Published Science

Previously published Type I (insulin-dependent) diabetes mellitus incidence in 0 to 14-year-old children from 10 countries or areas was compared with the national annual cow milk protein consumption. Countries which were selected for study had appropriate milk protein polymorphism studies, herd breed composition information and low dairy imports from other countries. Total protein consumption did not correlate with diabetes incidence (r = +0.402), but consumption of the beta-casein A1 variant did (r = +0.726). Even more pronounced was the relation between beta-casein (A1+B) consumption and diabetes (r = +0.982). These latter two cow caseins yield a bioactive peptide beta-casomorphin-7 after in vitro digestion with intestinal enzymes whereas the common A2 variant or the corresponding human or goat caseins do not. beta-casomorphin-7 has opioid properties including immunosuppression, which could account for the specificity of the relation between the consumption of some but not all beta-casein variants and diabetes incidence.

Psychotherapeutic drugs (antipsychotics and antidepressants) are widely used for treating anxiety. Many psychotherapeutic drugs are metabolized mainly by cytochrome P450 (CYP)2C19 and CYP2D6, and are often administered with other drugs. Therefore, it is necessary to be careful when coadministering psychotherapeutic drugs whose metabolism might be inhibited by other drugs. In particular, selective serotonin reuptake inhibitors (SSRIs) inhibit the metabolism of psychotherapeutic drugs mediated by CYP2C19 and CYP2D6. It is useful to phenotype CYP2C19 and CYP2D6 (extensive metabolizers or poor metabolizers) before giving such medication.

Since 1765, five major curricular reform movements have catalyzed significant changes in North American medical education. This article describes each reform movement in terms of its underlying educational practices and principles, inherent instructional problems, and the innovations that were carried forward. When considering the motivating factors underlying these reform movements, a unifying theme gradually emerges: increasing interest in, attention to, and understanding of the knowledge-base structures and cognitive processes that characterize and distinguish medical experts and novices. Concurrent with this emerging theme is a growing realization that medical educators must call upon and utilize the literature, research methods, and theoretical perspectives of cognitive science if future curricular reform efforts are to move forward efficiently and effectively. The authors hope that the discussion and perspective offered herein will broaden, stimulate, and challenge educators as they strive to create the reform movements that will define 21st-century medical education.

We describe the electrophysiological findings in 2 infants with deficient cobalamin intake. After normal development, psychomotor regression appeared after the 6th month, leading to severe hypotonia and apathy before the 12th month. Electrodiagnostic evaluation showed sensory neuropathy in both case …

The present study explored the relationships among dietary style (ranging from meat eating to veganism), cognitive restraint and feminist values. Two-hundred and twenty-seven participants with varying dietary styles completed the restraint subscale of the Three Factor Eating Questionnaire (TFEQ) and Attitudes Towards Feminism Scale (ATFS). Results indicated that among males, those who are high in cognitive restraint are more likely to exhibit a vegetarian dietary style than those low in cognitive restraint. Among women who are high in feminist values, those with high cognitive restraint are more likely to exhibit a vegetarian dietary style than those with low cognitive restraint, whereas for women low in feminist values those with high and low cognitive restraint are equally likely to exhibit vegetarian and non-vegetarian dietary styles. It is suggested that for some individuals, adoption of a vegetarian dietary style is an attempt to mask their dieting behaviour from others.

The relationship between jaw and skull morphology and feeding type (grazer, mixed feeder, browser, frugivorous, omnivorous) was analysed in 94 species of extant ungulates. A total of 21 morphological traits of the jaw and skull (17 and 4, respectively) were analysed using analysis of covariance, with body mass as covariate. To take into account the phylogenetic effect, simulations were generated under the Brownian motion model of character evolution. Analysis of covariance was applied to these simulations and the simulated F-ratios were used to assess the signification of the F-ratios for the real values of the traits. The feeding types had a weak effect on ungulate cranial and jaw morphology in comparison with the phylogenetic effect, since, before phylogeny correction, the analysis of covariance showed statistically significant differences associated with feeding type in 15 out of the 21 traits analysed. After controlling for phylogeny, only 2 significant traits remained, the length of the coronoid process and the occipital height. Omnivorous species had shorter coronoid processes than grazers or mixed feeders, and the occipital height was greater in the omnivorous species than in the grazers, mixed feeders or browsers. The coronoid process is involved in the generation of bite force, being the effective moment arm of the temporalis muscle, and occipital height is positively related to the force exerted by the temporalis muscle. This result matches the hypothesis that species with a toughness diet should show higher bite force ("toughness" describes the resistance of a material to being mechanically broken down). When the omnivorous species were excluded from the analysis, no differences in jaw and skull morphology were detected between the rest of the feeding types.

