bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of Vitamin D Supplementation on Strength, Physical Performance, and Falls in Older Persons: A Systematic Review
Authors: Latham Nancy K. , Anderson Craig S. , Reid Ian R.
Published: August 2003

Objectives: To identify, appraise, and synthesize data from randomized, controlled trials of vitamin D supplementation in older people.

Design: A systematic review of trials identified from searches of databases, reference lists, review articles, and recent conference proceedings.

Setting: Most studies performed in ambulatory setting.

Participants: Older people (mean age=60).

Interventions: Vitamin D or vitamin D metabolites.

Measurements: Strength, physical performance, or falls.

Results: Thirteen trials involving 2,496 patients met this study's inclusion criteria. Most of the trials were small and had methodological problems. In 10 trials, there was no evidence that vitamin D or vitamin D metabolites had an effect on falls or physical function, but three trials showed a positive effect of vitamin D in combination with calcium. When available data from the four highest quality trials were pooled (n=1,317), there continued to be no evidence that vitamin D reduced the risk of falling (relative risk= 0.99, 95% confidence interval=0.89–1.11), although a single trial of vitamin D and calcium showed a positive effect.

Conclusion: Although there is insufficient evidence that vitamin D supplementation alone improves physical performance in older people, some data suggest a benefit from vitamin D combined with calcium supplementation, but this requires confirmation in large, well‐designed trials.
Cognitive Impairment in Hip Fracture Patients: Timing of Detection and Longitudinal Follow‐Up
Authors: Gruber‐Baldini Ann L. , Zimmerman Sheryl , Morrison R. Sean , Grattan Lynn M. , Hebel J. Richard , Dolan Melissa M. , Hawkes William , Magaziner Jay
Published: August 2003

Objectives: To examine the prevalence, incidence, persistence, predictors, and outcomes of cognitive impairment after hip fracture.

Design: Longitudinal cohort study.

Setting: Eight hospitals in Baltimore, Maryland.

Participants: Six hundred seventy‐four hip fracture patients aged 65 and older living in the community before fracture.

Measurement: Delirium at admission and postsurgery, Mini‐Mental State Examination (MMSE) scores postsurgery, and prefracture proxy ratings of MMSE and dementia. Follow‐up measures at 2 and 12 months postfracture included mortality, MMSE, physical activities of daily living (PADLs), instrumental activities of daily living (IADLs), social functioning, and the Center for Epidemiologic Studies—Depression Scale.

Results: Overall, 28% had prefracture dementia or MMSE impairment, 8% had cognitive impairment first detected presurgery, 14% had impairment first detected postsurgery, and 50% were not impaired before or during hospitalization. Incident cognitive impairment was more likely in patients who were older, male, and less educated and had more prefracture PADL impairment, intertrochanteric fractures, and higher anesthesia risk ratings. Presurgery incident cases did not differ significantly from those detected postsurgery in functional outcomes or in persistence of cognitive impairment. Cognitive impairment first noted in the hospital persisted through 2 and 12 months in more than 40% of patients. Those with cognitive impairment persisting through 2 months had poorer 12‐month PADLs and social functioning.

Conclusion: Prefracture cognitive impairment and incident cognitive impairment during hospitalization are risk factors for poor functional outcomes. Many incident cognitive problems persisted over 2 to 12 months, and per‐sistence predicted later functional and social impairment.
Insulin‐Like Growth Factor‐1 and Interleukin 6 Predict Sarcopenia in Very Old Community‐Living Men and Women: The Framingham Heart Study
Authors: Payette Hélène , Roubenoff Ronenn , Jacques Paul F. , Dinarello Charles A. , Wilson Peter W. F. , Abad Leslie W. , Harris Tamara
Published: August 2003

Objectives: To assess the prognostic role of the inflammatory cytokine, interleukin 6 (IL‐6), and insulin‐like growth factor‐1 (IGF‐1) in predicting 2‐year changes in fat‐free mass (FFM) while controlling for potential confounders.

Design: Population‐based cohort, the Framingham Heart Study, examined in 1992–93 and 1994–95.

Setting: General community.

Participants: Two hundred thirty‐two men and 326 women aged 72 to 92.

Measurements: IGF‐1 was measured using radio‐immunoassay and cellular IL‐6 production using non‐cross‐reacting radioimmunoassays. FFM was estimated using population‐specific equations for predicting FFM from bioelectrical impedance analysis developed separately for men and women.

Results: Higher IGF‐1 predicted smaller loss of FFM in men than lower IGF‐1 did (P=.002), after adjusting for age, baseline FFM, fat mass, and 2‐year weight changes, whereas cellular IL‐6 was a significant predictor of sarcopenia in women (P=.02). Weight change was a strong determinant of change in FFM in both sexes (P<.0001).

Conclusion: Predictors of sarcopenia include body composition characteristics that are common to men and women and sex‐specific metabolic predictors. Sarcopenia appears to reflect a withdrawal of anabolic stimuli, such as growth hormone, in men but an increase in catabolic stimuli, such as cellular IL‐6, in women.
Activity Restriction Among Wheelchair Users
Authors: Hoenig Helen , Landerman Lawrence R. , Shipp Kathy M. , George Linda
Published: August 2003

Objectives: To identify factors associated with activity restriction.

Design: Cohort study.

Setting: Patients prescribed a new wheelchair at one of two teaching hospitals (one Veterans Affairs and one private hospital).

