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Does Breastfeeding Protect Against Childhood Obesity

Key words breast-feeding, overweight, obesity , prevention Abstract The impact of breast-feeding on overweight and obesity in children at school entry was assessed in a cross sectional study in Bavaria in 1997. The school entry health examination enrolled 134577 children. Data on early feeding were collected in two rural districts (eligible population n 13.345). The analyses were confined to 5 or 6 year old children with German nationality. The main outcome measures were overweight (BM1 90th percentile for all German children seen at the 1997 school entry health examination in Bavaria) and obesity (BM1 97th percentile). Information on breast-feeding was available for 9206 children of whom 56 had been breast-fed for any length of time. In non breast-fed children the upper tail of the BMI distribution was enlarged as compared to the breast-fed children whereas the median was almost identical. The prevalence of obesity in children who had never been breast-fed was 4.5 as compared to 2.8...

Hypothalamic Obesity

Part of the therapy for hypothalamic obesity involves early identification and initiation of preventive measures, including caloric and dietary control and maintenance of regular exercise. In addition to maintaining these lifestyle choices, several drug therapies have been used pragmatically or in research efforts. These include Dexedrine, Ritalin, metformin, and octreotide. Dexedrine and Ritalin are taken orally and act as stimulants with the side effect of appetite suppression (in this situation, beneficial). Metformin is taken orally twice a day and acts as a sensitizer to insulin effects and may serve to probe the etiology of

Correlation Between Dietary Taurine Intake Calculated Or Measured In 30 Recalled Diets

The correlation diagram of Figure 2 shows the relation between the calculated values of dietary taurine intake and the measured ones in order to evaluate the validity and reliability and confirm the propriety of the taurine composition tables. There was a significant correlation between both values of dietary taurine intake. However, we need to elucidate why intake values of calculated taurine intake were lower than values of measured taurine. Figure 2. Correlation between values of dietary taurine intake, calculated or measured in 30 recalled diets. Figure 2. Correlation between values of dietary taurine intake, calculated or measured in 30 recalled diets.

Dietary Taurine Intake For One

The histogram of Figure 3 shows dietary taurine intake for one day, calculated using the taurine composition tables of foods. A large number of the subjects were concentrated around the 100-200mg day range for daily taurine intake. There were also many subjects with a higher taurine intake distributed between 300 and 600mg day. The highest intakes were over 1000mg day. The mean of all subjects was 194.2mg day.Males were 225.5, and females were 162.6mg day. Figure 3. Dietary taurine intake for one day Figure 3. Dietary taurine intake for one day

Quantity Of Dietary Gluten

Quantity of dietary gluten during infancy as a risk factor for coeliac disease has mainly been investigated by means of international ecological studies. Thus, several countries have been compared with respect to estimated gluten intake in healthy infants and the incidence of the disease.41-43 A higher intake of wheat gluten was reported for infants in Sweden and Italy, compared to Finland, Denmark and Estonia. Further, the first mentioned countries reported a higher occurrence ofcoeliac disease than the latter. A report from the Netherlands contradicted this in spite of a comparatively high intake of dietary gluten the incidence of symptomatic coeliac disease was low.44 However, a recent screening study revealed that the disease is much more common than previously recognised.10 Thus, it seems that the Netherlands can also be included among those countries in which a comparison using an ecological approach supports the importance of a larger quantity of dietary gluten as a risk factor...

Dietary Sources And Recommended Intakes

The current recommended dietary allowance (RDA) for vitamin B6 is 1.3 mg day for adults 50 years old and younger.5 Because vitamin B6 is required by many enzymes in protein metabolism, high dietary protein intakes may increase vitamin B6 requirements.6,7 This may be important for athletes who consume protein supplements. Although recommended protein intakes for athletes range from 1.2-1.8 g kg body weight per day,8 some athletes have reported protein intakes of as high as 4.3 g kg body weight. The required ratio of dietary vitamin B6 to protein has been estimated to be 0.015-0.020 mg g.9,10 For an individual consuming 136 g of protein (2.0 g kg body weight for a 150 lb person), 2.7 mg of vitamin B6 would be required to supply 0.020 mg kg protein. Athletes and others consuming high-protein diets may need two or more times the current RDA to meet their metabolic need for vitamin B6.

Dietary And Supplemental Sources

Only recently have the concentrations and content of choline and choline-containing compounds in foods become readily available. In 2003 Zeisel et al.32 published the concentrations of choline and betaine in common foods so that choline intake could be assessed with a higher degree of accuracy than before and to establish a choline database. Such a database will be important for determining the dietary requirement for choline, developing nutrient recommendations and designing research studies relating choline intake to human performance and disease risk. It is anticipated that the choline database will be posted on the United States Department of Agriculture Nutrient Data Laboratory web site.52 Based on the available data, the major dietary sources of choline are eggs, meats, vegetables, soy and dairy products.52 Eggs, liver and soybeans contain choline in the form of lecithin, whereas vegetables such as cauliflower and lettuce provide free choline.37 Because choline data are now...

Case study 3 effect of reduced dietary sodium on blood pressure

Restricting the intake of salt in diet has been proposed as a method of lowering blood pressure, both in hypertensives and people with normal blood pressure. A systematic review of randomised studies of dietary sodium restrictions compared to control included 56 trials comparing salt lowering diets with control diets.34 Only trials which assessed salt reduction through measurement of sodium excretion were included. Twenty-eight of the studies recruited hypertensive participants, and 28 recruited normoten-sive participants 41 studies used a cross-over design, whilst 15 used a parallel group design. (ii) in a parallel group trial, as the difference in mean change in blood pressure whilst on the diets, between those on the salt lowering diet and those on the control diet On the basis of these analyses the authors concluded that salt-lowering diets may have some worthwhile impact on blood pressure for hypertensive people but not for normotensive people, contrary to current recommendations...