Urinary naphthols, 1- and 2-naphthol, recently have been suggested as route-specific biomarkers for exposure to airborne polycyclic aromatic hydrocarbons. For the proper application of urinary naphthols as biomarkers, we studied effects of lifestyle on urinary naphthols levels in 119 Japanese male workers. After improving the detection limit of urinary naphthols up to 0.27 microg/L by high-resolution capillary gas chromatography/mass spectrometry/selected ion monitoring, urinary naphthols were detectable in approximately 90% of the subjects. Among detectable samples, the geometrical mean (GM) of urinary 1-naphthol concentration was 5.13 microg/L (geometrical standard deviation, GSD, 4.90), while the GM of urinary 2-naphthol concentration was 3.16 microg/L (GSD, 5.61). We observed that urinary 1- and 2-naphthol level were three- and sevenfold higher, respectively, among smokers than among nonsmokers (p < 0.01). The ratios of urinary 2-naphthol to 1-naphthol were significantly higher among smokers than nonsmokers (p < 0.05). The number of cigarettes smoked and urinary cotinine levels were also positively related to the concentration of urinary naphthols (p < 0.01), while other lifestyle factors, i.e., age and consumption of alcohol, greasy or salty food, sweets, fruits, vegetables, meat, or fish, were not. We also studied whether genetic polymorphisms of enzymes, which were involved in naphthalene metabolism, affected urinary naphthols levels. The cytochrome P450 (CYP) 1A1 exon 7 genetic polymorphism was not related to urinary naphthol levels. Among smokers, the subjects with c1/c2 or c2/c2 type of CYP2E1, which was determined by CYP2E1 RsaI polymorphism in 5'-flaking region, showed higher concentrations of urinary 2-naphthol than the subjects with c1/c1 type regardless of creatinine-correction (p < 0.05) and the subjects with glutathione S-transferase (GST) M1 deficient type showed higher concentrations of both urinary 1- and 2-naphthol than those with GSTM1 normal type but only without creatinine-correction (p

To evaluate the hypothesis that endurance training increases intramuscular triglyceride (IMTG) oxidation, we studied leg net free fatty acid (FFA) and glycerol exchange during 1 h of cycle ergometry at two intensities before training [45 and 65% of peak rate of oxygen consumption (V(O2) peak)] and after training [65% pretraining V(O2) peak, same absolute workload (ABT), and 65% posttraining V(O2) peak, same relative intensity (RLT)]. Nine male subjects (178.1 +/- 2.5 cm, 81.8 +/- 3.3 kg, 27.4 +/- 2.0 yr) were tested before and after 9 wk of cycle ergometer training, five times per week at 75% V(O2) peak. The power output that elicited 66.1 +/- 1.1% of V(O2) peak before training elicited 54.0 +/- 1.7% after training due to a 14.6 +/- 3.1% increase in V(O2) peak. Training significantly (P

Observational studies primarily based on diet questionnaires or food records have reported that vegetarians can have a very low I intake. However, analytically ascertained data on the possible degree of I deficiency with this form of diet is lacking. Six healthy adult volunteers participated in the present controlled experimental diet study carried out in four separate 5 d diet periods. The study diets, normal, protein-rich, lactovegetarian, and repeat of the initial normal diet, were almost isoenergetic and contained no fish, sea food, iodized salt or processed foods fortified with I. During the last 48 h of each diet period two 24 h urine samples were obtained from each subject. I analyses were performed in the urine samples and in representative samples taken from all ingested diets. Urinary I excretion was significantly lower with the lactovegetarian diet (36.6 (SD 8.8) micrograms/d) than with the normal and the protein-rich diets (50.2 (SD 14.0) and 61.0 (SD 8.0) micrograms/d respectively). Accordingly, a markedly reduced I intake was confirmed analytically for the lactovegetarian diet (15.6 micrograms/d v. 35.2 and 44.5 micrograms/d respectively). Our results provide experimental confirmation of literature findings indicating that I supply is higher with non-vegetarian than with vegetarian diets. Specifically, the extremely low intake and urinary output of I as analytically determined for one exemplary vegetarian diet, demonstrate that dietary I may be limiting when strict forms of vegetarian dietary practices (no iodized salt, no I supplements) are followed. The present study is, therefore, the first diet-experiment-based pointer to the potential danger of I deficiency disorders due to strict forms of vegetarian nutrition, especially when fruits and vegetables grown in soils with low I levels are ingested.

Objective: To examine the association between self-reported consumption of foods and plasma vitamin C levels.Design: A cross-sectional analysis of dietary data and plasma vitamin C levels. Subjects placed the following foods into frequency categories: fresh fruit, leafy greens, other vegetables, fatty fish, other fish, chicken, meat, meat products, eggs, cheese and brown bread. The six frequency categories ranged from 'never' to 'at least daily'. Plasma vitamin C was measured by fluorometric assay.Setting: A population-based cohort study in Norfolk, UK.Subjects: 598 men and 566 women aged 45-74 years not taking vitamin supplements.Results: Plasma vitamin C was positively correlated with intake of fresh fruit (r=0.29 in men and r=0.25 in women, P<0.001), leafy greens (r=0.20 in men P<0.001, r=0.13 in women P<0.01), other vegetables (r=0.20 in men P<0.001, r=0.14 in women P<0.01) and brown bread (r=0.28 in men, r=0.17 in women, P<0.001) and negatively associated with intake of meat products (r=-0.13 in men P=0.02, r=-0.10 in women P<0.01). The difference in plasma vitamin C between never and daily eaters of brown bread was 13.6 micronol l(-1) in men and 9.9 micromol l(-1) in women, P