Participants: One hundred fifty‐three consecutive, community‐dwelling wheelchair users, who had a Short Portable Mental Status Score greater than 6 out of 10 and could be interviewed within 7 to 21 days of receiving the wheelchair.

Measurements: Dependent variables were selfreported nonmedical visits and medical visits in the preceding week (any vs no visits and the number of visits). Independent variables were self‐reported sociodemographic and health characteristics, mobility limitations, and environmental barriers.

Results: Study subjects reported, on average, 1.79 mobility limitations, 11.17 hours out of bed, and 5.56 hours of personal assistance per day. Multivariate analyses show that higher income was the only significant sociodemographic factor; it was associated with more medical visits (β=0.44, P<.01). Of health status characteristics, more comorbid conditions predicted fewer nonmedical visits (β=−0.14, P<.10) and amputation was associated with fewer medical visits (β−0.82, P<.05). Regarding mobility limitations, more mobility limitations was associated with lower odds of any nonmedical visit (odds ratio (OR)=0.71, P<.5) and fewer nonmedical visits (β=−0.28, P<.05); more hours out of bed predicted more nonmedical visits (β=0.05, P<.5) and lower odds any medical visit (OR=0.92, P<.05). More environmental barriers predicted fewer nonmedical (β=−0.32, P<.01) or medical visits (β=−0.21, P<.05).

Conclusion: Mobility limitations and environmental barriers were associated with restricted participation in diverse activities outside the home.
Effect of Nurse Case Management on the Treatment of Older Women with Breast Cancer
Authors: Goodwin James S. , Satish Shiva , Anderson Elizabeth T. , Nattinger Ann B. , Freeman Jean L.
Published: August 2003

Objectives: To evaluate the effect of nurse case management on the treatment of older women with breast cancer.

Design: Randomized prospective trial.

Setting: Sixty surgeons practicing at 13 community and two public hospitals in southeast Texas.

Participants: Three hundred thirty‐five women (166 control and 169 intervention) aged 65 and older newly diagnosed with breast cancer.

Intervention: Women seeing surgeons randomized to the intervention group received the services of a nurse case manager for 12 months after the diagnosis of breast cancer.

Measurements: The primary outcome was the type and use of cancer‐specific therapies received in the first 6 months after diagnosis. Secondary outcomes were patient satisfaction and arm function on the affected side 2 months after diagnosis.

Results: More women in the intervention group received breast‐conserving surgery (28.6% vs 18.7%; P=.031) and radiation therapy (36.0% vs 19.0%; P=.003). Of women undergoing breast‐conserving surgery, greater percentages in the case management group received adjuvant radiation (78.3% vs 44.8%; P=.001) and axillary dissection (71.4% vs 44.8%; P=.057). Women in the case management group were also more likely to receive more breast reconstruction surgery (9.3% vs 2.6%, P=.054), and women in the case management group with advanced cancer were more likely to receive chemotherapy (72.7% vs 30.0%, P=.057). Two months after surgery, higher percentages of women in the case manager group had normal arm function (93% vs 84%; P=.037) and were more likely to state that they had a real choice in their treatment (82.2% vs 69.9%, P=.020). Women with indicators of poor social support were more likely to benefit from nurse case management.

Conclusion: Nurse case management results in more appropriate management of older women with breast cancer.
Sex Differences in the Effect of Heart Rate on Mortality in the Elderly
Authors: Perk Gila , Stessman Jochanan , Ginsberg Gary , Bursztyn Michael
Published: August 2003

Objectives:  To examine the association between heart rate and mortality risk in the elderly.

Design:  Longitudinal cohort.

Setting:  Outpatient.

Participants: Four hundred twenty‐two people, aged 70 upon entry, were surveyed and followed for 6 years.

Measurements: Pulse rate was measured manually, while sitting and standing, and heart rate was measured from electrocardiogram recordings. The population was divided into quartiles of heart rate, with the top quartile comprising those with heart rate greater than 77 beats per minute (bpm) and the bottom quartile those with heart rate less than 60 bpm.

Results: After controlling for possible confounders, there was a clear correlation (r) between heart rate and all‐cause mortality in elderly women (r=0.25, P=.0003). The correlation in women was observed using the three different methods for measuring heart rate. Heart rate was associated with all‐cause and cardiovascular mortality. There was no relationship between heart rate and level of exercise or smoking status. In multiple regression analysis, the increased risk of death in the women was independent of previous cardiovascular or cerebrovascular disease, hypertension, anemia, congestive heart failure, smoking, and level of exercise or activities of daily living (relative odds ratio (ROR)=3.37, 95% confidence interval (CI)=0.96–11.8). When women using beta‐blockers were excluded, this relationship became even stronger (ROR=8.5, 95% CI=1.19–60.1).

Conclusion: Elevated heart rate is related to increased mortality in elderly women, thus representing a simple index of general health status in this population. Elevated heart rate did not predict mortality in elderly men.
Associations Between Polymorphisms of the High‐Affinity Immunoglobulin E Receptor and Late‐Onset Airflow Obstruction in Older Populations
Authors: Ruse Charlotte E. , Hill Maureen C. , Burton Paul R. , Connolly Martin J. , Wardlaw Andrew J. , Parker Stuart G.
Published: August 2003

Objectives: To test the hypothesis that genetic polymorphisms in the β subunit of the high‐affinity immunoglobulin E (IgE) receptor are associated with late‐onset airflow obstruction.

Design: Case‐control candidate gene association study.

Setting: Department of Medicine for the Elderly and Respiratory Medicine in three teaching hospitals in Leicester and Manchester, United Kingdom.

