal (2 +/- 1 mmHg). However, when the foot and ankle were positioned in full eversion, mean tarsal tunnel pressure increased to 32 +/- 5 mmHg (P < or = 0.005); in full inversion, mean pressure increased to 17 +/- 5 mmHg (P < or = 0.05). There was no significant difference in mean tarsal tunnel pressure between the everted and inverted positions. These results support the hypothesis that increased pressure within the tarsal tunnel when the foot is moved into the everted or inverted position may aggravate posterior tibial nerve entrapment. These findings may also provide an explanation for clinically observed aggravation of symptoms in these positions, night pain, and improvement of symptoms with neutral immobilization in some patients with tarsal tunnel syndrome.

A three year follow-up of attachment and indiscriminate friendliness in children adopted from Romanian orphanages

Attachment and indiscriminately friendly behavior were assessed in children who had spent at least 8 months in a Romanian orphanage (RO) and two comparison groups of children: a Canadian-born, nonadopted, never institutionalized comparison group (CB) and an early adopted comparison group adopted from Romania before the age of 4 months (EA). Attachment was assessed using 2 measures: an attachment security questionnaire based on parent report, and a Separation Reunion procedure that was coded using the Preschool Assessment of Attachment. Indiscriminately friendly behavior was examined using parents' responses to 5 questions about their children's behavior with new adults. Although RO children did not score differently from either CB or EA children on the attachment security measure based on parent report, they did display significantly more insecure attachment patterns than did children in the other 2 groups. In addition, RO children displayed significantly more indiscriminately friendly behavior than both CB and EA children, who did not differ in terms of indiscriminate friendliness. RO children's insecure attachment patterns were not associated with any aspect of their institutional environment, but were related to particular child and family characteristics. Specifically, insecure RO children had more behavior problems, scored lower on the Stanford-Binet Intelligence Scale, and had parents who reported significantly more parenting stress than RO children classified as secure.

Analysis of 50 patients with atypical odontalgia. A preliminary report on pharmacological procedures for diagnosis and treatment

Atypical odontalgia is a distressing and unusual chronic orofacial pain condition. It is often difficult to diagnose because it is associated with a lack of clinical and radiographic abnormalities. The condition is poorly understood on a pathophysiological basis, and patients often undergo repetitive and unnecessary dental procedures in attempts to alleviate pain. In this study, 50 patients diagnosed with odontalgia were evaluated by pharmacological procedures, including topical anesthetic application and phentolamine infusion. Results of these pharmacological procedures suggest that atypical odontalgia is a neuropathic pain of the oral cavity that may have a component of sympathetically maintained pain. Therapeutic trials of topical capsaicin were carried out to assess its efficacy for pain reduction. Topical capsaicin was effective in most patients.

Verbal and facial measures of children's emotion and empathy

The purpose of this study was to assess the relationship between two theoretically distinct aspects of children's emotional responses (Lewis & Michalson, 1983), their emotional experience (via verbal report) and emotional state (via nonverbal expression), in response to emotion-evoking stimuli. A related objective was to assess the concordance of these two verbal and nonverbal measures as indices of empathy, i.e., affective responses consistent with those of stimulus persons. Facial expressions of 60 10-year-old girls were unobtrusively videotaped while they individually viewed six stimulus vignettes. Half of these children pressed a button to indicate awareness of emotional arousal while viewing stimuli; half served as controls. Results indicated that emotional and empathic responses were not affected by the button press procedure, or by a social desirability response set. Expressive responses at button presses were microanalytically analyzed using AFFEX. Postviewing interviews assessed children's reported emotions and the affect match (empathy) between children's reported emotion for themselves and stimulus characters. Results indicated modest associations between the emotions children reported and those facially displayed and similar associations between children's verbal and facial empathy scores. Results address the concurrent validity of different measures of children's emotions, and contribute to the small number of extant multimethod studies on children's emotional responses and empathy.

Concentration-dependent effect of iron on gamma-linolenic acid toxicity in ZR-75-1 human breast tumor cells in culture

Polyunsaturated fatty acids are cytotoxic to ZR-75-1 human breast tumor cells in culture. This effect may be potentiated by the simultaneous addition of iron. When cytotoxicity was measured in the presence of different concentrations of both gamma-linolenic acid and ferrous chloride there was an increase in cell death above concentrations of 9 microM and 0.05 microM, respectively. The potentiation of the effects of 18:3n-6 at low concentrations by the simultaneous addition of Fe(II) ions supports the contention that an alteration in the intracellular Fe(II)/Fe(III) ratio is necessary to promote autocatalytic lipid peroxidation.