Thyroid Disease ana Obesity

The most important fact we wish to emphasize when it comes to thyroid disease and obesity is that it is extremely common for all obese persons to wonder whether their thyroid is making them fat. This chapter will help you sort out whether your obesity predates your thyroid problem, is aggravated by a thyroid problem, or is the result of one. Obesity refers to a body size that is too overweight for good health. Obese people have greater incidences of type 2 diabetes, heart attacks, strokes, peripheral vascular disease (circulation problems, leading to many other health problems), and certain types of cancers. Hypothyroidism can aggravate obesity and complications from obesity. Hyperthyroidism or thyrotoxicosis, however, may cause an unhealthy type of weight loss, aggravating other conditions that may be linked to obesity, such as heart disease (see Chapter 25) or type 2 diabetes. It is not known how many people with thyroid disease are obese but it is clear that the majority of obese...

How Thyroid Disease Impacts Obesity

The typical obese person with thyroid disease frequently has multiple problems going on at once, which are usually complications of obesity that can become magnified with thyroid disease. For example, the majority of obese people with thyroid disease are also managing high cholesterol, hypertension, and, frequently, type 2 diabetes. Worse, many people who are obese also smoke, which aggravates preexisting obesity complications. It's a complex health-care puzzle for most thyroid specialists. The key to managing thyroid disease in obese people is to treat all problems at once treat the thyroid problem as well as obesity and other health complications. In this way, many thyroid specialists see themselves as a primary care doctor. It's not unusual for the thyroid doctor to initiate prescriptions for thyroid hormone, cholesterol and blood pressure-lowering medications, as well as the most important prescription going to the type of program that emphasizes calorie-counting (such as Weight...

Other Antiobesity Pills

In 2000, an antiobesity pill that blocks the absorption of almost one-third of the fat people eat was approved. Unfortunately, this prescription drug, called orlistat (Xenical), can cause diarrhea when the fat content in your meal exceeds 20 percent. In the absence of thyrotoxicosis, to avoid the drug's side effects, simply avoid fat In the presence of thyrotoxicosis it is likely that usual problems with frequent bowel movements will become much worse. Critics of this medication are concerned that it can decrease absorption of vitamin D and other important nutrients. Another antiobesity drug, sibutramine, was approved for use in 2001. Sibutramine is meant for people whose body mass index (BMI) registers at 27 or higher. But if you're on thyroid hormone, as well as medications for depression, seizures, glaucoma, osteoporosis, gallbladder disease, liver disease, heart disease or stroke prevention, kidney disease, migraines, or Parkinson's disease, you should discuss whether sibutramine...

Lowering Fat and Healthy Eating

Dietary guidelines from nutrition experts, government nutrition advisories and panels, and registered dieticians have not changed in fifty years. A good diet is a balanced diet representing all food groups, based largely on plant foods, such as fruits, vegetables, legumes, and grains (also known as carbohydrates), with a balance of calories from animal-based foods, such as meats (red meat, poultry), fish, and dairy (also known as protein and fat). Nutrition research spanning the last fifty years has only confirmed these facts. What has changed in fifty years is the terminology used to define good diet, and the bombardment of information we receive about which foods affect which physiological processes in the body, such as cholesterol levels, triglycerides, blood sugar levels, and insulin. There are also different kinds of fats and carbohydrates, which Confusing information about low fat versus low carb has further distorted our perceptions about diet. But no matter how many properties...

Copper In Food And Its Dietary Requirement

Of all the minerals known to have a physiological function in the body, Cu was at one time considered one of the most limiting in the human diet. In 1980, the Food and Nutrition Board (FNB) of the National Research Council (NRC) of the U.S. National Academy of Sciences5 could not agree on a recommended dietary allowance (RDA) for Cu. Instead, a value called the estimated safe and adequate daily dietary intake (ESADDI) was established for Cu that ranged from 2.0 to 3.0 mg day for individuals over the age of 11. In 1989, the FNB again could not agree on an RDA for Cu, even though much more data had accumulated over the ensuing 9 years. The board instead lowered the ESADDI to 1.5 to 3 mg day.6 In the meantime, the Canadian estimate for an adequate intake of Cu was held at 1.0 to 2.0 mg day.7 During the most recent deliberations of the Institute of Medicine of the FNB, it was finally agreed to set the recommended Cu intake at 0.9 mg day for individuals of age 19 and over.4 Before the FNB...

My Obesity Is Caused by Hypothyroidism Even Though My TSH Levels Are Normal

How many euthyroid people are obese Millions Why is that Because they eat more food than they burn off in activity. We are a sedentary society that is aging and out of shape. If your TSH levels are normal, and you are clinically euthyroid, then your obesity is just as manageable as for those obese individuals with no thyroid problem. Coming from both a hypothyroid patient (Sara) and a thyroid specialist (Ken) who sees nothing but hypothyroid people all day long, we bemoan the unfortunate and inappropriate assumption made by patients that all their problems with obesity are consequent to hypothyroidism. If this were the case, all obese patients would be cured with thyroid hormone and no one with normal thyroid function would ever be overweight. Sadly, being a patient who is being treated for hypothyroidism with thyroid hormone therapy does not automatically disqualify one from the weight-control issues that plague all the other people with normal thyroid glands. During bouts of...

Risk factor obesity

Maps Body mass index Lakka HM, Lakka TA, Tuomilehto J, Salonen JT. Abdominal obesity is associated with increased risk of acute coronary events in men. European heart journal, 2002,23 706-713 (cited in Sowers JR. Obesity as a cardiovascular risk factor. American journal of medicine, Isomaa B, Almgren P, Tuomi T, et al. Cardiovascular morbidity and mortality associated with the metabolic syndrome. Diabetes care, 2001, 24 683-689 (cited in Sowers JR. Obesity as a cardiovascular risk factor. American journal of medicine, Overweight and obesity defining overweight and obesity WHO expert consultation. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet, 2004, 363 157-63. Eckel RH, Krauss RM. American Heart Association call to action obesity as a major risk factor for coronary heart disease. Circulation, 1998, 97 2099-2100. Peeters A, Barendregt JJ, Willekens F, Mackenbach JP, Mamun AA, Bonneux L. Obesity in adulthood and its...