We evaluated predictors of plasma concentrations of dichlorodiphenyldichloroethylene (DDE), a metabolite of dichlorodiphenyltrichloroethane (DDT), and polychlorinated biphenyls (PCBs) in a group of 240 women, controls from a breast cancer case-control study nested in the Nurses' Health Study. We considered personal attributes such as age, serum cholesterol, region of residence, adiposity, lactation, and dietary intake. DDE levels increased 0.17 ppb/year of age (p = 0.0003), and PCBs increased 0.08 ppb (p = 0.0001). DDE and PCBs increased 0.20 (p = 0.02) and 0.13 ppb (p = 0.001), respectively, per 10 mg/dl serum cholesterol. Women living in the western United States had higher levels of DDE (mean = 11.0 ppb; p = 0.003), and women in the Northeast and Midwest had higher levels of PCBs (mean = 5.6 ppb; p = 0.0002) as compared to women from other parts of the country (mean DDE = 6.3; mean PCBs = 4. 5 ppb). Levels of DDE could not be predicted from consumption of meat, fish, poultry, dairy products, vegetables, fruits, and grains. There was a positive association between fish consumption and PCB concentrations among women in the Northeast and Midwest. Using data from the cases in the nested case-control study to assess the predictive ability of the models, we confirmed that the most reliable predictors of DDE were age and serum cholesterol, and the most important predictors of PCBs were age, serum cholesterol, and residence in the Midwest or Northeast. The null results for the majority of the food variables suggest that specific dietary factors, other than fish, are not currently a substantial contributor to human exposure to DDE and PCBs.

Poisonous plants are an integral component of most rangelands in the western U.S. Although domestic livestock losses can be severe, obviously most wild and domestic animals grazing on rangelands do not die of toxic plant ingestion. Grazing animals use several interrelated behavioral and physiological strategies to reduce the risk of poisoning: (1) avoid or reduce toxin intake through changes in diet selection; (2) select a mixed diet and dilute the toxin; (3) consume a toxin in a cyclic or intermittent fashion; (4) eject a toxin once eaten; (5) complex, degrade, detoxify, and (6) tolerate the toxin once eaten. A central tenet of the first 3 strategies includes postingestive consequences and aversive conditioning, whereby animals learn from the negative or positive consequences of eating particular forages. The last 3 strategies describe how animals handle toxins once consumed. When livestock reject toxic plants in favor of less toxic or nontoxic species, learning is usually involved. Domestic livestock losses attest that learning is not a perfect avoidance mechanism. Nonetheless, learning enables most livestock to survive grazing on ranges with poisonous plants. Domestic livestock are more often harmed by toxic plants than are wild ungulates, probably because many livestock losses result from human management errors that override coping strategies. Furthermore, wildlife survival is probably enhanced by increased capacity to tolerate or detoxify toxins relative to livestock.

Populations of vegetarians living in affluent countries appear to enjoy unusually good health, characterized by low rates of cancer, cardiovascular disease, and total mortality. These important observations have fueled much research and have raised 3 general questions about vegetarians in relation to nonvegetarians: Are these observations the result of better nondietary lifestyle factors, such as lower prevalences of smoking and higher levels of physical activity?; Are they the result of lower intakes of harmful dietary components, in particular meat?; and Are they the result of higher intakes of beneficial dietary components that tend to replace meat in the diet? Current evidence suggests that the answer to all 3 questions is "Yes." Low smoking rates contribute importantly to the low rates of cardiovascular disease and many cancers, probably including colon cancer, in Seventh-day Adventists and other vegetarian populations. Also, avoidance of red meat is likely to account in part for low rates of cardiovascular disease and colon cancer, but this does not appear to be the primary reason for general good health in these populations. Evidence accumulated in the past decade emphasizes the importance of adequate consumption of beneficial dietary factors-rather than just the avoidance of harmful factors-including an abundance of fruit, vegetables, and whole grains and regular consumption of vegetable oils, including those from nuts. Although current knowledge already provides general guidance toward healthy diets, accumulated evidence now strongly indicates that diet has a powerful yet complex effect on health and that further investigation is needed.

