Best Weight Loss Programs That Work

Eat Stop Eat

This book by Brad Pilon explains on both fasting and routine weight training practices whereby fasting takes the center stage. A day of fasting serves to get rid of all those toxic substances in addition to boosting the general bodys metabolism. Brad Pilon has been in this particular field for quite some time and I do trust that the information contained on this book- Eat Stop Eat, are as a result of his huge bank of experience and careful experimentation on the theme. With Eat Stop Eat you can forget about all of these obsessive compulsive eating habits. Your metabolism will not slow down and you will not go into starvation mode. With Eat Stop Eat you will clearly see the research behind why short periods of fasting will Never cause you to go into starvation mode. Your metabolism will stay just as high as it ever was. The goodness about this approach is that its safe and easy to follow especially for anyone who cannot stay away from their favorite meals. You will have access to your meals over the fasting periods and still get the desired result. Read more...

Eat Stop Eat Summary


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Highly Recommended

The writer has done a thorough research even about the obscure and minor details related to the subject area. And also facts weren’t just dumped, but presented in an interesting manner.

This ebook does what it says, and you can read all the claims at his official website. I highly recommend getting this book.

Micronutrients in the Diets of Industrialized Countries

In the USA and Western Europe, agriculture and the food industry produce enough to feed the population and export large quantities of food. Despite this, many people are poorly nourished they are oversupplied with foods rich in fat, protein, sugar, and salt, and under-supplied with complex carbohydrates, fiber, vitamins, and minerals. Dietary surveys have repeatedly found that micronutrient deficiencies are widespread in the industrialized countries. For example Common dietary deficiencies of micronutrients in the USA and Western Europe* Common dietary deficiencies of micronutrients in the USA and Western Europe* Micronutrients in the Diets of Industrialized Countries

The Difference between the Diet of Our Distant Ancestors and Our Diet Today

In the industrialized countries diets have changed remarkably over the past 100 years. This dietary shift, combined with an increasingly sedentary lifestyle, is a major cause of many common diseases-heart disease, osteoporosis, tooth decay, high blood pressure, and diabetes. These disorders, so prevalent now, were rare before the 20th century. For thousands of years, humans adapted to and thrived on a diet radically different from today's diet.19,20 Looking at the diet of our ancestors provides an insight into what foods and nutrients humans were genetically designed to consume for good health. Clearly, our modern diet is dramatically different to the diet our species was brought up on. Humans were not designed to thrive on a highly refined, micronutrient-depleted diet rich in simple sugars, animal fat, sodium, and food additives.

Positive Energy Balance Overweight and Obesity

When the energy balance is positive, the adipose organ prevalently undergoes an increment in its white component. White adipocytes become hypertrophic and subsequently hyperplastic (likely due to a close causal relationship). In fact, it has been suggested that adipocytes are unable to expand beyond a given maximum volume, or 'critical size', which is genetically determined and specific for each depot 77 . Adipocytes that have reached the critical size trigger an increase in cell number 78-80 . In a recent review, Hausman et al. 81 , after considering the evidence for this theory, conclude that not only paracrine factors, but also circulating factors as well as neural influences may play a large role in regulating adipose tissue development and growth. They suggest that in the development of obesity, enlarged fat cells produce and release proliferative paracrine factors as internal controllers of preadipocyte proliferation, and that their proliferative response is modulated by neural...

Dietary Records and Diaries

Ly prefer the record system even if the food intake can be influenced by this process to such a degree that the subject's original food pattern can be changed. It is better to record dietary intake over a period of three non-consecutive days with a ratio of 5 2 between working days and holidays 34 .

Dietary Requirements for the Elderly

Nutrition may act in different ways first, lifestyle and nutritional habits of adulthood may contribute to the age-related loss of tissue function second, chronic degenerative diseases, such as atherosclerosis and cancer, appear to be influenced by nutrition finally, since elderly people eat less, the intake of some nutrients may fall below the recommended dietary allowances (RDA) 39 . But, until now, most of the nutritional recommendations for the elderly have been derived by extrapolation from data of younger adults 32, 39 . The controversial point is the choice of two-thirds of the RDA as a cut-off value for determining insufficient intake 32 . This could be incorrect because the chronic disease widespread in geriatrics might interfere with the dietary intake for groups of elderly subjects 40 .

The Fate of Dietary Protein Nitrogen During the Postprandial Phase

The diurnal cycle of feeding and fasting is accompanied by concurrent changes in protein turnover. Protein feeding is necessary to replenish the body protein stores that would be wasted during fasting 21-24 . Because of this, nitrogen retention calculated on a daily basis is lower than that derived just from the postprandial phase 21 , and, conversely, dietary protein utilisation calculated as the daily gain is lower than the postprandial gain. Dietary proteins, once ingested, are digested in the gut and thereafter absorbed as either free amino acids or dipeptides 25 . The absorbed amino acids are subjected to a variable first-pass extraction by splanchnic organs (mainly the liver) 26-28 and then they travel as such through the extracellular spaces before being used by the cells, either for catabolism or for protein synthesis. A minor fraction of amino acids are excreted unmodified into the urine 29 . The acute nitrogen deposition during the postprandial phase is likely to be the most...

Nitrogen Metabolism and Dietary Protein Characteristics

Of essential amino acids generates the ineffective utilisation of dietary nitrogen. Furthermore, besides such an insufficient utilisation, it is important to assess the amount of dietary and intestinal nitrogen that is absorbed as free amino acids or dipeptides, or excreted in the faeces, urine or other routes. Finally, the assessment of the anabolic utilisation for protein synthesis is a key step to measure amino acid retention in the body. Other factors may affect nitrogen retention. Differences in the gastric emptying rate of dietary proteins may result in highly variable rates of amino acid absorption in the small intestine 45 . Also, differences in the rate of protein digestion and or absorption result in relevant differences in amino acid oxidation and postprandial nitrogen accretion 46 . In this regard, the concept of net postprandial protein utilisation (NPPU) has been proposed, which is calculated using true ileal digestibility and true 15N-labelled protein deami-nation...

Good Dietary Sources

Plant foods, unless they are enriched with the vitamin, contain no vitamin B12. Although our intestinal bacteria synthesize small amounts of vitamin B12-like compounds, these do not contribute to nutritional needs. Therefore, the only significant dietary sources are animal products meat, seafood, eggs, and milk products.5 Vitamin B12 is sensitive to heat and substantial amounts can be lost during food preparation for example, milk boiled for 2 minutes loses 30 of its vitamin B12.

Other Dietary Considerations in MS

Constipation is a frequent complaint in people with MS. One way to improve constipation is to increase the amount of fiber in the diet. Good sources of fiber include whole grain breads and cereals, as well as fruits and vegetables. An increased intake of water and other fluids also may be beneficial for constipation six to eight 8-oz. glasses of fluid daily generally are recommended. Some people with MS may have frequent urinary tract infections, and increased fluid intake also may be helpful for this problem. Finally, for some people with MS-associated fatigue, it may be beneficial to avoid large increases or decreases in the blood sugar level. This may be accomplished by eating small meals and snacks throughout the day. Several other dietary factors should be kept in mind. Alcohol may, over the short-term, produce or worsen fatigue, bladder problems, walking difficulty, or clumsiness in the arms and legs. Grapefruit juice may increase the effects of many medications, including some...

Nutrigenomics Research on Dietary Beef

A major component of many low-carbohydrate diets, such as the Atkins diet, is 95 lean ground beef, typified by a hamburger without the bun (56). Lean ground beef consists of 35 fat and 65 protein ( Kcal), in addition to 65 mg cholesterol and 55 mg sodium per 85 gram portion. The fat portion consists of approximately equal amounts of saturated and mono-unsaturated fats (FDA food label). Surprisingly, we could only find one previous study in which Drosophila were fed dietary beef (63), and one microarray study where mice were fed beef tallow (64). The Drosophila beef paper was published in 1979 and the title is Failure of irradiated beef and ham to induce genetic aberrations in Drosophila (63). The purpose of this paper was to allay the unjustifiable fear, which, unfortunately, is still common among the public, that irradiated food is carcinogenic in humans. In addition to the mouse microarray paper cited previously (64), several other laboratories also fed mice pure beef fat (tallow)...

Ghrelin and Weight Loss in Obesity

Obesity is a chronic disease that is causally related to serious medical illnesses such as type 2 diabetes mellitus, hypertension, hyperlipidaemia, Based on evidence of the potent orexigenic action of ghrelin, its levels were at first expected to be increased in obesity. On the contrary, ghrelin levels turned out to be inversely related to body mass index. At present, the exact peripheral signals leading to a reduced ghrelin secretion in obesity have not yet been identified. The most likely hypothesis is that low ghrelin levels in obesity might represent a signal to the hypothalamic centres regulating food intake that energy stores are filled 34 . Ghrelin gene polymorphisms have been described by several groups linkage analysis studies, however, failed to prove a solid association between ghrelin and obesity 76,93,94 . While diet-induced human obesity, as well as polygenic (e.g. Pima Indians) or monogenic (e.g. MC4-R defect) causes of human obesity all present with low plasma ghrelin...

