Asymptomatic Hypothyroidism and Hypercholesterolemia

Hypothyroidism is a cause of secondary hyperlipidaemia. This study investigates the frequency of biochemically diagnosed hypothyroidism and its relationship with plasma cholesterol concentration in apparently healthy people.

Thyroid function tests (total T4, TSH, and free T4) were performed on 272 apparently healthy men and women (179 vegetarians, 93 meat eaters) with a plasma cholesterol concentration above 7 mmol/l and on 90 individuals with a plasma cholesterol below 4.1 mmol/l who were matched for age, sex and dietary habits.

Six per cent of those with a plasma cholesterol above 7 mmol/l had biochemical evidence of hypothyroidism as defined by a TSH greater than 10 mIU/l (reference range 1–6) and a low free T4 below 10 pmol/l (reference range 10.1–25). Eighty per cent of these people had a high titre of thyroid anti-microsomal antibodies. Of the 90 individuals with a plasma cholesterol level below 4.1 and the 25 randomly selected participants none had biochemical evidence of hypothyroidism.

Hypothyroidism is relatively common in apparently healthy people with a raised plasma cholesterol. It appears no commoner in vegetarians than in meat eaters.

Adhesion of Escherichia coli under flow conditions reveals potential novel effects of FimH mutations

FimH-mediated adhesion of Escherichia coli to bladder epithelium is a prerequisite for urinary tract infections. FimH is also essential for blood-borne bacterial dissemination, but the mechanisms are poorly understood. The purpose of this study was to assess the influence of different FimH mutations on bacterial adhesion using a novel adhesion assay, which models the physiological flow conditions bacteria are exposed to. We introduced 12 different point mutations in the mannose binding pocket of FimH in an E. coli strain expressing type 1 fimbriae only (MSC95-FimH). We compared the bacterial adhesion of each mutant across several commonly used adhesion assays, including agglutination of yeast, adhesion to mono- and tri-mannosylated substrates, and static adhesion to bladder epithelial and endothelial cells. We performed a comparison of these assays to a novel method that we developed to study bacterial adhesion to mammalian cells under flow conditions. We showed that E. coli MSC95-FimH adheres more efficiently to microvascular endothelium than to bladder epithelium, and that only endothelium supports adhesion at physiological shear stress. The results confirmed that mannose binding pocket mutations abrogated adhesion. We demonstrated that FimH residues E50 and T53 are crucial for adhesion under flow conditions. The coating of endothelial cells on biochips and modelling of physiological flow conditions enabled us to identify FimH residues crucial for adhesion. These results provide novel insights into screening methods to determine the effect of FimH mutants and potentially FimH antagonists.

Reflections on the Yearbook from the 1990's to the Present

The authors highlight IMIA's progress over the past twenty years as a key bridging organization that translates health informatics theory into practice. In contrast, they describe that electronic health record (EHR) systems built in the 20th Century are not meeting the needs of clinical users. Moreover, these EHRs are not architected to keep pace with the rapid changes in the evolving health ecosystem. They conclude that 21st Century health IT systems need to be architected into an ecosystem-wide suite of interacting complex adaptive systems that support individuals, clinicians, managers and policy-makers with the high value/high usability computing paradigm that dominates the Internet today.

Persistence of Human Papillomavirus, Overexpression of p53, and Outcomes of Patients After Endoscopic Ablation of Barrett's Esophagus

We investigated the role of high-risk human papillomavirus (hr-HPV) in patients with Barrett's dysplasia and adenocarcinoma (EAC). Clearance vs persistence of HPV (DNA, E6 or E7 mRNA, and p16INK4A protein) and overexpression or mutation of p53 were determined for 40 patients who underwent endotherapy for Barrett's dysplasia or EAC. After ablation, dysplasia or neoplasia was eradicated in 34 subjects (24 squamous, 10 intestinal metaplasia). Six patients had detectable lesions after treatment; 2 were positive for transcriptionally active hr-HPV, and 4 had overexpression of p53. Before endotherapy, 15 patients had biologically active hr-HPV, 13 cleared the infection with treatment, and dysplasia or EAC was eliminated from 12 patients. One patient who cleared HPV after ablation acquired a p53 mutation, and their cancer progressed. Of 13 patients with overexpression of p53 before treatment, 10 cleared the p53 abnormality after ablation with eradication of dysplasia or neoplasia, whereas 3 of 13 had persistent p53 mutation-associated dysplasia after endotherapy (P = .004). Immunohistochemical and sequence analyses of p53 produced concordant results for 36 of 40 samples (90%). Detection of dysplasia or neoplasia after treatment was associated with HPV persistence or continued p53 overexpression.

Omega-3 dietary Fatty Acid status of healthy older adults in Tasmania, Australia: an observational study

OBJECTIVES

To determine the dietary and supplement intake of omega-3 (n-3) polyunsaturated fatty acids (PUFA) of older Tasmanian adults; their plasma n-3 PUFA status and the relationship between n-3 PUFA intake and plasma status.

DESIGN

Cross-sectional study.

SETTING

Launceston and surrounding regions, Tasmania, Australia.

PARTICIPANTS

Seventy-three community-dwelling older adults: 23 men aged 70 ± 6.1 years and 50 women aged 70 ± 6.7 years.

MEASUREMENTS

A validated, semi-quantitative food frequency questionnaire estimated dietary PUFA intake. The plasma phospholipid fraction of venous blood samples was analysed for fatty acid content. Anthropometric data was recorded.

RESULTS

Thirty-five participants (48%) regularly ingested a fish oil supplement. Their plasma n-3 PUFA profile contained significantly more eicosapentaenoic acid (EPA) (odds ratio 3.14; 95% CI 1.37% to 7.30%; p<0.05) and docosahexaenoic acid (DHA) (odds ratio 2.64; 95% CI 1.16% to 6.01%; p<0.05) than non-supplement users. Fish and meat were the main dietary sources of n-3 PUFAs. Participants most commonly consumed fish 3-4 times per week. Significant associations of dietary α-linolenic acid (ALA), EPA, docosapentaenoic acid (DPA) and DHA with plasma n-3 PUFAs were noted but not always between dietary and plasma counterparts.

CONCLUSION

Without the use of fish oil supplements, most study participants were unable to meet the recommended daily intake of 0.5g EPA and DHA combined; however, the plasma n-3 PUFA profile of non-supplement-users was still robust compared to other Australian and overseas studies.

Can probiotic yogurt prevent diarrhoea in children on antibiotics? A double-blind, randomised, placebo-controlled study

OBJECTIVE

To estimate the efficacy of a probiotic yogurt compared to a pasteurised yogurt for the prevention of antibiotic-associated diarrhoea in children.

DESIGN AND SETTING

This was a multisite, randomised, double-blind, placebo-controlled clinical trial conducted between September 2009 and 2012. The study was conducted through general practices and pharmacies in Launceston, Tasmania, Australia.