Participants: Cases with late‐onset airflow obstruction with age‐, sex‐, and geographically matched controls.

Measurements: Subjects were genotyped for two polymorphisms of the β subunit of the high‐affinity IgE receptor (RsaI intron 2 and RsaI exon 7). The association between the polymorphisms and phenotypes was examined using contingency tables and linear regression models.

Results: Two hundred eighty‐three cases and 144 controls were genotyped. RsaI exon 7 AA was associated with eczema (odds ratio (OR)=2.27, 95% confidence interval (CI)=1.17–4.38, P=.015). No other associations were found. Total serum IgE levels were significantly higher in cases than controls (adjusted OR for high/low IgE=2.56, 95% CI=1.53–4.28, P<.001).

Conclusion: Serum IgE levels, but not the high‐affinity IgE receptor polymorphisms, were associated with late‐onset airflow obstruction, suggesting that interaction between environmental and genetic factors controlling serum IgE levels and disease pathogenesis may differ between early‐ and late‐onset airflow obstruction phenotypes.
Health Professionals' Views on Standards for Decision‐Making Capacity Regarding Refusal of Medical Treatment in Mild Alzheimer's Disease
Authors: Volicer Ladislav , Ganzini Linda
Published: August 2003

This study was designed to determine which elements professionals consider important for evaluation of decision‐making capacity. Survey with a vignette case report of an individual with mild dementia was mailed to four groups of individuals: 1. members of the Academy of Psychosomatic Medicine, 2. chairs of Veterans Affairs (VA) Ethics Advisory Committees (EACs), 3. randomly selected geriatricians who were members of the Gerontological Society of America (GSA), and 4. randomly selected psychologists who were members of the GSA. Two hundred thirty‐seven psychiatrists, 95 VA EAC chairs, 103 geriatricians, and 46 psychologists responded to this survey. The majority of the respondents endorsed all five basic elements as necessary for determination of decision‐making capacity in the presented vignette, but only a minority of respondents endorsed all five basic elements, and a small proportion of respondents endorsed only one or two elements. The results indicate that physicians do not use uniform standards for assessment of decision‐making capacity.
Integrating Mental Health Care into Residential Homes for the Elderly: An Analysis of Six Dutch Programs for Older People with Severe and Persistent Mental Illness
Authors: Depla Marja F. I. A. , Pols Jeannette , De Lange Jacomine , Smits Carolien H. M. , De Graaf Ron , Heeren Thea J.
Published: August 2003

Integrating mental health care into residential homes for the elderly is a potentially effective model to address the complex care needs of older chronically mentally ill people. Because no research was available on the implementation of such integrated care in practice, six programs already operating in the Netherlands were analyzed. At the administrative level, three types of cooperative arrangements existed: a psychiatric hospital renting a unit in a residential home for the elderly, a psychiatric hospital stationing mental health professionals in a residential home on a permanent basis, and a residential home employing its own psychiatrically trained staff. At the operational level, contrasting views emerged on the relation‐ship between physical and mental health care; these were delivered separately or in integrated form. In either case, the employees trained as elder care workers or as psychiatric nurses had difficulties understanding each other because they held different ideas about good‐quality care. These care visions can be characterized as the care‐giving approach (care workers) versus the problem‐oriented and the rehabilitation approaches (nurses). At the housing level, two models existed: mentally ill patients having apartments in a separate unit (concentrated housing) or located throughout the facility (dispersed housing). The most promising model appears to be the one in which a psychiatric hospital assigns mental health professionals to work in a residential home, where they remain administratively and operationally distinct from the standard residential services. Whether or not the psychiatric residents should be housed in separate units could not be decided based on this study.
Health Care for Older People in Ireland
Authors: O'Neill Desmond , O'Keeffe Shaun
Published: August 2003

Despite a low level of popular advocacy for older people, specialist medical and psychiatric services for older people have developed rapidly in Ireland, and geriatric medicine has become the largest medical specialty in hospital practice. Official policy has incorporated significant recognition of the special needs of older people, but implementation of these policies has been variable and inadequate. No significant transfer of funding has accompanied advances in specialist medical manpower, and there are deficiencies in the full complement of rehabilitation therapists available in the hospitals and the community. Community and long‐term care services are relatively underdeveloped; it may require legislative initiatives similar to the Older Americans Act to prompt the profound improvement required in these areas.
Assessment and Treatment of Nursing Home Residents with Depression or Behavioral Symptoms Associated with Dementia: A Review of the Literature
Authors: Snowden Mark , Sato Kersten , Roy‐Byrne Peter
Published: August 2003

Depression and the behavioral symptoms associated with dementia remain two of the most significant mental health issues for nursing home residents. The extensive literature on these conditions in nursing homes was reviewed to provide an expert panel with an evidence base for making recommendations on the assessment and treatment of these problems.