Evaluation of Nutritional Status using Dietary Assessment

Dietary assessment methods such as diet histories, food records, diet recalls, and food frequency questionnaires can be used to estimate dietary intake patterns and nutrient intake of subjects, and to determine relationships between diet and exercise 1-4 . However, those methods are not error proof and studies have shown that accuracy of reported dietary intake data is influenced by several factors such as age, gender, body weight, body composition, restrained eating habits, social class, and consumption of certain food groups 1-4,30,31 . This reporting bias can lead to misinterpretations of the nutrient adequacy of an individual's diet and nutritional status. Self-reported energy intake typically is underestimated, especially by adolescents and obese individuals, which can result in misinterpretation of individuals' nutritional status 1,2,30,31 . Additionally, length of the dietary evaluation period also needs to be given attention due to day-to-day variations in intake. It is thus...

Requirement And Recommended Dietary Intakes

Goiter occurs when iodine intakes are less than about 50 g day, and cretinism when intakes of mothers are 30 g day or less.12 Minimum requirements to prevent goiter are based on the urinary excretion associated with a high incidence of goiter in a population, estimated at 50 g g creatinine, and the observation that a minimum intake of 70 g day appears to be necessary to avoid signs of goiter. Therefore, the minimum requirement for prevention of goiter is approximately one g kg body weight day.61 However, recommended dietary intakes are based on physiological requirements, which are in turn based on a number of indicators, including thyroidal radio-iodine accumulation and turnover, iodine balance studies, urinary iodide excretion, thyroid hormones measures and thyroid volume. Physiological requirement is at least equal to the daily amount of hormonal iodine degraded in the peripheral tissues and not recovered by the thyroid. There is an obligatory loss of iodine from the body via...

Dietary and Lifestyle Factors Vegetables and Fibre

Particular dietary practices have been associated with colorectal cancer in defined groups of subjects (cohort studies) or comparing affected cases with matched controls (case-control studies) (Trock et al, 1990). However, these studies demonstrate associations rather than specific causality. Diets high in vegetables (raw, green or cruciferous) are protective although the nature of the specific agent is unclear. High on the list is fibre (the complex carbohydrate constituent of plant cell walls), which could act by diluting or binding potential carcinogens in the lumen of the bowel. Fibre is poorly digested in the small intestine but is fermented by bacteria in the proximal colon to generate short-chain fatty acids, notably butyrate. Resistant starch (that is not digested in the small bowel) is another source of butyric acid. Butyrate serves as an essential respiratory nutrient for colonic epithelium and its lack may be a factor in the aetiology of colorectal cancer. Butyrate may also...

Dietary Recommendations

The FNB set no dietary reference intakes (DRI) for silicon.51 On the basis of weak balance data, a recommended silicon intake of 30-35 mg day was suggested for athletes this was 5-10 mg higher than for non-athletes.198 Based on extrapolations from animal data, Seaborn and Nielsen199 speculated that a recommended intake may be between 5 and 10 mg day. Others have suggested that a daily minimum requirement may be near 10-25 mg based on the amount excreted in urine in 24 hours.188,200

Thyrotoxicosis and Obesity

In most cases of thyrotoxicosis (see Chapter 4), some weight loss occurs as the body and metabolism speed up. This is why thyroid hormone used to be wrongly prescribed as a diet drug. However, the hidden danger of thyrotoxicosis in obese people is that it overworks the heart in particular, which can be catastrophic for obese individuals with cardiovascular complications. Palpitations (sometimes because of atrial fibrillation) and angina (both discussed more in Chapter 25) can greatly increase the chances of an obese individual with thyrotoxicosis suffering from a sudden heart attack the risk of this increases if type 2 diabetes or smoking is in the picture. In such individuals, steps can be taken to reduce the risk of heart attack. First, the individual will be put on a beta-blocker (see Chapter 11), which stops the palpitations by blocking adrenaline. Second, a doctor will treat the underlying cause of thyrotoxicosis (for example, reduce the dosage of thyroid hormone or treat any...

Dietary Intake And Status Assessment

Dietary and Supplemental Sources 1. Pantothenic Acid Pantothenic acid is widely distributed in plant, animal and microbial cells. In foodstuffs, the majority of pantothenic acid is present as CoA and 4 phosphopantetheine. Rich dietary sources of pantothenic acid include chicken, beef, liver, egg yolk, potatoes, whole cereals, broccoli and cauliflower (containing more than 50 mg g of pantothenic acid). Cow's milk and human milk contain approximately 3.5 mg l and 2 mg l pantothenic acid, respectively.12,59

Dietary Supplement Health and Education Act DSHEA and Spirulina

Spirulina is sold in health food stores and similar outlets as a dietary supplement. There appears to be a lack of understanding about their regulatory status. Until 1994 dietary supplements were regulated as foods by FDA. However, with passage of the Dietary Supplement Health and Education Act of 1994 (DSHEA), Congress amended the food regulations to include several provisions that apply only to dietary supplements and dietary ingredients of dietary supplements. As a result of these provisions, dietary ingredients used in dietary supplements are no longer subject to the pre-market safety evaluations required of other new food ingredients or for new uses of old food ingredients. They must, however, meet the requirements of other safety provisions. FDA defines a dietary supplement as a product (other than tobacco) that is intended to supplement the diet that bears or contains one or more of the following dietary ingredients a vitamin, a mineral, an herb or other botanical, an amino...