This report summarizes current scientific evidence from the literature in four areas: the prevalence of attention-deficit/hyperactivity disorder (ADHD) among children 6 to 12 years old in the general population and the comorbidities that might occur with ADHD; the prevalence of ADHD among children presenting in primary care settings and the comorbidities that might occur with ADHD; the accuracy of various screening methods in diagnosing ADHD; and the prevalence of abnormal findings on selected medical screening tests commonly recommended in evaluating children suspected of having ADHD., The evidence on ADHD prevalence and comorbidities was gathered from published literature identified through searches of MEDLINE and PsycINFO databases, reference lists in review articles, and from 10 behavioral rating scale manuals. Articles on medical screening tests were identified through searches of MEDLINE. Additional articles that met eligibility criteria but were not yet listed in MEDLINE were identified by experts., The diagnosis of ADHD was based on criteria in one of the diagnostic reference standards. Study populations were limited to boys and girls 6 to 12 years of age. Only studies using general, unselected populations in communities or schools or pediatric/family practice clinics were used to address the prevalence questions. Data on the performance of screening tests could come from studies conducted in any setting. Two types of scales were examined for this report: “ADHD-specific,” designed to target ADHD symptoms only, and “broad-band,” designed to screen for various symptoms, including the symptoms found in ADHD patients. Data sought from medical tests included the prevalence of abnormal findings among children diagnosed with ADHD. Evidence was admissible if the study from which it came had representative study populations, comparable control groups and adequate description of demographic information. Only articles published in English between 1980 and 1997 were used in the analysis., Two trained specialists independently read each of the retrieved articles and completed a form which characterized the type of information in the article. The articles accepted for analysis were each abstracted by trained personnel and the subject specialist independently abstracted each article. The resulting sets of abstractions (2 abstractions per article) were compared, with differences discussed and resolved. A multiple logistic regression model with random effects was used to analyze simultaneously for the effect of age, gender, diagnostic tool, and setting. The analysis was done using the EGRET software Appropriate quality checks were performed., Prevalence of ADHD ranged from 4 to 12 percent in the general, unscreened, school-age U.S. population. Gender, diagnostic tool, and setting are significant factors in the prevalence of ADHD, but age is not significant. Boys have higher rates of ADHD than in girls for all types of ADHD, with the inattentive type most common. Up to one-third of children diagnosed with ADHD also qualify for one of the five conditions most commonly comorbid with ADHD: oppositional defiant disorder, conduct disorder, anxiety disorder, depressive disorder or learning disorders. The prevalence of ADHD in a pediatric clinic setting varies between two percent of children and five percent depending on the study. Coexistence of ADHD with other disorders in children seen by a pediatrician was found in the one study to be 59 percent and in a second to range from 8 to 20 percent, depending on the comorbid condition and whether the informant was the parent or the child. Studies of behavioral rating scales showed that the Conners Rating Scale of 1997, contains two highly effective indices for discriminating between children with ADHD and normal controls 94 percent of the time. The Barkley School Situations Questionnaire was 86 percent effective. Medical screening tests to detect a relationship between ADHD and lead levels, abnormal thyroid function, imaging of brain structures, or EEG abnormalities have not shown any relationship with ADHD., The prevalence of ADHD in the general unscreened school-age population was estimated from 4 percent to 12 percent. In the general, unscreened, school-age population, prevalence of ADHD co-occurring with other disorders was estimated to be high, based on results of four studies. Of children diagnosed with ADHD, approximately 35 percent also qualified for a diagnosis of oppositional defiant disorder, 28 percent qualified for a diagnosis of conduct disorder, 26 percent qualified for a diagnosis of anxiety disorder, and 18 percent also had a depressive disorder, and 12 percent had learning disabilities. Prevalence of ADHD in a pediatric clinic setting varied widely, with few studies available for analysis. The prevalence of comorbid ADHD in a pediatric clinic setting also varied too widely to draw useful conclusions. Studies of ADHD-specific rating scales showed that the Conners Rating Scale of 1997 is highly effective for discriminating between children with ADHD and normal controls. The studies reviewed could not be used to derive conclusions regarding the effectiveness of broad-band rating scales in distinguishing children with significant problems from children without significant problems. Evidence does not support the use of tests of such as lead levels, thyroid function brain imaging, EEG, and neurological screening to screen children suspected of having ADHD.

Models of Archaic period economy in the Lower Pecos River region of southwest Texas and Coahuila, Mexico, are based primarily on coprolite, faunal, and macroplant analysis of materials recovered from rockshelters. The models maintain that during the Middle Archaic period residential mobility is reduced and tethered to rockshelters in canyons near water, and diet dominated by the plant resources lechuguilla (Agave lechuguilla), sotol (Dasylirion texanum), and prickly pear (Opuntia spp.). I use archaeobotanical analysis and actualistic studies to determine the contents of earth-oven features, the number of plant food calories produced by ovens, and the quantity of refuse they generate. Considered within the framework of a diet-breadth model, the data demonstrate that return rates and caloric yields for lechuguilla and sotol processed in earth ovens are typical of a broad spectrum, low-return economy. Intensive use of these low-ranked resources indicates periods of subsistence stress beginning in the Early Archaic period and continuing through the Late Archaic. Use of low-ranked, high-cost resources in canyon zones indicates that food and fuel resources were quickly depleted forcing high residential mobility. Depletion of local resources, not the distribution of water sources governed residential mobility.