Numerous assessment instruments have been validated for depression and for behavioral symptoms. The Minimum Data Set, as routinely collected, appears to be of limited utility as a screening instrument for depression but is useful for assessing some behavioral symptoms. Laboratory evaluations are often recommended, but no systematic study of the outcomes of these evaluations could be found. Studies of nonpharmacological interventions out‐number those of pharmacological interventions, and randomized, controlled trials document the efficacy of many interventions. Antidepressants are effective for major depression, but data for minor depressive syndromes are limited. Recreational activities are effective for major and minor depression categories. Neither pharmacological nor nonpharmacological interventions totally eliminate behavioral symptoms, but both types of interventions decrease the severity of symptoms. In the absence of comparison studies, it is unclear whether one approach is more effective than another. Despite federal regulations limiting their use, antipsychotics are effective and remain the most studied medications for treating behavioral symptoms, whereas benzodiazepines and antidepressants have less support. Structured activities are effective, but training interventions for behavioral symptoms had limited results. There are sufficient data to formulate an evidenced‐based approach to treatment of depression and behavioral symptoms, but more research is needed to prioritize treatments.
Living Longer Depression Free
Authors: John Joshi , Kennedy Gary J.
Published: August 2003

Review of:

Miller MD, Reynolds CF III, eds. Living Longer Depression Free: A Family Guide to Recognizing, Treating and Preventing Depression in Later Life. Baltimore, MD: The Johns Hopkins University Press, 2002, pp. 186.
Whole-body fluxes and partitioning of amino acids to the mammary gland of cows fed fresh pasture at two levels of intake during early lactation
Authors: Pacheco D. , Tavendale M.H. , Reynolds G. W. , Barry T. N. , Lee J. , McNabb W. C.
Published: August 2003

The utilisation of essential amino acids (EAA) by the mammary gland of lactating dairy cows fed fresh forages was studied to provide basic information useful in designing strategies to increase the production of milk protein from pasture-fed dairy cows. The relationship between the flux of EAA in the whole body and their uptake by the mammary gland was determined in four cows in early lactation (length of time in milk 44 (SD 14·5) d) producing 21 (SD 4·0) kg milk/d. The cows were maintained in metabolism stalls and fed fresh perennial ryegrass (Lolium perenne) and white clover (Trifolium repens) pasturead libitumor restricted to 75 %ad libitumintake. The whole-body fluxes of amino acids (AA) were measured using an arterio-venous infusion of universally13C-labelled AA. Whole-body fluxes of fourteen AA were estimated. Isotope dilution indicated that mammary utilisation accounted for one-third of the whole-body flux of EAA, with individual AA ranging between 17 and 35 %. Isoleucine, leucine, valine and lysine were the EAA with the greatest partitioning towards the mammary gland (up to 36 % of the whole-body flux), which could reflect a potentially limiting effect on milk protein synthesis. In the case of AA with low partitioning to the mammary gland (for example, histidine), it is suggested that non-mammary tissues may have priority over the mammary gland and therefore the supply of this AA may also limit milk protein synthesis.
Folate bioavailability: UK Food Standards Agency workshop report
Authors: Sanderson Peter , McNulty Helene , Mastroiacovo Pierpaolo , McDowell Ian F. W. , Melse-Boonstra Alida , Finglas Paul M. , Gregory Jess F.
Published: August 2003

The UK Food Standards Agency convened a group of expert scientists to review current research investigating folate bioavailability. The workshop aimed to overview current research and establish priorities for future research. Discrepancies were observed in the evidence base for folate bioavailability, especially with regard to the relative bioavailability of natural folates compared with folic acid. A substantial body of evidence shows folic acid to have superior bioavailability relative to food folates; however, the exact relative bioavailability still needs to be determined, and in particular with regard to mixed diets. The bioavailability of folate in a mixed diet is probably not a weighted average of that in the various foods consumed; thus the workshop considered that assessment of folate bioavailability of whole diets should be a high priority for future research.
Inhibition of tumour necrosis factor-α and interleukin 6 production by mononuclear cells following dietary fish-oil supplementation in healthy men and response to antioxidant co-supplementation
Authors: Trebble Timothy , Arden Nigel K. , Stroud Mike A. , Wootton Stephen A. , Burdge Graham C. , Miles Elizabeth A. , Ballinger Anne B. , Thompson Rachel L. , Calder Philip C.
Published: August 2003

Increased dietary consumption of then-3 polyunsaturated fatty acids (PUFA) eicosapentaenoic acid (20:5n-3; EPA) and docosahexaenoic acid (22:6n-6; DHA) is associated with their incorporation into circulating phospholipid and increased production of lipid peroxide metabolites. The relationship between peripheral blood mononuclear cell (PBMC) function,n-3 PUFA intake and antioxidant co-supplementation is poorly defined. We therefore investigated tumour necrosis factor (TNF)-α and interleukin (IL) 6 production by PBMC and phospholipid fatty acid composition in plasma and erythrocytes of healthy male subjects (n16) receiving supplemental intakes of 0·3, 1·0 and 2·0 g EPA+DHA/d, as consecutive 4-week courses. All subjects were randomised in a double-blind manner to receive a concurrent antioxidant supplement (200 μg Se, 3 mg Mn, 30 mg D-α-tocopheryl succinate, 90 mg ascorbic acid, 450 μg vitamin A (β-carotene and retinol)) or placebo. There was a positive dose-dependent relationship between dietaryn-3 PUFA intake and EPA and DHA incorporation into plasma phosphatidylcholine and erythrocyte phosphatidylethanolamine, with a tendency towards a plateau at higher levels of intake. Production of TNF-α and IL-6 by PBMC decreased with increasingn-3 PUFA intake but tended towards a ‘U-shaped’ dose response. Both responses appeared to be augmented by antioxidant co-supplementation at intermediate supplementaryn-3 PUFA intakes. Thus, increased dietaryn-3 PUFA consumption resulted in defined but contrasting patterns of modulation of phospholipid fatty acid composition and PBMC function, which were further influenced by antioxidant intake.
Variable maternal nutrition and growth hormone treatment in the second quarter of pregnancy in pigs alter semitendinosus muscle in adolescent progeny
Authors: Gatford Kathryn L. , Ekert Jason E. , Blackmore Karina , De Blasio Miles J. , Boyce Jodie M. , Owens Julie A. , Campbell Roger G. , Owens Phillip C.
Published: August 2003

