Published Science

OBJECTIVE: The study investigated the nutrient intake of depressed and nondepressed subjects. METHOD: Twenty-nine depressed subjects and a matched group of nondepressed subjects completed a 3-day food record. RESULTS: Results revealed that depressed and nondepressed groups consume similar amounts of all nutrients except protein and carbohydrates. Nondepressed subjects consume more protein and depressed subjects consume more carbohydrates. The increase in carbohydrate consumption comes primarily from an increase in sucrose consumption. DISCUSSION: The increased carbohydrate consumption is consistent with the carbohydrate cravings characteristic of the depressed and may relate to the development or maintenance of depression.

The unique benefits for group therapy are examined with special emphasis on the treatment ofblacks and Latinos. Because ofracial prejudice, economic exploitation, and negative stereotypes, group forces have been especially detrimental to the personality development ofpeople ofcolor. The group therapist attempts to harness these powerful group forces and use them therapeutically, thus enabling people of color to relate better to others while retaining their own autonomy. Racial differences can intensely affect diagnosis, transference, countertransference, and the "real relationship. " Distinctions between cultural and functional paranoia are particularly relevant in interracial groups. Implications for training group therapists are also explored.

Eight dual-flow continuous-culture fermenters were used in four replicated periods to compare the effects of diet and microbial marker on estimates of N metabolism in continuous culture of ruminal microorganisms. A basal diet was supplemented with urea and tryptone, soybean meal (SBM), lignosulfonate-treated SBM, corn gluten meal, blood meal (BM), hydrolyzed feather meal, fish meal (FM), or meat and bone meal (MBM). Microbial protein flow and protein degradation in fermenters were estimated using purines, purine N, and 15N in bacteria obtained from fermenter flasks or from the effluent. The ratio of purine N to total N in bacteria averaged .083 and was not affected (P > .05) by treatment. Dietary purine content (percentage of DM) ranged from .033 in BM to .084 in FM. Escape of feed purine N (percentage of total purine N flow) averaged 1.7% (SE = 2.9) and was not different (P > .05) among treatments. Bacterial N flows obtained using purines were more variable than estimates obtained using 15N. Bacterial N flows calculated using 15N in bacteria isolated from fermenters were more variable than those obtained using bacteria isolated from the effluent. The use of purines as a microbial marker resulted in lower estimates of protein degradation and smaller differences among treatments compared with use of 15N. Data suggest that escape of feed purine N seems to be a minor factor affecting calculation of bacterial N flow and that the use of 15N in effluent bacteria may be a more accurate procedure when using continuous-culture fermenters.

An early postprandial insulin release has previously been described when high carbohydrate meals are fed. The present investigation on humans shows that this response takes place not only with high carbohydrate (sugar pie) but also with high lipid (whipped cream) and protein (beef steak or fish fillet) meals, suggesting that it is caused by the palatability of the food rather than to its composition. This increment takes place at the very beginning of the meal and even if the period of feeding lasted 10 min, the response has disappeared at that time. Thirty min later due to plasma glucose elevation, a significant increase in insulin was observed with the sugar pie. At that time a similar increase was observed with the fish filet or the beef steak but not with the whipped cream. A cephalic glucagon response was not observed with any of the meals but 30 min after feeding the plasma level of this hormone increased with both beef and fish feeding and decreased significantly with the sugar pie meal. The usefulness of these responses is discussed with relation to the metabolic responses associated with feeding.

Maximal oxygen uptake (VO2 max) and lactate threshold (LT) were measured during graded, incremental exercise in 8 healthy, untrained volunteers (aged 22 +/- 0.9 yrs) following 3 days on a control, mixed diet, or a ketogenic (50% fat, 45% protein and 5% carbohydrates) diet of equal energy content. Before and after exercise tests acid base balance, plasma beta-hydroxybutyrate (beta-HB), free fatty acid (FFA), and some hormone concentrations were determined. In comparison with the normal diet, the ketogenic diet resulted in: an increased VO2 max, decreased respiratory exchange ratio an a shift of LT towards higher exercise loads. Blood LA concentrations were lower before, during and after exercise. Post exercise blood pH, as well as pre-and post exercise base excess and bicarbonates were reduced. Resting beta-HB concentration was elevated to approx. 2.0 mM, and FFA to approx. 1.0 mM. During a 1 h recovery period beta-HB decreased to 0.85 mM (p

A review of the literature and research on food restriction indicates that inhibiting food intake has consequences that may not have been anticipated by those attempting such restriction. Starvation and self-imposed dieting appear to result in eating binges once food is available and in psychological manifestations such as preoccupation with food and eating, increased emotional responsiveness and dysphoria, and distractibility. Caution is thus advisable in counseling clients to restrict their eating and diet to lose weight, as the negative sequelae may outweigh the benefits of restraining one's eating. Instead, healthful, balanced eating without specific food restrictions should be recommended as a long-term strategy to avoid the perils of restrictive dieting.

