Dietary enrichment of resistant starches or fibers differentially alter the feline fecal microbiome and metabolite profile

BACKGROUND

Cats are strict carnivores but possess a complex gastrointestinal (GI) microbial community that actively ferments dietary substrates that are not digested and reach the colon. The GI microbiota responses to dietary inclusion of resistant starches versus fibers have not been tested in cats. Thus, our objective was to evaluate the effects of diets enriched in resistant starch or fibers on the fecal characteristics, microbiome, and metabolite profiles of cats. Twelve healthy adult domestic shorthair cats (age = 9.6 ± 4.0 year; body weight = 3.9 ± 1.0 kg) were used in a replicated 3 × 3 Latin square design to test diets that were enriched with: (1) resistant starch (ERS), (2) a fiber-prebiotic-probiotic blend (FPPB), or (3) a fiber-prebiotic-probiotic blend + immune-modulating ingredients (iFPPB). In each 28-day period, 22 days of diet adaptation was followed by fecal and blood sample collection. Fecal samples were used for shotgun metagenomic sequencing. In addition, fecal and blood metabolite measurements and white blood cell stimulation was performed to assess immune function.

RESULTS

A total of 1690 bacterial species were identified, with 259 species differing between fiber-rich and ERS treatments. In comparison with fiber-rich treatments that increased diversity and promoted Firmicutes and Bacteroidetes populations, resistant starch reduced microbial diversity and fecal pH, led to a bloom in Actinobacteria, and modified Kyoto Encyclopedia of Genes and Genomes orthology (KO) terms pertaining to starch and sucrose metabolism, fatty acid biosynthesis and metabolism, epithelial cell signaling, among others. Resistant starch also differentially modified fecal metabolite concentrations with relevance to GI and overall host health (increased butyrate; decreased propionate and protein catabolites - branched-chain fatty acids; phenols and indoles; ammonia) and reduced blood cholesterol, which correlated strongly with microbial taxa and KO terms, and allowed for a high predictive efficiency of diet groups by random forest analysis.

CONCLUSION

Even though domestic cats and other carnivores evolved by eating low-carbohydrate diets rich in protein and fat, our results demonstrate that the feline microbiome and metabolite profiles are highly responsive to dietary change and in directions that are predictable.

Effects of a high-protein, high-fiber diet rich in antioxidants and L-carnitine on body weight, body composition, metabolic status, and physical activity levels of cats after spay surgery

Spay and neuter surgeries are useful in controlling pet populations, but increase obesity risk due to increased appetite, decreased metabolic rate and decreased energy expenditure. Dietary management may help limit post-spay weight gain, but few research studies have been conducted in cats. Therefore, the objective of this study was to evaluate the effects of a high-protein, high-fiber diet (HPHF) compared to a moderate-protein, moderate-fiber diet (MPMF) in female cats following spay surgery. Twenty healthy female cats (9.5±0.1 mo) were used. After a 4-wk baseline phase with cats fed MPMF to maintain body weight (BW), 16 cats were spayed and allotted to MPMF (n=8) or HPHF (n=8), with the remaining cats being sham-operated and fed MPMF (n=4). Cats were fed to maintain BW for 12 wk, then allowed to eat up to twice that amount for another 12 wk. Daily food intake, twice weekly BW and twice weekly body condition scores (BCS) were assessed. Back fat thickness (BF) using ultrasound, body composition using dual-energy X-ray absorptiometry (DEXA), feline body mass index (fBMI), body fat percentage estimates using zoometry measurements, serum metabolites, and voluntary physical activity levels were measured prior to spay (wk 0) and every 6 wk post-spay. A treatment*time effect was observed for food intake (g/d), but not caloric intake (kcal ME/d). Caloric intake was affected by time and treatment, being reduced over the first 12 wk and reduced at higher amounts in HPHF and MPMF cats vs. sham cats. BW, BCS and body fat percentage were affected over time. Treatment*time effects were observed for blood urea nitrogen, alkaline phosphatase, and fructosamine, while blood triglycerides, total cholesterol, creatinine, total protein, phosphorus, and bicarbonate were affected by time. Physical activity was reduced over time. Our results demonstrate that spay surgery affects food intake, BW, metabolism, and physical activity of cats. Dietary intervention in this study, however, led to minor changes.

Dietary supplementation with fiber, "biotics," and spray-dried plasma affects apparent total tract macronutrient digestibility and the fecal characteristics, fecal microbiota, and immune function of adult dogs

A variety of functional ingredients, including fibers, prebiotics, probiotics, and postbiotics may be added to pet foods to support gastrointestinal and immune health. While many of these ingredients have been tested individually, commercial foods often include blends that also require testing. This study was conducted to evaluate the effects of diets containing blends of fibers, "biotics," and/or spray-dried plasma on apparent total tract digestibility (ATTD), stool quality, fecal microbiota and metabolites, and immune health outcomes of adult dogs. A total of 12 healthy adult intact English pointer dogs (6 M, 6 F; age = 6.4 ± 2.0 yr; BW = 25.8 ± 2.6 kg) were used in a replicated 3 × 3 Latin square design to test diets formulated to: 1) contain a low concentration of fermentative substances (control diet, CT); 2) be enriched with a fiber-prebiotic-probiotic blend (FPPB); and 3) be enriched with a fiber-prebiotic-probiotic blend + immune-modulating ingredients (iFFPB). In each 28-d period, 22 d of diet adaptation was followed by a 5-d fecal collection phase and 1 d for blood sample collection. All data were analyzed using SAS 9.4, with significance being P < 0.05 and trends being P < 0.10. FPPB and iFPPB diets led to shifts in numerous outcome measures. Dry matter (DM), organic matter, fat, fiber, and energy ATTD were lower (P < 0.01), fecal scores were lower (P < 0.01; firmer stools), and fecal DM% was higher (P < 0.0001) in dogs fed FPPB or iFPPB than those fed CT. Serum triglycerides and cholesterol were lower (P < 0.01) in dogs fed FPPB or iFPPB than those fed CT. Fecal protein catabolites (isobutyrate, isovalerate, indole, and ammonia) and butyrate were lower (P < 0.05), while fecal immunoglobulin A (IgA) was higher (P < 0.01) in dogs fed FPPB and iFPPB than those fed CT. Fecal microbiota populations were affected by diet, with alpha-diversity being lower (P < 0.05) in dogs fed iFPPB and the relative abundance of 20 bacterial genera being altered in dogs fed FPPB or iFPPB compared with CT. The circulating helper T cell:cytotoxic T cell ratio was higher (P < 0.05) in dogs fed iFPPB than those fed CT. Circulating B cells were lower (P < 0.05) in dogs fed FPPB than those fed iFPPB, and lower (P < 0.05) in dogs fed iFPPB than those fed CT. Our results demonstrate that feeding a fiber-prebiotic-probiotic blend may provide many benefits to canine health, including improved stool quality, beneficial shifts to fecal microbiota and metabolite profiles, reduced blood lipids, and increased fecal IgA.

Chemistry of surface water, precipitation, throughfall, leaves, sediment, soil, and air near a gold mining region in Peru

Artisanal and small-scale gold mining (ASGM) is the primary global source of anthropogenic mercury (Hg) emissions and a large source of landscape change. ASGM occurs throughout the world, including in the Peruvian Amazon. This dataset contains measurements of surface water, precipitation, throughfall, leaves, sediment, soil, and air samples from across the Madre de Dios region of Peru, in locations near and remote from ASGM. These data were collected to determine the fate and transport of Hg across the landscape. Samples were collected in 2018 and 2019. Data predominantly include total Hg and methyl Hg concentrations in surface water, precipitation, throughfall, leaves, sediment, soil, and air. Additional water and soil parameters were also measured to better characterize their chemistry. There are no copyright restrictions; please cite this data paper when the data are used in publication.