Leptin and Diet Induced Obesity

After the discovery of leptin, the initial hypothesis that human obesity results from a deficiency in leptin has failed. Obese humans have high plasma leptin concentrations related to the size of adipose tissue, but this elevated leptin signal does not induce the expected response. This fact suggests that obese humans are resistant to the effects of endogenous leptin. The resistance is also shown by the lack of effect of exogenous administration to induce weight loss in obese patients 64 . Leptin resistance may be defined as reduced sensitivity or complete insensitivity to leptin action, as occurs for insulin in type 2 diabetes 57 . Human and rodent studies indicate that the major cause of this resistance arises from an inability of leptin to cross the blood-brain barrier 81 . The leptin transporter is a saturable system beyond a certain plasma leptin level, increased production by the growing fat mass would be futile. Furthermore, severe hyperleptinaemia might down-regulate the...

Dietary Components Effective in Prevention

No form of a diet can prevent cancer with certainty, and epidemiological evidence of a correlation between diet and cancer is still incomplete yet it is possible to establish dietary recommendations that might reduce the risk of developing cancer (26). These markers can be used for interpreting epide-miological studies as well as for analyzing direct interactions in animal experiments and in-vitro assays. A final proof of their isolated mechanisms of action, however, is only possible through targeted dietary intervention studies (6).

Experimental Models of Caloric Restriction and Applicability to Humans

The lifespan-extending and other beneficial effects of CR, such as anti-tumor effects and the maintenance of more youthful physiology, have been reported in many hundreds of experiments over the past 70 yr. Nonetheless, the question of relevance to humans remains and will go unanswered until definitive human data are obtained (2). There are, however, data from a number of sources that suggest that CR may be relevant to human aging. For example, based on his study of Spanish nursing home residents, Vallejo (3) concluded that reduced caloric intake was associated with a significant reduction in morbidity and that mortality also tended to be lower in the group provided the fewest calories. Caloric intake in residents of the Japanese island of Okinawa differs by 20-40 in adults and children, respectively, compared to the national average (4). Interestingly, Okinawa has a greater proportion of centenarians, a lower overall death rate, and fewer deaths due to vascular disease and cancer....

Dietary Recommendations for the Prevention of Cancer

It is assumed that compliance with dietary recommendations will lead to the largest possible decrease in the incidence of cancer within the population. In addition, dietary recommendations give each and everyone the chance to lower the personal risk of cancer. Adhering to these recommendations does not ensure definitive protection it only reduces the average probability of developing the disease. On the other hand, even the most severe violations will not necessarily result in cancer. The recommendations have been compiled by the World Cancer Research Fund International (WCRF International) in such a way that they take into consideration all important dietary risk factors for cancer worldwide. They largely agree with the recommendations for the prevention of other chronic diseases, and most of them are identical to the recommendations of the German Society of Nutrition (Table 8.6).

Caloric Restriction Mimetics

We first proposed the idea of CR mimetics in 1998 (10) and further expanded on this potential approach in a subsequent article in Scientific American (11). In our initial study, we reported that disruption of cellular glucose metabolism (e.g., glycolysis) using the glucose analogue 2-deoxy-D-glucose (2DG) fed in the diet to rats lowered body temperature and fasting insulin levels without significantly reducing food intake over a 6-mo period at the selected dose (10). The 6-mo duration of this study was insufficient to assess indices of biological aging or longevity, but did validate that it may be possible to mimic metabolic effects of CR without reducing food intake. A follow-up survival study in rats unfortunately indicated that the window between efficacy and toxicity was too narrow to make this particular compound useful. The concept of CR mimetics has been further validated in other experiments. For example, similarly to CR, 2DG has been shown to be neuroprotective in rodent...

Diet and Eating Habits at School

For children with recurrent abdominal pain, Walker noted that diet and eating habits may exacerbate symptoms (4). Available foods and schedules for school lunch may contribute to symptoms. Many children may not have sufficient time to ingest their food and use the bathroom in the amount of time provided for lunch. In other cases, the types of food and beverages may also increase gastrointestinal symptoms and result in abdominal distress. In such cases, parents can advocate for specialized diets. With the epidemic of obesity in children and adolescents and the resulting increased risk for other diseases (e.g., type 2 diabetes, cardiovascular problems), it would be appropriate for the school to advocate for good nutritional standards in promoting positive health behaviors.

Lipid Metabolism and Fat Loss in Cancer Patients

Fat loss is frequently observed in cancer cachexia as well as in starvation, since adipose tissue comprises 90 of adult fuel reserves. Cachectic cancer patients show increased glycerol and fatty-acid turnover compared to normal subjects 2 . Also, their fasting plasma glycerol concentrations are higher, suggesting increased lipolysis 3 . In healthy individuals, lipid mobilisation is suppressed by glucose administration. In cancer patients, glucose infusion does not suppress lipid mobilisation and fatty acid oxidation 4 . This phenomenon appears as an early event in cancer patients, occurring even before weight loss and cachexia develop 5 .

Mechanisms of Action of High Doses of Dietary Antioxidants on Tumor Cells

To study the mechanisms of differential effects of antioxidant nutrients in cancer cells, it is important to establish whether the greater sensitivity of cancer cells to dietary antioxidant micronutrients (vitamin A, vitamin C, vitamin E, and carotenoids) is due to increased accumulation of antioxidants in these cells in comparison to that found in normal cells or whether cancer cells and normal cells accumulate the same levels of these antioxidant mi-cronutrients, with cancer cells being more sensitive to these micronutrients than normal cells.

Accumulation of Dietary Antioxidants in Normal and Cancer Cells

Cent normal tissues shows that the levels of individual antioxidant micronutrients in tumor tissue may be higher, lower, or the same in comparison to those found in the adjacent normal tissues (4548). The exact reasons for these variations are not known. Several factors may account for the above results. They include differences in the dietary intake, vascularity, and uptake and subsequent intracellular metabolism of antioxidant micronu-trients between normal and cancer cells.

Dietary AntioxidantInduced Alterations in Gene Expression in Cancer Cells

Formation, and apoptosis have been carried out only in cancer cells. These studies reveal that retinoids, vitamin E, and p-carotene attenuate the levels of those cell-signaling systems and gene expressions that can lead to decreased cell proliferation rate, increased differentiation, and or ap-optosis. They include expression of c-myc, H-ras (50, 51), N-myc (51), mutated p53 (27), protein kinase C (52, 53), caspase (54), tumor necrosis factor (55), transcriptional factor E2F (25), and Fas (24). Retinoids, vitamin E, and p-carotene enhance the levels of those cell signaling pathways and gene expression that can lead to reduced growth rate, increased differentiation, and or apoptosis, and they include the expression of wild-type p53 (27) and p21 (32), transforming growth factor p (TGF-p) (22), and the connexin gene (28). The above changes (Table 11.2) in gene expression may be one of the major factors that account for the growth-inhibitory effects of these dietary antioxidant...

Effect of Low Doses of Individual Dietary Antioxidants

In contrast to the effect of high doses of dietary antioxidant micronutrients, low doses of these mi-cronutrients can have no effect on the growth of cancer cells and normal cells, or they can stimulate the growth of some cancer cells without affecting the growth of normal cells. For example, vitamin C at a low dose stimulated the growth of human parotid carcinoma cells in culture (16) and human leukemic cells in culture (15), but had no effect on the growth of human melanoma cells in culture (16) or murine neuroblastoma cells (20). Polar car-otenoids at low doses can stimulate the growth of human melanoma cells in culture (17). In addition, certain amounts of antioxidants are needed for the growth of normal and cancer cells. Therefore, we do not recommend low doses of individual or multiple antioxidants during radiation therapy.

Effect of Multiple Dietary Antioxidants

A mixture of dietary antioxidants is more effective in reducing the growth of cancer cells than the individual antioxidants. A mixture of retinoic acid, a-TS, vitamin C, and polar carotenoids produced approximately 50 growth inhibition in human melanoma cells in culture at doses which produced no significant effect on growth when used individually (Table 11.3). Doubling the dose of vitamin C in the mixture caused a dramatic enhancement of growth inhibition. Similar observations were made on human parotid carcinoma cells in culture (16). A reduction of 50 in the dose of each micronutrient in a mixture did not affect the growth of human melanoma cells in culture. Each of the dietary antioxidants has different modes of action and therefore, it is essential that multiple dietary antioxidants are used in combination with radiation therapy.

High Doses of Dietary Antioxidants Enhance the Effect of Irradiation on Cancer Cells

Dietary antioxidants enhance the effect of irradiation selectively on cancer cells while protecting normal cells against some of the injuries. To observe this effect, antioxidants must be given before and after irradiation at high doses, and they must be present throughout the experimental period. The extent of enhancement of radiation damage by dietary antioxidant micronutrients depends upon the dose of radiation, dose and types of antioxi-dants, treatment period, and type of tumor cells. against chromosomal damage (43). In another study, we have reported that an aqueous form of a-tocopheryl and a-TS enhanced the level of radiation-induced growth inhibition in neuroblastoma (NB) cells (Fig. 11.4) (43, 61). Vitamin C enhanced the effect of irradiation on neuroblastoma (NB) cells, but not on glioma cells in culture (20). Dehy-droascorbic acid (DHA), the major metabolite of ascorbic acid, acts as a radiosensitizer for hypoxic tumor cells (62). These studies show that certain antioxidant...