The effect of recombinant human hepatocyte growth factor (HGF) on low density lipoprotein (LDL) receptor gene expression was studied in the human hepatoma cell line HepG2. HepG2 cells were incubated with serum-free media in the presence and absence of HGF for various times and 125I-labeled LDL specific binding at 4 degrees C, uptake at 37 degrees C, and the levels of LDL receptor mRNA were measured. Incubation with HGF produced time- and concentration-dependent increases in 125I-labeled LDL binding (2-fold), uptake (2.5-fold), and LDL receptor mRNA (6-fold). HGF increased the rate of LDL receptor gene transcription 4- to 5-fold relative to that of several "house-keeping" genes as measured by nuclear run-on transcription. The half-life of LDL receptor mRNA, measured with actinomycin D, was not increased in HGF-treated cells. The stimulation of LDL receptor expression occurred independently of changes in cellular cholesterol or DNA biosynthesis or total cell protein. HepG2 cells were transiently transfected with plasmids bearing either three copies of repeats 2 and 3 (pLDLR(23)3LUC) or one copy of the LDL receptor promoter from -556 to +53 (pLDLR600LUC) linked to firefly luciferase. Incubation of pLDLR(23)3LUC, or pLDLR600LUC-transfected cells with HGF for 4 or 24 h at 37 degrees C produced a concentration-dependent increase in luciferase activity. A maximal stimulation of 3 to 6-fold was achieved for each construct at an HGF concentration of 100 ng/ml. In contrast, HGF had little or no effect on reporter activity in HepG2 cells transfected with a luciferase reporter plasmid bearing the HMG-CoA reductase promoter extending from -325 to +22. Thus, when compared to the native LDL receptor promoter, multiple copies of repeats 2 and 3 of the LDL receptor promoter can fully support activation of the luciferase reporter gene by HGF, demonstrating that the effect of HGF is mediated through the SRE-1. The lack of HGF effects mediated through the HMG-CoA reductase sterol regulatory element suggests, however, that sterol depletion may not be responsible for the induction of the LDL receptor promoter by growth factors. The signalling pathways or effectors responsible for activation of the LDL receptor and HMG-CoA reductase genes thus differ in their response to HGF. These data suggest that the level of SREBP's reaching the nucleus may be determined by as yet unidentified second messengers as well as by sterols.

1. Body weight, digestive organ weights, and activities of disaccharidases (maltase and saccharase) activities were determined from day of hatch to 21 d of age in meat- and egg-type chickens. Blood plasma was analysed for enzyme activities and metabolite concentration. 2. In meat-type chickens food intake and growth rate were about 3-fold those in egg-type chickens. Food efficiency was superior in meat-type chickens throughout the experimental period. 3. Meat-type chickens hatched with disaccharidase activities exceeding those found in their egg-type counterparts 2- to 5-fold. From 7 d of age on, this trend reversed, i.e. activity was much higher in egg-type than in meat-type chickens. 4. Blood plasma amylase activity increased gradually in meat-type chickens and was higher than in egg-type chickens to 14 d of age. No breed differences were observed for alkaline phosphatase or lactate dehydrogenase activities during the experimental period. 5. Blood plasma concentrations of total protein, albumin, glucose, and calcium, were lower in meat than in egg-type chickens.