Weight loss and high-protein, high-fiber diet consumption impact blood metabolite profiles, body composition, voluntary physical activity, fecal microbiota, and fecal metabolites of adult dogs

Canine obesity is associated with reduced lifespan and metabolic dysfunction, but can be managed by dietary intervention. This study aimed to determine the effects of restricted feeding of a high-protein, high-fiber (HPHF) diet and weight loss on body composition, physical activity, blood metabolites, and fecal microbiota and metabolites of overweight dogs. Twelve spayed female dogs (age: 5.5 ± 1.1 yr; body weight [BW]: 14.8 ± 2.0 kg, body condition score [BCS]: 7.9 ± 0.8) were fed a HPHF diet during a 4-wk baseline phase to maintain BW. After baseline (week 0), dogs were first fed 80% of baseline intake and then adjusted to target 1.5% weekly weight loss for 24 wk. Body composition using dual-energy x-ray absorptiometry and blood samples (weeks 0, 6, 12, 18, and 24), voluntary physical activity (weeks 0, 7, 15, and 23), and fresh fecal samples for microbiota and metabolite analysis (weeks 0, 4, 8, 12, 16, 20, and 24) were measured over time. Microbiota data were analyzed using QIIME 2. All data were analyzed statistically over time using SAS 9.4. After 24 wk, dogs lost 31.2% of initial BW and had 1.43 ± 0.73% weight loss per week. BCS decreased (P < 0.0001) by 2.7 units, fat mass decreased (P < 0.0001) by 3.1 kg, and fat percentage decreased (P < 0.0001) by 11.7% with weight loss. Many serum metabolites and hormones were altered, with triglycerides, leptin, insulin, C-reactive protein, and interleukin-6 decreasing (P < 0.05) with weight loss. Relative abundances of fecal Bifidobacterium, Coriobacteriaceae UCG-002, undefined Muribaculaceae, Allobaculum, Eubacterium, Lachnospira, Negativivibacillus, Ruminococcus gauvreauii group, uncultured Erysipelotrichaceae, and Parasutterella increased (P < 0.05), whereas Prevotellaceae Ga6A1 group, Catenibacterium, Erysipelatoclostridium, Fusobacterium, Holdemanella, Lachnoclostridium, Lactobacillus, Megamonas, Peptoclostridium, Ruminococcus gnavus group, and Streptococcus decreased (P < 0.01) with weight loss. Despite the number of significant changes, a state of dysbiosis was not observed in overweight dogs. Fecal ammonia and secondary bile acids decreased, whereas fecal valerate increased with weight loss. Several correlations between gut microbial taxa and biological parameters were observed. Our results suggest that restricted feeding of a HPHF diet and weight loss promotes fat mass loss, minimizes lean mass loss, reduces inflammatory marker and triglyceride concentrations, and modulates fecal microbiota phylogeny and activity in overweight dogs.

Physical activity patterns of free living dogs diagnosed with osteoarthritis

Osteoarthritis (OA) affects about 90% of dogs > 5 yr of age in the United States, resulting in reduced range of motion, difficulty climbing and jumping, reduced physical activity, and lower quality of life. Our objective was to use activity monitors to measure physical activity and identify how activity counts correlate with age, body weight (BW), body condition score (BCS), serum inflammatory markers, veterinarian pain assessment, and owner perception of pain in free-living dogs with OA. The University of Illinois Institutional Animal Care and Use Committee approved the study and owner consent was received prior to experimentation. Fifty-six client-owned dogs (mean age = 7.8 yr; mean BCS = 6.1) with clinical signs and veterinary diagnosis of OA wore HeyRex activity collars continuously over a 49-d period. Blood samples were collected on day 0 and 49, and dog owners completed canine brief pain inventory (CBPI) and Liverpool osteoarthritis in dogs (LOAD) surveys on day 0, 21, 35, and 49. All data were analyzed using SAS 9.3 using repeated measures and R Studio 1.0.136 was used to generate Pearson correlation coefficients between data outcomes. Average activity throughout the study demonstrated greater activity levels on weekends. It also showed that 24-h activity spiked twice daily, once in the morning and another in the afternoon. Serum C-reactive protein concentration was lower (P < 0.01) at day 49 compared to day 0. Survey data indicated lower (P < 0.05) overall pain intensity and severity score on day 21, 35 and 49 compared to day 0. BW was correlated with average activity counts (P = 0.02; r = -0.12) and run activity (P = 0.10; r = -0.24). Weekend average activity counts were correlated with owner pain intensity scores (P = 0.0813; r = -0.2311), but weekday average activity count was not. Age was not correlated with total activity count, sleep activity, or run activity, but it was correlated with scratch (P = 0.03; r = -0.10), alert (P = 0.03; r = -0.13), and walk (P = 0.09; r = -0.23) activities. Total activity counts and activity type (sleep, scratch, alert, walk, and run) were not correlated with pain scored by veterinarians, pain intensity or severity scored by owners, or baseline BCS. Even though the lack of controls and/or information on the individual living conditions of dogs resulted in a high level of variability in this study, our data suggest that the use of activity monitors have the potential to aid in the management of OA and other conditions affecting activity (e.g., allergy; anxiety).

Evaluation of a novel animal milk oligosaccharide biosimilar: macronutrient digestibility and gastrointestinal tolerance, fecal metabolites, and fecal microbiota of healthy adult dogs and in vitro genotoxicity assays

Milk oligosaccharides (MO) are bioactive compounds in mammalian milk that provide health benefits to neonates beyond essential nutrients. GNU100, a novel animal MO biosimilar, was recently tested in vitro, with results showing beneficial shifts in microbiota and increased short-chain fatty acid (SCFA) production, but other effects of GNU100 were unknown. Three studies were conducted to evaluate the safety, palatability, and gastrointestinal (GI) tolerance of GNU100. In study 1, the mutagenic potential of GNU100 was tested using a bacterial reverse mutation assay and a mammalian cell micronucleus test. In study 2, palatability was assessed by comparing diets containing 0% vs. 1% GNU100 in 20 adult dogs. In study 3, 32 adult dogs were used in a completely randomized design to assess the safety and GI tolerance of GNU100 and explore utility. Following a 2-wk baseline, dogs were assigned to one of four treatments and fed for 26 wk: 0%, 0.5%, 1%, and 1.5% GNU100. On weeks 2, 4, and 26, fresh fecal samples were collected to measure stool quality, immunoglobulin A, and calprotectin, and blood samples were collected to measure serum chemistry, inflammatory markers, and hematology. On weeks 2 and 4, fresh fecal samples were collected to measure metabolites and microbiota. On week 4, total feces were collected to assess apparent total tract macronutrient digestibility. Although revertant numbers were greater compared with the solvent control in tester strain WP2uvrA(pKM101) in the presence of metabolic activation (S9) in the initial experiment, they remained below the threshold for a positive mutagenic response in follow-up confirmatory tests, supporting that GNU100 is not mutagenic. Similarly, no cytotoxicity or chromosome damage was observed in the cell micronucleus test. The palatability test showed that 1% GNU100 was strongly preferred (P < 0.05; 3.6:1 consumption ratio) over the control. In study 3, all dogs were healthy and had no signs of GI intolerance or illness. All diets were well accepted, and food intake, fecal characteristics, metabolite concentrations, and macronutrient digestibilities were not altered. GNU100 modulated fecal microbiota, increasing evenness and Catenibacterium, Megamonas, and Prevotella (SCFA producers) and reducing Collinsella. Overall, the results suggest that GNU100 is palatable and well-tolerated, causes no genotoxicity or adverse effects on health, and beneficially shifts the fecal microbiota, supporting the safety of GNU100 for the inclusion in canine diets.

Development of a novel model of cholecystectomy in subsequently ovariectomized mice and characterization of metabolic and gastrointestinal phenotypes: a pilot study

Background

Cholecystectomy (XGB) is the most common abdominal surgery performed in the United States and is associated with an increased post-surgery incidence of metabolic and gastrointestinal (GI) diseases. Two main risk factors for XGB are sex (female) and age (40–50 yr), corresponding with onset of menopause. Post-menopausal estrogen loss alone facilitates metabolic dysfunction, but the effects of XGB on metabolic and GI health have yet to be investigated in this population. Study objectives were to (1) identify possible short-term effects of XGB and (2) develop a novel murine model of XGB in human menopause via subsequent ovariectomy (OVX) and assess longitudinal effects of OVX on metabolism, GI physiology, and GI microbiota in XGB mice.

Methods

Female C57BL/6 mice were utilized in two parallel studies (S1&S2). In S1, XGB mice were compared to a non-XGB baseline group after six wk. In S2, mice were XGB at wk0, either sham (SHM) or OVX at wk6, and sacrificed at wk12, wk18, and wk24. Body composition assessment and fresh fecal collections were conducted periodically. Serum and tissues were collected at sacrifice for metabolic and GI health endpoints.

Results

Compared to baseline, XGB increased hepatic CYP7A1 and decreased HMGCR relative expression, but did not influence BW, fat mass, or hepatic triglycerides after six wk. In S2, XGB/OVX mice had greater BW and fat mass than XGB/SHM. Cecal microbiota alpha diversity metrics were lower in XGB/OVX mice at wk24 compared the XGB/SHM. No consistent longitudinal patterns in fasting serum lipids, fecal microbial diversity, and GI gene expression were observed between S2 groups.

Conclusions

In addition to developing a novel, clinically-representative model of XGB and subsequent OVX, our results suggest that OVX resulted in the expected phenotype to some extent, but that XGB may modify or mask some responses and requires further investigation.