"'Whether or not food passes into the truth of human nature' was among the questions that scholastic theologians routinely disputed. Many twelfth-century theologians, including Peter Lombard, argued that the 'truth' of every human body came entirely from Adam, and that food stimulated its growth but was not incorporated into it."--BOOK JACKET. "The first part of the book traces the origins of such questions in theology, medicine and natural philosophy. The second part analyzes their treatment and development in thirteenth-century theology."--Jacket. "The study illumines theologians' opinions about reproduction, fetal development, growth, nutrition, digestion, aging, corporeal identity, matter, physical quantity, the resurrection, and the relationship between theology and the natural sciences."--Jacket.

This study was designed to assess average daily dietary intakes of energy in 82 vegetarian children (group A: 6- 9-y-old girls and 6-11-y-old boys), adolescents (group B: 10- 15-y-old girls and 12-17-y-old boys), and young adults (group C: 16-30-y-old females and 18-30-y-old males) and included determination of height and weight; triceps, suprailiac, and calf skinfold thicknesses; puberty ratings; and physical fitness. Dietary energy intake was lower than recommended values in all 3 groups. Height and weight did not differ significantly from the reference data except in group B, which had significantly lower heights and weights and lower body mass indexes (P<0.05). Triceps and suprailiac skinfold thicknesses were lower in all age groups, whereas the calf skinfold thickness was only significantly lower in the 10-15-y-old girls (P<0.05). The vegetarian children were as physically fit as the reference group. The vegetarian adolescent boys and girls and the young adults scored significantly lower on the standing long jump and 30-s sit-up (P<0.05). The vegetarian subjects of groups B and C recovered significantly faster from the step test (P

Aims. Cardiac failure patients were studied systematically using polysomnography 1 month after recovering from acute pulmonary oedema, and again after 2 months of optimal medical treatment for cardiac failure. Methods and Results. This prospective study of consecutive patients was conducted in a cardiac care unit of a university hospital. Vo2 measurements and left ventricular ejection fraction were recorded. Thirty-four patients, initially recruited with pulmonary oedema, improved after 1 month of medical treatment to NYHA II or III. They were aged less than 75 years and had a left ventricular ejection fraction less than 45% at the time of inclusion. Age was 62 (9) years, body mass index = 27 (5) kg.m-2 and an ejection fraction = 30 (10)%. Eighteen of the 34 patients (53%) had coronary artery disease. Twenty-eight of the 34 had sleep apnoea syndrome with an apnoea + hypopnoea index \textgreater 15.h-1 of sleep. Thus, the prevalence of sleep apnoea in this population was 82%. Twenty-one of 28 (75%) patients had central sleep apnoea and seven of 28 (25%) had obstructive sleep apnoea. Patients with central sleep apnoea had a lower Paco2 than those with obstructive sleep apnoea (33 (5) vs 37 (5) mmHg, P \textless 0.005). Significant correlations were found between apnoea + hypopnoea index and peak exercise oxygen consumption (r = -0.73, P \textless 0.01), and apnoea + hypopnoea index and Paco2 (r= -0.42, P = 0.03). When only central sleep apnoea patients were considered, a correlation between apnoea + hypopnoea index and left ventricular ejection fraction was also demonstrated (r = -0.46, P \textless 0.04). After 2 months of optimal medical treatment only two patients (both with central sleep apnoea) showed improvement (apnoea + hypopnoea index \textless 15.h-1). Conclusions. We have demonstrated a high prevalence of sleep apnoea, which persisted after 2 months of medical treatment, in patients referred for acute left ventricular failure. Central sleep apnoea can be considered a marker of the severity of congestive heart failure.

c-myc, N-myc and L-myc are the three members of the myc oncoprotein family whose role in the pathogenesis of many human neoplastic diseases has received wide empirical support. In this review, we first summarize data, derived mainly from non-clinical studies, indicating that these oncoproteins actually serve quite different roles in vivo. This concept necessarily lies at the heart of the basis for the observation that the deregulated expression of each MYC gene is reproducibly associated with only certain naturally occurring malignancies in humans and that these genes are not interchangeable with respect to their aberrant functional consequences. We also review evidence implicating each of the above MYC genes in specific neoplastic diseases and have attempted to identify unresolved questions which deserve further basic or clinical investigation. We have made every attempt to review those diseases for which significant and confirmatory evidence, based on studies with primary tumor material, exists to implicate MYC members in their causation and/or progression.

The widespread prevalence of diet-related health problems, particularly in highly industrialized nations, suggests that many humans are not eating in a manner compatible with their biology. Anthropoids, including all great apes, take most of their diet from plants, and there is general consensus that humans come from a strongly herbivorous ancestry. Though gut proportions differ, overall gut anatomy and the pattern of digestive kinetics of extant apes and humans are very similar. Analysis of tropical forest leaves and fruits routinely consumed by wild primates shows that many of these foods are good sources of hexoses, cellulose, hemicellulose, pectic substances, vitamin C, minerals, essential fatty acids, and protein. In general, relative to body weight, the average wild monkey or ape appears to take in far higher levels of many essential nutrients each day than the average American and such nutrients (as well as other substances) are being consumed together in their natural chemical matrix. The recommendation that Americans consume more fresh fruits and vegetables in greater variety appears well supported by data on the diets of free-ranging monkeys and apes. Such data also suggest that greater attention to features of the diet and digestive physiology of non- human primates could direct attention to important areas for future research on features of human diet and health.