Mechanisms of Action of Dietary Antioxidant Induced Enhancement of Radiotherapy and Chemotherapy

The exact reasons for the dietary antioxidant mi-cronutrient-induced enhancement of damage produced by standard therapeutic agents on cancer cells are unknown. We propose the following Free radicals produced by cancer treatment become irrelevant to antioxidant-affected cancer cells however, other mechanisms of damage continue to exert their influence. Micronutri-ents such as retinoic acid inhibit the repair of radiation damage in cancer cells more than in normal cells (60). In contrast to cancer cells, normal cells are not harmed by these dietary antioxidants. When treated with radiation or chemotherapeutic agents, antioxidants protect them at least from damage by free radicals.

Clinical Studies with Multiple Dietary Antioxidant Micronutrients in Combination with Standard Therapy

A randomized placebo-controlled trial on the use of antioxidants during radiation therapy has not been performed as yet. Dr. Jae Ho Kim of the Henry Ford Hospital in Detroit, Michigan, has completed a randomized pilot trial with high-dose multiple micronutrients including dietary antioxidants (vitamin C and vitamin E, and natural p-carotene) in cancer patients receiving chemotherapy and radiation therapy. Results showed that all patients tolerated high-dose micronutrients well and that quality of life was improved during radiation therapy with no adverse effect on the efficacy of standard therapy (personal communication). A few oncologists have used high dose multiple antioxi-dants in combination with standard cancer therapy, and improved outcomes have been reported (39, 40). A preliminary randomized trial with high dose antioxidants in combination with chemo-therapeutic agents (cisplatin and paclitaxel combination) in patients with advanced non-small cell lung carcinoma reported...

Dietary Treatment of the

In the past, the low albumin concentration in the serum and the pronounced loss of protein in the urine of patients with the nephrotic syndrome led nephrologists to advise a high dietary protein intake. In the mid-1980s, however, several reports appeared documenting that dietary protein restriction not only reduced urinary loss of protein, but in some cases led to an increase in serum albumin level. As yet, no explanation for this paradoxical effect has been proposed. (Note In these studies, most doctors used a low-protein diet instead of the supplemented very-low-protein diet that has been suggested in this book.) Subsequently, Simin Sistani and I have found that one type of nephro-tic syndrome in particular benefits from this approach, a disease known as focal segmental glomerulosclerosis, which was particularly hard to treat in the past. In patients with the nephrotic syndrome, in general, the greater the amount of protein lost in the urine before starting the diet, the greater the...

Dietary Intake of Proteins in Patients with Cancer

The typical nutrient intakes of individuals with advanced cancer have not been widely studied. This would appear to be an important deficit, as it is obvious that no anti-cachexia strategy is likely to be entirely effective unless coupled with adequate intake of essential nutrients, including proteins, and any need for supplementation must necessarily be considered in the context of the level of intake. A couple of relevant citations on dietary intakes of cancer patients may be found in the recent literature. Fearon (2003) reported the typical protein and energy intake of patients with unresectable pancreatic cancer who completed 3-day dietary records 16 . On average, total energy intakes were 1500-1600 kcal day and protein intakes were 60-63 g protein day, to provide an overall protein energy

What are the Dietary Protein Requirements of Cancer Patients

Dietary protein and amino acid requirements of cancer patients have never been formally determined, and we have argued elsewhere that this is an important deficit in the literature that would hopefully draw the attention of nutritional scientists with appropriate expertise 18 . Methods for the determination of human protein requirements continue to advance conceptually and technically, and the subset of these that are minimally invasive merit particular scrutiny for use, since patients with advanced malignancy may not tolerate extensive or invasive investigations. The indicator amino acid oxidation approach has been extensively developed for clinical use by Ball and co-workers 19,20 . This method is based on the principle that the oxidation of an indicator amino acid is high when a test amino acid is limiting for protein synthesis, and that indicator oxidation decreases to reach a low and constant value once amino acid requirements are met 19, 21 . Using this technique, breath and...

Obesity Overweight and Metabolic Syndrome

Obesity has been described as one of the modern epidemics. The numbers that support this argument are real and staggering. Since 1991, the prevalence of obesity has increased 75 and has been observed in every ethnic group.1 The direct and indirect costs of obesity-related diseases has been estimated to be over 100 billion annually. Perhaps the most alarming statistic relative to obesity is the magnitude of the increase in children. In the past 30 years, the prevalence of overweight and obese children has increased fourfold and currently has extended to preschool children where over 10 of children 2-5 years old are overweight.1 Factors responsible for this alarming increase in obesity include alterations in diet and nutrition and physical inactivity, both of which are also risk factors for CVD. Obesity not only increases the risk for the development of CVD but also for the development of type 2 diabetes. Thus, the risk factors for CVD can actually synergize with each other and produce...

Caloric Restriction And Aging

Caloric restriction (30-40 reduction in total caloric intake without malnutrition) has been recognized for over 60 years (33) as a means to extend the life span in many species, including rodents and probably primates. Similar to the dauer pathway in C. elegans, caloric restriction increases stress resistance and postpones reproduction. Certain mutations in C. elegans affect the ability to eat (eat mutants) and the rate of living, including feeding (clk mutants). Genetic epistasis experiments indicate that mutations in eat and clk affect the same pathway (reviewed in Ref. 34). In contrast, the daf pathway is independent, because daf-2 clk-1 double mutants live longer than either single mutant. Which of these mutants most closely resembles caloric restriction (CR) is not clear. The mechanism of CR has not been elucidated, but one hypothesis is that is that it slows the production of toxic ROS, and thus decreases the accumulation of oxidative damage. Interestingly, some important...

Caloric Restriction And Erc Formation

Caloric restriction has been shown to extend the life span in a wide number of organisms (68-71). Growth on low glucose has been used as a model for caloric restriction in yeast and was found to extend the life span (72,73). Yeast are normally grown in medium containing 2 glucose. Growth on 0.1 glucose results in a 55 extension of the median life span (72) growth on 0.5 glucose results in a more modest 24 extension in the life span (73). In yeast, glucose activates the cAMP-dependent protein kinase pathway. Components of this pathway include the GTP GDP-binding proteins (Ras1 and Ras2 proteins), and a GTP-GDP exchange factor (Cdc25 protein) that interacts with the Ras proteins (74,75). Mutations in CDC25 and several other genes within the protein kinase A (PKA)-signalling pathway that decreased PKA activity have been found to extend the life span (73). Growth on low glucose does not further extend the life span of the long-lived cdc25 mutant, suggesting that low glucose and low PKA...

Dietary Intake

Self-sufficient, not self-sufficient and institutionalised 30 . Besides, nutritional examination in a selected healthy elderly population would not show variations in dietary patterns in fact, they try to maintain the food habits because of a reduction of the adaptation capacity with age 31 . Elderly people's associations with food are more emotional than those of younger adults for some, food intake is the main event in the course of the day, often providing the only possibility of social contact 31 . The elderly have repeatedly been told that good food means good health 31 . So, the elderly may eat simply because they know they have to, even if they do not feel like eating, or they may eat because the food is delivered and throwing it away would be wasteful 32 . Another question is the continuing debate about the use of reference parameters in nutritional studies in the elderly. In fact, the value of dietary intake data as an indicator of health status in an elderly population is...

Body Mass Index

A more recent approach to the evaluation of nutritional status refers to body mass index (BMI). It affords a more accurate measurement, as follows body weight (kg) height2 (m2). The reference table (Table 11) includes only five classes 0 < 20 kg m2, weight deficit N 20-24.9 kg m2, normal 1 25-29.9 kg m2, mild weight excess 2 30-39.9 kg m2, obesity 3 > 40 kg m2, severe obesity. Table 11. Body mass index values of the body classes Table 11. Body mass index values of the body classes Recently it has been proposed that the obesity threshold should be lowered to 25 kg m2, based on epidemiological studies showing an increase in all-cause, metabolic, cancer and cardiovascular morbidity when BMI is greater than or equal to 25. In normal adults in western countries, the mean is 24, in less developed countries it is 20-21, with a mean of 18 in some cases.


One in four Americans has a BMI of 30 or greater and is therefore considered to be obese. This crisis in obesity is the result you would expect when constant access to cheap, high-fat, energy-dense, unhealthful food is combined with lack of exercise. Nowhere is this relationship more clearly illustrated than it is in the case of the Pima Indians. This example illustrates the impact of lifestyle over genetics since the Pima of Arizona share many genes with their New Mexican cousins but have far less healthful lives due to their diet and lack of exercise. The example of the Pima Indians also shows that genes influence body weight, because the Pima of Arizona have higher rates of obesity and diabetes than other Americans whose lifestyle they share. (Genetics is discussed in Chapter 4.) Whether obesity is the result of genetics, diet, or lack of exercise, the health risks associated with obesity are the same. As your weight increases, so do your risks of diabetes, hypertension, heart...