Effect of a novel animal milk oligosaccharide biosimilar on macronutrient digestibility and gastrointestinal tolerance, fecal metabolites, and fecal microbiota of healthy adult cats

GNU100 is a novel animal milk oligosaccharide (AMO) biosimilar. In a recent in vitro fermentation study, GNU100 was shown to be fermentable by feline gastrointestinal microbiota and lead to increased short-chain fatty acid production. Our objectives herein were to evaluate the palatability, safety, and gastrointestinal tolerance of GNU100 in healthy adult cats. Exploratory end-points were measured to assess utility. In study 1, 20 adult cats were used to test the palatability of diets containing 0% or 1% GNU100. In study 2, 32 (mean age = 1.9 yr; mean body weight = 4.6 kg) male (n = 12) and female (n = 20) adult cats were used in a completely randomized design. After a 2-wk baseline, cats were assigned to one of the following treatment groups and fed for 26 wk: control (CT, no GNU100), low dose (LD, 0.5% GNU100), medium dose (MD, 1.0% GNU100), and high dose (HD, 1.5% GNU100). On weeks 2, 4, and 26, fresh fecal samples were collected for the measurement of stool quality and immune and inflammatory markers and on weeks 2 and 4 for microbiota and metabolites. On week 4, total feces were collected to measure apparent total tract macronutrient digestibility. On weeks 2, 4, and 26, blood samples were collected for serum chemistry, hematology, and inflammatory marker measurement. The palatability test showed that 1% GNU100 was strongly preferred (P < 0.05), with GNU100 having a 17.6:1 consumption ratio compared with control. In the long-term study, all cats remained healthy, without any signs of gastrointestinal intolerance or illness. All diets were well accepted, resulting in similar (P > 0.05) food intake, fecal characteristics, immunoglobulin A, and calprotectin, and dry matter, organic matter, fat, and crude protein digestibilities. Fecal butyrate was greater (P = 0.02) in cats fed HD than cats fed LD or MD. Fecal indole was lower (P = 0.02) in cats fed HD than cats fed LD. Cats fed CT had a higher (P = 0.003) relative abundance of Actinobacteria than cats fed LD. The relative abundance of Peptococcus was impacted by diet and time. At 4 wk, Campylobacter was lower in fecal samples of cats fed HD. Overall, the data suggest that dietary GNU100 supplementation was highly palatable, well tolerated, did not cause detrimental effects on fecal quality or nutrient digestibility, increased fecal butyrate concentrations, and reduced fecal indole concentrations, supporting the safety of GNU100 for inclusion in feline diets and suggesting potential benefits on gastrointestinal health of cats.

PSVI-27 Novel dietary blends improve stool quality and alter fecal microbiota, metabolites, and immune markers of healthy adult cats

Functional ingredients may support gastrointestinal and immune health, but little is known in cats. Our objective was to evaluate the effects of diets containing a blend of fibers, prebiotics, probiotics, and/or immune mediators on stool quality and fecal microbiota, metabolites and immune markers of cats. Twelve healthy adult domestic shorthair cats (age = 9.6±4.0 yr; BW = 3.9±1.0 kg) were used in a replicated 3x3 Latin square design to test diets containing 1) no prebiotics or probiotics (Control), 2) a fiber-prebiotic-probiotic blend-containing formula (Test1), and 3) a fiber-prebiotic-probiotic blend + immuno-modulating ingredient-containing formula (Test2). In each 28-d period, 22d of diet adaptation was followed by fecal and blood sample collection. All procedures were approved by the Kennelwood, Inc. IACUC prior to experimentation. All data were analyzed using Mixed model procedures of SAS 9.4, with significance set at P&lt; 0.05. Fecal pH and SCFA, phenol + indole, and ammonia concentrations were lower in cats fed Control vs. Test1 or Test2 diets. Fecal score was higher (looser stools) and fecal DM was lower in cats fed Control vs. Test2 diet. Fecal butyrate was lowest in cats fed Test2 and highest in cats fed Control. Fecal total BCFA and 7-methylindole were lower in cats fed Control vs. Test1 diet. Fecal IgA concentration was lower in cats fed Test2 vs. Control or Test1 diets. Fecal bacterial alpha-diversity measures of species richness were higher in cats fed Test1 or Test2 vs. Control diet. Fecal Actinobacteria and Megasphaera were higher, and Bacteroidetes, Firmicutes, and Prevotella were lower, in cats fed Control vs. Test1 or Test2 diets. Our results suggest that dietary fibers, prebiotics, and probiotics affect fecal microbiota, metabolites, and immune markers that may impact gastrointestinal health of cats.

Saccharomyces cerevisiae Fermentation Product Did Not Attenuate Clinical Signs, but Psyllium Husk Has Protective Effects in a Murine Dextran Sulfate Sodium-Induced Colitis Model

BACKGROUND

Yeast products and psyllium husk may provide relief from clinical signs of colitis due to their ability to promote gut integrity, modulate gut microbiota, or positively affect immune responses, which have been demonstrated in several species.

OBJECTIVE

The objective of this study was to investigate the effects of a Saccharomyces cerevisiae fermentation product (SCFP) and psyllium husk (PH) on cecal and fecal microbiota, colonic gene expression and histopathology, and mesenteric lymph node (MLN) immune cells in a dextran sulfate sodium (DSS)-induced colitis model.

METHODS

Male C57BL/6J mice (n = 54) were assigned to a control, 5% SCFP, or 5% PH diet. After 2 wk of diet adaptation, mice were provided distilled water or 3% (wt:vol) DSS for 5 d ad libitum. Body weight, food and water intakes, and disease activity index (DAI) were recorded daily during the treatment period. Fresh fecal samples were collected before and during treatment for microbial analyses. After treatment, mice were killed, followed by tissue collection. Tissues were stored in proper solutions until further analyses. Data were analyzed using the Mixed Models procedure of SAS 9.4 (SAS Institute).

RESULTS

Consumption of SCFP increased (P < 0.05) species richness of the gut microbiota and relative abundance of Butyricicoccus in fecal and cecal samples compared with control or PH mice. PH mice had greater (P < 0.05) gene expression of claudin (Cldn) 2, Cldn3, Cldn8, and occludin(Ocln) compared with control mice. DAI, MLN immune cell populations, colonic histopathology, and colonic gene expression were not affected (P > 0.05) by SCFP in DSS mice. DSS mice consuming PH had lower (P < 0.05) DAI compared with control or SCFP mice.

CONCLUSIONS

Results suggest that, despite the modest changes it had on cecal and fecal microbiota, SCFP did not attenuate clinical signs associated with DSS-induced colitis in mice, while PH showed protective effects.

Inclusion of the direct-fed microbial Clostridium butyricum in diets for weanling pigs increases growth performance and tends to increase villus height and crypt depth, but does not change intestinal microbial abundance

An experiment was conducted to test the hypothesis that inclusion of the direct fed microbial Clostridium butyricum in diets for weanling pigs will improve growth performance, systemic immune function, microbiota composition, and gut morphology in weaned pigs. A total of 275 newly weaned pigs (20 ± 2 d of age) with an average initial BW of 6.4 ± 0.8 kg were allotted to a randomized complete block design with 11 pens per treatment. Diets included a positive control diet containing Carbadox, a negative control diet without Carbadox, and three treatment diets in which 1,250 × 108 cfu/kg, 2,500 × 108 cfu/kg, or 3,500 × 108 cfu/kg of C. butyricum was added to the negative control diet. A two-phase feeding program was used (phase 1, 14 d; phase 2, 21 d). At the conclusion of the experiment (day 35), a blood sample was collected from one pig per pen (11 pigs per treatment) and this pig was then euthanized and digesta and tissues samples were collected. Results indicated that for the overall phase, pigs fed the positive control diet had greater (P < 0.05) ADG and ADFI and tended (P = 0.064) to have greater final BW than pigs fed the negative control diet. The ADG and G:F increased and then decreased as increasing doses of C. butyricum were included in the diet (quadratic, P < 0.05). The concentration of tumor necrosis factor-α was less (P < 0.05) in pigs fed the positive control diet compared with pigs fed the negative control diet or diets containing C. butyricum. Crypt depth tended (P = 0.08) to be less in pigs fed the negative control diet compared with pigs fed the positive control diet and villus height tended to increase as the doses of C. butyricum increased in the diets (quadratic, P = 0.08). Villus height also tended (P = 0.084) to be greater in pigs fed diets containing C. butyricum compared with pigs fed the positive control diet. Crypt depth increased as the dose of C. butyricum increased (quadratic, P < 0.05) and villus width at the bottom tended to increase (linear, P = 0.072) as the dose of C. butyricum increased in the diet. Alpha and beta diversity indices of ileal and colonic microbiota were not affected by diet. In conclusion, addition of 1,250 × 108 cfu/kg of C. butyricum, but not greater levels, to diets fed to weanling pigs increased growth performance and tended to increase villus height and crypt depth, but changes in the abundance of intestinal microbiota were not observed.