1. Broiler breeder females were fed ad libitum, or according to a commercial food restriction programme or to gain 0.85, 0.70, 0.55, 0.40 or 0.25 of the body weight of ad libitum-fed birds. Several indices of the welfare of the birds were assessed at 3-weekly intervals to 18 weeks of age and related to body weight by regression analysis. Results for 6, 12 and 18 weeks of age are presented in detail. 2. Water intake was consistently higher in the 0.25, 0.40 and commercial restriction treatments. 3. There was a negative curvilinear relationship at each age group between body weight and the heterophil-lymphocyte ratio and plasma corticosterone concentration. 4. There was a positive relationship between the plasma concentration of creatine kinase and body weight at 12 and 18 weeks of age. The relationships between body weight and the plasma activity of alkaline phosphatase and aspartate transaminase changed with the age and there were no differences between treatments for lactate dehydrogenase. 5. The time spent resting increased with body weight at each age. The relationship between time spent preening and body weight changed with age whereas that for oral activities was similar among restricted birds at 6, and among all treatments at 12 weeks of age. At 18 weeks there was an increase in oral activities with decreasing body weight. 6. Fearfulness was positively related to body weight. The response of the comb to phytohaemagglutinin injection was similar in all treatments and the antibody titre to injections of sheep red blood cells was curvilinear. 7. A principal components analysis of all measured traits at 6, 12 and 18 weeks of age was conducted. Most of the variables were redundant but at least one from each of the different classes of welfare indices was retained at 6 and 12 weeks of age. 8. It was concluded that a body weight during rearing in the range of 0.5 to 0.85 of ad libitum might provide for optimum welfare of broiler breeder females.

PURPOSE: To determine the energy and nutrient intakes of some omnivorous and vegetarian female adolescents to compare their risk for nutrient inadequacies. METHODS: A convenience sample of 78 lacto-ovo-vegetarians (LOV), 15 semi-vegetarians (SV), and 29 omnivorous (OM) females aged 14-19 years completed three-day weighed records from which mean intakes and major food sources of energy, nutrients, and dietary fiber (as nonstarch polysaccharides (NSP)) were calculated. RESULTS: Mean daily intakes for energy and most nutrients were comparable for the three groups although LOV had higher intakes (p

Body composition changes with increasing age in men, in that lean body mass decreases whereas fat mass increases. Whether this altered body composition is related to decreasing physical activity or to the known age-associated decrease in growth hormone secretion is uncertain. To address this question, three groups of healthy men (n = 14 in each group), matched for weight, height and body mass index, were investigated using dual-energy X-ray absorptiometry, indirect calorimetry and estimate of daily growth hormone secretion [i.e. plasma insulin-like growth factor I (IGF-I-) levels]. Group 1 comprised young untrained subjects aged 31.0 +/- 2.1 years (mean +/- SEM) taking no regular physical exercise; group 2 consisted of old untrained men aged 68.6 +/- 1.2 years; and group 3 consisted of healthy old men aged 67.4 +/- 1.2 years undergoing regular physical training for more than 10 years with a training distance of at least 30 km per week. Subjects in group 3 had for the past three years taken part in the 'Grand Prix of Berne', a 16.5-km race run at a speed of 4.7 +/- 0.6 min km-1 (most recent race). Fat mass was more than 4 kg higher in old untrained men (P < 0.01, ANOVA) than in the other groups (young untrained men, 12.0 +/- 0.9 kg; old untrained men, 16.1 +/- 1.0 kg; old trained men, 11.0 +/- 0.8 kg), whereas body fat distribution (i.e. the ratio of upper to lower body fat mass) was similar between the three groups. The lean mass of old untrained men was more than 3.5 kg lower (P < 0.02, ANOVA) than in the other two groups (young untrained men, 56.4 +/- 1.0 kg; old untrained men, 52.4 +/- 1.0 kg; old trained men, 56.0 +/- 1.0 kg), mostly because of a loss of skeletal muscle mass in the arms and legs (young untrained men, 24.0 +/- 0.5 kg; old untrained men 20.8 +/- 0.5 kg; old trained men, 23.6 +/- 0.7 kg; P < 0.01, ANOVA). Resting metabolic rate per kilogram lean mass decreased with increasing age independently of physical activity (r = -0.42, P < 0.005). Fuel metabolism was determined by indirect calorimetry at rest. Protein oxidation was similar in the three groups. Old untrained men had higher (P < 0.001) carbohydrate oxidation (young untrained men, 13.2 +/- 1.0 kcal kg-1 lean mass; old untrained men, 15.2 +/- 1.3 kcal Kg-1; old trained men, 7.8 +/- 0.8 kcal kg-1), but lower (P < 0.05, ANOVA) fat oxidation (young untrained men, 10.1 +/- 1.2 kcal kg-1 lean mass; old untrained men, 6.5 +/- 1.0 kcal kg-1; old trained men, 13.7 +/- 1.0 kcal kg-1) than the other two groups. Mean plasma IGF-I level in old trained men was higher than in old untrained men (P < 0.05), but was still lower than that observed in young untrained men (P