Dietary Conditions

Other dietary considerations are diets that have identical phosphate levels, protein levels, lipid levels, glycemic index, and so on, but vary in the source of these components. We have not yet performed experiments in Drosophila with these parameters controlled, but they are important considerations depending on the nutritional question being asked. For example, in mammalian models, intake of a low-phosphate diet stimulates transepithelial transport of inorganic phosphate (Pi) in the small intestine, which is associated with a change in the apical localization of NaPi cotransporters (69). A low-Pi diet can also lead to an increase in the level of vitamin D3 absorbed in the small intestine in mammals (69). Finally, depending on the goals of a particular nutrigenomics study, other considerations must also be made about the food components. One might want to consider glycemic index (GI), which is related to the speed in which nutrients are digested and absorbed, or glycemic load (GL),...

Weight Gain

Normal, steady weight gain is a characteristic of a pregnancy that is progressing well. On average, a woman should gain approximately 0.45 kg week during the middle months of pregnancy, and about 0.4 kg week during the final 3 months. In well-nourished women, average total weight gain during pregnancy is about 10.5-12.5 kg.4 In the USA and Western Europe many mothers gain too much weight during pregnancy. This can harm both the baby and the mother. Excess weight gain increases the chance of having a larger baby, which can prolong labor and may reduce oxygen supply to the baby during delivery. In the mother, too much weight gain increases risk of developing high blood pressure during pregnancy and makes returning to the prepregnancy weight more difficult, increasing risk of later obesity.4

Diet Obesity

Diets high in fat increase risk of weight gain. Protein and carbohydrate each contain 4 kcal of energy per gram, whereas fat has 9 kcal per gram. Moreover, dietary fat is efficiently stored as body fat, while protein and carbohy Weight-loss diets should contain generous amounts of dietary fiber.3 Fiber adds nondi-gestible bulk, so that eating fiber-rich foods results in satiety with lower caloric intake, encouraging weight loss. Fruits, vegetables, whole grains, and legumes are fiber-rich foods that should be a part of diets for weight loss. Alcoholic drinks (beer, wine, and spirits) contain large amounts of calories for example, a medium-sized glass of dry wine contains about 120 kcal. Fig. 5.6 Relationship between mortality from all causes and body weight as defined by body mass index (BMI). Very low or very high BMIs correlate with increased early mortality risk.

Psychiatric Disorders 601411 Schizophrenia

The overall prognosis for schizophrenia is poor. Only 60-70 of patients respond to currently available therapies, and the response is incomplete. In particular, the negative symptoms are usually refractory to treatment with atypical antipsychotics. In addition, there are significant adverse effects associated with prolonged use of antipsychotics including weight gain, increased production of prolactin, and tardive dyskinesia. Research into sleep disorders (see 6.06 Sleep) has intensified over the last decade given new generations of hypnotics and the success of the novel wake-promoting agent modafinil. The sleep spectrum involves insomnia, narcolepsy, and excessive daytime sleepiness (EDS). Dyssomnias are primary sleep disorders characterized by an abnormal amount, quality, or timing of sleep, and include primary insomnia, narcolepsy, and breathing-related sleep disorder. Primary insomnia is defined as a difficulty in initiating or maintaining sleep, or an inability to obtain...

Functional Anatomy of White Adipose Tissue

University discovered the gene of obesity 8 their subjects were mice, which in the 1950s had developed a spontaneous mutation resulting in hyper-phagia, infertility and reduced activity of the sympathetic nervous system, and consequently in early, massive obesity (ob ob mice) 9 . The researchers' enthusiasm was dampened by a paper in which Maffei 17 reported in a large sample of patients an unexpected, close correlation between BMI (the body mass index obtained by calculating the ratio of weight in kg to the square of height in metres) and leptinaemia as this entails that obese subjects have high values of leptinaemia and are thus prone to leptin resistance, they would be unaffected by the leptin treatment beneficial to Over time, other molecules were reported to be WAT secretion products (adipokines), and the relationship between their excessive secretion and the severe complications of obesity became increasingly apparent. Especially interesting was the correlation between secretion...

The Role of Micronutrients in Prevention and Therapy

Reaching health effects beyond simple prevention of the classic deficiency diseases. He realized that many chronic illnesses occur when micronutrient deficiencies or imbalances cripple the body's biochemistry and metabolism.5 Although initially Pauling's ideas met with skepticism within the scientific community, time and the progress of scientific research have shown the value of his basic principles. Correcting deficiencies and imbalances by providing the missing nu-trients-often at levels greater than those normally found in the diet-has proved to be a powerful new therapeutic approach.6-8 Pauling termed this new medicine orthomolecu-lar medicine, which he defined as Approximately 45 essential micronutrients are necessary for life and must be supplied by the diet because they cannot be synthesized in the human body. Why are these substances so critical for health Micronutrients are basic components of every cell in the body. They serve as chemical messengers, building blocks, and...

Functional Anatomy of Brown Adipose Tissue

Non-shivering thermogenesis is to be ascribed to this tissue. As mentioned above, food intake is also capable of activating it 1 , and several synthetic molecules, called specific 33-AR agonists, have been manufactured industrially. Pharmacological utilisation demonstrated their effectiveness in treating obesity and the consequent diabetes in both genetically and diet-induced rodent obesity 29, 30 , whereas the drugs developed in the hope of treating human obesity gave disappointing results 31 commonly attributed to the scarce presence of BAT in adult humans.

Variability in Micronutrient Requirements among Individuais

Put simply, each person has unique nutritional requirements. Depending on one's individual genetic makeup, striking variability can exist in the body's biochemistry. A nutrient intake sufficient for one person may be inadequate for another. For example, 2 mg day of vitamin B6 is adequate for good health in most people, yet some individuals with inherited defects in vitamin B6 metabolism need up to 30 to 100 times this amount.25 The absorption and daily requirement for calcium can vary four- to fivefold among healthy middle-aged women.26 Normal plasma concentrations for 1,25 (OH)2 vitamin D (the activated form of the vitamin) vary between 15 and 45 pg ml in healthy adults.9 In the 10 of the population who are heterozygous for the hemochromatosis gene (see pp. 68), dietary iron intakes that normally maintain health may be toxic in the long-term.27 Biochemical individuality also helps explain why different people react differently to dietary factors. For example, a high intake of salt...

Molecular Mechanisms of Transdifferentiation

Energy expenditure via activation of the orthosympathetic system is essential for the energy balance indeed, mice lacking all p receptors (1, 2 and 3), though not exhibiting changes in the amount of food intake or in motor activity, become precociously and massively obese 66 . These mice exhibit a complete and early transformation of BAT into WAT, in line with the observations that absence of BAT results in obesity and that ectopic UCP1 expression in WAT makes mice resistant to obesity. These data also agree with the finding that BAT activation and the white-to-brown transdifferentiation induced by administration of p3-AR agonists cure obesity. On the other hand, the mechanism by which mice lacking UCP1 fail to become obese is still obscure. Transgenic mice lacking the RIIp subunit (one of the subunits regulating AMPc-dependent pro-teinphosphokinase A, abundant in adipose tissues) overexpress RIa subunit, which involves increased sensitivity of proteinphosphokinase A to AMPc in WAT,...

Risk Factors and Cancer

Diet and obesity in adults account for 30 of all cancer deaths in the USA. Diet has been shown to play a significant role in the causation of cancer but little is known about how it plays its role as a carcinogen.15,18 Excessive fat in the diet raises the risk of colorectal and breast cancer and possibly prostate cancer. Adult obesity is associated with endometrial cancer, postmenopausal breast cancer, and cancers of the colon, rectum, and kidney.15,18 Obesity in concert with other risk factors such as low activity level, menopausal status, and predisposition to insulin resistance significantly increase the risk of cancer. While some methods of food preparation and preservation have been shown to increase the risk of various forms of cancers, certain classes of foods appear to contain protective substances against cancer including vegetables, whole grain products (fiber), and citrus fruits.12,15,18,20 Salt intake has been associated with risk of stomach cancer, but no other food...

The Human Adipose Organ

The visceral depots are very similar to those described in small mammals. In overweight or obese individuals, the abdominal visceral depots tend to grow in men and in post-menopausal women. This type of fat accumulation is dangerous for its association with the diseases secondary to overweight and obesity (diabetes, hypertension, myocardial infarct). In massively obese individuals, the fat mass may quadruple to 60-70 of body weight 88,89 . Recent works reporting a massive presence of macrophages in the adipose tissue of obese subjects hypothesise that many cytokines produced by adipose tissue and responsible for most of the adverse symptoms of obesity are in fact histiocyt-ic in origin. The cause of this macrophage infiltration is unclear, but seems to be related to The reduced lipolytic activity appears to stem from a relative preponderance of the antilipolytic activity of a2-ARs over that of lipolytic p-ARs 91 . In general, a2-ARs are more represented in human than murine adipose...

Meat Beef Pork Lamb and Poultry

Meat is exceptionally rich in iron, zinc, and vitamins B6 and B12. Moreover, the micronu-trients in meat tend to be highly bioavailable. About 20 of the iron in meat is absorbed, compared to only 2-5 from most plant foods.23 In the average US diet, meat provides 70-75 of the total dietary zinc requirement and almost all of the vitamin B12 requirement. At the same time, meat is the major source of saturated fat and cholesterol in the diet of the industrialized countries. A high meat intake may increase the risk of heart disease, stroke, and colon cancer. A large study in the USA found that women who eat meat (beef, pork, or lamb) at least once a day are twice as likely to develop colon cancer as those with a lower meat intake.24 Women who regularly eat chicken or fish rather than red meat cut their risk by about 50 . Moderation when eating meat is the key eating too much is harmful, but occasional consumption of meat can provide important nutrients without adding too much fat to the...