PSIII-41 Fecal characteristics and metabolite concentrations of cats fed a high-protein, high-fiber diet after spay surgery

Dietary fiber and protein concentrations can impact large intestinal fermentation and metabolite concentrations, consequently affecting gastrointestinal health and fecal characteristics. The objective of this study was to evaluate the effects of dietary intervention on fecal characteristics and metabolite concentrations of cats after spay surgery. Twenty healthy female cats (mean age=9.5±0.1 months) were used in a 29-wk longitudinal study. After a 5-wk baseline phase being fed a moderate-protein, moderate-fiber (MPMF) diet, sixteen cats were spayed and randomly allotted to the MPMF diet (n = 8) or a high-protein, high-fiber (HPHF) diet (n = 8) and fed for 24wk. Remaining cats (n = 4) were sham-operated and fed the MPMF diet. Cats were fed to maintain BW the first 12wk, then fed up to twice that amount for another 12wk to measure changes in fecal characteristics and metabolite concentrations when allowed to overeat. Fresh fecal samples were collected before surgery (wk0) and 2, 4, 6, 12, 18, and 24wk after surgery for fecal score, pH and metabolite measurements. Fecal pH was higher (P &lt; 0.01) in HPHF cats than MPMF and sham cats. Sham cats generally had greater (P &lt; 0.05) fecal total SCFA, acetate, butyrate, total BCFA and phenol concentrations than HPHF cats. HPHF cats also had lower (P &lt; 0.01) fecal valerate, but higher (P &lt; 0.01) fecal indole concentrations than MPMF and sham cats. Significant time effects (P &lt; 0.01) were observed for fecal score, pH, acetate, butyrate, propionate, total SCFA, isobutyrate, isovalerate, valerate, total BCFA, 4-ethylphenol, indole, total indole and phenols, and ammonia. Some treatment*time effects (P &lt; 0.05) were observed for fecal pH, isovalerate, ammonia, butyrate, valerate, BCFA, and indole. Our results suggest that dietary protein and fiber concentrations affect the fecal characteristics and metabolite profiles of cats. Future studies should evaluate the microbiota affected to determine which groups are responsible and what these changes mean to feline health.

PSIII-40 Dietary effects on food intake, body weight, body composition and metabolism of adult female cats after spay surgery

Spay and neuter surgeries are common procedures to control the pet population, but have been associated with increased risk for obesity due to changes in appetite, decreased metabolic rate, and decreased energy expenditure. Dietary management post-spay could help decrease obesity risk, but few research studies have been conducted on cats following spay surgery. Therefore, the objective of this study was to evaluate the effects of a high-protein, high-fiber diet (HPHF) vs. a moderate-protein, moderate-fiber diet (MPMF) in female cats following spay surgery. Twenty healthy female cats (9.5±0.1 months old) were used. After a 5-wk baseline phase with cats fed MPMF to maintain BW, 16 cats were spayed and randomly allotted to MPMF (n = 8) or HPHF (n = 8), with the remaining cats being sham-operated and fed MPMF (n = 4). Cats were fed to maintain BW for 12 wk, then fed up to twice that amount during the subsequent 12 wk of study. Daily food intake, twice weekly BW and twice weekly BCS were assessed. Body composition using DEXA, serum metabolite concentrations, and voluntary physical activity levels were measured prior to spay (wk 0) and every 6 wk post-spay. A treatment*time effect was observed for food intake (g/d), but not caloric intake (kcal ME/d). Caloric intake was affected by time and treatment effects, being reduced over the first 12 wk and reduced at higher amounts in HPHF and MPMF cats vs. sham cats. BW, BCS and body fat percentage were affected over time. A treatment*time effect was observed for blood urea nitrogen, ALP, and fructosamine, while blood triglycerides, total cholesterol, creatinine, total protein, phosphorus, and bicarbonate were affected by time. Physical activity was also reduced over time. Our results demonstrate that spay surgery affects food intake, BW, metabolism, and physical activity in cats. Dietary intervention in this study, however, led to minor changes.

Physical activity during pregnancy is associated with a lower prevalence of gestational diabetes mellitus in Vietnam

AIMS

To assess the association between physical activity (PA) during pregnancy and the prevalence of gestational diabetes mellitus (GDM) accounting for sitting time.

METHODS

The study used data from a cohort study of 2030 pregnant women in Vietnam. Women were recruited from six hospitals in Ha Noi, Hai Phong, and Ho Chi Minh City. Baseline measurements including PA and GDM were taken at 24-28 weeks of gestation. PA was assessed during the past 3 months before the interview using the interviewer-administered Pregnancy Physical Activity Questionnaire. GDM was diagnosed at 24-28 weeks of gestation using the 2013 World Health Organization criteria.

RESULTS

1987 out of 2030 pregnant women were included in the final analysis, of which 432 had GDM (21.7%). Women undertaking the highest level (upper tertile) of PA during pregnancy appeared to have a lower risk of GDM [odds ratio (OR) 0.70, 95% confidence interval (CI) 0.53-0.94, P_trend 0.017] when compared to those at the lowest tertile of PA. Similarly, women with increased levels of moderate-intensive activity and household/caregiving activity during pregnancy were associated with reduced risks of GDM (OR 0.66, 95% CI 0.50-0.86, P_trend 0.002 and OR 0.72, 95% CI 0.55-0.95, P_trend 0.020, respectively). These apparent inverse associations were not attenuated by their sitting time. There were no significant associations between sitting time, light-intensity activity, vigorous-intensity activity, occupation, sports/exercise, commuting, or meeting exercise guidelines and GDM risk.

CONCLUSIONS

High levels of PA, particularly moderate-intensity and household/caregiving activities during pregnancy were associated with a lower prevalence of GDM independent of sitting time.

An Argument for Amphetamine-Induced Hallucinations in an Invertebrate

Hallucinations – compelling perceptions of stimuli that aren’t really there – occur in many psychiatric and neurological disorders, and are triggered by certain drugs of abuse. Despite their clinical importance, the neuronal mechanisms giving rise to hallucinations are poorly understood, in large part due to the absence of animal models in which they can be induced, confirmed to be endogenously generated, and objectively analyzed. In humans, amphetamine (AMPH) and related psychostimulants taken in large or repeated doses can induce hallucinations. Here we present evidence for such phenomena in the marine mollusk Tritonia diomedea. Animals injected with AMPH were found to sporadically launch spontaneous escape swims in the absence of eliciting stimuli. Deafferented isolated brains exposed to AMPH, where real stimuli could play no role, generated sporadic, spontaneous swim motor programs. A neurophysiological search of the swim network traced the origin of these drug-induced spontaneous motor programs to spontaneous bursts of firing in the S-cells, the CNS afferent neurons that normally inform the animal of skin contact with its predators and trigger the animal’s escape swim. Further investigation identified AMPH-induced enhanced excitability and plateau potential properties in the S-cells. Taken together, these observations support an argument that Tritonia’s spontaneous AMPH-induced swims are triggered by false perceptions of predator contact – i.e., hallucinations—and illuminate potential cellular mechanisms for such phenomena.

Soyfood and isoflavone intake and risk of type 2 diabetes in Vietnamese adults

BACKGROUND/OBJECTIVES

Animal studies have demonstrated that soy isoflavones exert antidiabetic effects. However, evidence regarding the association between soyfood intake, a unique source of isoflavones, and type 2 diabetes remains inconclusive. This study assessed the relationship between habitual intakes of soyfoods and major isoflavones and risk of type 2 diabetes in Vietnamese adults.

SUBJECTS/METHODS

A hospital-based case-control study was conducted in Vietnam during 2013-2015. A total of 599 newly diagnosed diabetic cases (age 40-65 years) and 599 hospital-based controls, frequency matched by age and sex, were recruited in Hanoi, capital city of Vietnam. Information on frequency and quantity of soyfood and isoflavone intake, together with demographics, habitual diet and lifestyle characteristics, was obtained from direct interviews using a validated and reliable questionnaire. Unconditional logistic regression analyses were performed to examine the association between soy variables and type 2 diabetes risk.

RESULTS

Higher intake of total soyfoods was significantly associated with a lower risk of type 2 diabetes; the adjusted odds ratio (OR) for the highest versus the lowest intake was 0.31 (95% confidence interval (CI): 0.21-0.46; P<0.001). An inverse dose-response relationship of similar magnitude was also observed for total isoflavone intake (OR: 0.35; 95% CI: 0.24 to 0.49; P<0.001). In addition, inverse associations of specific soyfoods (soy milk, tofu and mung bean sprout) and major isoflavones (daidzein, genistein and glycitein) with the type 2 diabetes risk were evident.

CONCLUSIONS

Soyfood and isoflavone intake was associated with a lower type 2 diabetes risk in Vietnamese adults.