PARTICIPANTS AND INTERVENTIONS

Children (aged 1-12 years) prescribed antibiotics, were randomised to receive 200 g/day of either yogurt (probiotic) containing Lactobacillus rhamnosus GG (LGG), Bifidobacterium lactis (Bb-12) and Lactobacillus acidophilus (La-5) or a pasteurised yogurt (placebo) for the same duration as their antibiotic treatment.

OUTCOMES

Stool frequency and consistency were recorded for the duration of treatment plus 1 week. Primary outcome was stool frequency and consistency, classified at different levels of diarrhoea severity. Due to the small number of cases of diarrhoea, comparisons between groups were made using Fisher's exact analysis.

RESULTS

72 children commenced and 70 children (36 placebo and 34 probiotic) completed the trial. There were no incidents of severe diarrhoea (stool consistency ≥6, ≥3 stools/day for ≥2 consecutive days) in the probiotic group and six in the placebo group (Fisher's exact p=0.025). There was also only one episode of minor diarrhoea (stool consistency ≥5, ≥2 stools/day for ≥2 days in the probiotic group compared to 21 in the placebo group (Fisher's exact p<0.001). The probiotic group reported fewer adverse events (1 had abdominal pain, 1 vomited and 1 had headache) than the placebo group (6 had abdominal pain, 4 had loss of appetite and 1 had nausea).

CONCLUSIONS

A yogurt combination of LGG, La-5 and Bb-12 is an effective method for reducing the incidence of antibiotic-associated diarrhoea in children.

TRIAL REGISTRATION NUMBER

Australian New Zealand Clinical Trials Registry ACTRN12609000281291.

Selected micronutrient intake and status in men with differing meat intakes, vegetarians and vegans

Dietary factors play a critical role in human health. The aim of this cross-sectional study was to examine micronutrient intake and status of subjects who were habitual meat eaters eating different quantities of meat with those who were habitual vegetarians or vegans. One hundred and thirty-nine healthy male subjects (vegan, n = 18; ovolacto-vegetarian, n = 46; moderate meat-eater, n = 65; and high meat-eater, n = 18) aged 20-55 years were recruited in metropolitan Melbourne. Each volunteer completed a semiquantitative Food Frequency Questionnaire (FFQ) and gave a fasting venous blood sample. Dietary sodium/potassium ratio was significantly lower and vitamin C, fibre and iron intakes were higher in vegetarians than in meat-eaters. High meat-eaters had a significantly higher calcium, retinol and zinc intake than did the other three dietary groups; moderate meateaters had the lowest mean intake of fibre, vitamin C and β-carotene. Vegans had a significantly higher β-carotene intake than did the other groups. Serum ferritin and vitamin B12 levels, and haemoglobin concentration were significantly lower in vegetarians than in meat-eaters. Vegans had a significantly higher serum folate concentration than did ovolacto-vegetarian and moderate meat-eater groups. There was no significant difference in serum α-tocopherol concentration. There are differences between the four diet groups that have potential to affect the subjects' health and susceptibility to chronic diseases including cardiovascular disease and cancer. Based on the present data, high meat-eaters may particularly benefit from altering their dietary pattern to reduce their sodium and saturated fat intake, and moderate meat-eaters from increasing their fibre and antioxidant consumption. Vegetarians, especially vegans, may need to increase their vitamin B12 and zinc intakes.

Transcriptionally active human papillomavirus is strongly associated with Barrett's dysplasia and esophageal adenocarcinoma

OBJECTIVES

The role of human papillomavirus (HPV) in Barrett's esophagus (BE) remains unclear. The few studies that have previously investigated HPV and esophageal adenocarcinoma (EAC) or BE have produced either negative data or positive results of doubtful clinical/etiological significance or have detected only low-risk HPV types. We therefore prospectively determined the prevalence of biologically active HPV in esophageal epithelium of patients representing the Barrett's metaplasia-dysplasia-adenocarcinoma sequence.

METHODS

HPV DNA was estimated by nested PCR and viral transcriptional activity detected by E6/7 oncogene mRNA expression and p16INK4A immunohistochemistry in fresh frozen and paraffin-embedded esophageal biopsies of patients with BE, Barrett's dysplasia (BD), and EAC, as well as controls. Biopsies were obtained from the transformation zone (squamocolumnar junction (SCJ)) and the lesion, or corresponding site in controls, i.e., 2 cm above the gastroesophageal junction (GEJ).

RESULTS

Of the 261 patients, 81 were positive for HPV DNA. In controls and BE, the virus was mostly detected at the transformation zone. Compared with controls (18.0%), HPV positivity was significantly more common in BD (68.6%, incidence rate ratio (IRR) 2.94, 95% confidence interval (CI) 1.78-4.85, P<0.001) and EAC (66.7%, IRR 2.87, 95% CI 1.69-4.86, P<0.001), but not in BE (22.1%, IRR 1.06, 95% CI 0.60-1.85, P=0.85). Of the patients, 92.6% were high-risk (HR) HPV, i.e., types 16 and 18. Again, p16INK4A positivity was greatest in BD and EAC and much less in BE patients (44.1%, IRR 17.0 (95% CI 4.86-59.6, P<0.001), 44.4%, 17.0 (95% CI 4.87-59.4, P<0.001), and 10.6%, 3.93 (95% CI 1.01-15.3, P=0.048) respectively). In 66 HPV DNA-positive patients tested for E6/E7 mRNA, none of the control (n=16) or BE (n=13) individuals were positive, whereas 9/22 BD and 9/15 EAC patients demonstrated oncogene expression (P<0.001). When HPV DNA, p16INK4A, and E6/E7 mRNA were all positive, there was a very strong association with disease severity (SCJ: odds ratio (OR) 104, 95% CI 20.3-529, P<0.001; lesion: OR 62.2, 95% CI 12.4-311, P<0.001) than when all were negative.

CONCLUSIONS

Transcriptionally active HR-HPV was strongly associated with BD and EAC, but was largely biologically irrelevant in BE and controls, suggesting a potential role in esophageal carcinogenesis. These data provide robust justification for further detailed longitudinal, interventional, and molecular studies.

Serum [25(OH)D] status, ankle strength and activity show seasonal variation in older adults: relevance for winter falls in higher latitudes

BACKGROUND

seasonal variation exists in serum [25(OH)D] and physical activity, especially at higher latitudes, and these factors impact lower limb strength. This study investigates seasonal variation in leg strength in a longitudinal repeated measures design concurrently with serum vitamin D and physical activity.

METHODS

eighty-eight community-dwelling independently mobile older adults (69.2 ± 6.5 years) were evaluated five times over a year, at the end of five consecutive seasons at latitude 41.1°S, recruited in two cohorts. Leg strength, serum [25(OH)D] and physical activity levels were measured. Time spent outside was recorded. Monthly falls diaries recorded falls. Data were analysed to determine annual means and percentage changes.

RESULTS

significant variation in [25(OH)D] (±15%), physical activity (±13%), ankle dorsiflexion strength (±8%) and hours spent outside (±20%) (all P < 0.001) was demonstrated over the year, with maximums in January and February (mid-summer). Low mean ankle strength was associated with increased incidence of falling (P = 0.047). Quadriceps strength did not change (±2%; P = 0.53).