With Antithrombotic And Antiplatelet Drugs

To plasma proteins and endothelial cells. This leads to a more predictable antithrombotic dose-response relationship, and eliminates the need for routine laboratory monitoring of the anticoagulant effect. The long half-life of about 4 h after subcutaneous injections enables once or twice daily subcutaneous injection. LMWHs have an increase in minor (cutaneous) bleeding compared to UFH, but have the distinct advantages of not requiring aPTT monitoring, have a reduced rate of heparin-induced thrombocytopenia (35), and intravenous site infections are avoided. Because of the long half-life of LMWH, and difficulties in achieving rapid reversal of effect, UFH is often preferred in those patients in whom early or immediate intervention is planned, and in patients with marked obesity or renal failure. However, administration of protamine sulfate results in approx 60 reversal of the anti-factor Xa effects of LMWH and may result in decreased bleeding (36,37). Long-term therapy with...

The first step investigation of patterning

The first step in comparative analyses is to describe the patterns of distribution of the characteristics of interest across a chosen sample, in order to establish whether the conditions for one of the four methods exist. This involves investigating whether particular variants of one categorical variable are associated with particular variants of another, or whether continuous variables are correlated across the sample. Essentially, this is a similar process whether the variables concerned are categorical or continuous, and many features can be described either way. For example, dietary variation can be categorised according to the predominant food, as insectivory, frugivory etc., or measured according to the proportion of a particular food type in the diet, such as percentage fruit (e.g see Chapter 13). Where there is a choice of either a categorical or continuous measure, factors such as the nature and quality of available data, and the question under investigation are important....

First Generation Typical Antipsychotic Drugs

The serendipitous finding in 1951 that the major tranquilizer, chlorpromazine 1, was effective in treating delusions and hallucinations associated with schizophrenia and other psychotic disorders marks the beginning of modern therapy for schizophrenia.3 Unfortunately, treatment with chlorpromazine was accompanied by the development of EPS, some appearing even after the first dose (e.g., dystonias, akathisia). Other adverse effects were delayed for days or weeks such as parkinsonism, and the sometimes fatal neuroleptic malignant syndrome. Tardive dyskinesia, characterized by abnormal involuntary movements of the tongue, facial muscles, or limb muscles, develops in about 20 of patients and may be irreversible. Chlorpromazine also increased prolactin secretion leading to gynecomastia, galactorrhea, menstrual irregularities, sexual dysfunction, and possibly bone loss over the long term. Sedation, hypotension, and weight gain were also common with chlorpromazine. Despite these concerns,...

Complex Picture Emerges

Dietary factors The findings of Pittman and Cohen may be summarised as follows dietary factors, i.e. reduced supply of nutrients to the body, as discussed before, are generally accepted as a factor of primary importance in the genesis of cachexia. Many reasons for a reduced food intake in the setting of chronic disease have been discussed. Patients frequently complain of gastrointestinal problems and many reasons were identified reduced gastric

The Spectrum of Malnutrition

Nearly 30 of humanity - infants, children, adolescents, adults and older persons in the developing world - are currently suffering from one or more of the multiple forms of malnutrition. This remains a continuing travesty of the recognised fundamental human right to adequate food and nutrition, and freedom from hunger and malnutrition, particularly in a world that has both the resources and knowledge to end this catastrophe. The tragic consequences of malnutrition include death, disability, stunted mental and physical growth and as a result, retarded national socioeconomic development. Some 49 of the 10.7 million deaths each year among children aged under 5 in the developing world are associated with malnutrition. Iron-deficiency anaemia affects 2 billion people, especially women and children. Iodine deficiency is the greatest single preventable cause of brain damage and mental retardation worldwide 740 million are affected. PEM affects 150 million children aged under 5. Intrauterine...

Reduced Side Effect Liability

Current pharmacological approaches to the treatment of schizophrenia suffer from two major issues side effects and limited efficacy. The first major unmet medical need is improved side effect liability. Even the best of the modern atypical antipsychotics produce significant side effects with a low therapeutic index. Individuals with schizophrenia have an increased risk of death and, in general a 20 shorter life span84'85 that, in part, may be attributable to the use of current antipsychotic medications. As discussed above, atypical antipsychotics have a clear lower risk of inducing EPS and hyperprolactinemia (with the exception of risperidone) when compared to typical antipsychotics, but the risk still exists. Furthermore, several atypicals, particularly clozapine and olanzapine, increase the risk of sedation, obesity, high blood sugar and diabetes, and dyslipidemia. Very rare cases of neuroleptic malignant syndrome, a rare but potentially fatal reaction characterized by fever,...

Cachexia and Infectious Diseases

1981 and 1983, were determined in hospitalised patients 17 . Weight loss to an average of 80 of ideal weight was found in this population. Evidence of protein deficiency was documented by demonstrating deficiencies in serum proteins (transferrin, albu-min),haemoglobin, and by muscle wasting (midarm circumference). Several other studies also reported a high prevalence of severe weight loss in AIDS patients at the time of hospital admission. The results of formal nutritional assessments in HIV infection, using high-precision techniques, were first reported in 1985 18 . In a cross-sectional study, body cell mass as total body potassium content, fat content, and body water volumes (total body water, intracellular water and extracellular water), were measured in hospitalised, clinically ill AIDS patients and compared to results in normal controls. The AIDS patients averaged 82 of ideal body weight. However, the body cell mass was depleted disproportionately and was only 68 as compared to...

Apl Differentiation Syndrome

The pathophysiology and treatment of RA syndrome or APL differentiation syndrome have recently been reviewed,45 46 and knowledge of the manifestations of this potentially fatal complication of induction therapy is essential to all clinicians who treat APL. The most common presenting symptoms47-49 are respiratory distress, fever, pulmonary infiltrates, weight gain, and pleural pericardial effusions. Less common signs and symptoms include renal failure, cardiac failure, hypotension, and bone pain. These symptoms can develop at virtually any time after presentation (and may be present before any therapy), but the median time to development is between weeks 1 and 2 after the start of induction.47-49 The differential diagnosis includes sepsis acute respiratory distress syndrome, as well as pulmonary hemorrhage, and the outcome can be fatal if the disorder is not recognized, diagnosed correctly, and properly treated. Treatment of RA syndrome is with corticos-teroids (given at the earliest...

Dna Damage And Repair

The sources of DNA damage are protean. Environmental agents may act as mutagens, thus increasing the likelihood of the occurrence of mutations. Known agents in this category include ultraviolet (UV) light (the major source being exposure to sunlight), ionizing radiation, cigarette smoke, and various carcinogens such as asbestos and possible dietary factors. Whereas exposure to environmental factors frequently can be reduced or minimized by behavioral modification, other sources of DNA alteration are unavoidable errors during DNA replication (which occur with each cell division), damage from by-products of normal cellular metabolism (including reactive oxygen species superoxide anions, hydroxyol radicals, and hydrogen peroxide derived from oxidative respiration), and products of lipid peroxidation. Other weak mutagens, such as thermally promoted hydrolysis of nucleotide residues by water, may occur under physiological conditions. Deamination results in base substitutions, such as the...

Neurokinin3 Antagonists

Two neurokinin3 (NK3) antagonists, osanetant 76 and talnetant 77, which have selective interactions with the NK3 receptor in the range of 1 nM, have been reported to have clinical efficacy in schizophrenia.74 Osanetant had similar efficacy to haloperidol on positive symptoms with reduced EPS and weight gain liabilities. NK3 receptors present on DA neurons in the A9 and A10 groups are thought to modulate DA release, agonists increasing DA release.

Energy Values from the Food Composition Tables

Together, the monosaccharides + disaccharides + starch represent the available carbohydrates. Cellulose, hemicellulose, pectin, gums, and resistant starch* (collectively referred to as dietary fibre or unavailable carbohydrates) are not considered to have energetic value. However, unavailable, unaltered carbohydrates reach the colon, where they can be fermented by the local microflora, which consist of several genera of anaerobic microorganisms. These utilise dietary fibre to produce pyruvic acid, an important metabolic intermediate from which short-chain fatty acids (SCFA), i.e. acetic, propionic, and butyric acids, and other gases are produced (Fig. 2) 9 . Since the SCFA, produced at an estimated average amount of 380 mmol day, can be absorbed in the intestinal mucosa and metabolised to yield energy, an energetic value for dietary fibre of 1.5 Kcal g can be calculated 10 . In practice, however, since dietary fibre reduces the absorption of other energetic nutrients and increases...

Energy Distribution Among Nutrients

The choice of foods according to their energy value represents the basis for building-up the energy-controlled dietary regimens that are required under different conditions, such as reduction of body weight (in overweight or obese patients), increased energy demand during recovery from illness or surgery, or high-level physical activity 11,12 . Dietary fiber However, in addition to the importance of controlling the total amount of dietary energy, food choices should be directed towards a balanced distribution of energy among nutrient sources. Epidemiological and experimental studies have led to the establishment of correct energy distribution among carbohydrates, fats, and protein, in order to prevent the onset of chronic diseases and to assure the maintenance of a good nutritional and health status. In this view, in the USA, more than 20 years ago, a Senate Select Committee stated that the energy distribution compatible with good health and that should be reached by the American...