Plasma concentrations of coffee polyphenols and plasma biomarkers of diabetes risk in healthy Japanese women

Coffee consumption has been reported to reduce the risk of type 2 diabetes in experimental and epidemiological studies. This anti-diabetic effect of coffee may be attributed to its high content in polyphenols especially caffeic acid and chlorogenic acid. However, the association between plasma coffee polyphenols and diabetic risks has never been investigated in the literature. In this study, fasting plasma samples were collected from 57 generally healthy females aged 38-73 (mean 52, s.d. 8) years recruited in Himeji, Japan. The concentrations of plasma coffee polyphenols were determined by liquid chromatography coupled with mass tandem spectrometer. Diabetes biomarkers in the plasma/serum samples were analysed by a commercial diagnostic laboratory. Statistical associations were assessed using Spearman's correlation coefficients. The results showed that plasma chlorogenic acid exhibited negative associations with fasting blood glucose, glycated hemoglobin and C-reactive protein, whereas plasma total coffee polyphenol and plasma caffeic acid were weakly associated with these biomarkers. Our preliminary data support previous findings that coffee polyphenols have anti-diabetic effects but further replications with large samples of both genders are recommended.

RECENT TRENDS IN GENDER RATIO AT BIRTH IN HANGZHOU, CHINA

INTRODUCTION

Higher than normal sex ratios at birth in China have been reported since the early 1980's. This study aimed to investigate recent trends in sex ratio at birth in Hangzhou, capital of Zhejiang Province in southeast China.

METHODS

Information on selected maternal and birth-related characteristics was extracted from the Hangzhou Birth Information Database for all pregnant women who delivered live births during 2005-2014. The sex ratios at birth were calculated after excluding infants with missing data on gender and those born with ambiguous genitalia.

RESULTS

A total of 478,192 male births and 430,852 female births were recorded giving an overall ratio of 111.0. The sex ratio at birth was almost constant at around 110.7 during the period 2005-2008, followed by an increase to the peak at 113.1 in 2010 and then declined back to 109.6 in 2014.

CONCLUSION

The gender ratio at birth in Hangzhou remained unbalanced for the past decade.

Acute Neurological Illness in a Kidney Transplant Recipient Following Infection With Enterovirus-D68: An Emerging Infection?

We report the first case of enterovirus-D68 infection in an adult living-donor kidney transplant recipient who developed rapidly progressive bulbar weakness and acute flaccid limb paralysis following an upper respiratory infection. We present a 45-year-old gentleman who underwent pre-emptive living-donor kidney transplantation for IgA nephropathy. Eight weeks following transplantation, he developed an acute respiratory illness from enterovirus/rhinovirus that was detectable in nasopharyngeal (NP) swabs. Within 24 h of onset of respiratory symptoms, the patient developed binocular diplopia which rapidly progressed to multiple cranial nerve dysfunctions (acute bulbar syndrome) over the next 24 h. Within the next 48 h, asymmetric flaccid paralysis of the left arm and urinary retention developed. While his neurological symptoms were evolving, the Centers for Disease Control reported that the enterovirus strain from the NP swabs was, in fact, Enterovirus-D68 (EV-D68). Magnetic resonance imaging of the brain demonstrated unique gray matter and anterior horn cell changes in the midbrain and spinal cord, respectively. Constellation of these neurological symptoms and signs was suggestive for postinfectious encephalomyelitis (acute disseminated encephalomyelitis [ADEM]) from EV-D68. Treatment based on the principles of ADEM included intensive physical therapy and other supportive measures, which resulted in a steady albeit slow improvement in his left arm and bulbar weakness, while maintaining stable allograft function.

Fruit and vegetable consumption and risk of esophageal cancer: a case-control study in north-west China

The north-western region of China carries a big burden of esophageal cancer with incidence above the national average. This study ascertained the association between fruit and vegetable consumption and the risk of esophageal cancer in this remote part of China. A case-control study was undertaken in Urumqi and Shihezi, Xinjiang Uyghur Autonomous Region of China, between 2008 and 2009. Participants were 359 incident esophageal cancer patients and 380 hospital-based controls. Information on habitual fruit and vegetable consumption was obtained by face-to-face interview using a validated semiquantitative food frequency questionnaire. Unconditional logistic regression analyses were performed to assess the strength of the associations. The esophageal cancer patients consumed significantly less fruits (mean 364.3, standard deviation [SD] 497.4 g) and vegetables (mean 711.4, SD 727.9 g) daily than their counterparts without the disease (mean 496.5, SD 634.4 g and mean 894.5, SD 746.1 g, respectively). The adjusted odds ratios were 0.48 (95% confidence interval 0.33-0.71) and 0.46 (95% confidence interval 0.32-0.68) for consuming at least 515 g of fruits and 940 g of vegetables per day, respectively, relative to at most 170 g and 520 g. With respect to nutrients contained in fruits and vegetables, intakes of vitamin C, vitamin E, β-cryptoxanthin, potassium, and magnesium at high levels also reduced the esophageal cancer risk. In conclusion, inverse associations were evident between consumption of fruits and vegetables and the risk of esophageal cancer for adults residing in north-west China.

Sustainability of a physical activity and nutrition program for seniors

OBJECTIVE

This prospective cohort study aimed to determine the impact of a low cost, home-based physical activity and nutrition program for older adults at 6 months follow-up.

DESIGN

A follow-up survey was conducted 6 months after program completion via computer-assisted telephone interviewing. The International Physical Activity Questionnaire and the Fat and Fibre Barometer were used to measure physical activity levels and dietary behaviours, respectively. Self-reported height, weight, waist and hip circumferences were obtained. Changes over three time points of data collection (baseline, post-program, follow-up) and differences between the intervention and control groups were assessed. The use of program materials was also evaluated.

SETTING

Community and home-based.

PARTICIPANTS

Insufficiently active 60 to 70 year olds (n = 176, intervention and n = 198, control) residing in suburbs within the Perth metropolitan area.

RESULTS

A sustained improvement was observed for the intervention group in terms of fat avoidance behaviours (p interaction = .007). Significant improvements were found for strength exercises, fibre intake, body mass index and waist-to-hip ratio at either post-program or follow-up, however the overall effect was not significant. At post-program, the intervention group increased time spent participating in moderate activity by 50 minutes (p > .05), which was followed by a significant decline at follow-up (p < .05). Among intervention group participants, males and females differed with respect to strength exercises and moderate physical activity.

CONCLUSION

This low-cost physical activity and nutrition intervention resulted in a sustained improvement in fat avoidance behaviours and overall short-term gains in physical activity. Future studies for older adults are recommended to investigate gender-specific behavioural barriers as well as booster interventions which focus on physical activity.

Comparison between a moving bed bioreactor and a fixed bed bioreactor for biological phosphate removal and denitrification

Moving bed bioreactors (MBBR) and fixed bed bioreactors (FBBR) were compared for biological phosphorus removal and denitrification. The sorption denitrification P-elimination (S-DN-P) process was selected for this study. Results indicated that all nutrients were removed by the FBBR process compared with the MBBR process: 19.8% (total COD), 35.5% (filtered COD), 27.6% (BOD(5)), 62.2% (acetate), 78.5% (PO(4)-P), and 54.2% (NO(3)-N) in MBBR; 49.7% (total COD), 54.0% (filtered COD), 63.2% (BOD(5)), 99.6% (acetate), 98.6% (PO(4)-P), and 75.9% (NO(3)-N) in FBBR. The phosphate uptake and NO(3)-N decomposition in the FBBR process during the denitrification phase were much higher than for the MBBR process despite being of shorter duration. Results obtained from this study are helpful in elucidating the practical implications of using MBBR and FBBR for the removal of bio-P and denitrification from wastewater.

High incidence of respiratory infections in 'nil by mouth' tube-fed acute ischemic stroke patients

BACKGROUND

Respiratory infections are common in acute stroke. Previous studies have found dysphagia is associated with respiratory infections. Of interest is whether patients who are 'Nil by Mouth' (NBM) and tube fed have higher risk of developing infections due to aspiration of bacteria-laden saliva or refluxed material than stroke patients who are fed orally.

METHODS

Prospective cohort of 330 ischemic stroke survivors were followed for 30 days and infections recorded.

RESULTS

115 infections were treated with antibiotics; these included 51 respiratory infections. Incidence of infection in NBM tube-fed stroke patients (n = 74) was 69%, with 30 respiratory infections occurring in 74 patients who received enteral feeding after stroke. Logistic regression analysis showed tube feeding during admission was a significant risk for respiratory infection. We also saw a significant time-to-event effect with 73% (22/30) respiratory infections in tube-fed survivors diagnosed on days 2-4 after stroke, and 76% (39/51) of infections in all tube-fed survivors occurring by day 7 after stroke. Relevance to a theory of critical period of susceptibility to infection in acute stroke is discussed.

CONCLUSIONS

NBM tube-fed survivors were unlikely to have aspirated anything other than saliva/secretions or reflux, yet experienced significantly higher rates of respiratory infections than survivors fed orally. Stringent oral care and measures to prevent reflux are potentially modifiable aspects of stroke management.