Prevalence Of Overweight Obesity In Breastfed Children In Bavaria

The age and sex specific distribution of the BMI in all German children investigated during the 1997 school health examination in Bavaria was used as the reference to define overweight (BMI 90thpercentile) and obesity (BMI 97th percentile). The 90th and 97th percentile in Bavaria are considerably higher than the widely used French reference values 13 (table 3). This means that most children defined as overweight according to the Bavarian percentiles would have BMI values above the 95thpercentile of the French reference values. The lower prevalence of overweight obesity in breast-fed children in Bavaria does not reflect a shift in the entire distribution of the BMI's in breast-fed children as compared to those on formula. There is no shift ofthe mean but the upper tail of the distribution is fatter in non breast-fed children (figure 3). This has implications for further studies These findings might not be reproduced, if only means and their 95 confidence intervals are considered. The...

Physical Activity and HRQL in Obesity

Score Activity

The negative effects of obesity on HRQL are clearly demonstrated. Both physical and mental components of HRQL are remarkably impaired when compared with population norms, particularly in subjects seeking treatment 21 and in those with psychological or psychiatric distress 22,23 .Also in subjects where obesity is superimposed on other chronic illnesses, a further deleterious impact is observed 24 , limited to physical components. Behavior therapy produces a systematic improvement in all scales of HRQL, largely outweighing the effects on body weight and resulting in a significant change in self-perceived health status 25 . Several uncontrolled studies have consistently demonstrated that physical exercise can positively influence the quality of life in obese adolescents, at risk of psychological distress for the stigma of obesity. Walker et al. investigated the change in body image, self-esteem, and worries in 57 obese adolescents attending a residential, weight-loss camp 26 . Obese...

Correlation Between Dietary Taurine Intake And Fish And Shellfish Intake

Taurine Half Life

Correlation between dietary taurine intake and fish and shellfish intake Below the correlation diagram in Figure 4 are data for the person with the highest fish and shellfish intake and the person with the highest taurine intake. Dietary fish and shellfish intake for the latter person is about half of that of the person with the highest fish and shellfish intake, and energy intake is also lower. The reason may be due to the latter eating more oysters, in which taurine concentration is high.

Recommended Dietary Allowance

Riboflavin deficiency can lead to a variety of clinical abnormalities including degenerative changes in the nervous system, anemia, endocrine dysfunction and skin disorders, and can lead to an increase in the susceptibility to carcinogens.12-14 Feeding studies, in which clinical signs and symptoms of riboflavin deficiency were observed, were used to determine the recommended dietary allowance (RDA).15 The 1989 RDA for riboflavin was determined on the basis of energy and protein intake (0.6 mg 1000 kcal).3 Specifically, men 23 to 50 years of age need 1.7 mg and women 23 to 50 years of age need 1.3 mg of riboflavin. Individuals 50+ years of age are recommended to consume less, based on lower energy requirements. The dietary reference intake (DRI) for riboflavin set in 1998 suggests an intake of 1.3 mg d for men and 1.1 mg d for women 19 to 70 years of age.4

Biological Causes of Obesity

The physiological cause of obesity is eating more calories than you burn. People gain weight for two reasons they may eat excessively (often excessive amounts of nutritious foods), which results in daily consumption of just too many calories or they may eat moderately, but simply be too inactive for the calories they do ingest. Genetic makeup can predispose some body types to obesity earlier in life because of thrifty genes. But, in general, experts in nutrition agree that genetics plays only a small role in the sharp increase in obesity. Since genetic changes take place over centuries, and our obesity rate has at least doubled since the 1960s, it's fairly obvious that lifestyle factors are the chief culprit. Furthermore, as we age, our metabolism slows down. This means that unless we decrease our calorie intake or increase activity levels to compensate, we will probably gain weight. Clearly, thyroid problems, such as hypothyroidism, can contribute to obesity. Rarely is the appetite...

Dietary Forms of Iron

The iron molecule is tightly bound within the porphyrin ring structure as is found in both myoglobin and hemoglobin. Nonheme iron refers to all other forms of iron. Contaminant iron that is derived from dust and soil iron is relatively unavailable to the absorptive cells, but may constitute a significant amount of iron intake in developing countries. There is substantial information that demonstrates that nearly all nonheme dietary iron mixes in a luminal pool of iron in the upper gastrointestinal (GI) tract because of acidification in the stomach and then exposure to pancreatic and GI enzymes. Inorganic iron is solubilized and ionized by gastric acid juice, reduced to the ferrous form, and kept soluble in the upper GI tract by chelation to compounds such as citrate and ascorbic acid. The type and amount of other materials, such as ascorbic acid, that can chelate iron to keep it in solution, also determine the amount of nonheme iron in a soluble luminal pool. The number of...

Exercise in the Treatment of Obesity

Physical exercise is known to be an effective therapy for overweight and obesity 1 in fact, exercise, when combined with dietary advice, enhances weight loss 2 and prevents weight regain 3, 4 . An increase of physical activity, which induces an increase of exercise-induced and resting energy expenditure, can effectively counterbalance the reduction of energy consumption determined by decreased food intake 1 , while preventing the reduction of lean mass associated with weight loss 5 . Furthermore, the increase of activity level determines an improvement of insulin sensitivity, glucose tolerance, lipid profile, and blood pressure, as well as a reduction of several inflammatory markers, leading to a substantial decrease of long-term cardiovascular risk 1,6 . In patients already affected by obesity-associated conditions, such as type 2 diabetes, hypertension, or dyslipidemia, physical activity is associated with an improvement of blood glucose, blood pressure, HDL cholesterol, and...