CONCLUSION

ankle dorsiflexor strength varied seasonally. Increased ankle strength in summer may be influenced by increased levels of outdoors activity over the summer months. Reduced winter-time dorsiflexor strength may predispose older people to increased risk of tripping-related falls, and warrants investigation in a multi-faceted falls prevention programme.

Progressive resistance training might improve vascular function in older women but not in older men

OBJECTIVES

Resistance exercise training increases strength and muscle mass in older adults however there is no consensus for its effect on arterial health. The aim of this study was to determine the effect of community based resistance training versus flexibility training on indicators of arterial stiffness and central blood pressure in healthy older adults and to test whether the effects of training are gender specific.

DESIGN

A randomised crossover intervention study.

METHODS

Forty-nine healthy elderly participants (23 males) aged 66.7±4.3 years (mean±SD) participated in this study which involved undertaking 16 weeks of resistance training and 16 weeks of flexibility training in a random order separated by a four week washout period of usual activity. Prior to and following each training protocol period, participants underwent testing of arterial stiffness as augmentation index; and central blood pressure.

RESULTS

When all participants were compared no changes in any measure of arterial stiffness or central blood pressure following resistance training compared to flexibility training were found. When male and female participants were analysed separately, a statistically significant decrease in augmentation index was observed in females (-5.28%; 95% CI: -10.29 to -0.26; p=0.04) but not males (+1.72%; 95% CI: -3.04 to 6.48; p=0.48).

CONCLUSIONS

Community based resistance exercise training does not adversely affect vascular function in apparently healthy older adults and may actually improve arterial function in females.

Relationships between single nucleotide polymorphisms of antioxidant enzymes and disease

The presence and progression of numerous diseases have been linked to deficiencies in antioxidant systems. The relationships between single nucleotide polymorphisms (SNPs) arising from specific antioxidant enzymes and diseases associated with elevated oxidative stress have been studied with the rationale that they may be useful in screening for diseases. The purpose of this narrative review is to analyse evidence from these studies. The antioxidant enzyme SNPs selected for analysis are based on those most frequently investigated in relation to diseases in humans: superoxide dismutase (SOD2) Ala16Val (80 studies), glutathione peroxidise (GPx1) Pro197Leu (24 studies) and catalase C-262T (22 studies). Although the majority of evidence supports associations between the SOD2 Ala16Val SNP and diseases such as breast, prostate and lung cancers, diabetes and cardiovascular disease, the presence of the SOD2 Ala16Val SNP confers only a small, clinically insignificant reduction (if any) in the risk of these diseases. Other diseases such as bladder cancer, liver disease, nervous system pathologies and asthma have not been consistently related to this SOD SNP genotype. The GPx1 Pro197Leu and catalase C-262T SNP genotypes have been associated with breast cancer, but only in a small number of studies. Thus, currently available evidence suggests antioxidant enzyme SNP genotypes are not useful for screening for diseases in humans.

Effect of hereditary haemochromatosis genotypes and iron overload on other trace elements

PURPOSE

Hereditary haemochromatosis is a common genetic disorder involving dysregulation of iron absorption. There is some evidence to suggest that abnormal iron absorption and metabolism may influence the status of other important trace elements. In this study, the effect of abnormal HFE genotypes and associated iron overload on the status of other trace elements was examined.

METHODS

Dietary data and blood samples were collected from 199 subjects (mean age = 55.4 years; range = 21-81 years). Dietary intakes, serum selenium, copper and zinc concentrations and related antioxidant enzymes (glutathione peroxidase and superoxide dismutase) in subjects with normal HFE genotype (n = 118) were compared to those with abnormal HFE genotype, with both normal iron status (n = 42) and iron overload (n = 39).

RESULTS

For most dietary and biochemical variables measured, there were no significant differences between study groups. Red cell GPx was significantly higher in male subjects with normal genotypes and normal iron status compared to those with abnormal genotypes and normal iron status (P = 0.03) or iron overload (P = 0.001). Red cell GPx was also highest in normal women and significantly lower in the abnormal genotype and normal iron group (P = 0.016), but not in the iron overload group (P = 0.078).

CONCLUSION

Although it may not be possible to exclude a small effect between the genotype groups on RBC GPx, overall, haemochromatosis genotypes or iron overload did not appear to have a significant effect on selenium, copper or zinc status.

Cardiovascular and metabolic effects of community based resistance training in an older population

Ageing is associated with decreases in strength and cardiovascular fitness, and increased cardiovascular risk factors. The aim of the current study was to determine the effectiveness of 16 weeks of community based resistance compared to flexibility training on strength, cardiovascular fitness and cardiovascular and metabolic parameters in a group of previously sedentary, healthy older men and women. A randomised controlled crossover intervention study. Forty nine healthy sedentary participants (23 males; age 66.7 ± 4.3 years; weight 78.6 ± 15.4 kg; mean ± SD) completed 16 weeks of supervised community-based resistance training and 16 weeks of flexibility training in a randomised order. Prior to and following each intervention, participants were assessed for muscle strength, cardiovascular fitness (VO(2 peak)), fasted blood lipids and blood glucose, insulin and insulin resistance. Resistance training resulted in significant increases in knee extension (+25.7 Nm; p < 0.001) and knee flexion strength (+8.9 Nm; p = 0.048) and decreases in fasting total cholesterol (-0.51 mmol L(-1); p = 0.001), HDL cholesterol (-0.12 mmol L(-1); p = 0.035), LDL cholesterol (-0.35 mmol L(-1); p = 0.022), glucose (-0.42 mmol L(-1); p < 0.001), insulin (-1.28 μU/mL; p = 0.049) and insulin resistance (-0.50 μU/mL; p = 0.004) compared to the flexibility protocol. No significant changes between the treatments were observed in VO(2peak) (+2.04 mL kg(-1)min(-1); p = 0.12). Community based resistance training is suitable for improving strength and reducing cardiovascular and metabolic risk factors in healthy older individuals.

Glutathione peroxidase, superoxide dismutase and catalase genotypes and activities and the progression of chronic kidney disease

BACKGROUND

Oxidative stress has been linked to the progression of disease, including chronic kidney disease (CKD). The aim of the present study was to determine the association between single-nucleotide polymorphisms (SNPs) of the antioxidant enzymes, superoxide dismutase (SOD), glutathione peroxidase (GPx) and catalase and their activities and the progression of CKD.

METHODS

This is a prospective cohort study of 185 CKD patients (Stages 2-4), followed for up to 12 months. All patients were genotyped for SNPs of SOD (SOD Ala16Val), GPx (GPx Pro197Leu) and catalase (C-262T). The rate of change over the study period of estimated glomerular filtration rate (eGFR), plasma and red blood cell (RBC) GPx, RBC SOD and RBC catalase activities were determined.

RESULTS

CKD patients with the SOD Ala/Val and Val/Val genotypes had a significantly greater eGFR decline compared to those with the Ala/Ala genotype (Ala/Val compared with Ala/Ala odds ratio (OR) 0.35, 95% CI 0.19 to 0.64, P = 0.001; Val/Val compared with Ala/Ala OR 0.25, 95% CI 0.10 to 0.65, P = 0.005). The progression of CKD was not associated with SNPs of the GPx or catalase genes studied but there was a direct relationship between the rate of change of plasma GPx activity and the rate of change of eGFR over 12 months (P = 0.025).