Intracellular free Fatty-Acid release and lipid-peroxidation in cultured human breast-cancer cells in response to gamma-linolenic Acid with iron (gla + fe)

Intracellular free fatty acid (FFA) release and peroxidation of polyunsaturated fatty acid (PUFA) were studied in cultured human breast cancer cells (ZR-75-1) exposed to gamma-linolenic acid with iron (GLA + Fe). This treatment results in cell death. Increased intracellular FFA were observed in association with both the accelerated peroxidation of PUFA and the killing effect. Vitamin E reduced all three effects. The FFA were methyl esterified and analyzed by gas chromatography-mass spectrometry. The identified FFAs were 16: 0, 18: 3, 20: 3 and 20: 4 (numbers of carbons and double bonds indicated). These results suggest an association of intracellular FFA release with the peroxidation of PUFA and the cancer cell-killing by GLA in the presence of iron.

Cholesterol-lowering effect of a low-fat diet containing lean beef is reversed by the addition of beef fat

The aim of this study was to differentiate between lean beef and beef fat as risk factors for elevated plasma cholesterol concentrations. Ten healthy weight-stable subjects (five men, five women) participated. Energy intake was kept constant over the 5-wk study. Total cholesterol concentrations fell significantly within 1 wk of commencing the very-low fat (9%) energy from fat) lean-beef (500 g/d) diet (5.91 +/- 0.47 to 4.72 +/- 0.42 mmol/L, p less than 0.001) and rose as beef drippings were added in a stepwise manner in weeks 4 and 5 (5.45 +/- 0.56 mmol/L in week 5). The changes in total cholesterol concentrations were due almost entirely to changes in the concentration of low-density lipoprotein cholesterol levels. These results indicate that it is the beef fat, not lean beef itself, that is associated with elevations in cholesterol concentrations and that lean beef can be included in cholesterol-lowering diets provided it is free of all visible fat and the saturated fatty acid content of the diet is low.

Effect of short-term consumption of a high-fat, low-carbohydrate diet on metabolic control in insulin-deficient diabetic rats

This study examined the effect of changing the proportion of dietary fat on metabolic control in rats rendered mildly diabetic with streptozotocin (STZ). The high-fat (HF) diet contained 66% energy as fat and 12% as carbohydrate while the low-fat (LF) diet contained 12% energy as fat and 66% as carbohydrate. Both diets had a P/S ratio of 1:3. Young male rats weighing 100 g were treated with STZ (60 mg/kg IV) and randomly allocated to either the LF of HF diet. After 2 weeks, the fasting plasma glucose concentrations were significantly higher in the HF-STZ rats than in the LF-STZ rats (13.2 +/- 1.2 mmol/L v 7.1 +/- 0.8 mmol/L, respectively, P less than 0.001). The increase in plasma glucose above the basal level following the intravenous glucose load (0.5 g/kg body wt) was similar in both groups of STZ-treated rats and glucose clearance was similarly impaired. The fall in glucose concentrations in the 30 minutes following the IV insulin (0.5 U Actrapid insulin/kg body wt) was greater in the LF-STZ rats (delta AUC = -1.60 +/- 0.20 mmol/L 0.5h) than in the HF-STZ group (delta AUC = -0.97 +/- 0.20 mmol/L 0.5 h, P less than 0.05) and either of the control groups (delta AUC = -0.94 +/- 0.37, -0.83 +/- 0.09 mmol/L 0.5 h for LF and HF rats, respectively, P less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

More severe impairment of oral than intravenous glucose tolerance in rats after eating a high fat diet

Glucose and insulin responses to oral and intravenous glucose (1 g/kg body weight) were measured after consumption of a high fat (HF) or low fat (LF) diet for 3 wk in conscious rats with implanted intravenous and intra-arterial catheters. The HF diet resulted in impaired glucose tolerance and insulin resistance after both oral and intravenous glucose; the effect was more pronounced after oral glucose. In an attempt to understand the basis of the impairment of glucose tolerance after consuming the HF diet, the activity of hepatic glucokinase and the rate of intestinal glucose uptake were also measured. The more severe impairment of glucose tolerance by oral rather than intravenous administration was not explained by an increased rate of intestinal glucose uptake. Indeed, there was a small but significant reduction in the rate of jejunal glucose uptake in the HF rats. However, the greatly reduced activity of hepatic glucokinase in the HF rats was consistent with a reduced capacity for hepatic glucose uptake, which may have contributed significantly to the impaired glucose tolerance. The effects of the HF diet on the insulin response to glucose were much more pronounced after oral rather than intravenous glucose administration. This indicated that the HF diet may have stimulated the enteroinsular axis. However, it is also possible that the particularly high circulating insulin levels, resulting from oral glucose in the HF rats, were a direct response to hyperglycemia, secondary to reduced glucose removal.