This study compared fuel substrate kinetics in trained cyclists who ingested a 10% carbohydrate (CHO) drink without prior CHO-loading ([NLC] n=9) with those in cyclists who ingested a water placebo after CHO-loading ([CLP] n=7) during 180 minutes of cycling at 70% maximum oxygen consumption (Vo2 max). Muscle glycogen at the start of exercise was 194 +/- 4 and 124 +/- 8 mmol/kg wet weight (mean +/- SEM) in CLP and NLC subjects, respectively . Total CHO oxidation was similar. Total rate of appearance of glucose from endogenous (Raend) and exogenous (Raexog) origin and plasma glucose oxidation increased significantly (P<.05), with NLC subjects ending significantly higher than CLP subjects (104 +/- 17 v 79 +/- 9 and 115 +/- 16 v 74 +/- 11 micromol/min/kg fat-free mass [FFM], respectively). However, Raend was lower (P

Although it has been known for over 50 years that lipoprotein lipase (LPL) hydrolyzes triglyceride in chylomicrons, during the past half decade there has been a reinterest in the physiologic and pathophysiologic actions of this enzyme. In part, this has coincided with clinical studies implicating increased postprandial lipemia as a risk factor for atherosclerosis development. In addition, the recent creation of genetically altered mice with hypertriglyceridemia has focused the interest of geneticists and physiologists on the pathophysiology of triglyceride metabolism. As reviewed in this article, it is apparent that the lipolysis reaction is only partially understood. Several factors other than LPL are critical modulators of this process, in part, because the reaction requires the lipoproteins to interact with the arterial or capillary wall. Among the factors that affect this are the apolipoprotein composition of the particles, the size of the lipoproteins, and how LPL is displayed along the endothelial luminal surface. Zilversmit's observation that LPL activity is found in greater amounts in atherosclerotic than normal arteries has led to a large number of experiments linking LPL with atherogenesis. In medium and large arteries LPL is found on the luminal endothelial surface and in macrophage-rich areas within the plaque. LPL actions in both of these locations probably have major effects on the biology of the blood vessel. Possible atherogenic actions for this LPL based on in vitro experiments are reviewed.

There is a lack of information concerning the diet of vegetarian children. The present study compared the dietary intake of fifty vegetarian children, aged 7-11 years, with fifty matched omnivores. Three 3 d food records were completed by each child at intervals of 6 months. The day after completing the record each child was interviewed to clarify food items and assess portion sizes. Food records were analysed using Microdiet (University of Salford). Finger-prick cholesterol and haemoglobin measurements were taken from a subsample of the group. Only one child's family was a member of the Vegetarian Society and almost one-third of vegetarian children had omnivorous parents (seventeen of fifty subjects). The energy intake (MJ) of the vegetarians was significantly lower than that of the omnivores, 7.6 (SD 1.05) and 8.0 (SD 1.36) respectively; there were no significant differences in Fe or fat intakes. For the vegetarians polyunsaturated:saturated fat ratio (P:S 0.7 (SD 0.04)) and NSP intake (13.8 (SD 0.7) g/d) were significantly higher than those of the omnivores (P:S 0.5 (SD 0.02), NSP 10.3 (SD 0.4) g/d). There was no significant difference in cholesterol measurements (mmol/l) between the two groups: vegetarian 3.5 (SD 0.12), omnivores 3.7 (SD 0.15). The haemoglobin level (g/l) of the vegetarians (11.8 (SD 0.2)) was significantly below that of the omnivores (12.4 (SD 0.2)); 47.5% of the vegetarian children fell below the third percentile of the Dallman reference curves (Dallman & Siimes, 1979). The intake of the vegetarians more closely resembled current recommendations (Department of Health, 1991), although they need to be as aware as omnivores of the need to reduce fat intake. The haemoglobin levels of vegetarian children suggest that they need dietary advice to ensure optimal absorption of Fe.

Major risk factors for coronary heart disease were assessed in two populations of Tanzania, one on a fish diet (FD) living along the coast of Lake Nyasa, and the other, mainly on a vegetarian diet (VD), living in a farming area. Lower blood pressure values were found in the FD subjects (n = 618) vs. VD (n = 618) (systolic blood pressure, SBP, 120 +/- 15 vs. 135 +/- 20, P < 0.01; diastolic blood pressure, DBP, 70 +/- 9 vs. 78 +/- 11, P < 0.01, respectively). In an FD subgroup (n = 61), total cholesterol (TC) (122 vs. 136 mg/dL, P < 0.01); triglycerides (TG) (82 vs. 105 mg/dL, P < 0.01); and lipoprotein (a) [Lp(a)] (19.9 +/- 18.4 vs. 32.3 +/- 22.4, P < 0.001) were lower than in a VD subgroup (n = 55). Serum fatty acids (FA) in the FD subgroup were as follows: eicosapentaenoic acid (EPA) (20:5) 2.48 vs. 0.72%, docosahexaenoic acid (DHA) (22:6) 5.93 vs. 1.49%, vs. the VD, respectively. Arachidonic acid (AA) (20:4n-6) also was higher in the FD vs. the VD group (9.85 vs. 8.30%, P