CONCLUSION

CKD patients with the SOD Ala/Val and Val/Val genotypes have a greater decline in kidney function than those with the Ala/Ala genotype.

A prospective randomized, controlled trial of intravenous versus oral iron for moderate iron deficiency anaemia of pregnancy

BACKGROUND

Iron deficiency anaemia is the most common deficiency disorder in the world, affecting more than one billion people, with pregnant women at particular risk.

OBJECTIVES AND DESIGN

We conducted a single site, prospective, nonblinded randomized-controlled trial to compare the efficacy, safety, tolerability and compliance of standard oral daily iron versus intravenous iron.

SUBJECTS

We prospectively screened 2654 pregnant women between March 2007 and January 2009 with a full blood count and iron studies, of which 461 (18%) had moderate IDA. Two hundred women matched for haemoglobin concentration and serum ferritin level were recruited.

INTERVENTIONS

Patients were randomized to daily oral ferrous sulphate 250 mg (elemental iron 80 mg) with or without a single intravenous iron polymaltose infusion.

RESULTS

Prior to delivery, the intravenous plus oral iron arm was superior to the oral iron only arm as measured by the increase in haemoglobin level (mean of 19.5 g/L vs. 12 g/L; P < 0.001); the increase in mean serum ferritin level (222 microg/L vs. 18 ug/L; P < 0.001); and the percentage of mothers with ferritin levels below 30 microg/L (4.5% vs. 79%; P < 0.001). A single dose of intravenous iron polymaltose was well tolerated without significant side effects.

CONCLUSIONS

Our data indicate that intravenous iron polymaltose is safe and leads to improved efficacy and iron stores compared to oral iron alone in pregnancy-related IDA.

Effects of atorvastatin on arterial stiffness in chronic kidney disease: a randomised controlled trial

AIM

Central pulse pressure and measures of arterial stiffness (augmentation index (AIx) and aortic pulse wave velocity (PWV)) predict morbidity and mortality in patients with stage 2-4 chronic kidney disease (CKD). Although statin therapy may be of vascular benefit in patients with CKD, the long-term effect of statins on central pulse pressure and arterial stiffness has not been assessed in this patient population. Hence, the aim of this study was to assess the long-term effects of atorvastatin on arterial stiffness and central blood pressure in patients with CKD.

METHODS

We enrolled 37 patients with serum creatinine levels > 1.36 mg/dL into a randomized, double blind trial. Patients were allocated to receive 10 mg of atorvastatin per day (19) or placebo (18) for three years. Aortic PWV, AIx, estimated central and brachial blood pressures and were determined every nine months.

RESULTS

At baseline, there were no significant differences in aortic PWV, AIx, central or brachial blood pressures between atorvastatin-treated and placebo-treated patients. During the trial, aortic PWV significantly (p=0.05) increased in placebo-treated, but not (p=0.10) in atorvastatin-treated patients (0.51+/-0.95 vs. 0.30+/-0.75 m/sec/yr; p=0.48). This represented a 41% (but not statistically significant) slowing of the rate of increase in aortic stiffness. There were no significant changes between groups in the rate of change of AIx (atorvastatin -0.15+/-5.65 vs. placebo 0.39+/-5.38%/yr, p=0.53) or central pulse pressure (atorvastatin -2.32+/-7.46 vs. placebo -0.36+/-6.64 mmHg/yr p= 0.61).

CONCLUSION

In patients with CKD arterial stiffness measured by aortic PWV showed a significant increase over time in placebo-treated patients but not in atorvastatin-treated patients.

Acute effects of food on postprandial blood pressure and measures of arterial stiffness in healthy humans

BACKGROUND

Recent research suggests that central pulse pressure may be a better indicator of cardiovascular disease outcomes than brachial pressure. Little information is available regarding the effect of food intake on postprandial central pressure and other measures of arterial stiffness when measured with a noninvasive pulse wave analysis (PWA) technique.

OBJECTIVE

The objective was to investigate the effects of water and food plus water intake on brachial and central blood pressure (BP) and measures of arterial stiffness, including augmentation pressure and augmentation index, by using the PWA technique.

DESIGN

Measurements of BP and PWA were made at fasting and for 2 h after the intake of water or breakfast (1300 kJ) in random order in 35 subjects.

RESULTS

Baseline fasting measures of BP and arterial stiffness were not significantly different before the 2 interventions. Consumption of food plus water, compared with water alone, led to a significantly lower (all P < 0.01) brachial diastolic pressure (difference: -3.8 mm Hg), central BP (difference: systolic, -6.1 mm Hg; diastolic, -3.8 mm Hg), central pulse pressure (difference: -2.4 mm Hg), mean arterial pressure (difference: -4.6 mm Hg), augmentation pressure (difference: -2.9 mm Hg), and augmentation index (difference: -5.3 mm Hg).

CONCLUSIONS

Markers of central hemodynamics are sensitive to feeding state and therefore should be measured at fasting to avoid variability due to recent (within 2-3 h) food intake. This is especially important when measurements are repeated over time to assess the effect of medication or lifestyle changes on cardiovascular disease risk factors.

Measurement of immunoglobulin A in saliva by particle-enhanced nephelometric immunoassay: sample collection, limits of quantitation, precision, stability and reference range

BACKGROUND

Total immunoglobulin A in saliva (s-IgA) is normally assayed using an enzyme-linked immunosorbent assay. We have investigated methodological issues relating to the use of particle-enhanced nephelometric immunoassay (PENIA) to measure s-IgA in whole unstimulated saliva and determine its reference range.

METHODS

Whole unstimulated resting saliva was collected to determine sample stability (temperature, time, effect of a protease inhibitor), limit of quantitation (LOQ), assay precision and analytical variation. The reference range for 134 healthy adults was determined.

RESULTS

Linearity was excellent (4-10.3 mg L(-1), P < 0.001; R(2) = 0.997) and without significant bias (mean of -0.7%). The lowest intra- and inter-analytical coefficients of variation were 1.8% and 7.5% and LOQ was 1.4 mg L(-1). The concentration of s-IgA is stable at room temperature for up to 6 h, at 4 degrees C for 48 h, at -4 degrees C for two weeks and at -80 degrees C for up to 1.3 yr. There is no evidence that a protease inhibitor increases the stability or that repeated freeze-thawing cycles degrade sample quality. The reference ranges for s-IgA concentration, s-IgA secretion, s-IgA:albumin and s-IgA:osmolality were 15.9-414.5 mg L(-1), 7.2-234.9 microg min(-1), 0.4-19 and 0.6-8.9, respectively.

CONCLUSION

Automated PENIA assay of s-IgA is precise and accurate. High stability of collected saliva samples and the ease and speed of the assay make this an ideal method for use in athletic and military training situations. The convenience of measuring albumin and IgA on the same analytical platform adds to the practicability of the test.