The available evidence supports neither a beneficial nor a detrimental effect of a vegetarian diet on physical performance capacity, especially when carbohydrate intake is controlled for. Concerns have been raised that an emphasis on plant foods to enhance carbohydrate intake and optimize body glycogen stores may lead to increases in dietary fiber and phytic acid intake to concentrations that reduce the bioavailability of several nutrients, including zinc, iron, and some other trace minerals. There is no convincing evidence, however, that vegetarian athletes suffer impaired nutrient status from the interactive effect of their heavy exertion and plant-food based dietary practices to the extent that performance, health, or both are impaired. Although there has been some concern about protein intake for vegetarian athletes, data indicate that all essential and nonessential amino acids can be supplied by plant food sources alone as long as a variety of foods is consumed and the energy intake is adequate. There has been some concern that vegetarian female athletes are at increased risk for oligoamenorrhea, but evidence suggests that low energy intake, not dietary quality, is the major cause. In conclusion, a vegetarian diet per se is not associated with improved aerobic endurance performance. Although some concerns have been raised about the nutrient status of vegetarian athletes, a varied and well-planned vegetarian diet is compatible with successful athletic endeavor.

We documented publication trends of vegetarian nutrition articles in biomedical literature between 1966 and 1995 using the National Institutes of Health MEDLINE bibliographic database. The publication rate of vegetarian articles increased steadily during the 3 decades, from an average of

OBJECTIVE To study the effect on weight loss in obese subjects by replacement of carbohydrate by protein in ad libitum consumed fat-reduced diets. DESIGN Randomized dietary intervention study over six months comparing two ad libitum fat reduced diets (30% of total energy) strictly controlled in composition: High-carbohydrate (HC, protein 12% of total energy) or high-protein (HP, protein 25% of total energy). SETTING AND PARTICIPANTS Subjects were 65 healthy, overweight and obese subjects (50 women, 15 men, aged 18-55 y) randomly assigned to HC (n = 25), HP (n = 25) or a control group (C, n = 15). All food was provided by self-selection in a shop at the department, and compliance to the diet composition was evaluated by urinary nitrogen excretion. MAIN OUTCOME MEASURE Change in body weight, body composition and blood lipids. RESULTS More than 90% completed the trial. Weight loss after six months was 5.1 kg in the HC group and 8.9 kg in the HP group (difference 3.7 kg, 95% confidence interval (CI)(1.3-6.2 kg) P \textless 0.001), and fat loss was 4.3 kg and 7.6 kg, respectively (difference 3.3 kg (1.1-5.5 kg) P \textless 0.0001), whereas no changes occurred in the control group. More subjects lost \textgreater 10 kg in the HP group (35%) than in the HC group (9%). The HP diet only decreased fasting plasma triglycerides and free fatty acids significantly. CONCLUSIONS Replacement of some dietary carbohydrate by protein in an ad libitum fat-reduced diet, improves weight loss and increases the proportion of subjects achieving a clinically relevant weight loss. More freedom to choose between protein-rich and complex carbohydrate-rich foods may allow obese subjects to choose more lean meat and dairy products, and hence improve adherence to low-fat diets in weight reduction programs.

The purpose of our work is to compare the resting metabolic rate (RMR) and thermogenic effect of food (TEF) in a group of vegetarians and a group of subjects consuming a Mediterranean diet. The composition of the diets was similar. Thirty-two subjects were studied: 16 vegetarians (age 34 +/- 9 years, BMI 21 +/- 2) and 16 omnivors (age 30 +/- 5 years, BMI 22 +/- 3). All were in excellent general health. Each subject consumed a dish of pasta (100 g) and bread (30 g) after RMR had been measured. TEF was measured over the next 3 h and calculated as the incremental area above RMR. Energy (vegetarians and omnivors 7,727 +/- 3,516 vs 8,970 +/- 2,273 kJ/day, respectively) and carbohydrate (vegetarians and omnivors 285.1 +/- 141.3 vs. 300.1 +/- 74 g/day, respectively) intakes of the 2 groups were similar. The vegetarian group consumed a higher quantity of fiber (30.5 +/- 16.7 vs. 16.5 +/- 7.9) and a lower amount of protein (44.9 +/- 18.3 vs. 70.1 +/- 14.9) than the omnivorous group. No significant differences were observed in RMR (4.23 +/- 0.96 vs. 4.06 +/- 0.54 kJ/min) and TEF (0.50 +/- 0.25 vs. 0.38 +/- 0.25 Delta kJ/min) between the groups. Results did not change after correcting for weight, age and gender. Our study failed to show any significant differences in RMR and TEF between vegetarians and subjects consuming a Mediterranean diet. We conclude that vegetarianism per se is not accompanied by a difference in RMR and TEF when the carbohydrate content of the diet is similar to a control group of nonvegetarians.