Hospital admissions and length of stay for coronary disease in an Aboriginal cohort

BACKGROUND AND AIMS

Coronary disease (CHD)-related hospital admission is more common among indigenous than non-indigenous Australians. We aimed to identify predictors of hospital admission potentially useful in planning prevention programs.

METHODS AND RESULTS

Length of stay (LOS), interval between, and number of recurrent admissions were modelled with proportional hazards or negative binomial models using lifestyle data recorded in 1988-1989 among Aborigines (256 women, 258 men, aged 15-88years) linked to hospital records to 2002. Among 106 Aborigines with CHD, hypertension (hazard ratio (HR) 1.69, 95% CI 1.05-2.73); smoking (HR 1.90, 95% CI 1.02-3.53); consuming processed meat >4 times/month (HR 1.81, 95% CI 1.01-3.24); >6 eggs/week (HR 1.73, 95% CI 1.03-2.94); and lower intake of alcohol (HR 0.54, 95% CI 0.35-0.83) predicted LOS. Eating eggs (HR 1.05, 95% CI 1.01-1.09) and bush meats > or =7 times/month (HR 0.46, 95% CI 0.23-0.92) predicted interval between recurrent admissions. Hypertension (IRR 4.07; 95% CI 1.32-12.52), being an ex-drinker (IRR 6.60, 95% CI 2.30-19.00), eating red meat >6 times/week (IRR 0.98, 95% CI 0.97-0.99), bush meats >7 times/month (IRR 0.26, 95% CI 0.10-0.67), and adding salt to meals (IRR 3.16, 95% CI 1.12-8.92) predicted number of admissions.

CONCLUSION

Hypertension, alcohol drinking, smoking, and diet influence hospital admissions for CHD in Aboriginal Australians.

The CUPDAY Study: prebiotic-probiotic milk product in 1-3-year-old children attending childcare centres

AIM

The aim of the study was to evaluate the efficacy of a milk product containing probiotics and prebiotics (CUPDAY Milk) on the incidence of diarrhoea in children attending daycare centres.

METHODS

The study was undertaken in a randomized controlled trial with 496 children aged 1-3 years attending 29 childcare centres in Perth, Australia. The endpoint for the study was the number of days in which children were recorded as having four or more stools. The diarrhoeal rates were analyzed by Poisson regression using 'intention to treat' (all children) and 'reduced' (children enrolled for more than 10 days) data sets.

RESULTS

There was no difference in demographic characteristics between the case and control groups. In the 'intention to treat' analysis, a total of 41 745 child-days were included in the study. The adjusted risk ratio for those consuming the 'Cupday' milk drink was 0.82 (95% CI 0.73-0.94) for the intention to treat sample (n = 496) and 0.80 (95% CI 0.70-0.91) for the reduced sample (n = 315). The children consuming the 'Cupday' drink had a 20% reduction in the number of days experiencing four or more stools per day.

CONCLUSION

A milk containing probiotics and prebiotics reduced the number of days children attending child care who had four or more stools by 20%.

Health-related behaviours as predictors of mortality and morbidity in Australian Aborigines

OBJECTIVE

To examine predictors of coronary heart disease (CHD) and all-cause mortality in Aboriginal Australians.

METHOD

In 1988-89, a survey of Western Australian Aborigines (256 women, 258 men) aged 15-88 years documented diet, alcohol and smoking habits. Linkage to mortality and hospital admissions to the end of 2002 provided longitudinal data for modelling of coronary heart disease endpoints and all-cause mortality using Cox regression.

RESULTS

Coronary heart disease risk increased with smoking (HR 2.62, 95% CI: 1.19, 5.75), consumption of processed meats >once/week (HR 2.21, 95% CI: 1.05, 4.63), eggs >twice/week (HR 2.59, 95% CI: 1.11, 6.04) and using spreads on bread (HR 3.14. 95% CI: 1.03, 9.61). All-cause mortality risk was lower with exercise >once/week (HR 0.51, 95% CI 0.26, 1.05), increased in ex-drinkers (HR 3.66, 95% CI: 1.08, 12.47), heavy drinkers (HR 5.26, 95% CI: 1.46, 7.52) and with consumption of take away foods >nine times/month (HR 1.78, 95% CI 0.96, 3.29). Greater alcohol intake, smoking and adverse dietary choices clustered in 53% of men and 56% of women and increased risk of coronary heart disease (HR 2.1, 95% CI: 1.1, 4.0) and all-cause mortality (HR 2.3, 95% CI: 1.2, 4.2).

CONCLUSION

Lifestyle in Aboriginal Australians predicts coronary heart disease and all-cause mortality. Clustering of adverse behaviours is common and increases risk of coronary heart disease and death.

Alcohol intake and incidence of coronary disease in Australian aborigines

AIMS

To examine risk for coronary heart disease (CHD) and cardiovascular disease (CVD) in relation to alcohol in a cohort of Australian Aborigines.

METHODS

In 1988-1989, alcohol intake, drinking pattern, and beverage preference were elicited by interviewer-administered questionnaire in Western Australian Aborigines (258 men, 256 women) and cardiovascular outcomes ascertained through linkage to mortality and hospital admission records to 2002.

RESULTS

In proportional hazards models, risk for CHD, relative to lifetime abstainers, was significantly increased in ex-drinkers [Hazard ratio (HR) 2.29, 95% CL 1.23, 4.27], those drinking 41-60 g/day in men or 21-40 g/day in women (HR 2.80, 95% CL 1.04, 7.53), and those drinking >150 g/day for men or >100 g/day for women (HR 2.25, 95% CL 1.03, 4.90) with a J-shaped relationship. Low-to-moderate drinkers had lower waist girth, exercised more, and had a lower prevalence of overweight and smoking than at-risk drinkers. A preference for wine was associated with lower HR (0.28, 95% CL 0.10, 0.95). With CVD, only ex-drinkers showed significantly increased risk (HR 1.87, 95% CL 1.20, 2.91).

CONCLUSIONS

More favourable health-related behaviours in low-to-moderate drinkers suggest that lower risk could be mediated by lifestyle, as proposed in other populations.

Alcohol intake and incidence of coronary disease in Australian aborigines

AIMS

To examine risk for coronary heart disease (CHD) and cardiovascular disease (CVD) in relation to alcohol in a cohort of Australian Aborigines.

METHODS

In 1988-1989, alcohol intake, drinking pattern, and beverage preference were elicited by interviewer-administered questionnaire in Western Australian Aborigines (258 men and 256 women) and cardiovascular outcomes ascertained through linkage to mortality and hospital admission records to 2002.

RESULTS

In proportional hazards models, risk for CHD, relative to lifetime abstainers, was significantly increased in ex-drinkers [Hazard ratio (HR), 2.29; 95% confidence intervals (CI), 1.23-4.27], those drinking 41-60 g/day in men or 21-40 g/day in women (HR 2.80; 95% CI, 1.04-7.53) and those drinking >150 g/day for men or >100 g/day for women (HR, 2.25; 95% CI, 1.03-4.90) with a J-shaped relationship. Low-to-moderate drinkers had lower waist girth, exercised more and had a lower prevalence of overweight and smoking than at-risk drinkers. A preference for wine was associated with lower HR (0.28; 95% CI, 0.10-0.95). With CVD, only ex-drinkers showed significantly increased risk (HR, 1.87; 95% CI, 1.20-2.91).

CONCLUSIONS

More favourable health-related behaviours in low-to-moderate drinkers suggest that lower risk could be mediated by lifestyle, as proposed in other populations.

Emergency presentations by vulnerable road users: implications for injury prevention

Most emergency presentations by vulnerable road users were the result of collisions that did not involve a motor vehicle. Many injuries occurred off-road without police attendance. Hence, reliance on official police records would underestimate the magnitude and scope of these injuries. Suggestions to provide a safer road environment are given.