Evaluation of the Randox colorimetric serum copper and zinc assays against atomic absorption spectroscopy

BACKGROUND

Analysis of copper and zinc in serum is commonly performed using atomic absorption spectrometry (AAS); however, these methods are often not readily available in smaller laboratories. Randox colorimetric assays for copper and zinc in serum were evaluated on the Thermo Electron Data Pro analyser against flame AAS methods.

METHODS

Copper and zinc were measured in 48 serum samples using the Randox colorimetric copper (CU2340) and zinc (ZN2341) assays on the Data Pro analyser and the results compared with those from a Varian Spectra 880 atomic absorption spectrometer. A smaller set of samples (n = 15) were also analysed colorimetrically for zinc on the Roche Cobas Mira.

RESULTS

Linear regression analyses of Bland and Altman plots from the Data Pro - AAS comparison gave the following results for copper: correlation r = 0.6669 (P < 0.01), slope = -0.2499 (P < 0.01), intercept = 3.219 (P < 0.01). For zinc, results were as follows: correlation r = 0.1976, slope = 0.1807, intercept = -1.922. For the smaller set of samples, the Cobas Mira - AAS comparison for zinc gave correlation r = 0.4379, slope = 0.5294, intercept = -4.074. The results indicated significant systematic and fixed bias between the colorimetric copper and the AAS method.

CONCLUSION

Performances in comparison to AAS methods indicated the colorimetric methods, as used, are unsuitable for the accurate determination of copper and zinc in human serum.

The Lipid lowering and Onset of Renal Disease (LORD) Trial: a randomized double blind placebo controlled trial assessing the effect of atorvastatin on the progression of kidney disease

Background

There is evidence that dyslipidemia is associated with chronic kidney disease (CKD). Experimental studies have established that lipids are damaging to the kidney and animal intervention studies show statins attenuate this damage. Small clinical trials, meta-analyses, observational studies and post-hoc analyses of cardiovascular intervention studies all support the concept that statins can reduce kidney damage in humans. Based on this background, a double blind randomized placebo controlled trial was designed to assess the effectiveness of atorvastatin 10 mg on slowing the progression of kidney disease in a population of patients with CKD.

Method/Design

The Lipid lowering and Onset of Renal Disease (LORD) trial is a three-year, single center, multi-site, double blind, randomized, placebo controlled trial. The primary outcome measure is kidney function measured by eGFR calculated by both Modification of Diet in Renal Disease (MDRD) and Cockcroft and Gault equations. Secondary outcome measures include kidney function measured by 24-hour urine creatinine clearance and also 24-hour urinary protein excretion, markers of oxidative stress, inflammation and drug safety and tolerability.

Discussion

The results of this study will help determine the effectiveness and safety of atorvastatin and establish its effects on oxidative stress and inflammation in patients with CKD.

Trial Registration

ANZCTRN012605000693628

Translational research in medical informatics or from theory to practice. A call for an applied informatics journal

OBJECTIVE

To bridge the divide between health informatics 'bench research' and the application of informatics in clinical and health care settings.

METHOD

Identifying weak points in translational activities, i.e. in the process from health informatics research outcomes to IT system design and information management in clinical practice.

RESULTS AND CONCLUSIONS

The creation of a new peer-reviewed journal, designed to cultivate broad readership across health care, is suggested in order to communicate on informatics topics of translational interest and on the application of informatics principals. Such an applied informatics journal may appeal to practicing physicians, healthcare administrators and CIOs as well as medical informaticians. In a globalizing world with eHealth initiatives spanning across borders, such a journal should be an international effort. Close ties to the International Medical Informatics Association (IMIA) and to the journal Methods of Information in Medicine are suggested.

Failure to provide clinicians useful IT systems: opportunities to leapfrog current technologies

OBJECTIVE

To discuss why clinical information systems are failing.

METHOD

Subjectively analyzing the development of clinical IT systems during the last decades.

RESULTS AND CONCLUSIONS

The challenge is to anticipate what information clinicians need and then deliver it in a way that is tailored for their unique views. Clinicians need workstations that offer the highest level possible of user-determined flexibility and customization. We envision and outline a so-called point of care work station, automatically scaling to the display, hardware capacity, operating system, applications (local or distributed) the user needs and across diverse health IT systems.

The effect of an ultra-endurance running race on mucosal and humoral immune function

AIM

There are reports of the effect of endurance exercise on mucosal immune function and of the effect of short duration exercise on humoral immune function. However, little is known of the effect of endurance exercise on humoral immune function and the related risk of infection. This study examined the effects of an ultra-endurance running race on salivary immunoglobulin-A (s-IgA), serum IgA, leukocyte subset concentrations and the incidence of upper respiratory tract infections (URTI).

METHODS

Thirteen male and 4 female competitors provided saliva samples and blood before and at several times after the running race. Self-reported symptoms of URTI were also recorded for 2 weeks before and 2 weeks after the race.

RESULTS

Salivary IgA secretion rate (P=0.005) and ratio to osmolality (P=0.006) were lower immediately postrace and decreased further for at least 2 more h. s-IgA secretion rate had not returned to normal the next morning (P=0.009). Serum IgA concentration was lower post- than prerace (P=0.003) and was even lower the next morning (P<0.001). Leukocyte concentration was elevated postrace (P<0.001), mainly because of an increase in neutrophils (P<0.001) and both remained high the morning after the race (P<0.001). Lymphocyte concentration decreased postrace (P<0.001) and was still depressed the next morning (P=0.032). The incidence of symptoms of URTI was the same in the two 2-week periods before and after the race.

CONCLUSION

These findings support the hypotheses that an ultra-endurance run may adversely affect mucosal immunity and cause significant changes in the concentration of leukocyte subsets.

Effects of a Controlled Diet Supplemented with Chickpeas on Serum Lipids, Glucose Tolerance, Satiety and Bowel Function

OBJECTIVE

To compare the effect of a diet supplemented with chickpeas to a wheat-based diet of similar fibre content on serum lipids, glucose tolerance, satiety and bowel function. A third, lower-fibre wheat diet provided further information on dietary fibre quantity and bowel function and satiety.

METHOD

Twenty-seven free-living adults followed two randomized, crossover dietary interventions each of five weeks duration. The chickpea diet included canned drained chickpeas, bread and shortbread biscuits containing 30% chickpea flour. The wheat diet included high-fibre wheat breakfast cereals and wholemeal bread. The diets were isoenergetic to the participants' usual diet, matched for macronutrient content and controlled for dietary fibre. Following on from the second randomised intervention, a sub-group of 18 participants underwent a third, isoenergetic lower-fibre wheat diet that included low-fibre breakfast cereals and bread.

RESULTS

Repeated measures ANOVA revealed reductions in serum TC of 0.25 mmol/L (p < 0.01) and LDL-C of 0.20 mmol/L (p = 0.02) following the chickpea diet compared to the wheat. An unintended significant increase in PUFA and corresponding decrease in MUFA consumption occurred during the chickpea diet and statistical adjustment for this reduced but did not eliminate the effect on serum lipids. There was no significant difference in glucose tolerance. Perceived general bowel health improved significantly during the chickpea diet although there was considerable individual variation. Some participants reported greater satiety during the chickpea diet.