Food and Dietary Supplement GMPs

Spirulina is regulated as food and as a dietary supplement. The latter is a subset of food and falls under FDA's regulation. As discussed earlier, Spirulina is produced under FDA GMPs for food. The FDA has recently released a separate regulation for dietary supplement GMP. Nevertheless, some companies have already attained dietary supplement GMP certification through the industry's (Natural Products Association) certification program. The two facilities in the United States are subject to inspection by federal, state, and local regulatory bodies.

Ways to Promote Physical Activity in Obese Patients

Although the essential role of physical activity in the treatment of obesity is widely recognized, the simple prescription of exercise by health care providers does not seem to have any relevant effect on long-term behavior of overweight and obese individuals 8,9 . In fact, the increase of activity levels requires a complex modification of lifestyle, which cannot be achieved through a simple prescription. Two different strategies can be implemented (and have been tested in clinical trials) supervised programs of aerobic training, or behavioral techniques either to increase lifestyle activity or to promote structured unsupervised exercise programs. Behavior therapy for obesity includes a variety of interventions specifically aimed at long-term modification of eating and exercise habits, which is obtained through a direct involvement of the patient in the management of diet and physical activity 10 . Although behavioral treatments can be very different one from another, typical features...

Correlation Between Dietary Taurine Intake And Meat Intake

Pneumatic Hvac Control System

The relation between dietary meat intake and dietary taurine intake is shown in Figure 5. There was no significant correlation between meat intake and taurine intake. The dataof the subject with highest meat intake is also shown in Figure 5. This female had higher energy intake and protein intake than others. Figure 5. Correlation between dietary taurine intake and meat intake Figure 5. Correlation between dietary taurine intake and meat intake

Maintenance of Weight Loss

Maintaining weight loss is difficult. Historically, maintenance has been evaluated by providing an intervention, measuring weight loss, and then telling patients to continue making changes on their own and measuring weight loss again at follow-up. If people regain weight, some believe the treatment failed. An alternate view is that treatment did work, which is proven by the fact that clients gained weight when it ended. The challenge is finding treatment approaches that are innovative and flexible enough to encourage adherence over the long term. Obesity is a chronic disorder like diabetes, not a curable condition like an ear infection. A chronic care model, however, conflicts with the desire of many overweight individuals to lose weight quickly and then forget about vigilance. Most successful maintainers continue thinking carefully about food and exercise for the rest of their lives.

Recommended Dietary Allowances

The recommended dietary allowances (RDAs) are a means of describing the amount of a nutrient necessary to meet the needs of approximately 97 to 98 of all individuals in a certain age and gender group. The RDAs are a part of a larger classification, the dietary reference intakes (DRIs). Included in the DRIs are adequate intakes (Als) and tolerable upper intake levels (ULs). The Als are recommendations for the intake of those nutrients for which there is not enough research available to make a recommendation as definite as the RDAs. The UL is the maximum daily intake of a nutrient that can be taken without the likelihood of causing adverse health effects in almost all of the population in certain age and gender groups.71 The ULs have not been determined for all nutrients. Table 7.3 lists the latest recommendations for folate. In 1998, the National Academy of Sciences completed an exhaustive review of the evidence available on folate intake, status and health for all age groups. As a...

Dietary Sources

There are no known toxicities associated with riboflavin. However, there is evidence of a possible dietary interaction dietary fiber may reduce the absorptive ability of riboflavin. Roe et al. studied the effect of dietary fiber from wheat bran and psyllium gum on the absorption of riboflavin in healthy women. Determined by fluorometric techniques, psyllium gum and a combination of fiber supplements significantly reduced the 24-hour absorption of riboflavin by 31.8 and 26.1 , respectively. The wheat bran supplement had no effect on riboflavin aborption.11

Rapid Weight Loss

It's been observed that Graves' disease commonly presents in people (women in particular) after they have begun a rapid weight-loss program. The rapid weight loss from the diet can mask the symptoms of Graves', and even lead some physicians to suspect amphetamine abuse or an eating disorder. A theory (not confirmed) is that sudden changes in the metabolic rate, which can be brought on by starvation or rapid weight loss, may trigger autoimmune thyroid disease in people who have antithyroid antibodies.

Defining Obesity

At one time, anyone who weighed 20 percent more than the ideal weight for his or her age and height was defined as clinically obese. But this is not as accurate an indicator as the body mass index (BMI), which is now the best measurement of obesity. The BMI is calculated by dividing your weight (in kilograms) by your height (in meters) squared. (The formula used is BMI kg m2 if you're doing this on your calculator.) BMI charts abound on the Internet, on the backs of cereal boxes, and in numerous health magazines. Most people can now easily find BMI converters on the Internet, where you simply type in your weight in pounds and your height to arrive at your BMI. A good chart will calculate BMI by gender and sometimes age ranges. Currently, a BMI of 18.5 or less indicates that you are underweight. A BMI between 18.5 and 24.9 is normal. The most recent clinical guidelines define people with a BMI between 25 and 29.9 as overweight, and those with a BMI between 30 and 34.9 as obese (mild to...

Morbid Obesity

People with BMIs in the upper 30s or higher than 40 are classified as morbidly obese. Another method to calculate morbid obesity is through ideal body weight. When people exceed their ideal weight by more than 100 pounds, they are considered morbidly obese. People who are morbidly obese are at the highest risk of health complications. For example, morbidly obese men between the ages of twenty-five and thirty-five have twelve times the risk of dying prematurely than their peers of normal weights. Morbid obesity also causes a range of medical problems, such as breathing difficulties, gastrointestinal ailments, endocrine problems (especially diabetes), musculoskeletal problems, hygiene problems, sexual problems, and so on. Many people now undergo bariatric surgery (the stomach stapling procedure or an intestinal bypass) to lower their risk of dying from their fat. It's important to clarify that surgery for morbid obesity is not plastic surgery it is...