Maternal nutrition and growth hormone (GH) treatment during early- to mid-pregnancy can each alter the subsequent growth and differentiation of muscle in progeny. We have investigated the effects of varying maternal nutrition and maternal treatment with porcine (p) GH during the second quarter of pregnancy in gilts on semitendinosus muscle cross-sectional area and fibre composition of progeny, and relationships between maternal and progeny measures and progeny muscularity. Fifty-three Large White×Landrace gilts, pregnant to Large White×Duroc boars, were fed either 2·2 kg (about 35 %ad libitumintake) or 3·0 kg commercial ration (13·5 MJ digestible energy, 150 g crude protein (N×6·25)/kg DM)/d and injected with 0, 4 or 8 mg pGH/d from day 25 to 50 of pregnancy, then all were fed 2·2 kg/d for the remainder of pregnancy. The higher maternal feed allowance from day 25 to 50 of pregnancy increased the densities of total and secondary fibres and the secondary:primary fibre ratio in semitendinosus muscles of their female progeny at 61 d of age postnatally. The densities of secondary and total muscle fibres in semitendinosus muscles of progeny were predicted by maternal weight before treatment and maternal plasma insulin-like growth factor-II during treatment. Maternal pGH treatment from day 25 to day 50 of pregnancy did not alter fibre densities, but increased the cross-sectional area of the semitendinosus muscle; this may be partially explained by increased maternal plasma glucose. Thus, maternal nutrition and pGH treatment during the second quarter of pregnancy in pigs independently alter muscle characteristics in progeny.
Effect of isoenergetic low- and high-carbohydrate diets on substrate kinetics and oxidation in healthy men
Authors: Koutsari Christina , Sidossis Labros S.
Published: August 2003

The effect of diet composition on post-absorptive (15 h fast) fatty acid and glucose metabolism was investigated in five healthy men after 2 weeks on a low-carbohydrate (Low-CHO) diet (30% energy intake from carbohydrates, 55% from fat, 15% from protein) and after 2 weeks on a high-carbohydrate (High-CHO) diet (energy intake 75, 10 and 15% from carbohydrates, fat and protein respectively). The diets were isoenergetic and comprised real foods. Stable-isotope tracer methodology and indirect calorimetry were employed to measure glucose and fatty acid kinetics and oxidation. The relative contribution of carbohydrate to the total energy expenditure was significantly higher after the High-CHO diet. After the High-CHO diet, total and plasma fatty oxidation (2·4 (SE 0·7) and 2·1 (SE 0·4) μmol/kg per min respectively) were significantly lower than after the Low-CHO diet (4·8 (SE 0·5) and 4·6 (SE 0·8) μmol/kg per min for total and plasma fatty oxidation respectively). The rate of appearance (Ra) of non-esterified fatty acids (NEFA) in plasma and the arterial NEFA concentration were both significantly lower following the High-CHO than the Low-CHO diet. However, even after the High-CHO diet, NEFA Ra was threefold higher than plasma fatty acid oxidation. Thus, the decrease in fatty acid oxidation after consumption of a high-carbohydrate diet for 2 weeks in healthy men is unlikely to result from decreased fatty acid delivery to the tissues. Glucose Ra and arterial plasma glucose concentration were similar after the two diets. After the High-CHO diet, arterial lactate concentration was higher and total carbohydrate oxidation rate well exceeded glucose Ra in plasma. Therefore, alterations in intracellular mechanisms may limit fatty acid oxidation after high-carbohydrate diets.
Intra-individual variation of basal metabolic rate and the influence of daily habitual physical activity before testing
Authors: Adriaens Mirjam P. E. , Schoffelen Paul F. M. , Westerterp Klaas R.
Published: August 2003

The present study determined the intra-individual variation of BMR measurements, using a standard out-patient protocol, with the subjects transporting themselves to the laboratory for the BMR measurements after spending the night at home. The effect of a non-fasting state and variation in daily habitual physical activity the day before testing was evaluated. Eight male and eleven female subjects participated in three BMR measurements with 2-week intervals. Physical activity was estimated with a tri-axial accelerometer for movement registration, during the 3 d before each BMR measurement. There were no significant differences in estimated BMR (ANOVA repeated measures, P=0·88) and in physical activity (ANOVA repeated measures, P=0·21). Mean within-subject CV in BMR was found to be 3·3 (SD 2·1) %, ranging from 0·4 to 7·2 %. Differences between BMR measurements could not be explained by differences in physical activity the day before; however the mean within-subject CV in BMR changed from 5·7 to 5·2 % after correcting for within-machine variability and from 5·2 to 3·3 % after excluding five measurements because of non-compliance to the protocol including fasting. In conclusion, BMR values measured with a standard out-patient protocol are sufficiently reproducible for most practical purposes despite the within-subject variability in physical activity the day before the measurement. For this purpose, however, non-fasting subjects must be excluded and a regular function check of the ventilated-hood system is recommendable.
Antioxidative probiotic fermented goats' milk decreases oxidative stress-mediated atherogenicity in human subjects
Authors: Kullisaar Tiiu , Songisepp Epp , Mikelsaar Marika , Zilmer Kersti , Vihalemm Tiiu , Zilmer Mihkel
Published: August 2003