CONCLUSIONS

The small but significant decrease in serum TC and LDL-C during the chickpea diet compared to the equivalent fibre wheat diet was partly due to unintentional changes in macronutrient intake occurring because of chickpea ingestion. If dietary energy and macronutrients were not controlled, chickpea consumption might result in greater benefits via influence on these factors.

Dietary intake of patients with chronic kidney disease entering the LORD trial: adjusting for underreporting

OBJECTIVE

The study objective was to determine the dietary intake of patients with chronic kidney disease before and after filtering for suspected underreporters and to investigate the impact of underreporting on the interpretation of diet data.

DESIGN

This was a cross-sectional study.

SETTING

The study included outpatients from hospitals and clinics in Northern Tasmania, Australia.

PATIENTS

Data from 113 patients enrolled in the Lipid Lowering and Onset of Renal Disease trial were used in this study. Patients with serum creatinine greater than 120 mmol/L were included, and those taking lipid-lowering medication were excluded.

METHODS

Patients completed a 4-day self-report diet diary, and FoodWorks software was used to determine their daily intake of energy, macronutrients, and specific micronutrients. Diet diaries were assessed for likely underreporting using the Goldberg cutoff approach with a ratio of energy intake to estimated resting energy expenditure of 1.27. Nutrient intakes were compared with current National Kidney Foundation's Kidney Disease Outcomes Quality Initiative guidelines, World Health Organization recommendations, recommended daily allowances, and daily values adjusted for energy intake.

RESULTS

Demographics of the patients were as follows: male/female, 71/42; age (mean +/- standard deviation), 60 +/- 15 years; body mass index, 28.6 +/- 6.0 kg/m(2), and serum creatinine, 223.4 +/- 110.0 mmol/L. According to the criteria, 80 patients (70.8%) were underreporting their energy intake. Underreporters were more likely to be female and younger, and have a higher body mass index and elevated serum creatinine. In all patients, daily energy intake (89.6 +/- 32.4 kJ/kg) was lower than recommended (125-145 kJ/kg); however, this was not the case for valid reporters (128.3 +/- 23.7 kJ/kg). Protein intake was higher (0.9 +/- 0.3 g/kg) than recommended (0.75 g/kg) in all patients and even higher (1.2 +/- 0.3 g/kg) in valid reporters. Mean calcium, zinc, and dietary fiber intakes were all below recommendations in all patients, but these differences were not apparent in valid reporters.

CONCLUSION

Interpreting self-report diet diary data from patients with chronic kidney disease without attempting to exclude underreporters will lead to erroneous conclusions, especially in respect to energy, protein, dietary fiber, calcium, and zinc intakes.

Effects of daily ingestion of chilli on serum lipoprotein oxidation in adult men and women

Laboratory studies have shown that the resistance of isolated LDL-cholesterol or linoleic acid to oxidation is increased in incubations with chilli extracts or capsaicin – the active ingredient of chilli. It is unknown if these in vitro antioxidative effects also occur in the serum of individuals eating chilli regularly. The present study investigated the effects of regular consumption of chilli on in vitro serum lipoprotein oxidation and total antioxidant status (TAS) in healthy adult men and women. In a randomised cross-over study, twenty-seven participants (thirteen men and fourteen women) ate ‘freshly chopped chilli’ blend (30g/d; 55% cayenne chilli) and no chilli (bland) diets, for 4 weeks each. Use of other spices, such as cinnamon, ginger, garlic and mustard, was restricted to minimum amounts. At the end of each dietary period serum samples were analysed for lipids, lipoproteins, TAS and Cu-induced lipoprotein oxidation. Lag time (before initiation of oxidation) and rate of oxidation (slope of propagation phase) were calculated. There was no difference in the serum lipid, lipoproteins and TAS at the end of the two dietary periods. In the whole group, the rate of oxidation was significantly lower (mean difference −0·23 absorbance ×10−3/min; P=0·04) after the chilli diet, compared with the bland diet. In women, lag time was higher (mean difference 9·61min; P<0·001) after the chilli diet, compared with the bland diet. In conclusion, regular consumption of chilli for 4 weeks increases the resistance of serum lipoproteins to oxidation.

IMIA presidential retrospectives on medical informatics

OBJECTIVES

The International Medical Informatics Association (IMIA) celebrates its 40th anniversary in 2007. Three IMIA Presidents from three continents were invited to give their personal retrospectives on the world's largest organization in medical informatics.

METHOD

Reports, based on personal reminiscenses.

RESULTS AND CONCLUSIONS

IMIA was established in the 1970s by individuals already active in medical informatics in their home countries. It has evolved into a strong international organization based on the mutual trust and friendship of members throughout the world. IMIA serves as a 'bridge' organization both within an interorganizational context and within the broader context of IMIA's professional aims. Being a driving motor for successive waves of change in the field, IMIA helps to significantly improve health care by building bridges across regions, disciplines, and professions, to bridge the distances around the globe.

Dietary supplementation with chickpeas for at least 5 weeks results in small but significant reductions in serum total and low-density lipoprotein cholesterols in adult women and men

AIM

To compare the effects of a chickpea-supplemented diet and those of a wheat-supplemented diet on human serum lipids and lipoproteins.

METHODS

Forty-seven free-living adults participated in a randomized crossover weight maintenance dietary intervention involving two dietary periods, chickpea-supplemented and wheat-supplemented diets, each of at least 5 weeks duration.

RESULTS

The serum total cholesterol and low-density lipoprotein cholesterol levels were significantly lower (both p < 0.01) by 3.9 and 4.6%, respectively, after the chickpea-supplemented diet as compared with the wheat-supplemented diet. Protein (0.9% of energy, p = 0.01) and monounsaturated fat (3.3% of total fat, p < 0.001) intakes were slightly but significantly lower and the carbohydrate intake significantly higher (1.7% of energy, p < 0.001) on the chickpea-supplemented diet as compared with the wheat-supplemented diet. Multivariate analyses suggested that the differences in serum lipids were mainly due to small differences in polyunsaturated fatty acid and dietary fibre contents between the two intervention diets.

CONCLUSIONS

Inclusion of chickpeas in an intervention diet results in lower serum total and low-density lipoprotein cholesterol levels as compared with a wheat-supplemented diet.

Baseline serum lipids and renal function in chronic kidney disease patients entering the LORD trial

OBJECTIVE

Previous studies investigating associations between serum lipids and renal disease have generally not taken into account dietary intake or physical activity both known to influence circulating lipids. Furthermore, inclusion of patients on HMG-CoA reductase inhibitors may also have influenced findings due to the pleiotropic effect of this medication. Therefore, the aim of this study is to determine the relationships between serum lipids and renal function in a group of patients not taking lipid-lowering medication and taking into account dietary intake and physical activity.