Psychosocial and Supportive Care

Honing social and interpersonal skills is an important developmental milestone during adolescence. Cancer treatment for these patients must accommodate this important developmental process. We have discharged a patient from the intensive care unit to allow her to attend her senior prom, and readmitted her when the party was over. Yet boundaries must be set, so that treatment effectiveness is not compromised to keep a social calendar. Certainly, cancer therapy causes practical problems in social arenas. Adolescent and young adult patients, who are developmentally dependent on peer-group approval, often feel isolated from peers by their experience the cancer patient's issues are illness and death, while their peers are consumed by lipstick and homework. All adolescents agonize over their personal appearance and hate to be singled out or to appear different. In adolescents with cancer, having to be isolated from peers and society by having a disease that makes them different and having...

Physiological Regulation

P-Adrenergic receptors (pARS) transmit the thermogenetic signal to peripheral target tissue (brown fat, and possibly muscle and other tissues) and play an important role in diet-induced ther-mogenesis and therefore also in prevention of diet-induced obesity. Various components of the energy balance system in the brain have been identified and include the leptin receptor, melanocyte stimulating hormone (MSH), the melanocortin-4 receptor (MC4 receptor), neuropeptide Y (NPY), and agouti-related protein (AgRP) (Fig. 2) 6 . Alterations in DIT may be of great importance in controlling body weight and in promoting obesity, as indicated by the fact that most animal models of obesity (ob ob, db db and MC-4 receptor gene knock-out mice) have defects in adaptive thermogenesis.

The Design of Ezetimibe

Scientists at the SPRI have recently discovered that ezetimibe blocks the activity of the cholesterol transporter NPC1L1 that is expressed at the apical surface of enterocytes.14 It is believed to be the transporter for dietary cholesterol absorption. As a further proof, it was demonstrated that in NPC1L1 knockout animals, ezetimibe was ineffective in preventing the absorption of cholesterol.

Mini Nutritional Assessment MNA

Items 38 and can be administered by a healthcare professional in less than 15 minutes. It involves a general assessment of health, a dietary assessment, anthropometric measurements, and a subjective self-assessment by the patient (Table 2). The results of the MNA test classify the patient as well nourished, at risk for malnutrition, or malnourished. The MNA test was shown to be 92-98 accurate. It is a simple, non-invasive, well-validated screening tool for malnutrition in elderly persons.

Biochemical Parameters of Nutrition in the Elderly

And metabolism should be studied more closely. Vitamins that act as antioxidants appear to have a role in preventing coronary artery disease and cancer 53 . Current work is focusing on the actions of vitamins as related to immune function, the formation of cataracts, and the development of osteoporosis, all associated with ageing 53 . The Food and Nutrition Board, the Institute of Medicine, and the National Academy of Science and Health of Canada have recently developed a standard set of nutrient recommendations, known as dietary reference intakes (DRIs), which has added, with regard to vitamin intakes, the groups for ages 51-70 years and for 70 years and older 54 . These recommendations are listed in Table 3 54 .

Analytical techniques

Inertia into account in a formalised manner, but which rely on biological knowledge and sensitive investigation of the data sets involved to ensure that results are properly founded, grade shifts certainly can be, and are, recognised (contra Purvis and Webster). On the other hand, grade shifts are not necessarily easy to identify using CAIC. For example, a grade shift may not be marked and hence not produce a clearly outlying contrast point. In any case, the size of the contrast measurements between species points on either side of a grade shift is a meaningless combination of the effects of the grade shift and the relationship within any one grade between the two variables concerned. This combination may produce pairs of contrast values that stand out as outlying points on a contrast plot, or it may not, and hence a grade effect would be missed. Also, a grade shift may involve multiple points in a phylogeny. Whilst there is a single phylogenetic link between strepsirhines and...

Regulation of endogenous glucose output during euglycaemic hyperinsulinaemia

Several metabolic conditions known to be associated with resistance of insulin induced suppression of endogenous glucose output should be considered when a clamp protocol is planned. For example, impaired glucose tolerance (Bavenholm etal. 2001), type 2 diabetes mellitus and obesity (Kolterman etal. 1981 DeFronzo etal. 1985 Butler etal. 1990 Staehr etal. 2001 Krssak etal. 2004), steroid therapy (Rizza etal. 1982), increased availability of free fatty acids and or triglycerides (Bajaj et al. 2002 Boden et al. 2002) and fat accumulation in the liver (Seppala-Lindroos etal. 2002 Krssak etal. 2004) are associated with defective insulin induced suppression of endogenous glucose output. In terms of a dose-response curve of insulin action on endogenous glucose output, the curve is shifted to the right under these metabolic conditions, indicative of hepatic insulin resistance (Kolterman etal. 1981). In line with these studies, the half maximal effective plasma insulin concentration to...

Pivotal and emerging issues in FDAs approach to safety assessment

Exposure estimates derived from packaging factors are 'averages' across the U.S. population and may be thought of as 'per capita' estimates. FDA believes that this 'per capita' -based approach to estimating exposure to food packaging components is appropriate because consumer selection of food is not generally dependent on the type of packaging rather, it is dependent on the eating habits and spending preferences of the consumer. In fact, one criticism of FDA's approach to consumer exposure for packaging materials is the assumption that a food(s) eaten by a given consumer will have been packaged with the same material 100 of the time. For example, if a notifier proposes use of an antioxidant in high-density polyethylene, the consumer is assumed to ingest the selected food(s) only if it is packaged in the high- In applying the hazard information gained in toxicology testing to a safety evaluation, it is essential to assess the hazard based on the exposure resulting from the use(s) of a...

History Of Substance Abuse Treatment

Historical and literary accounts have long documented individual attempts to draw back from the abyss of alcohol and drug abuse. At various times autobiographical, biographical, journalistic, and anecdotal, these descriptions list centuries-old recovery methods still employed today in lay and professional settings. Modalities include gradual decrease in dosage symptomatic use of nonad-dicting medications isolation from the substance relocation away from fellow users religious conversion group support asylum in a supportive and non-demanding environment and treatment with a variety of shamanistic, spiritual, dietary, herbal, and medicinal methods (Westermeyer, 1998).

Etiology and Pathogenesis 361 Etiology

The increasing ratio of male to female cases across the three age groups 13 to 14 years, 15 to 19 years, and 20 to 24 years suggests that the onset of osteosarcoma and Ewing tumor may be associated with the adolescent growth spurt, which occurs earlier in females than in males. Dietary and hormonal factors may be relevant. The possibility of a viral etiology for osteosar-coma has also been considered, and SV40-like sequences have been detected in osteosarcoma tissue in several studies 60-63 . In the most recent of these studies, the frequency of SV40-like sequences in peripheral blood cells from osteosarcoma patients was compared with that in normal, healthy controls and was found to be substantially increased in the osteo-sarcoma patients 63 . Space-time clustering has been reported in childhood STS 64 . It would be of considerable interest to determine whether STS in adolescents and young adults exhibit space-time clustering.

Protein Requirement and Energy Intake

Relationship between dietary protein requirement (in grams of protein per kg of body weight), titrated to the achievement of zero nitrogen balance, and energy intake (in kJ per kg of body weight) in a weight-stable healthy adult man 19,20 Table 4. Relationship between dietary protein requirement (in grams of protein per kg of body weight), titrated to the achievement of zero nitrogen balance, and energy intake (in kJ per kg of body weight) in a weight-stable healthy adult man 19,20

Why the Andrews Reiter Treatment Was Developed

Discussed, including where the seizure occurred what activities preceded it over a few days to months life events preceding the seizure, including sleep pattern, travel, work, or social changes and stresses emotional highs and lows, including excitement, fear, boredom, worry eating habits alcohol or drug habits and so forth. Were there any warning symptoms before the seizure What repetitive patterns are present with recurrent seizures Using the A R method, the patient can accomplish seizure control with help from a support person and professionals.

Substrates of sulfotransferases

Sulfotransferases act on a very large variety of compounds bearing a phenolic, alcoholic, hydroxylamino, or amino function. These substrates include endogenous compounds (e.g., catecholamines, steroids, and bile acids), dietary constituents (e.g., flavonoids), procarcinogens (e.g., benzylic alcohols and heterocyclic aromatic amines, see below), and drugs.

Evolution and progression of atherosclerotic lesions in coronary arteries of children and young adults

This paper describes a large series of coronary histology data from 565 human subjects who died between full-term birth and 29 years of age. At the time of this study, there was controversy regarding the extent of atherosclerosis in the young and at what age dietary interventions to reduce atherosclerosis should be instituted. The left main, proximal left anterior descending and proximal circumflex arteries were analysed. Based on the findings of this series, a classification system was developed to characterize development of atherosclerotic lesions. Type 1 lesions consist of isolated macrophage foam cells in the proteoglycan layer with no extracellular lipid or vascular smooth muscle cells. These lesions were seen in some infants as early as the first week of life and appeared to be decreased after the first year. Type II lesions are fatty streaks composed of layers of cells with lipid droplet-inclusions. More macrophages are present than type I lesions. These lesions were noted...