Morphological and immunophenotypic analysis of breast carcinomas with basal and myoepithelial differentiation

The aim of this study was to assess the morphological characteristics and immunohistochemical profile of breast carcinomas with basal and myoepithelial phenotypes to obtain a better understanding of their biological behaviour and nature. One thousand nine hundred and forty-four invasive breast carcinomas were examined, using tissue microarray (TMA) technology and immunohistochemistry, to identify those tumours that showed basal and myoepithelial phenotypes, and their immunophenotype profile was characterized using a variety of markers. In addition, haematoxylin and eosin-stained sections of these tumours were studied for several morphological parameters. The findings were correlated with patient and tumour characteristics and outcome data. Tumours were classified into two groups: (1) tumours with basal phenotype [expressing one or both basal markers (CK5/6 and/or CK14)] and (2) tumours with myoepithelial phenotype (expressing SMA and/or p63). Group 1 was further subdivided into two subgroups: (A) dominant basal pattern (more than 50% of cells positive) and (B) basal characteristics (10-50% of cells positive). Group 1 tumours constituted 18.6% (8.6% and 10% for groups 1A and 1B, respectively) and group 2 constituted 13.7% of the cases. In both groups, the most common histological types were ductal/no specific type, tubular mixed and medullary-like carcinomas; the majority of these tumours were grade 3. There were positive associations with adenoid cystic growth pattern, loss of tubule formation, marked cellular pleomorphism, poorer Nottingham prognostic index, and development of distant metastasis. In addition, associations were found with loss of expression of steroid hormone receptors and FHIT proteins and positive expression of p53 and EGFR. The most common characteristics in group 1 were larger size, high-grade comedo-type necrosis, development of tumour recurrence, and absence of lymph node disease. Group 2 tumours were more common in younger patients and were associated with central acellular zones, basaloid change, and positive E-cadherin protein expression. Group 1 characteristics were associated with both reduced overall survival (OS) [log rank (LR) = 22.5, p < 0.001] and reduced disease-free interval (DFI) (LR = 30.1, p < 0.001), while group 2 characteristics showed an association with OS (LR = 5, p = 0.02) but not with DFI. Multivariate analysis showed that basal, but not myoepithelial, phenotype has an independent value in predicting outcome. Breast cancers with basal and myoepithelial phenotypes are distinct groups of tumours that share some common morphological features and an association with poor prognosis. The basal rather than the myoepithelial phenotype has the strongest relationship with patient outcome.

Indoor environmental quality in a 'low allergen' school and three standard primary schools in Western Australia

To investigate indoor environmental quality in classrooms, assessments were undertaken in a 'low allergen' school and three standard primary schools in Western Australia. Dust allergens, air pollutants and physical parameters were monitored in the four schools at four times (summer school term, autumn holiday, winter school term and winter holiday) in 2002. The levels of particulate matter (PM(10)) and volatile organic compounds were similar between the four primary schools. Although slightly decreased levels of dust-mite and cat allergens were observed in the 'low allergen' school, the reductions were not statistically significant and the allergen levels in all schools were much lower than the recommended sensitizing thresholds. However, significantly lower levels of relative humidity and formaldehyde level during summer-term were recorded in the 'low allergen' school. In conclusion, the evidence here suggests that the 'low allergen' school did not significantly improve the indoor environmental quality in classrooms. Practical Implications School is an important environment for children in terms of exposure to pollutants and allergens. By assessing the levels of key pollutants and allergens in a low allergen school and three standard primary schools in Western Australia, this study provides useful information for implementation of healthy building design that can improve the indoor environment in schools.

Contraception within six-month postpartum in rural Vietnam: implications on family planning and maternity services

OBJECTIVES

This longitudinal study documents contraception practice and factors influencing contraception decision within the first six months postpartum, amongst women residing in the rural Northern Central region of Vietnam.

METHODS

A sample of 463 rural women who gave birth during August-October 2002 were recruited and interviewed at one, 16 and 24 weeks postpartum.

RESULTS

The proportion of contraceptive users at weeks 16 and 24 were 17% and 43% respectively. At week 24, of contraceptive users, 57% used IUD, 25% used condom, and 14% used traditional methods. Logistic regression analysis found age, sufficient knowledge on contraceptives and husband/partner opinion can significantly affect the contraception decision.

CONCLUSIONS

In order to improve the situation, health authorities should be encouraged to provide counselling on postpartum contraceptive methods during ante- and postnatal care visits. Health education on family planning and breastfeeding should also involve the husband/partner group taking into account local socio-cultural features.

A quantitative food frequency questionnaire for women in southeast China: development and reproducibility

This study describes the development and reproducibility of a 128-item quantitative food frequency questionnaire (FFQ) to measure usual food consumption for women in southeast China. The FFQ was pre-tested using 51 Chinese women who recently migrated to Australia. Cronbach's alpha coefficient was 0.81 for internal consistency. The reliability of the FFQ was then assessed by another test-retest study. A sample of 41 women residing in southeast China was interviewed twice within 12 weeks. Intraclass correlation coefficients were moderate to high for mean food group consumption (0.43-0.96) and mean daily nutrient intakes (0.47-0.89). Kappa statistics for eating habits ranged from 0.27 to 0.89 in the test-retest. The mean ratio of energy intake to basal metabolic rate was 1.73 (S.D. 0.39) in both test and retest samples. The study confirmed that the FFQ method using standard containers is appropriate to assess dietary intake for women in southeast China.

Prolonged lactation reduces ovarian cancer risk in Chinese women

To investigate the effect of lactation on the risk of ovarian cancer for Chinese women, a case-control study was conducted in Hangzhou, capital of Zhejiang province, China. Cases were 275 patients with histologically confirmed epithelial ovarian cancer. Controls were 623 women without neoplasm. All participants were parous women who had given at least one live birth and had been residents of Zhejiang province for at least 10 years. Information was collected using a validated and reliable questionnaire on total months of lactation, number of children breastfed, and average duration of lactation per child. Multivariate logistic regression models were used to assess the association between ovarian cancer risk and lactation variables, accounting for age, locality, full-term pregnancy, oral contraceptive use and family history of the cancer. The adjusted odds ratios were 0.51 (95% confidence interval (CI) 0.3-0.9) and 0.44 (95% CI 0.2-0.9) respectively for women with over 12 months of lactation and at least three children breastfed, compared with those with 4 months or less lactation and one child breastfed. The corresponding dose-response relationships were also significant (P<0.05). Therefore, prolonged lactation could reduce the risk of ovarian cancer for Chinese women.

Altered glycosylation leads to Tr polyagglutination

BACKGROUND

Polyagglutination refers to red blood cells (RBCs) that are agglutinated by a high proportion of ABO-matched adult sera but not by cord sera. Polyagglutinable RBCs have been associated with microbial infection, myeloproliferative disorders, and myelodysplasia. Lectins aid in the identification of polyagglutination.

CASE STUDY

A Hispanic male infant with mild hemolytic anemia, a "Bernard-Soulier-like" syndrome, intermittent neutropenia, mitral valve regurgitation, ligament hyperlaxity, and mild mental retardation was studied. The patient's Group O RBCs were polyagglutinable; they were agglutinated by normal human sera, several lectins [including Arachis hypogea, Salvia sclarea, Salvia horminum, Glycine max, Ulex europaeus, Griffonia simplicifolia I, and Gr. simplicifolia II], and some monoclonal antibodies. His RBCs were not agglutinated by cord sera, Dolichos biflorus, or Phaseolus lunatus. Sodium dodecyl sulfate-polyacrylamide gel electrophoresis on the RBC membranes followed by staining with periodic acid-Schiff stain showed markedly reduced staining of glycophorins A and B. Staining with Coomassie brilliant blue revealed that Band 3 has a faster mobility than normal.

CONCLUSIONS

Collectively, the results suggest that the patient's RBCs have a reduction in N-acetylneuraminic acid on both N- and O-glycans, exposing, respectively, beta1,4-galactosidase and beta1,3-galactosidase. The patient likely has an altered glycosyltransferase that results in defective glycosylation in RBCs and other cell lineages. This type of polyagglutination was named Tr.

Hospitalisation for gastroenteritis in Western Australia

AIMS

To document gastroenteritis hospitalisations of the 1995-96 cohort of infants born in Western Australia to mid-2002, and to assess factors associated with their hospitalisations and readmissions.

METHODS

Retrospective analysis of the State's hospitalisation data, Midwives' Notification of Births data, the Australian Bureau of Statistics mortality data and clinical and demographic information.

RESULTS

Aboriginal infants were hospitalised for gastroenteritis eight times more frequently than their non-Aboriginal peers, and were readmitted more frequently and sooner for diarrhoeal illnesses than the other group. They also stayed in hospital for twice as long and many Aboriginal patients were hospitalised on numerous occasions. Hospitalisation rates were higher in remote areas and were significantly associated with co-morbidities such as undernutrition, anaemia, co-existing infections, and intestinal carbohydrate intolerance.

CONCLUSIONS

Gastroenteritis is very prevalent in Australian Aboriginal infants and children and is a major cause of their hospitalisation in Western Australia. It is often associated with undernutrition, anaemia, intestinal parasitic infestations, other infections, intestinal carbohydrate intolerance, and, in some instances, with low birth weight. This is often due to unhygienic living conditions and behaviours and presents major challenges to public health, health promotion, and clinical personnel, particularly paediatric services. Childhood diarrhoeal diseases occur commonly in other indigenous groups but have not received the attention that they deserve.

Do preserved foods increase prostate cancer risk?