METHODS

Data from 100 patients enrolled in the Lipid Lowering and Onset of Renal Disease (LORD) trial were used in this study. Patients were included with serum creatinine > 120 micromol/l, and excluded if they were taking lipid-lowering medication. Unadjusted and adjusted relationships were determined between fasting serum lipid concentrations (total cholesterol, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, triglycerides and total cholesterol/HDL ratio) and measures of renal function (estimated glomerular filtration rate (eGFR), creatinine clearance and serum creatinine) and urinary protein excretion.

RESULTS

Significant (p < 0.05) negative unadjusted relationships were found between lipids (total cholesterol, LDL and HDL cholesterol) and serum creatinine. In support of these findings, logarithmically-transformed lipids (total cholesterol, LDL and HDL cholesterol) were significantly associated with eGFR and creatinine clearance although the effects were of a smaller magnitude. Adjustment for dietary saturated fat intake and physical activity did not substantially change these effects.

CONCLUSION

These data do not support the premise that lipids are associated with renal dysfunction in patients with normocholesterolemia.

The effect of 4-week chilli supplementation on metabolic and arterial function in humans

OBJECTIVE

To investigate the effects of regular chilli ingestion on some indicators of metabolic and vascular function.

DESIGN

A randomized cross-over dietary intervention study.

SETTING

Launceston, Australia.

SUBJECTS

Healthy free-living individuals.

INTERVENTION

Thirty-six participants (22 women and 14 men), aged 46+/-12 (mean+/-s.d.) years; BMI 26.4+/-4.8 kg/m(2), consumed 30 g/day of a chilli blend (55% cayenne chilli) with their normal diet (chilli diet), and a bland diet (chilli-free) for 4 weeks each. Metabolic and vascular parameters, including plasma glucose, serum lipids and lipoproteins, insulin, basal metabolic rate, blood pressure, heart rate, augmentation index (AIx; an indicator of arterial stiffness), and subendocardial-viability ratio (SEVR; a measure of myocardial perfusion), were measured at the end of each diet. In a sub-study, during week 3 of each dietary period, the vascular responses of 15 subjects to glyceryl-trinitrate (GTN) and salbutamol were also studied.

RESULTS

For the whole group, there were no significant differences between any of the measured parameters when compared at the end of the two dietary periods. When analysed separately, men had a lower resting heart rate (P=0.02) and higher SEVR (P=0.05) at the end of the chilli diet than the bland diet. In the sub-study, baseline AIx on the chilli diet was lower (P<0.001) than on the bland diet, but there was no difference in the effects of GTN and salbutamol between the two diets.

CONCLUSION

Four weeks of regular chilli consumption has no obvious beneficial or harmful effects on metabolic parameters but may reduce resting heart rate and increase effective myocardial perfusion pressure time in men.

Effects of capsaicin, dihydrocapsaicin, and curcumin on copper-induced oxidation of human serum lipids

The oxidation of low-density lipoprotein (LDL) is believed to be the initiating factor for the development and progression of atherosclerosis. The active ingredients of spices such as chili and turmeric (capsaicin and curcumin, respectively) have been shown to reduce the susceptibility of LDL to oxidation. One of the techniques used to study the oxidation of LDL is to isolate LDL and subject it to metal-induced (copper or iron) oxidation. However, whole serum may represent a closer situation to in vivo conditions than using isolated LDL. We investigated the effects of different concentrations (0.1-3 microM) of capsaicin, dihydrocapsaicin, and curcumin on copper-induced oxidation of serum lipoproteins. The lag time (before initiation of oxidation) and rate of oxidation (slope of propagation phase) were calculated. The lag time increased, and the rate of oxidation decreased with increasing concentrations of the tested antioxidants (p < 0.05). A 50% increase in lag time (from control) was observed at concentrations between 0.5 and 0.7 microM for capsaicin, dihydrocapsaicin, and curcumin. This study shows that oxidation of serum lipids is reduced by capsaicinoids and curcumin in a concentration-dependent manner.

Effects of chili consumption on postprandial glucose, insulin, and energy metabolism

BACKGROUND

Animal and some human studies have indicated that the consumption of chili-containing meals increases energy expenditure and fat oxidation, which may help to reduce obesity and related disorders. Because habitual diets affect the activity and responsiveness of receptors involved in regulating and transporting nutrients, the effects of regular consumption of chili on metabolic responses to meals require investigation.

OBJECTIVE

The objective was to investigate the metabolic effects of a chili-containing meal after the consumption of a bland diet and a chili-blend (30 g/d; 55% cayenne chili) supplemented diet.

DESIGN

Thirty-six subjects with a mean (+/-SD) age of 46 +/- 12 y and a body mass index (in kg/m2) of 26.3 +/- 4.6 participated in a randomized, crossover, intervention study with 2 dietary periods (chili and bland) of 4 wk each. The postprandial effects of a bland meal after a bland diet (BAB), a chili meal after a bland diet (CAB), and a chili meal after a chili-containing diet (CAC) were evaluated. Serum insulin, C-peptide, and glucose concentrations and energy expenditure (EE) were measured at fasting and up to 120 min postprandially.

RESULTS

Significant heterogeneity was observed between the meals for the maximum increase in insulin and the incremental area under the curve (iAUC) for insulin (P = 0.0002); the highest concentrations were with the BAB meal and the lowest with the CAC meal. When separated at the median BMI (26.3), the subjects with a BMI > or = 26.3 also showed heterogeneity in C-peptide, iAUC C-peptide, and net AUC EE (P < 0.02 for all); the highest values occurred after the BAB meal and the lowest after the CAC meal. Conversely, the C-peptide/insulin quotient (an indicator of hepatic insulin clearance) was highest after the CAC meal (P = 0.002).

CONCLUSION

Regular consumption of chili may attenuate postprandial hyperinsulinemia.

Effects of olive oil and tomato lycopene combination on serum lycopene, lipid profile, and lipid oxidation

OBJECTIVE

We compared the effect of two diets (a diet high in olive oil and a diet high in carbohydrate and low in olive oil) with high lycopene content and other controlled carotenoids on serum lycopene, lipids, and in vitro oxidation.

METHODS

This was a randomized crossover dietary intervention study carried out in Launceston, Tasmania, Australia in healthy free-living individuals. Twenty-one healthy subjects who were 22 to 70 y old were recruited by advertisements in newspapers and a university newsletter. A randomized dietary intervention was done with two diets of 10 d each. One diet was high in olive oil and the other was high in carbohydrate and low in olive oil; the two diets contained the same basic foods and a controlled carotenoid content high in lycopene.

RESULTS

Significant increases (P<0.001) in serum lycopene concentration on both diets were to similar final concentrations. Higher serum high-density lipoprotein cholesterol (P<0.01), lower ratio of total cholesterol to high-density lipoprotein (P<0.01), and lower triacylglycerols (P<0.05) occurred after the olive oil diet compared with the high-carbohydrate, low-fat diet. There was no difference in total antioxidant status and susceptibility of serum lipids to oxidation.

CONCLUSIONS

Serum lycopene level changes with dietary lycopene intake irrespective of the amount of fat intake. However, a diet high in olive oil and rich in lycopene may decrease the risk of coronary heart disease by improving the serum lipid profile compared with a high-carbohydrate, low-fat, lycopene-rich diet.