The increasing interest in a healthy diet is stimulating innovative development of novel scientific products in the food industry. The viable lactic acid bacteria in fermented milk products, such as yoghurt, have been associated with increased lactose tolerance, a well-balanced intestinal microflora, antimicrobial activity, stimulation of the immune system and antitumoural, anticholesterolaemic and antioxidative properties in human subjects. Recently, we have studied a humanLactobacillusspp. strain that possesses antioxidative activity. The aim of the present pilot study was to develop goats' milk fermented with the human antioxidative lactobacilli strain,Lactobacillus fermentumME-3, and to test the effect of the fermented probiotic goats' milk on oxidative stress markers (including markers for atherosclerosis) in human blood and urine and on the gut microflora. Twenty-one healthy subjects were assigned to two treatment groups: goats' milk group and fermented goats' milk group (150 g/d) for a period of 21 d. Consumption of fermented goats' milk improved anti-atherogenicity in healthy subjects: it prolonged resistance of the lipoprotein fraction to oxidation, lowered levels of peroxidized lipoproteins, oxidized LDL, 8-isoprostanes and glutathione redox ratio, and enhanced total antioxidative activity. The consumption of fermented goats' milk also altered both the prevalence and proportion of lactic acid bacteria species in the gut microflora of the subjects. We conclude that the goats' milk fermented with our special antioxidative lactobacilli strainLactobacillus fermentumME-3 exhibits anti-atherogenic effects.
Influence of grapefruit-, orange- and apple-juice consumption on urinary variables and risk of crystallization
Authors: Hönow Ruth , Laube Norbert , Schneider Anke , Keßler Torsten , Hesse Albrecht
Published: August 2003

Alkalizing beverages are highly effective in preventing the recurrence of calcium oxalate (Ox), uric acid and cystine lithiasis. The aim of the present study was to evaluate the influence of grapefruit-juice and apple-juice consumption on the excretion of urinary variables and the risk of crystallization in comparison with orange juice. All investigations were carried out on nine healthy female subjects without any history of stone formation and aged 26–35 years. Each juice was tested in a 5 d study. During the study, the subjects received a standardized diet. Fluid intake of 2·75 litres was composed of 2·25 litres neutral mineral water, 0·4 litre coffee and 0·1 litre milk. On the fourth and fifth day 0·5 litre mineral water was partly substituted by 0·5 or 1·0 litre juice under investigation respectively. The influence on urinary variables was evaluated in 24 h urine samples. In addition, the BONN risk index of CaOx, relative supersaturation (RS)CaOx crystallization was determined. Due to an increased pH value and an increased citric acid excretion after consumption of each juice, the RSCaOx decreased statistically significantly (P<0·05) for grapefruit juice, but not significantly for orange and apple juice. The BONN risk index yielded a distinct decrease in the crystallization risk. We showed that both grapefruit juice and apple juice reduce the risk of CaOx stone formation at a magnitude comparable with the effects obtained from orange juice.
Can prescription of sip-feed supplements increase energy intake in hospitalised older people with medical problems?
Authors: Roberts Margaret , Potter Jan , McColl John , Reilly John
Published: August 2003

A blinded randomised controlled trial of prescribed oral sip-feed supplements compared with routine hospital practice was undertaken in acute admissions to a geriatric medicine department. Patients were eligible for inclusion if they were admitted from home, were not obese (BMI>75th percentile), had no swallowing difficulties and were not deemed to be in the terminal stage of illness. On admission they were stratified by nutritional status (BMI<5th, >5th to <25th, >25th to <75th percentile) and randomised. The intervention group received 120 ml oral sip-feed supplement prescribed three times per d in the medicine prescription chart (22·5 g protein, 2260 kJ (540 kcal) energy/d) distributed at medication rounds for the duration of hospital stay. The control group received routine hospital care. Outcomes were patient compliance with supplement, total energy intake and nursing staff views of the method. Patients were randomised to receive supplements (n 186 of total n 381). Half had full compliance and three-quarters at least moderate compliance. Total energy intake was significantly increased, on average, in the intervention group (P=0·001). The proportion of patients meeting estimated minimum energy requirements was significantly increased (P=0·023), but was still <50 % for the sample of patients in the intervention group. The present study suggests this method is acceptable to patients and staff and improves total energy intake. However, the amount prescribed did not ensure minimum energy requirements were met in all cases.
Relationship between body mass index, serum cholesterol, leisure-time physical activity, and diet in a Mediterranean Southern-Europe population
Authors: Schröder Helmut , Marrugat Jaume , Elosua Roberto , Covas Maribel I.
Published: August 2003

The aim of the present study was to determine the relationship of BMI with other cardiovascular risk factors, leisure-time physical activity and diet. Participants were recruited in a cross-sectional population-based survey in a southern-Europe Mediterranean population (Spain); cardiovascular risk factors were measured, and leisure-time physical activity and diet intake were evaluated. Linear regression analysis adjusted for several confounders showed a significant, direct association of BMI and total cholesterol (P<0·005) and LDL-cholesterol (P<0·006), in men. HDL-cholesterol was inversely related to BMI in both sexes (P<0·0001). Higher BMI was more frequent in less-active men (P<0·04) but not in women. BMI increased significantly (P<0·0001) by 1·92 kg/m2with each 4·18 MJ consumed in men but not in women. Dietary intakes of carbohydrate (P<0·03), total fat (P<0·03) and saturated fatty acids (P<0·02) were directly associated with BMI in men but not in women, in whom protein intake was correlated (P<0·001) with BMI. Linear regression models including dietary components explained up to 10·6 and 21·1 % of BMI variability in men and women, respectively. Sex differences in the association of BMI with total cholesterol, and LDL-cholesterol, may account for the lower risk for CHD in women compared with men of similar BMI reported in the literature for the southern-Europe Mediterranean region. An increases of BMI may be more deleterious in populations in which it is accompanied by other risk factors such as a higher intake of total fat and, particularly, of saturated fatty acids, or lower leisure-time physical activity.
Influence of plant and bacterial myrosinase activity on the metabolic fate of glucosinolates in gnotobiotic rats
Authors: Rouzaud Gabrielle , Rabot Sylvie , Ratcliffe Brian , Duncan Alan J.
Published: August 2003