Preserved foods have been found in some studies to be associated with increased cancer risks. The possible relationship between preserved foods and prostate cancer was investigated in a case-control study in southeast China during 2001-2002 covering 130 histologically confirmed cases and 274 inpatient controls without malignant disease. The total amount of preserved food consumed was positively associated with cancer risk, the adjusted odds ratio being 7.05 (95% CI: 3.12-15.90) for the highest relative to the lowest quartile of intake. In particular, the consumption of pickled vegetables, fermented soy products, salted fish and preserved meats was associated with a significant increase in prostate cancer risk, all with a significant dose-response relationship.

Factors influencing hospitalisation of infants for recurrent gastroenteritis in Western Australia

OBJECTIVE

To determine factors affecting length of hospitalisation of infants for recurrent gastroenteritis using linked data records from the Western Australia heath information system.

METHODS

A seven-year retrospective cohort study was undertaken on all infants born in Western Australia in 1995 who were admitted for gastroenteritis during their first year of life (n = 519). Linked hospitalisation records were retrieved to derive the outcome measure and other demographic variables for the cohort. Unlike previous studies that focused mainly on a single episode of gastroenteritis, the durations of successive hospitalisations were analysed using a proportional hazards model with correlated frailty to determine the prognostic factors influencing recurrent gastroenteritis.

RESULTS

Older children experienced a shorter stay with an increased discharge rate of 1.9% for each month increase in admission age. An additional co-morbidity recorded in the hospital discharge summary slowed the adjusted discharge rate by 46.5%. Aboriginal infants were readmitted to hospital more frequently, and had an adjusted hazard ratio of 0.253, implying a much higher risk of prolonged hospitalisation compared to non-Aborigines.

CONCLUSIONS

The use of linked hospitalisation records has the advantage of providing access to hospital-based population information in the context of medical informatics. The analysis of linked data has enabled the assessment of prognostic factors influencing length of hospitalisations for recurrent gastroenteritis with high statistical power.

Factors affecting length of hospitalization of infants and children for recurrent gastroenteritis in Western Australia

AIM

Aboriginal infants in Western Australia (WA) have much higher rates of hospitalization for gastroenteritis than do their non-Aboriginal peers. The aim of this 7-y retrospective study was to investigate the factors affecting the duration of hospitalizations due to recurrent gastroenteritis in WA.

METHODS

All infants born in WA in 1995 and 1996 who had indexed gastroenteritis admissions during their first year of life (n = 1009) were followed until 31 May 2002. Linked hospitalization and birth records were retrieved to derive the outcome measures, associated co-morbidities and other demographic variables. A proportional hazards frailty model was then used to determine factors influencing discharge from hospital for the study cohort.

RESULTS

Aboriginal patients were readmitted to hospital more frequently and stayed in hospital more than twice as long as non-Aborigines. Factors that slowed the rate of discharge from hospital included Indigenous status and the presence of coexisting conditions such as dehydration, sugar intolerance, failure to thrive and iron-deficiency anaemia.

CONCLUSION

Gastrointestinal infections are common illnesses in infants and children, particularly for those who live in overcrowded and unhygienic conditions. Coexisting morbidities including undernutrition, nutrient deficiencies, other infections and gastrointestinal carbohydrate intolerance contribute to prolonged and recurrent hospitalization. Multifaceted clinical, disease prevention and health/hygiene promotion are needed to lessen the burden of these infections.

Perceptions of the quality of life for the adolescent with a chronic illness by teachers, parents and health professionals: a Delphi study

AIMS

The perceptions that teachers, parents and health professionals have on the relative importance of different aspects of quality of life (QOL) for the adolescent with a chronic illness were explored using a three-round Delphi study.

METHODS

The first round questionnaire identified the level of importance each panel attached to 16 aspects relating to QOL. Panellists were also encouraged to provide additional comments on why they felt a particular item was important. In round two, panellists were asked to prioritize the items in order of importance, whereas round three attempted to achieve consensus among each of the three panels.

RESULTS

Differences between and within panels in the prioritization of items in round one and round two were evident. However, consensus was achieved in round three, except for the prioritization of very important items by the panel of teachers. Items identified by all three panels as extremely important included the adolescent's attitude, family relationships and friendships with the same age group. Themes to emerge from the qualitative responses to the open-ended questions included the perception of the chronically ill adolescent 'not wanting to be different' and the importance of a 'positive attitude'. The majority of participants also perceived adolescents with a chronic illness as having worse QOL than their healthy counterparts.

CONCLUSIONS

By increasing the awareness among the different groups of the impact of chronic illness on various aspects of adolescent QOL, the overall care and support of those adolescents could be improved. Further studies should also be undertaken to explore the views of the chronically ill adolescents themselves.

Assessing quality of life for adolescents in western Australia

This study investigates the quality of life (QOL) for adolescents residing in Perth, Western Australia. The Quality of Life Profile-Adolescent Version (QOLPAV), a generic self-reported questionnaire, was administered to 363 adolescents aged between ten and 18 years who were enrolled in 20 high schools within metropolitan Perth. Stepwise regression analysis of the data showed that age, control, opportunity and perceptions of health have significant associations with QOL. It was also found that adolescents with a chronic condition and those without have similar QOL scores. This suggests that, in terms of QOL, the chronically ill adolescents do not view themselves as different from their healthy counterparts.

Diet and ovarian cancer risk: a case-control study in China

This case-control study, conducted in Zhejiang, China during 1999-2000, investigated whether dietary factors have an aetiological association with ovarian cancer. Cases were 254 patients with histologically confirmed epithelial ovary cancer. The 652 controls comprised 340 hospital visitors, 261 non-neoplasm hospital outpatients without long-term diet modifications and 51 women recruited from the community. A validated food frequency questionnaire was used to measure the habitual diet of cases and controls. The risks of ovarian cancer for the dietary factors were assessed by adjusted odds ratios based on multivariate logistic regression analysis, accounting for potential confounding demographic, lifestyle, familial factors and hormonal status, family ovarian cancer history and total energy intake. The ovarian cancer risk declined with increasing consumption of vegetables and fruits but vice versa with high intakes of animal fat and salted vegetables. The adjusted upper quartile odds ratio compared to the lower quartile was 0.24 (0.1-0.5) for vegetables, 0.36 (0.2-0.7) for fruits, 4.6 (2.2-9.3) for animal fat and 3.4 (2.0-5.8) for preserved (salted) vegetables with significant dose-response relationship. The risk of ovarian cancer also appeared to increase for those women preferring fat, fried, cured and smoked food.

Public versus private hospital maternity length of stay: a gamma mixture modelling approach

Application of a gamma mixture model to obstetrical diagnosis-related groups (DRGs) revealed heterogeneity of maternity length of stay (LOS). The proportion of long-stay subgroups identified, which can account for 30% of admissions, varied between DRGs. The burden of long-stay patients borne was estimated to be much higher in private hospitals than public hospitals for normal delivery, but vice versa for Caesarean section. Such differences highlights the impact of DRG-based casemix funding on inpatient LOS and have significant implications for health insurance companies to integrate casemix funding across the public and private sectors. The analysis also benefits hospital administrators and managers to budget expenditures accordingly.

Determinants of maternity length of stay: a Gamma mixture risk-adjusted model

With obstetrical delivery being the most frequent cause for hospital admissions, it is important to determine health- and patient-related characteristics affecting maternity length of stay (LOS). Although the average inpatient LOS has decreased steadily over the years, the issue of the appropriate LOS after delivery is complex and hotly debated, especially since the introduction of the mandatory minimum-stay legislation in the USA. The purpose of this paper is to identity factors associated with maternity LOS and to model variations in LOS. A Gamma mixture risk-adjusted model is proposed in order to analyze heterogeneity of maternity LOS within obstetrical Diagnosis Related Groups (DRGs). The determination of pertinent factors would benefit hospital administrators and clinicians to manage LOS and expenditures efficiently.

Zero-inflated Poisson regression with random effects to evaluate an occupational injury prevention programme

This study presents a zero-inflated Poisson regression model with random effects to evaluate a manual handling injury prevention strategy trialled within the cleaning services department of a 600 bed public hospital between 1992 and 1995. The hospital had been experiencing high annual rates of compensable injuries of which over 60 per cent were attributed to manual handling. The strategy employed Workplace Risk Assessment Teams (WRATS) that utilized a workplace risk identification, assessment and control approach to manual handling injury hazard reduction. The WRATS programme was an intervention trial, covering the 1988-1995 financial years. In the course of compiling injury counts, it was found that the data exhibited an excess of zeros, in the context that the majority of cleaners did not suffer any injuries. This phenomenon is typical of data encountered in the occupational health discipline. We propose a zero-inflated random effects Poisson regression model to analyse such longitudinal count data with extra zeros. The WRATS intervention and other concomitant information on individual cleaners are considered as fixed effects in the model. The results provide statistical evidence showing the value of the WRATS programme. In addition, the methods can be applied to assess the effectiveness of intervention trials on populations at high risk of manual handling injury or indeed of injury from other hazards.