There is overwhelming evidence in favor of fever being an adaptive host response to infection that has persisted throughout the animal kingdom for hundreds of millions of years. As such, it is probable that the use of antipyretic/anti-inflammatory/analgesic drugs, when they lead to suppression of fever, results in increased morbidity and mortality during most infections; this morbidity and mortality may not be apparent to most health care workers because fever is only one of dozens of host defense responses. Furthermore, most infections are not life-threatening and subtle changes in morbidity are not easily detected.

Although cardiovascular disease is a major cause of morbidity and mortality after renal transplantation, its pathogenesis and treatment are poorly understood. We conducted separate analyses of risk factors for ischemic heart disease, cerebral, and peripheral vascular disease after 706 renal transplants, all of which functioned for at least 6 months. We used Cox proportional hazards analysis to examine the effects of multiple pretransplant and posttransplant risk factors and included time-dependent variables measured at 3, 6, and 12 months, and annually to last follow-up at 7.0 +/- 4.2 yr. The independent relative risk (RR) of diabetes was 3.25 for ischemic heart disease, 3.21 for cerebral vascular disease, and 28.18 peripheral vascular disease (P

Space explorers on the Moon, Mars, or even in a space craft might grow plants in a CELSS to remove CO2 and provide O2 and food. Selection of crops to be studied has been rather arbitrary but should be based on plants that can provide a balanced and attractive, mostly vegetarian diet. Additional selection criteria include ease of growth in artificial environments and sufficient variety provided over long intervals. This article is based on a workshop convened to study vegetarian diets for use in a CELSS. Participants included nutritional scientists, practicing vegetarians, and interested employees of the Johnson Space Center. It was concluded that diets meeting the criteria could be formulated, and a list of suitable crops was compiled.

Background: Recent studies have shown that insulin has a direct vasodilator effect and that vascular sensitivity to insulin is impaired in hypertension. How the vasodilator effect of insulin is regulated physiologically is unknown. It has been appreciated that salt restriction may have adverse effects on glucose and lipid metabolism - processes regulated by insulin. To determine whether dietary salt restriction might affect vascular sensitivity to insulin, we studied 13 subjects (including eight borderline hypertensive subjects and five normotensive subjects) after 1 week of a normal sodium diet (240 mEq/day) and after 1 week of a low-sodium diet (20 mEq/day) with a randomized, double-blind crossover design. Methods and Results: Vascular sensitivity to insulin was assessed with the dorsal hand vein linear variable differential transformer technique. When the 'normal' salt diet was given, vascular sensitivity for insulin was significantly less (i.e., dose that produced the half-maximal response [ED50] insulin was higher) in hypertensive subjects (ED50 insulin for hypertensive subjects, 5.75 milliunits (mU)/min; ED50 insulin for normotensive subjects, 0.23 mU/min; p \textless 0.05). Vascular sensitivity to insulin was inversely correlated with mean arterial pressure and plasma norepinephrine concentration. When the low salt diet was given, vascular sensitivity to insulin decreased in both the normotensive and hypertensive groups, paralleling an increase in plasma norepinephrine. Blood pressure was not significantly decreased by reducing salt intake. Conclusion: In these younger normotensive and hypertensive subjects, dietary salt restriction increases resistance to the vasodilating effects of insulin.

Earth mounds are pre-European heaps of raised dirt, which consist mainly of charcoal rich sediment with fragments of burnt clay. The two objectives of this paper are to describe the earth mounds which occur in the Macquarie Marshes in northern New South Wales and to advance a speculative hypothesis that the earth mounds in southeastern Australia could have functioned as gardens. Over a thousand of these mounds have been recorded in southeastern Australia. Most have been recorded from the Murray Valley but many occur on the Murrumbidgee River and in the western districts of Victoria (Fig. 1). Mounds appear to be associated with major water-ways but their distribution in New South Wales is patchy. Despite extensive surveys, they have not been found in all riverine environments.