Dietary Iron

Approximately one third of dietary iron intake in the U.S. diet is from meat, fish, and poultry and one third is from cereals and grain products. Vegetables and fruits provide about 15 of the dietary iron intake, with lesser amounts from eggs and legumes, fats, sweets, drinks and milk and dairy products.100 The bioavailability of heme iron is 2-3 times greater than that of nonheme iron. Average heme iron absorption is 23 . Heme iron absorption is affected by the amount of stored iron and is greatest when iron stores are depleted. Not all of the iron in meat, poultry and fish is heme iron. Liver, pork and fish iron will be approximately 30-40 heme iron and chicken, beef and lamb are about 50-60 heme iron.101 The remaining iron in meat, poultry and fish is nonheme iron. Nonheme iron bioavailability is much lower and quite variable, ranging from 2-8 of the food iron. It is enhanced by factors found in meat, fish and poultry that are present in the same meal with the nonheme iron. For...

Dietary Zinc

Cereals represent significant sources of energy and Zn in many areas throughout the world. Large differences in the Zn content, depending on the cereal type and including the variety, class and location of production have been reported. For example, the Zn content of wheat has been found to range from 15-102 mg kg depending on the strain and from 219-61 mg kg for the same variety of wheat grown in different locations and different years.84 Cereal and grain products provide about 13 of the dietary Zn in the U.S.83 Data for the Zn content of legumes consumed by humans are limited. As with cereals, factors such as variety, strain and growing location impact the Zn content of legumes.

Total Calories

Nutrition plays important roles in carcinogenesis through a variety of mechanisms. It is well established that excess calorie intake results in high incidences of spontaneously and chemically induced tumours in various organs in rats and mice, including the mammary glands, colon, lung, haematopoietic system and skin. Similar effects have also been suggested in humans by epidemiological studies, e.g. regarding incidence and mortality rates for cancers of the breast, colon, rectum, uterus and kidney in women and


Obesity is one of the major risk factors for OSA in Caucasian and Afro-American adults, but to a lesser extent in children and the elderly and in Polynesians, Chinese and those from other Far Eastern countries. The adipose tissue that is most relevant is that which is deposited within the neck rather than elsewhere in the body. The fat is located not within the wall of the airway but around it, and when the muscle tone is reduced during sleep the fatty tissue, in effect, mass-loads the airway and tends to collapse it. Obesity also predisposes to OSA by reducing the functional residual capacity and thereby reflexly reducing Obesity

Dietary Intervention

A measure that is likely to be associated with general compliance is the addition to the diet of a cheap and palatable ingredient, particularly if this can be added safely to a product that is widely consumed anyway. Of the possible protective dietary factors that have been identified so far, resistant starch would be one of the easiest to accommodate in the diet. A rich natural source is unripe bananas, but resistant starch can be added to bread or sprinkled on food without altering its taste.

Weight Control

Obesity has become a global epidemic. Twenty-seven percent of American adults are obese, and an additional 34 are overweight. The prevalence of overweight children has doubled in the last 20 years. Paradoxically, this has occurred while there have been major scientific, medical, and commercial efforts to develop effective means of weight control. One limitation is that these methods have been based on a medical model that emphasizes causes and remedies for individuals. More recently, obesity is considered a public health crisis that demands innovative public policy interventions. This chapter highlights advances in treating obesity, the important issue of stigma, and suggestions for public policy research. Obesity is a difficult condition to treat. The most optimistic estimates are that 25 of people lose weight and keep it off, leading some experts to emphasize prevention. Yet even if prevention becomes a major priority, the vast numbers of people already overweight deserve compassion...

Stigma of Obesity

Obesity is a highly stigmatized condition, and obese individuals experience bias and discrimination in many domains of life, including education, employment, and access to medical care. Some argue that the stigma of obesity serves as an incentive for people to try to lose weight. This is faulty logic if social pressure to be thin worked, we would not have an obesity epidemic. Aclimate of blame and criticism not only makes weight loss more difficult but also can lead to emotional distress and further eating disturbance. Research is needed on how to ameliorate the stigma of obesity and provide effective coping methods to those who experience it.

Sleep and obesity

The control of sleep is closely linked to feeding behaviour and energy expenditure. These determine the body weight and in particular the body fat and lean body mass. Body weight and body mass index (weight in kg height in m squared) are only indirect indicators of obesity because they do not assess body composition. Other measures, such as the waist to hip ratio and collar circumference, give an indication of the distribution of body fat and in particular whether it has a central rather than a peripheral location. Central fat deposition is more common in males and post-menopausal females, and peripheral fat is more common in pre-menopausal females. Control of sleep and obesity A genetic failure to produce leptin can lead to obesity of early onset, but in obesity there is usually an increased leptin level due to leptin resistance. Leptin is also increased in obstructive sleep apnoeas due to increased sympathetic activity, but is reduced in narcolepsy, where there is also a loss of the...

Dietary Factors

Among all dietary factors that have been examined with respect to essential hypertension, ingestion of sodium, mainly in the form of salt, has the most consistent linkage (Law, 1997). intersalt, the largest multi-culture study conducted examining the relation between sodium excretion and blood pressure, found that a relation was evident in each of its 52 international sites (Stamler et al., 1991 Elliott et al., 1996). The association between sodium excretion and blood pressure was strongest in the older age groups, demonstrating perhaps the effect of chronic exposure to high salt intakes. In another line of research, sodium restriction has been shown to be reliably associated with reductions in blood pressure (Cutler, Follman, and Alexander, 1997), providing further confirmation of the strong association between sodium intake and blood pressure status. Another electrolyte, potassium, has received considerable attention regarding its role in the etiology of essential hypertension (He...