Preparation for Quitting

Difficulty concentrating, increased appetite and weight gain). For most individuals, these symptoms peak within a few days of quitting and dissipate within 1 or 2 weeks. (4) The physician can help the patient identify high-risk or dangerous situations. These are events, internal states, or activities that increase the risk of smoking or relapse due to their past association with smoking (e.g. negative emotional states, being around other smokers, drinking alcohol). These situations should be avoided early on, if possible. (5) The physician can help the patient select cognitive and behavioural coping skills to use when she experiences an urge (or craving) for cigarettes. Examples of cognitive coping skills are reminding him herself reasons for quitting telling him herself that urge will pass and repeating the phrase, Smoking is not an option. Behavioural coping skills include leaving the situation, engaging in some distracting activity, taking deep breaths, and seeking social support.

Scientific Foundations

To get diabetes, high blood pressure, heart attacks, and stroke. (Together, high blood pressure, heart attacks, and stroke are called cardiovascular disease.) A person having less than 1 milligram of C-reactive protein per liter of blood (1 mg L) is at low risk for cardiovascular disease. A person with 1 to 3 mg L has average risk. If a person has more than 3 mg L, they have high risk. Smoking, lack of exercise, and being overweight increase C-reactive protein in the blood.

Height and Body Weight

Unclothed measurements must be taken using an anthropometer and weight scales. Body weight is the most obvious index of nutritional status, but, taken alone, it is not an accurate measurement. Actual body weight must be compared with ideal body weight (IBW) and other anthropometric parameters. For example, patients with ascites and or oedema may have a normal body weight but severe malnutrition. Several approaches are used for estimating the IBW. One simple method consists of measuring body height and wrist circumference as an index of bone structure. The subject is allocated to one of three groups (short-limbed, normal-limbed or long-limbed), and the ideal body weight (Y) is estimated as reported in Table 10a. Table 10a. Estimating ideal body weight by anthropometry Y, ideal weight X, height (metres) Y, ideal weight X, height (metres) Table 10b. Ideal weight (kg) and bone size with respect to skeletal structure Table 10b. Ideal weight (kg) and bone size with respect to skeletal...

Descriptive Epidemiology of Herbal and Vitamin Poisonings

An herb is a leafy plant without a woody stem, but herbal preparations include all natural, alternative, and traditional remedies. Twenty-five percent of current, proprietary pharmaceuticals come from plant-herb sources. As a result of the Dietary Supplement and Health Education Act of 1994, the FDA has no authority over regulating herbal and vitamin products, unless they prove to be toxic. 80 of the world's population use herbal products and vitamins daily most are benign, and offer no health benefit (e.g., vitamin C and Echinacea) or potentially lethal drug interactions (e.g., St. John's wort and SSRIs garlic, ginkgo, and ginseng, and anticoagulants ASA, heparin, warfarin ).

Tissue distribution and ontogenic development

MAO is mainly located in the outer membrane of mitochondria of presynaptic nerve terminals, where oxidative deamination of norepinephrine, epinephrine, and serotonin by MAO inactivates these neurotransmitters and abrogates the neural stimulus. Both MAO-A and MAO-B are expressed in several human tissues, with the highest concentrations evident in liver, followed by myocardium, renal cortex, and intestine.57 MAO-A is selectively expressed in the placenta while MAO-B is selectively expressed in blood platelets.58 Intestinal MAO is implicated in the breakdown of dietary amines, notably the indirectly acting sympathomimetic tyramine, which is present in high concentrations in aged cheeses and red wine. Normally, tyramine is metabolized by intestinal MAO before it enters systemic circulation. When MAOIs, like isoniazid and tranylcypromine and foods high in tyramine are taken concurrently, large amounts of dietary tyramine can reach the systemic circulation and precipitate a hypertensive...

Alternative randomization procedures

The single consent design is widely used in screening trials, for example the occult blood screening trial for bowel cancer 11 . Here subjects may be identified from GP lists and randomized to receive an invitation to be screened or not. As patients would not be offered screening outside of the trial, and as the outcome measures and further data required are no more than would be obtained for routine audit, this design has been considered acceptable. In addition, this type of approach means that control patients truly represent patients in normal clinical practice. This can be particularly important in, for example, trials of dietary intervention, in which knowledge of the trial's experimental arm, and the effect that the intervention is hoped to have, may lead the control group to alter their diet anyway.

What is the role of nutritional factors in the susceptibility to COPD

Nutrition may play a role in the development of COPD, especially where oxi-dants and antioxidants are involved. Protective dietary factors concerned include the antioxidant vitamins C and E, magnesium and fish oils. In addition to the endogenous enzymatic antioxidant systems, the antioxidant vitamins C and E may enhance host defences against the oxidative stress of cigarette smoke. Fish oil contains highly polyunsaturated w-3 fatty acids that act as competitive inhibitors of arachidonic acid metabolism. Fish oil may therefore down-regulate the inflammatory potency of lipid mediators such as LTB4 and provide protection against COPD 66,67 . It is possible that smokers who develop COPD have dietary deficiencies in the nutritional elements mentioned above. However, this hypothesis is not supported by longitudinal studies 68 and would not explain the whole problem, since there are so many confounding factors between diet and cigarette smoking (alcohol intake, etc.).

Influence of Nutritional Status on Immune Response

A survey of the literature shows that most nutritional deficits lead to suppressed immune responses. This is not surprising, since anabolic and catabolic pathways in the immune system require the same sort of building blocks and energy sources as other physiological activities. Caloric restriction is another area of emerging interest, with important implications for human health. In general, moderate caloric restriction appears to have beneficial effects on longevity and disease resistance. However, these trends and generalisations must be approached with some caution 62 .

Regression of coronary artery disease as a result of intensive lipidlowering therapy in men with high levels of

BACKGROUND AND METHODS The effect of intensive lipid-lowering therapy on coronary atherosclerosis among men at high risk for cardiovascular events was assessed by quantitative arteriography. Of 146 men no more than 62 years of age who had apolipoprotein B levels greater than or equal to 125 mg per deciliter, documented coronary artery disease, and a family history of vascular disease, 120 completed the 2.5-year double-blind study, which included arteriography at base line and after treatment. Patients were given dietary counseling and were randomly assigned to one of three treatments lovastatin (20 mg twice a day) and colestipol (10 g three times a day) niacin (1 g four times a day) and colestipol (10 g three times a day) or conventional therapy with placebo (or colestipol if the low-density lipoprotein LDL cholesterol level was elevated). RESULTS The levels of LDL and high-density lipoprotein (HDL) cholesterol changed only slightly in the conventional-therapy group (mean changes, -7...

Blood pressure level the main haemodynamic basis

In type 2 diabetes, blood pressure is usually increased with microalbuminuria, but again there is a huge overlap, and many patients with type 2 diabetes have elevated blood pressure even with normoalbuminuria and at the clinical diagnosis of diabetes 83 . This may be related to the metabolic syndrome or to simple obesity.

Dependence of Symptoms on Lab Results

In an effort to see if symptoms can be correlated with lab results, Ramesh Mazhari and I conducted a study based on the symptoms of 167 patients with chronic kidney disease (renal failure or the nephrotic syndrome). They were graded as to the severity of the disease, based on their biochemical abnormalities, and the severity of their anemia. We chose four symptoms to analyze in detail fatigue, muscle cramps, itching, and nausea and vomiting. When we placed most of these patients on dietary treatment, in many cases symptoms improved or disappeared. In the second analysis, we documented the level of each of the lab measurements we used to determine severity of kidney failure when, during follow-up and worsening of their renal failure, these same symptoms reappeared (or appeared for the first time). Thus we obtained two estimates of how these symptoms depend on the abnormalities seen in blood tests.

The Functional Impact of Cancer Cachexia

Many of the consequences of cachexia are likely to impact on patient function but as yet this has not been studied in detail. There is, however, a considerable body of knowledge about the importance of weight loss in relation to clinical end-points and treatment variables. Scott 37 studied patients with inoperable non-small-cell lung cancer -about 40 had at least 5 weight loss and almost 80 an elevated CRP. Weight-losing patients had a significantly lower KPS and overall QoL and greater fatigue and pain. An elevated CRP was independently associated with increased fatigue. In patients with advanced gastrointestinal (GI) cancer receiving palliative chemotherapy, Persson 38 showed that those who were losing weight had a reduced global QoL. In addition, on multi-variate analysis, poor performance status and weight loss were independently related to decreased survival and a lower probability of responding to treatment.

Vitamin C Ascorbic Acid

Most animals are able to synthesize all the vitamin C they need from dietary sugars humans, along with other primates, are among the few species of animals unable to synthesize the vitamin.1 Vitamin C plays an important role in the body's ability to handle physiologic stress during infection, injury, or chronic disease. While most animals are able to increase synthesis of vitamin C during times of stress, humans' strict dependence on dietary sources of the vitamin increases risk of deficiency during stress periods.