Cross-sectional comparisons, case-control studies and trends in food intakes show high rates of colorectal cancer in populations consuming diets high in meat and fat, and low in starch, NSP and vegetables. These studies suggest that the potential for prevention of colorectal cancer by diet is very great. Attributable population risk estimates from case-control studies suggest that 25-35% of colorectal cancers might be prevented by high intake of vegetables and fibre and that 15-25% of colorectal cancers could be attributed to a high fat intake (Tomatis er al. 1990). There are plausible physiological reasons for a protective effect of starch and NSP in large bowel cancer. Cross-sectional comparisons suggest that the recommendation (Department of Health, 1991) to increase starch and NSP consumption in the UK by 50% from 12 to 18 g/d will increase stool weight by 25% and reduce large bowel cancer incidence on a population level by 15%. Existing results from cohort investigations show only weak associations and more data are required from large studies using accurate dietary assessment techniques in populations where there is extensive dietary variation, and which have collected biological samples in order that interaction between diet, biomarkers of diet, and different genotypes that may determine risk can be examined. A major problem in epidemiological studies of large bowel cancer is the absence of an easily accessible intermediate risk marker, known to alter in response to diet in metabolic studies, that can be used to link dietary intake and the presence of the disease in either intervention or prospective studies. To meet the Department of Health (1991) recommendations for NSP intake, vegetable and fruit consumption needs to double in the UK. Vegetables may have added benefits in reducing colorectal cancer rates because they contain antioxidant nutrients and flavonoids, sulphur-containing compounds, and folate, all of which can be shown to favourably affect factors thought to be important in reducing risk. Intervention studies are generally held to be the most robust way of testing hypotheses but those already conducted with β-carotene and vitamin E have not reduced risk of either large bowel cancer or recurrence of precursor lesions such as adenomatous polyps. Results from other interventions with calcium, NSP and resistant starch are awaited. A protective effect of starch and NSP probably arises from their marked effect on bacterial metabolism in the large bowel, which leads to an increase in stool weight, and in butyrate production, and reduced pH, and levels of secondary bile acids, diacylglycerol, and free ammonia. In rodents given known carcinogens, 'insoluble' sources of NSP are generally protective, and high fat (or energy) diets increase tumorigenesis. Tumorigenesis may be reduced by n-3 fatty acids, but the effects of fat in rodent models of colon cancer are less consistent than those found in mammary tumorigenesis. In humans, a role for fat in increasing risk via increased bile acid excretion has been proposed. A risk from red and processed meat seems to be emerging from prospective studies, and high levels of meat increase faecal ammonia and NOC concentrations, and intakes of HAA. Some NOC and HAA are known carcinogens and some of the chromosomal mutations found in colorectal cancer are consistent with effects of NOC and HAA. Meat consumption should not increase. There has also been some interest in the past in the effect of bacterial enzymes in modifying carcinogen metabolism but the relevance of this to human diets and carcinogenesis is uncertain. The effect of diet on fecapentaene excretion is unknown. There are numerous different compounds in vegetables actively under investigation for their effect on carcinogenesis at different sites, including the large bowel, but intervention studies already conducted with β-carotene and vitamin E suggest that the active ingredients in vegetables involved in colorectal cancer protection are not antioxidant nutrients. As these attempts to alter risk with supplements have so far not been successful, they are not recommended for the general population.

Background. Prospective studies suggest that hyperinsulinemia may be an important risk factor for ischemic heart disease. However, it has not been deter- mined whether plasma insulin levels are independently related to ischemic heart disease after adjustment for other risk factors, including plasma lipoprotein levels. Methods. In 1985 we collected blood samples from 2103 men from suburbs of Quebec City, Canada, who were 45 to 76 years of age and who did not have ischemic heart disease. A first ischemic event (angina pectoris, acute myocardial infarction, or death from coronary heart disease) occurred in 114 men (case patients) between 1985 and 1990. Each case patient was matched for age, body-mass index, smoking habits, and alcohol consump- tion with a control selected from among the 1989 men who remained free of ischemic heart disease during fol- low-up. After excluding men with diabetes, we compared fasting plasma insulin and lipoprotein concentrations at base line in 91 case patients and 105 controls. Results. Fasting insulin concentrations at base line were 18 percent higher in the case patients than in the con- trols (P ? 0.001). Logistic-regression analysis showed that the insulin concentration remained associated with ische- mic heart disease (odds ratio for ischemic heart disease with each increase of 1 SD in the insulin concentration, 1.7; 95 percent confidence interval, 1.3 to 2.4) after ad- justment for systolic blood pressure, use of medications, and family history of ischemic heart disease. Further ad- justment by multivariate analysis for plasma triglyceride, apolipoprotein B, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol concentrations did not significantly diminish the association between the insulin concentration and the risk of ischemic heart disease (odds ratio, 1.6; 95 percent confidence interval, 1.1 to 2.3). Conclusions. High fasting insulin concentrations ap- pear to be an independent predictor of ischemic heart disease in men. (N Engl J Med 1996;334:952-7.)