The notion that dietary factors may influence rheumatoid arthritis (RA) has been a part of the folklore of the disease, but scientific support for this has been sparse. In a controlled, single-blind trial we tested the effect of fasting for 7-10 d, then consuming an individually adjusted, gluten-free, vegan diet for 3.5 mo, and then consuming an individually adjusted lactovegetarian diet for 9 mo on patients with RA. For all clinical variables and most laboratory variables measured, the 27 patients in the fasting and vegetarian diet groups improved significantly compared with the 26 patients in the control group who followed their usual omnivorous diet throughout the study period. One year after the patients completed the trial, they were reexamined. Compared with baseline, the improvements measured were significantly greater in the vegetarians who previously benefited from the diet (diet responders) than in diet nonresponders and omnivores. The beneficial effect could not be explained by patients' psychologic characteristics, antibody activity against food antigens, or changes in concentrations of prostaglandin and leukotriene precursors. However, the fecal flora differed significantly between samples collected at time points at which there was substantial clinical improvement and time points at which there were no or only minor improvements. In summary, the results show that some patients with RA can benefit from a fasting period followed by a vegetarian diet. Thus, dietary treatment may be a valuable adjunct to the ordinary therapeutic armamentarium for RA.

The Oxford Vegetarian Study is a prospective study of 6000 vegetarians and 5000 nonvegetarian control subjects recruited in the United Kingdom between 1980 and 1984. Cross-sectional analyses of study data showed that vegans had lower total- and LDL-cholesterol concentrations than did meat eaters; vegetarians and fish eaters had intermediate and similar values. Meat and cheese consumption were positively associated, and dietary fiber intake was inversely associated, with total-cholesterol concentration in both men and women. After 12 y of follow-up, all-cause mortality in the whole cohort was roughly half that in the population of England and Wales (standardized mortality ratio, 0.46; 95% CI, 0.42, 0.51). After adjusting for smoking, body mass index, and social class, death rates were lower in non-meat-eaters than in meat eaters for each of the mortality endpoints studied [relative risks and 95% CIs: 0.80 (0. 65, 0.99) for all causes of death, 0.72 (0.47, 1.10) for ischemic heart disease, and 0.61 (0.44, 0.84) for all malignant neoplasms]. Mortality from ischemic heart disease was also positively associated with estimated intakes of total animal fat, saturated animal fat, and dietary cholesterol. Other analyses showed that non-meat-eaters had only half the risk of meat eaters of requiring an emergency appendectomy, and that vegans in Britain may be at risk for iodine deficiency. Thus, the health of vegetarians in this study is generally good and compares favorably with that of the nonvegetarian control subjects. Larger studies are needed to examine rates of specific cancers and other diseases among vegetarians.

The Oxford Vegetarian Study is a prospective study of 6000 vegetarians and 5000 nonvegetarian control subjects recruited in the United Kingdom between 1980 and 1984. Cross-sectional analyses of study data showed that vegans had lower total- and LDL-cholesterol concentrations than did meat eaters; vegetarians and fish eaters had intermediate and similar values. Meat and cheese consumption were positively associated, and dietary fiber intake was inversely associated, with total-cholesterol concentration in both men and women. After 12 y of follow-up, all-cause mortality in the whole cohort was roughly half that in the population of England and Wales (standardized mortality ratio, 0.46; 95% CI, 0.42, 0.51). After adjusting for smoking, body mass index, and social class, death rates were lower in non-meat-eaters than in meat eaters for each of the mortality endpoints studied [relative risks and 95% CIs: 0.80 (0. 65, 0.99) for all causes of death, 0.72 (0.47, 1.10) for ischemic heart disease, and 0.61 (0.44, 0.84) for all malignant neoplasms]. Mortality from ischemic heart disease was also positively associated with estimated intakes of total animal fat, saturated animal fat, and dietary cholesterol. Other analyses showed that non-meat-eaters had only half the risk of meat eaters of requiring an emergency appendectomy, and that vegans in Britain may be at risk for iodine deficiency. Thus, the health of vegetarians in this study is generally good and compares favorably with that of the nonvegetarian control subjects. Larger studies are needed to examine rates of specific cancers and other diseases among vegetarians.

Observations of the relations between food choices and health have been made since ancient times, but epidemiology, which can be regarded as the science of systematically studying these relations, has played a key role in official nutritional guidance only in recent years. In the past 20 y the principal goal of nutritional guidance has changed from the prevention of nutritional deficiencies to the prevention of chronic diseases. This evolving purpose of nutritional guidance has demanded that nutritional epidemiology play an increasingly important role. Although no other type of nutritional science can equal epidemiology in the relevance of either the dietary exposures or the health outcomes, substantial problems limit the ability of nutritional epidemiology to convincingly prove causal associations. The classic criteria for causation are often not met by nutritional epidemiologic studies, in large part because many dietary factors are weak and do not show linear dose-response relations with disease risk within the range of exposures common in the population. The most important problem in nutritional epidemiology in the past has been the inaccuracy of dietary assessment. In the future, an additional problem will be the proliferation of hypotheses that can be tested in multiple ways among the many subgroups of the population that can be defined by factors such as age, sex, and genotype. Future progress in our understanding of the relations between diet and health will necessitate improved methods in nutritional epidemiology and a better integration of epidemiologic methods with those used in the clinical nutritional sciences.