Dietary Balances

The energy liberated from each gram of carbohydrate as it is oxidized to carbon dioxide and water is 4.1 Calories (1 Calorie equals 1 kilocalorie), and that liberated from fat is 9.3 Calories.The energy liberated from metabolism of the average dietary protein as each gram is oxidized to carbon dioxide, water, and urea is 4.35 Calories. Also, these substances vary in the average percentages that are absorbed from the gastrointestinal tract about 98 per cent of carbohydrate, 95 per cent of fat, and 92 per cent of protein. Therefore, the average physiologically available energy in each gram of these three foodstuffs is as follows Table 71-1 gives the compositions of selected foods, demonstrating especially the high proportions of fat and protein in meat products and the high proportion of carbohydrate in most vegetable and grain products. Fat is deceptive in the diet because it usually exists as 100 per cent fat, whereas both proteins and carbohydrates are mixed in watery media so that...

Disorders of the Back

Is the most expensive cause of work-related disability.8 Risk factors for the development of low back pain include heavy lifting and twisting, bodily vibration, obesity, and poor conditioning however, low back pain is common even among patients without these risk factors.1 In cases of more severe back pain, occupational exposures are much more significant, including repetitive heavy lifting, pulling, or pushing, and exposures to industrial and vehicular vibrations. If even temporary work loss occurs, additional important risk factors include job dissatisfaction, supervisor ratings, and job environment (i.e., boring, repetitive tasks).1 Factors associated with recurrence of low back pain include traumatic origin of first attack, sciatic pain, radiographic changes, alcohol abuse, specific job situations, and psychosocial stigmata.

Diagnosing Thyroid Disease

When trying to determine if fatigue, weight gain, dry skin, and other conditions are caused by a thyroid condition, other health disorders, or simply normal life variations, it all comes down to blood tests. These tests help doctors determine if you have appropriate amounts of thyroid hormone in your blood.

Preface To The Series

The business of dietary supplements in the Western World has expanded from the Health Store to the pharmacy. Alternative medicine includes plant based products. Appropriate measures to ensure the quality, safety and efficacy of these either already exist or are being answered by greater legislative control by such bodies as the Food and Drug Administration of the USA and the recently created European Agency for the Evaluation of Medicinal Products, based in London. In the USA, the Dietary Supplement and Health Education Act of 1994 recognised the class of phytotherapeutic agents derived from medicinal and aromatic plants. Furthermore, under public pressure, the US Congress set up an Office of Alternative Medicine and this office in 1994 assisted the filing of several Investigational New Drug (IND) applications, required for clinical trials of some Chinese herbal preparations. The significance of these applications was that each Chinese preparation involved several plants and yet was...

Study design and setting

Figure 1 Overweight and Obesity in Bavarian Children at school entry in 1997 In order to identify covariables potentially associated with breastfeeding several additional items were considered. These regarded housing characteristics and lifestyle (e.g. the age of the house, child's own bedroom, maternal smoking in pregnancy, spare time spent outside in summer and winter), questions on the child's health (e.g. prematurity, low birth weight,) and questions on diet (time of introduction of solid food, consumption of own cooked food or industrial ready-to-meal products, food bought in health food shops) and explorative questions (never, less than once weekly, once or twice, 3 - 6 times weekly or daily) on the consumption of selected dietary items (milk products, fish, meat, fat, carbohydates). The highest education of either parent was used as a marker for social class. There was a progressive reduction of the prevalence of overweight and even more pronounced of obesity in children at...

Nutrients Growth And The Development Of Programmed Metabolic Function

Abstract For each individual, the genetic endowment at conception sets the limits on the capacity or metabolic function. The extent to which this capacity is achieved or constrained is determined by the environmental experience. The consequences of these experiences tend to be cumulative throughout life and express themselves phenotypically as achieved growth and body composition, hormonal status and the metabolic capacity for one or other function. At any time later in life the response to an environmental challenge, such as stress, infection or excess body weight is determined by an interaction amongst these factors. When the metabolic capacity to cope is exceeded, the limitation in function is exposed and expresses itself as overt disease. During early life and development the embryo, fetus and infant are relatively plastic in terms of metabolic function. The effect of any adverse environmental exposure is likely to be more marked than at later ages and the influence is more likely...

Relating Genes to Inherited Traits

A simple example can be drawn from the genetic disorder of obesity in mice. Obese (ob) is an autosomal recessive mutation on mouse chromosome 6. The normal gene encodes the Ob protein which functions in a signal pathway for the body to adjust its energy metabolism and fat accumulation (see Section 17.4). Mice carrying 2 mutant copies (ob ob) of the gene develop progressive obesity with increased efficiency in metabolism (i.e. increase weight gain per calorie intake). Mice with ob ob genotype apparently do not produce the gene product (Ob protein), because both copies of the ob gene are nonfunctional.

Fetal Origins Of Adult Disease

Despite the obvious dependence of fetal growth on the delivery of nutrients from the mother, it has been difficult to demonstrate simple relationships between maternal diet, energy or nutrient consumption, during pregnancy and the growth of the fetus. Although it has been possible to show relations between size at birth and the maternal intake of macronutrients, and selected micronutrients, the relative contribution to the variability in birth weight appears modest, explaining ofthe order of3 to 5 of the variability in birth weight22-24. This is similar to the 5 to 7 of variation in birth weight explained by smoking22. When characterising the nutritional status of an individual, the dietary intake is only one part, and body composition and the functional ability or the metabolic state of adaptation also have to be taken into consideration25. Thus, relative to the explanatory power of dietary consumption, maternal fat mass during pregnancy showed a much stronger relationship with the...