Lipoedema is a common but infrequently recognized condition causing bilateral enlargement of the legs in women. Although generally considered to be the result of an abnormal deposition of subcutaneous fat with associated oedema, the precise mechanisms responsible for oedema formation have yet to be fully established. In order to evaluate the possible role of lymphatic or venous dysfunction in the pathogenesis of lipoedema. 10 patients were investigated by photoplethysmography (venous function) and quantitative lymphoscintigraphy (lymphatic function). The results were compared with those from patients with primary lymphoedema and those from healthy volunteers. The results demonstrated minor abnormalities of venous function in only two patients. One patient had moderately impaired lymphatic function in both legs and seven patients had a marginal degree of impairment in one or both legs. However, in none of these cases did the impairment attain the low levels seen in true lymphoedema. Lipoedema appears to be a distinct clinical entity best classified as a lipodystrophy rather than a direct consequence of any primary venous or lymphatic insufficiency.

The tooth surfaces are unique in that they are the only body part not subject to metabolic turnover. Once formed, the teeth are, under the correct conditions, essentially indestructible, as witnessed by their importance in fossil records and forensic medicine. Yet in the living individual, the integrity of the teeth is assaulted by a microbial challenge so great that dental infections rank as the most universal affliction of humankind. The discomfort caused by these infections and their enormous cost (dental infections rank third in medical costs, behind heart disease and cancer, in the United States) gives dental diseases prominence despite their non-life-threatening nature. This chapter reviews the bacterial aspects of dental caries and periodontal disease and suggests that, in the future, treatment will be directed toward eliminating or suppressing certain bacterial species that appear to be overt pathogens in the dental plaque.

Assuming that crops grown in controlled ecological life-support systems (CELSS) should provide a basis for meals that are both nutritious and attractive (to taste and vision), and that CELSS diets on the moon or Mars or in space-craft during long voyages will have to be mostly vegetarian, a workshop was convened at the Johnson Space Center, Houston, Texas, U.S.A. on 19 to 21 January, 1994. Participants consisted of trained nutritionists and others; many of the approximately 18 presenters who discussed possible diets were practicing vegetarians, some for more than two decades. Considering all the presentations, seven conclusions (or points for discussion) could be formulated: nutritious vegetarian diets are relatively easily to formulate, vegetarian diets are healthy, variety is essential in vegetarian diets, some experiences (e.g., Bios-3 and Biosphere 2) are relevant to planning of CELSS diets, physical constraints will limit the choice of crops, a preliminary list of recommended crops can be formulated, and this line of research has some potential practical spinoffs. The list of crops and the reasons for including specific crops might be of interest to professionals in the field of health and nutrition as well as to those who are designing closed ecological systems.

Purdue University, as well as the Johnson and Kennedy Space Centers and NASA Ames Research Center, are investigating approximately 5-10 plants that will be grown hydroponically to provide not only the energy and nutrients, but also the oxygen for humans habitating in Mars and lunar bases. The growth and nutritional status of rats fed either a control diet (adequate in all macro- and micronutrients) or a strict vegetarian diet consisting of 5 (vegan-5) or 10 (vegan-10) candidate crop species were investigated. In addition, vegan-10 diets were supplemented with mineral and/or vitamin mix at a level similar to the control diets to assess the effect of supplementation on nutrient status. The assessment of inedible plant material as an alternative food source was also investigated. Results of this study demonstrated that consumption of the vegan-10 diet significantly improved weight gain of rats compared to that for rats fed the vegan-5 diet. Mineral supplementation, at a level present in the control diet, to the vegan-10 diet improved growth and nutrient status, but growth was significantly lower compared to the control-fed rats. Inclusion of inedible plant material, high in ash content, improved some indices of nutrient status, without improving growth.