Senile plaques in Alzheimer's diseased brains: possible association of beta-amyloid with herpes simplex virus type 1 (HSV-1) L-particles

The characteristic insoluble, senile (neuritic) plaques found extracellularly in brains of patients with Alzheimer's disease (AD) contain the fibrillar form of beta-amyloid (Abeta42). A substantial proportion of autopsied elderly brains have demonstrated DNA evidence of herpes simplex virus type 1 (HSV-1) infiltration. HSV-1-infected cells produce significant quantities of non-infectious, non-DNA-containing light particles (L-particles) comprised of viral envelope and tegument proteins. HSV-induced L-particles can be exocytosed out of their host cells. This report advances the hypothesis that (1) Abeta binds to L-particles; (2) Abeta permeabilizes L-particles, destroying the integrity of the envelope and allowing the contained tegument proteins to spill into the extracellular space; and (3) these events are followed by a conformational shift of Abeta into its fibrillar form, physically trapping the L-particle-derived substances and resulting in the plaques characteristic of AD. These hypotheses are supported by reports of biomolecular changes and pathophysiologies which have been simultaneously observed in both AD- and HSV-infected brains.

Lupin kernel fibre-enriched foods beneficially modify serum lipids in men

OBJECTIVE

To examine the effect of a diet containing a novel legume food ingredient, Australian sweet lupin (Lupinus angustifolius) kernel fibre (LKFibre), compared to a control diet without the addition of LKFibre, on serum lipids in men.

DESIGN

Randomized crossover dietary intervention study.

SETTING

Melbourne, Australia--Free-living men.

SUBJECTS

A total of 38 healthy males between the ages of 24 and 64 y completed the intervention.

INTERVENTION

Subjects consumed an LKFibre and a control diet for 1 month each. Both diets had the same background menus with seven additional experimental foods that either contained LKFibre or did not. Depending on energy intake, the LKFibre diet was designed to contain an additional 17 to 30 g/day fibre beyond that of the control diet.

RESULTS

Compared to the control diet, the LKFibre diet reduced total cholesterol (TC) (mean+/-s.e.m.; 4.5+/-1.7%; P=0.001), low-density lipoprotein cholesterol (LDL-C) (5.4+/-2.2%; P=0.001), TC: high-density lipoprotein cholesterol (HDL-C) (3.0+/-2.0%; P=0.006) and LDL-C:HDL-C (3.8+/-2.6%; P=0.003). No effects on HDL-C, triacylglycerols, glucose or insulin were observed.

CONCLUSIONS

Addition of LKFibre to the diet provided favourable changes to some serum lipid measures in men, which, combined with its high palatability, suggest this novel ingredient may be useful in the dietary reduction of coronary heart disease risk.

Micronutrient deficiencies and gender: social and economic costs

Vitamin and mineral deficiencies adversely affect a third of the world's people. Consequently, a series of global goals and a serious amount of donor and national resources have been directed at such micronutrient deficiencies. Drawing on the extensive experience of the authors in a variety of institutional settings, the article used a computer search of the published scientific literature of the topic, supplemented by reports and published and unpublished work from the various agencies. In examining the effect of sex on the economic and social costs of micronutrient deficiencies, the paper found that: (1) micronutrient deficiencies affect global health outcomes; (2) micronutrient deficiencies incur substantial economic costs; (3) health and nutrition outcomes are affected by sex; (4) micronutrient deficiencies are affected by sex, but this is often culturally specific; and finally, (5) the social and economic costs of micronutrient deficiencies, with particular reference to women and female adolescents and children, are likely to be considerable but are not well quantified. Given the potential impact on reducing infant and child mortality, reducing maternal mortality, and enhancing neuro-intellectual development and growth, the right of women and children to adequate food and nutrition should more explicitly reflect their special requirements in terms of micronutrients. The positive impact of alleviating micronutrient malnutrition on physical activity, education and productivity, and hence on national economies suggests that there is also an urgent need for increased effort to demonstrate the cost of these deficiencies, as well as the benefits of addressing them, especially compared with other health and nutrition interventions.

Can a herpes simplex virus type 1 neuroinvasive score be correlated to other risk factors in Alzheimer's disease?

Herpes simplex virus type 1 (HSV-1) is latent in the nervous system of most humans. Ball [Can J Neurol Sci 9 (1982) 303] first suggested the hypothesis that HSV-1 could be involved in the pathogenesis of Alzheimer's Disease (AD) by noting that regions of the brain particularly and earliest affected in AD were the same as those most damaged during HSV encephalitis. Data from Itzhaki's research suggests that HSV-1 in the brain and the carriage of an apolipoprotein E allele 4 (ApoE e4) together confer risk for AD [J Pathol 97 (2002) 395], [Mol Chem Neuropathol 28 (1996) 135], [Alzheimer's Rep 1 (1998) 173], [Biochem Soc Trans 26 (1998) 273]. Of the two other studies based on Itzhaki's findings, one showed similar results [Lancet 349 (1997) 1102], and the other showed a similar trend [Lancet 351 (1998) 1330], [Lancet 352 (1998) 1312]. To further examine the role of HSV-1 in the etiology of AD, we have formulated a Neuroinvasive Score that quantifies the presence and viral load of HSV-1 in eight brain regions. These regions are: entorhinal cortex, hippocampus, pons, cerebellum, and neocortex (temporal, parietal, occipital, and frontal). We hypothesize that the Neuroinvasive Score that encompasses the presence, amount, and extent of HSV-1 spreading (neuroinvasiveness), will correlate with the genetic risk factor, ApoE e4, in the assessment of autopsy samples from AD patients. If the neuroinvasive score can be directly correlated to the different stages of AD (mild, moderate, severe), this will strengthen the hypothesis that HSV-1 is involved in AD and that ApoE e4 also confers risk for the development and progression of AD.

Diet rich in saturated fat decreases the ratio of thromboxane/prostacyclin in healthy men

OBJECTIVE

To investigate the effect of dietary saturated fat (SFA) from animal sources on the urine excretion 11-dehydro thromboxane B2 (TXB2) and 6-keto prostaglandin F 1alpha (PGF 1alpha) in 27 healthy free-living male subjects aged 30 to 55 years.

METHODS

It was a randomized crossover design. Each volunteer was randomly assigned to one of the two diets (high fat and low fat) for a period of 4 weeks, after which each subject resumed his usual diet for 2 weeks as a 'wash-out period', before being assigned to the other diet for an additional 4 weeks.

RESULTS

Serum proportion of 20:4n-6 was 5% lower in the high fat (6.2% of total fatty acid) than in the low fat diet (6.5% of total fatty acid), which was associated with a significantly decreased ratio of the urinary excretion 11-dehydro TXB2 to 6-keto PGF 1alpha (P < 0.05). However, there was no significant fall in the absolute urinary excretion of 11-dehydro TXB2.

CONCLUSIONS

Diet rich in SFA from animal sources may influence TXA2 formation via effect on tissue proportion of 20:4n-6.