Role of Hypothalamic Neuroimmune Interactions

Recent data suggested that hypothalamic sero-tonergic neurotransmission may be critical in linking cytokines and the melanocortin system. Fenfluramine is a serotonin agonist once widely prescribed in the treatment of obesity. It has been recently shown that fenfluramine raises hypothalamic serotonin levels, which in turn activate POMC CART neurons in the arcuate nucleus, therefore inducing anorexia and reduced food intake 54 . It is also well-documented that cytokines, and particularly IL-1, stimulate the release of hypothalamic serotonin 55 . Thus, it could be speculated that during disease cytokines increase hypothalamic serotonergic activity, which in turn contributes to persistent activation of POMC CART neurons, leading to the onset of anorexia and reduced food intake. Supporting the role of serotonin in the pathogenesis of anorexia, we demonstrated that in anorectic tumour-bearing animals hypothalamic serotonin levels are increased when compared with the levels in control rats...

How can one make lowsodium cheese

Although sodium is an essential component in the human diet, excessive intakes have undesirable physiological effects, the most significant of which are hypertension and increased calcium excretion (which can lead to osteoporosis). The recommended daily requirement of sodium for the adult human is -2.4 g Na+, which is equivalent to -6 g NaCl, per day. Sodium intake in the modern western diet is 2-3-fold higher than recommended. This has given rise to recommendations for reduced dietary intake of Na+ and an increased demand for reduced-sodium foods, including cheese. However, owing to the important role of salt in cheese 39 , reduction in salt level must be such that the quality and safety of the cheese are not compromised. Probably the most effective approaches to date for reducing sodium are

Voluntary and Involuntary Weight Loss

An intake of protein calories and or any of the 39 essential nutrients that is less than the minimal required threshold leads to disruption of the balance between energy expenditure and nutrient requirements, resulting in various undernutrition syndromes and weight loss. Still, weight loss may be an ambiguous finding, as the presence of oedema may mask depletions in fat or lean body mass, or, conversely, a gain in fat and lean body mass may not be apparent in the presence of massive diuresis. Undernutrition may be primary, due to an inadequate dietary supply of essential nutrients, or secondary, in which nutrient intake is adequate but disease or excessive utilisation prevents adequate absorption or metabolism. Although primary and secondary mechanisms often reinforce each other, the respective pathways to weight loss are different. The secondary form takes place as a In the majority of individuals, approximately 50 of the energy introduced by the consumption of food is utilised for...

Experimental Models for the Study of Carcinogenesis

Multistage carcinogenesis has also been observed for liver tissue. For example, Peraino et al.89 observed that a 3-week exposure of rats to AAF in the diet produced only a small number of hepatomas after several months, but if the animals were subsequently treated with phenobarbital for several months after carcinogen feeding was discontinued, a high incidence of hepatomas was noted. Similar results have been obtained by Kitagawa et al.,90 who fed rats a nonhepatocarcinogenic dose of 2-methyl-N,N-dimethyl-4-aminoazobenzene for 2 to 6 weeks, and then a dietary administration of phenobarbital for 70 weeks. By 72 weeks, many large hepatocellular carcinomas had developed in the phenobarbital-treated animals, whereas only a few small tumor nodules were observed in the rats not given phenobarbital. Thus, the action of phenobarbital appears to be analogous to that of TPA in the mouse skin system that is, it fixes the damage to cells induced by an initiating agent and causes a clone of cells...

Dimension of the Nutritional Problem in the World

Tion is the DES (dietary energy supply). The DES expresses the daily average of available energy per person, taking into account all the alimentary sources of a country during a certain period. However, because of the unequal distribution of available food among social classes, age groups, and those with special physiological needs (pregnancy, childhood, old age, and illness), the DES underestimates the real alimentary needs. DES tables are produced by the FAO based on food balance sheets (FBS), which track the supply and use of food worldwide but do not indicate actual consumption or equity in the distribution of available supplies. Nevertheless, trends in food and energy supplies at the national and regional levels are well-expressed by the FBS. Accordingly, the diets of 800 million people lack 100-400 kcal per day, but most of these people are not dying of starvation they become thin but are not emaciated (Fig. 1). health reveal dramatic trends. One-third of young children residing...

Tamoxifen and Breast Cancer Prevention

An assessment of quality of life showed no difference in depression scores between groups. Hot flushes were noted in 81 of the women on tamoxifen compared to 69 of the placebo group and the tamoxifen-associated hot flushes appeared to be of greater severity than those in the placebo group. Moderately bothersome or severe vaginal discharge was reported by 29 of the women in tamoxifen group and 13 in the placebo group. No differences in occurrence of irregular menses, nausea, fluid retention, skin changes, or weight gain or loss were

Importance of In Vitro Tools in Drug Interaction Studies

Drug interactions can be defined as the modification of the safety and efficacy profile of a medication following the coadministration of drugs, environmental pollutants, ingredients or additives present in the diet (see 5.35 Modeling and Simulation of Pharmacokinetic Aspects of Cytochrome P450-Based Metabolic Drug-Drug Interactions).

Congenital Partial Lipodystrophy Type 1 Dunningam Syndrome

Atrophy of the subcutaneous fat layer usually manifests at puberty, involving the arms, legs, and buttocks. The subcutaneous adipose tissue of the face, neck, and intra-abdominal area may be preserved, giving patients a silhouette of visceral obesity. An increase in intramuscular fat has been reported. Insulin resistance, reduced glucose tolerance, overt diabetes, hypertriglyceridaemia, and low levels of HDL cholesterol are associated with Dunningam syndrome and lead to early onset of atherosclerotic vascular diseases. Acute pancreatitis and liver steatosis may complicate the clinical picture. The identification of missense mutations on chromosome 1q 21-22, involving genes encoding lamins A and C, in affected members of a family suggests the molecular basis of the disease 33 . Lamins provide structural integrity to the nuclear membrane, such that mutations in the

Bl22 Immunogenicity Plasma Levels And Toxicity In Hcl Patients

High levels of neutralizing antibodies were observed in patients 5, 9, and 12 after cycles 1, 1, and 5, respectively. Patient 5 had preexisting low levels of neutralizing antibodies prior to receiving BL22. Patient 2 had low levels of neutralizing antibodies after cycle 5. Plasma levels in patients with high disease burden increased greatly on subsequent cycles after patients responded. Dose-limiting toxicity in patient 5 included a cytokine release syndrome in patient 5 with fever, hypotension, bone pain, and weight gain (VLS) without pulmonary edema, which resolved within 3 days. Patients 8 and 13 had a completely reversible hemolytic uremic syndrome (HUS),

Familial Partial Lipodystrophy Associated with a PPARg Gene Mutation

Garg et al. recently reported on a missense heterozygous mutation, Arg397Cys, in peroxisome-proliferator-activated receptor-gamma (PPARy) gene in a 64-year-old woman with diabetes, hypertriglyceridaemia, hypertension, hirsutism, and marked subcutaneous fat loss, more prominent in her forearms and calves than in her upper arms and thighs 35 .

Optic Neuropathies of Malnutrition Definition

An optic neuropathy of malnutrition is one caused by a dietary deficiency. In the developed parts of the world, this is most commonly a deficiency of vitamin Bi2. Such cases are uncommon, and are most often caused by macrocytic anemia. Vitamin Bi2 and folate levels are easily measured. Other risk factors for malnutrition include intestinal bypass or gastric stapling for weight loss and the hepatic cirrhosis of alcoholism. Treatment should include intramuscular injections of high doses of hydroxycobolamine.

Use in Prevention and Therapy

Regular intake of laxatives to treat constipation may actually worsen symptoms by causing depletion of body potassium. Reducing laxative use, increasing dietary potassium and fiber intake, and increasing exercise can produce more regular bowel habits. Cardiac arrhythmias. Potassium depletion (often together with magnesium depletion) produced by diuretic therapy and or low dietary intake can increase the risk of arrhythmias. People with heart disease and those taking thiazide or 'loop' diuretics should be sure to obtain adequate dietary potassium.

Description Of Empirical Research

Additional adaptations of DBT have recently been developed and evaluated for a range of populations and diagnostic groups, including eating disorders (Palmer et al., 2003 Safer, Telch, & Agras, 2001 Telch, Agras, & Linehan, 2000 Telch, Agras, & Linehan, 2001 Wisniewski & Kelly, 2003) incarcerated men (McCann, Ball, Ghanizadeh, Gallietta, & Froelich, 2002), suicidal adolescents (Miller, 1999 Miller, Wyman, Huppert, Glassman, & Rathus, 2000 Rathus & Miller, 2002), female juvenile offenders (Trupin, Stewart, Beach, & Boesky, 2002), and older adults with depression (Lynch, Morse, Mendelson, & Robins, 2003) preliminary data are encouraging. Although apparently disparate groups, each can be conceptualized according to the combined capability deficit and motivational model that underlies DBT. For example, Telch and colleagues view binge eating behavior as dysfunctional emotion regulation behavior that develops from inadequate emotion regulation skills and is...

Data sources and their problems

Two 'measures' of environmental risk were incorporated in the analyses. The first was that defined by Ross (1988) in relation to predictability of the environment. Ross' measure assessed resource type, its productivity and seasonality, without relying on specific dietary variables (see also Chapter 4). Diet may be related to evolved digestive capacities, and thus more subject to phylogenetic error than are general habitat parameters. The second measure categorises potential mortality risk due to predation pressure, and is derived from a population-level assessment of predator presence, contacts between primates and predators, antipredator behaviour and observed predations (see Hill and Lee, 1998). These qualitative categories were used in preference to more quantitative vari-ables, as a means of discriminating between gross habitat qualities.

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