Obese persons are at risk for cholesterol gallstones because their bile is saturated with cholesterol. The risk increases during rapid weight loss by means of certain very-low-calorie diets or gastric bypass surgery. Gallstone risk factors during rapid weight loss include increased bile cholesterol saturation index and gallbladder stasis. Obese subjects were randomized to one of two low-calorie liquid diets for rapid weight loss: a 520-kcal diet with less than 2 g fat/d, and a 900-kcal diet with 30 g fat/d (including one 10-g fat meal to stimulate maximal gallbladder emptying). Bile and blood lipids, saturation index, leukocyte 3-hydroxy-3-methylglutaryl coenzyme A (HMG CoA) reductase activity, and ultrasonographic gallbladder emptying were measured repeatedly during dietary treatment. Both diets produced comparable weight loss of 22%. Bile cholesterol saturation index increased during both diets (26%), but fell to 15% below prediet level after weight loss. Compared with subjects' maximal gallbladder emptying fraction of 66%, the 520-kcal diet provided poor gallbladder emptying (35%), whereas the 10-g fat meal of the 900-kcal diet provided maximal emptying. Gallstones developed in four of six 520-kcal subjects and none of seven 900-kcal subjects (P = .021), an unanticipated difference that resulted in premature study termination for ethical reasons. Blood lipids and HMG CoA reductase activity in mononuclear leukocytes fell at week 8 during both diets, but recovered while weight was still being lost. The findings suggest that gallstone risk during rapid weight loss may be reduced by maintenance of gallbladder emptying with a small amount of dietary fat. Ultimately, weight loss reduced bile cholesterol saturation and improved highdensity lipoprotein (HDL) levels.

The spectrum of lipids in 20 patients with dyslipoproteinemia type IIa and IIb (group I and group II) was studied. The patients were treated for 24 days with a lactoovovegetarian diet used for the first time in the country. No drugs were employed. A decrease in the levels of cholesterol, atherogenic lipoproteins and atherogenic coefficient was observed after the treatment. The patients, who were offered a questionnaire highly appreciated the diet.

BACKGROUND: Animal experiments and epidemiological studies have suggested that coronary disease could be prevented, arrested, or even reversed by maintaining total serum cholesterol levels below 150 mg/dL (3.88 mmol/L). In 1985, we began to study how effective one physician could be in helping patients achieve this cholesterol level and what the associated effect of achieving and maintaining this cholesterol level has on coronary disease. METHODS: The study included 22 patients with angiographically documented, severe coronary artery disease that was not immediately life threatening. These patients took cholesterol-lowering drugs and followed a diet that derived no more than 10% of its calories from fat. Disease progression was measured by coronary angiography and quantified with the percent diameter stenosis and minimal lumen diameter methods. Serum cholesterol was measured biweekly for 5 years and monthly thereafter. RESULTS: Of the 22 participants, 5 dropped out within 2 years, and 17 maintained the diet, 11 of whom completed a mean of 5.5 years of follow-up. All 11 of these participants reduced their cholesterol level from a mean baseline of 246 mg/dL (6.36 mmol/L) to below 150 mg/dL (3.88 mmol/L). Lesion analysis by percent stenosis showed that of 25 lesions, 11 regressed and 14 remained stable. Mean arterial stenosis decreased from 53.4% to 46.2% (estimated decrease = 7%; 95% confidence interval [CI], 3.3 to 10.7, P

Antioxidant status was investigated in 20 Finnish middle-aged female vegans and in one male vegan who were following a strict, uncooked vegan diet ("living food diet"), by means of a dietary survey and biochemical measurements (blood concentrations of vitamins C and E and beta-carotene, and the activities of the zinc/copper-dependent superoxide dismutase and selenium-dependent glutathione peroxidase). Values were compared with those of omnivores matched for sex, age, social status, and residence. Antioxidant supplementation was used by 4 of 20 female vegans and by 11 of 20 control subjects. Based on dietary records, the vegans had significantly higher intakes of beta-carotene, vitamin E, vitamin C, and copper, and a significantly lower intake of selenium than the omnivorous control subjects. The calculated dietary antioxidant intakes by the vegans, expressed as percentages of the US recommended dietary allowances, were as follows: 305% of vitamin C, 247% of vitamin A, 313% of vitamin E, 92% of zinc, 120% of copper, and 49% of selenium. Compared with the omnivores, the vegans had significantly higher blood concentrations of beta-carotene, vitamin C, and vitamin E, as well as higher erythrocyte superoxide dismutase activity. These differences were also seen in pairs who were using no antioxidant supplements. The present data indicate that the "living food diet" provides significantly more dietary antioxidants than does the cooked, omnivorous diet, and that the long-term adherents to this diet have a better antioxidant status than do omnivorous control subjects.