We have performed a number of studies including dietary interventions and cross-sectional studies on subjects consuming uncooked vegan food called living food (LF) and clarified the changes in several parameters related to health risk factors. LF consists of germinated seeds, cereals, sprouts, vegetables, fruits, berries and nuts. Some items are fermented and contain a lot of lactobacilli. The diet is rich in fiber. It has very little sodium, and it contains no cholesterol. Food items like berries and wheat grass juice are rich in antioxidants such as carotenoids and flavonoids. The subjects eating living food show increased levels of carotenoids and vitamins C and E and lowered cholesterol concentration in their sera. Urinary excretion of sodium is only a fraction of the omnivorous controls. Also urinary output of phenol and p-cresol is lowered as are several fecal enzyme levels which are considered harmful. The rheumatoid arthritis patients eating the LF diet reported amelioration of their pain, swelling of joints and morning stiffness which all got worse after finishing LF diet. The composite indices of objective measures showed also improvement of the rheumatoid arthritis patients during the intervention. The fibromyalgic subjects eating LF lost weight compared to their omnivorous controls. The results on their joint stiffness and pain (visual analogue scale), on their quality of sleep, on health assessment questionnaire and on general health questionnaire all improved. It appears that the adoption of vegan diet exemplified by the living food leads to a lessening of several health risk factors to cardiovascular diseases and cancer. Rheumatoid patients subjectively benefited from the vegan diet which was also seen in serum parameters and fecal analyses.

The purpose of this article and the accompanying vegetarian food guide pyramid graphic is to provide the conceptual framework for the development of a new and unique food guide. Food guides for vegetarians have tended to be adaptations of guides developed for the general nonvegetarian population instead of being designed to emphasize the healthy components of vegetarian dietary patterns. A subcommittee of the organizers of the Third International Congress on Vegetarian Nutrition began a process that led to the development of a pyramid-shaped graphic illustration and a supporting document, both of which were introduced at the congress. The 5 major plant-based food groups (whole grains, legumes, vegetables, fruit, nuts, and seeds) form the trapezoid-shaped lower portion of the pyramid. Optional food groups, which may be avoided by some vegetarians (vegetable oils, dairy, eggs, and sweets), form the smaller, separate, triangle-shaped top portion of the pyramid. The supporting document discusses the concepts that affect vegetarian food guidance and the rationale for selecting the food groups. It is hoped that this framework will provide the impetus for further research and discussion and will lead to the development of a guide that is nutritionally adequate, is conducive to good health, and can be adopted by vegetarians of diverse eating practices.

AIM: To study the effects of newly developed antiatherogenic vegetarian diet enriched with soya bean products on clinico-hemodynamic characteristics of elderly patients with coronary heart disease (CHD). MATERIALS AND METHODS: Clinico-hemodynamic parameters, lipid blood spectrum and plasmic hemostasis were studied in 28 elderly CHD patients divided into groups by dyslipidemia type (IIA, IIB, IV). RESULTS: The antiatherogenic vegetarian diet promoted normalization of central hemodynamics, lowering of blood atherogenic lipids, positive changes in blood rheology. CONCLUSION: The proposed balanced antiatherogenic vegetarian diet proved to be an effective monotherapy of dyslipidemia in elderly patients with coronary heart disease.

OBJECTIVES: Dairy products consistently have been associated with an increased risk of prostate cancer, yet the mechanism of this relationship remains unknown. Recent hypotheses propose that 1,25 dihydroxyvitamin D (1,25 D) is protective for prostate cancer. One study in the United States found that calcium consumption, which can lower circulating 1,25 D, was associated with higher risk of advanced prostate cancer, and we sought to address this hypothesis in a distinct population. METHODS: We analyzed data from a population-based case-control study of prostate cancer conducted in Orebro, Sweden, with 526 cases and 536 controls. Using unconditional logistic regression models, we examined the relationship of dairy products, dietary calcium, phosphorous, and vitamin D with risk of total, extraprostatic, and metastatic prostate cancer. RESULTS: Calcium intake was an independent predictor of prostate cancer (relative risk (RR) = 1.91, 95 percent confidence interval (CI) 1.23-2.97 for intake > or = 1183 vs.

Recent studies in social psychology are reviewed for evidence relevant to seven Freudian defense mechanisms. This work emphasizes normal populations, moderate rather than extreme forms of defense, and protection of self-esteem against threat. Reaction formation, isolation, and denial have been amply shown in studies, and they do seem to serve defensive functions. Undoing, in the sense of counterfactual thinking, is also well documented but does not serve to defend against the threat. Projection is evident, but the projection itself may be a by-product of defense rather than part of the defensive response itself. Displacement is not well supported in any meaningful sense, although emotions and physical arousal states do carry over from one situation to the next. No evidence of sublimation was found.