The breakdown of glucosinolates, a group of thioglucoside compounds found in cruciferous plants, is catalysed by dietary or microbial myrosinase. This hydrolysis releases a range of breakdown products among which are the isothiocyanates, which have been implicated in the cancer-protective effects of cruciferous vegetables. The respective involvement of plant myrosinase and gut bacterial myrosinase in the conversion, in vivo, of glucosinolates into isothiocyanates was investigated in sixteen Fischer 344 rats. Glucosinolate hydrolysis in gnotobiotic rats harbouring a whole human faecal flora (Flora+) was compared with that in germ-free rats (Flora−). Rats were offered a diet where plant myrosinase was either active (Myro+) or inactive (Myro−). The conversion of prop-2-enyl glucosinolate and benzyl glucosinolate to their related isothiocyanates, allyl isothiocyanate and benzyl isothiocyanate, was estimated using urinary mercapturic acids, which are endproducts of isothiocyanate metabolism. The highest excretion of urinary mercapturic acids was found when only plant myrosinase was active (Flora−, Myro+ treatment). Lower excretion was observed when both plant and microbial myrosinases were active (Flora+, Myro+ treatment). Excretion of urinary mercapturic acids when only microbial myrosinase was active (Flora+, Myro− treatment) was low and comparable with the levels in the absence of myrosinase (Flora−, Myro− treatment). No intact glucosinolates were detected in the faeces of rats from the Flora+ treatments confirming the strong capacity of the microflora to break down glucosinolates. The results confirm that plant myrosinase can catalyse substantial release of isothiocyanates in vivo. The results also suggest that the human microflora may, in some circumstances, reduce the proportion of isothiocyanates available for intestinal absorption.
Effect of altered dietaryn-3 fatty acid intake upon plasma lipid fatty acid composition, conversion of [13C]α-linolenic acid to longer-chain fatty acids and partitioning towards β-oxidation in older men
Authors: Burdge Graham C. , Finnegan Yvonne E. , Minihane Anne M. , Williams Christine M. , Wootton Stephen A.
Published: August 2003

The effect of increased dietary intakes of α-linolenic acid (ALNA) or eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) for 2 months upon plasma lipid composition and capacity for conversion of ALNA to longer-chain metabolites was investigated in healthy men (52 (SD 12) years). After a 4-week baseline period when the subjects substituted a control spread, a test meal containing [U-13C]ALNA (700 mg) was consumed to measure conversion to EPA, docosapentaenoic acid (DPA) and DHA over 48 h. Subjects were then randomised to one of three groups for 8 weeks before repeating the tracer study: (1) continued on same intake (control,n5); (2) increased ALNA intake (10 g/d,n4); (3) increased EPA+DHA intake (1·5 g/d,n5). At baseline, apparent fractional conversion of labelled ALNA was: EPA 2·80, DPA 1·20 and DHA 0·04 %. After 8 weeks on the control diet, plasma lipid composition and [13C]ALNA conversion remained unchanged compared with baseline. The high-ALNA diet resulted in raised plasma triacylglycerol-EPA and -DPA concentrations and phosphatidylcholine-EPA concentration, whilst [13C]ALNA conversion was similar to baseline. The high-(EPA+DHA) diet raised plasma phosphatidylcholine-EPA and -DHA concentrations, decreased [13C]ALNA conversion to EPA (2-fold) and DPA (4-fold), whilst [13C]ALNA conversion to DHA was unchanged. The dietary interventions did not alter partitioning of ALNA towards β-oxidation. The present results indicate ALNA conversion was down-regulated by increased product (EPA+DHA) availability, but was not up-regulated by increased substrate (ALNA) consumption. This suggests regulation of ALNA conversion may limit the influence of variations in dietaryn-3 fatty acid intake on plasma lipid compositions.
New aspects in pathogenesis of konzo: neural cell damage directly caused by linamarin contained in cassava (Manihot esculenta Crantz)
Authors: Sreeja V. G. , Nagahara N. , Li Q. , Minami M.
Published: August 2003

Epidemic spastic paraparesis (konzo) found in tropical and subtropical countries is known to be caused by long-term intake of cassava (Manihot esculenta Crantz), which contains a cyanoglucoside linamarin (α-hydroxyisobutyronitrile-β-D-glucopyranoside). It has been reported that linamarin is enzymatically converted to cyanide by bacteria in the intestine, and this is absorbed into the blood and then damages neural cells. However, unmetabolized linamarin was found in the urine after oral administration of cassava; thus, we hypothesized that konzo could be caused by direct toxicity of the unmetabolized linamarin that was transferred to the brain and could be transported into neural cells via a glucose transporter. In the present study it was confirmed that linamarin directly damaged neural culture pheochromocytoma cell (PC) 12 cells; 0·10 mM-linamarin caused cell death at 13·31 (SD 2·07) %, which was significantly different from that of control group (3·18 (SD 0·92) %,P=0·0004). Additional 10 μM-cytochalasin B, an inhibitor of a glucose transporter, prevented cell death: the percentage of dead cells significantly decreased to 6·06 (SD 1·98),P=0·0088). Furthermore, glucose also prevented cell death. These present results strongly suggest that linamarin competes with cytochalasin B and glucose for binding to a glucose transporter and enters into cells via glucose transporter.
Carbohydrates digestibility and faecal nitrogen excretion in rats fed raw or germinated faba bean (Vicia faba)- and chickpea (Cicer arietinum)-based diets
Authors: Rubio Luis A.
Published: August 2003

Raw or germinated faba bean (Vicia fabaminor var. Alameda) and chickpea(Cicer arietinumkabuli var. Athenas) seed meals were incorporated in essential amino acid-supplemented and energy-equalized diets for growing (65 (SD 1) g) male Wistar rats as the only sources of dietary protein. A lactalbumin-based diet was used as the control. Faecal dry weight and N excretion of animals fed legume-containing diets were greater (P<0·01) and DM digestibility lower (P<0·01) than controls. Apparent faecal digestibilities of amino acids were found to be not different or lower (P<0·01) than controls in rats fed diets containing legume seeds, either germinated or not. Total diaminopimelic acid (DAPA) and purine bases excretion were significantly (P<0·01) higher than controls in rats fed both legume seed meals. Faecal bacterial N calculated according to DAPA or purine bases values was similar and significantly higher (P<0·01) than controls in rats fed legume seed meals. Bacterial N accounted for 50 to 80 % of total faecal N in rats fed legume diets. Apparent faecal N digestibility values (53–65 %) of rats fed legume-based diets were lower (P<0·01) than controls, but became substantially higher (85–92 %) when calculated taking into account bacterial N values. Faecal NSP digestibility values for legume diets were 40–57 g/100 g ingested. Germination decreased starch faecal excretion (P<0·05) and increased (P<0·05) faecal starch and NSP digestibilities of faba bean seeds.
Associations between intake of added sugars and intakes of nutrients and food groups in the diets of German children and adolescents
Authors: Alexy Ute , Sichert-Hellert Wolfgang , Kersting Mathilde
Published: August 2003

The aim of the present analysis was to evaluate the effect of intake of added sugars on intakes of nutrients and food groups. We used a mixed linear model (PROC MIXED) to analyse data from the Dortmund Nutritional and Anthropometric Longitudinally Designed (DONALD) study (an ongoing longitudinal cohort study between infancy and adulthood). Between July 1985 and August 2001, 3 d weighed dietary records (n 4993) from 849 children and adolescents (416 male, 433 female) aged 2–18 years were collected and evaluated. Overall mean intake of added sugars was 12·4 (SD 5·3) (median 12·0) % energy. Fat intake (% energy) and intake of all analysed nutrients (as % reference values for nutrient intakes) fell across quintiles 1–5 of energy intake from added sugars (P<0·001). With the exception of ‘Sugary foods’ and ‘Beverages’ (significant increase, P<0·0001) and ‘Dairy’ (NS), intake of all other food groups decreased with increasing intake of added sugars (P<0·0001). In conclusion, we found a slight, but statistically significant, nutrient-dilution effect of added sugars and a significant reduction in intake of important nutrient-bearing food groups. However, the DONALD study gives no clear indicator on grounds of micronutrient dilution for a quantitative limit on intake of added sugars.
Dietary docosahexaenoic acid-induced production of tissue lipid peroxides is not suppressed by higher intake of ascorbic acid in genetically scorbutic Osteogenic Disorder Shionogi/Shi-od/od rats
Authors: Sekine Seiji , Kubo Kazuhiro , Tadokoro Tadahiro , Maekawa Akio , Saito Morio
Published: August 2003

In previous studies, we showed that docosahexaenoic acid (DHA) ingestion enhanced the susceptibility of rat liver and kidney to lipid peroxidation, but did not increase lipid peroxide formation to the level expected from the relative peroxidizability index (P-index) of the total tissue lipids. The results suggested the existence of some suppressive mechanisms against DHA-induced tissue lipid peroxide formation, as increased tissue ascorbic acid (AsA) and glutathione levels were observed. Therefore, we focused initially on the role of AsA for the suppressive mechanisms. For this purpose, we examined the influence of different levels of dietary AsA (low, moderate, high and excessive levels were 100, 300 (control), 600 and 3000 mg/kg diet respectively) on the tissue lipid peroxide and antioxidant levels in AsA-requiring Osteogenic Disorder Shionogi/Shi-od/od (ODS) rats fed DHA (6·4 % total energy) for 32 or 33 d. Diets were pair-fed to the DHA- and 100 mg AsA/kg diet-fed group. We found that the lipid peroxide concentrations of liver and kidney in the DHA-fed group receiving 100 mg AsA/kg diet were significantly higher or tended to be higher than those of the DHA-fed groups with AsA at more than the usual control level of 300 mg/kg diet. Contrary to this, the liver α-tocopherol concentration was significantly lower or tended to be lower in the DHA and 100 mg AsA/kg diet-fed group than those of the other DHA-fed groups. However, tissue lipid peroxide formation and α-tocopherol consumption were not suppressed further, even after animals received higher doses of AsA. The present results suggest that higher than normal concentrations of tissue AsA are not necessarily associated with the suppressive mechanisms against dietary DHA-induced tissue lipid peroxide formation.