Results Of Pneumatic Dilatation For Achalasia

Relief of dysphagia with pneumatic dilatation is variable, with a range between 32 and 98 and in most studies between 60 and 80 . Studies that use standard clinic visit techniques have a tendency to overestimate success because of the patient's desire to please the doctor and by the patient's lack of knowledge of dietary changes, which

Consumption And Programmed Metabolic Function

In function which lead to subsequent pathology within a range of maternal food intakes, birth weights and growth during infant which have in the past been considered to encompass a normal range function4 21 Therefore, we have been interested to develop an animal model within which to explore the possibility that relatively modest changes in maternal intake during pregnancy might exert an influence upon metabolic function in the offspring. The level of protein in the maternal diet has been shown to influence the development and function of the endocrine pancreas34. We have varied the protein intake during pregnancy in a range from adequate (about 20 protein) through marginally adequate to frankly inadequate (about 6 protein) and demonstrated a graded response to the programming of a wide range ofmetabolic functions. The dams are given different levels ofprotein in the diet before and or during pregnancy. At birth they are placed onto normal laboratory chow and the offspring are weaned...

Characteristics of Stroke

Apart from age, the most important risk factor for CVD is arterial hypertension. Control of severe and moderate, and even mild, hypertension has been shown to reduce stroke occurrence and stroke fatality. Cardiac impairment ranks third, following age and hypertensive disease. At any level of blood pressure, people with cardiac disease, occult or overt, have more than twice the risk of stroke. Other risk factors are cigarette smoking, increased total serum cholesterol, blood hemoglobin concentration, obesity, and use of oral contraceptives.

Summary And Conclusions

At this point, what is known about the most commonly used dietary supplement multiple vitamin-mineral products and their effects on physical performance Consumers of multiple vitamin-mineral products want to know whether the pills they are popping keep them healthy and performing at peak efficiency. Consumers want to know if multiple vitamin-mineral products are a waste of money that creates expensive sewage, as many health care professionals claim. Consumers want to know whether these products are safe and contain the amounts of nutrients listed on the label. The following points are based on the evidence to date, along with a familiarity of research from non-exercise fields

Incisional Preference

Laparoscopic fundoplication has become the preferred operative approach for surgical therapy of reflux disease at an increasing number of centers. We reiterate that the indications for surgery should not be altered because of the availability of a minimally invasive technique. There are no specific contraindications for laparoscopic fundoplication beyond open procedures, but several factors merit consideration. The most important decisions relate to whether surgery is warranted and to what procedure is most likely to provide the best outcome for the individual patient. The selection of a traditional open versus a laparoscopic approach is dependent on the surgeon's skill and training, the patient's disease process, and the patient's understanding of surgical options, including relative advantages and disadvantages of the approaches. Laparoscopic antireflux procedures are technically demanding and require advanced suturing skills and two-handed dissection abilities. Further, the...

Selection procedures for sensory panellists

Methods for the selection of panellists to ensure that they are capable of carrying out the required sensory tests are described in an ISO Standard (ISO, 1993). This recommends tests for acuity of visual perception, taste and odour perception, but not tests for texture perception ability, other than the generation of verbal descriptions. As part of a European Union-funded project on Healthy Eating for the Elderly, Fillion and Kilcast (2001) have developed tests designed to investigate texture perception and oral dexterity in the elderly. These tests are potentially of great value in screening panellists for use in food texture assessment, and are currently being adapted for this purpose.

Animal Feeding Studies

Male Sprague-Dawley rats were purchased from Harlan Sprague-Dawley (Indianapolis, lN). Rats were housed individually in stainless steel mesh cages in a room maintained at 20 C and 60-70 humidity with light from 20 00 to 08 00 h. Rats had free access to diet and water for the duration of each experiment. Animals were blocked into groups by initial body weight. In each feeding study, rats within each block were randomly assigned to receive one of five semi-purified experimental diets. The composition of the experimental diets for feeding studies 1 and 2 are shown in Tables 1, 2, and 3.

Injury of the Hypothalamic Pituitary Axis in Patients with Cancer

Hypothalamic obesity GH deficiency is commonly believed to be the first hypothalamic-pituitary deficiency to emerge after injury to the HPA, followed by deficiencies of gonadotropin, ACTH and TSH 60,65 however, these deficiencies can occur in any order 11,21,35,54,67 . Although the most common neuroendocrinologic abnormality in survivors of childhood cancer is GH deficiency, hypothyroidism is at least as prevalent when sensitive testing methods are used 54 . The next most common alteration is in pubertal timing (precocious, rapid, delayed, or absent). ACTH deficiency, although less common than the other disorders, has more serious consequences if it is not detected. Osteopenia may result from hypothalamic-pituitary deficiency, particularly GH deficiency, hypothyroidism and hypogonadism. Hypothalamic injury resulting from tumor, surgery, or irradiation can result in unrelenting weight gain, termed hypothalamic obesity.

Low Calcium and Vitamin D Intake

Low calcium intake is associated with low BMD 83 and therefore may contribute to the development of stress fractures. Myburgh and colleagues 57 observed an association between decreased calcium intake and increased stress fracture risk. However, other studies found no association between calcium intake and stress fracture risk, with both stress fracture and nonstress fracture groups having normal calcium intake 13,84,85 . Athletes whose calcium intake is below the daily recommended value are likely to be at risk for stress fractures, but for those with normal dietary calcium intake, other factors play a larger role.

Signs and Symptoms Prompting Immediate Evaluation

(1) slow growth rate or failure to show catch up growth (2) failure to thrive (3) obesity (4) persistent fatigue or anorexia (5) polydipsia and polyuria (6) severely dry skin or thin and brittle hair (7) altered timing of onset of puberty (e.g. signs of puberty before age 9 years or, in patients with short height, failure to enter puberty by age 12 years in girls and 13 years in boys) (8) abnormal tempo of puberty (e.g. rapid or interrupted progression of puberty) (9) galactorrhea and (10) abnormal menstruation or sexual function.

Associated Medical Findings

Proptosis or periorbital fullness suggests an orbital process such as Graves' disease, orbital meningioma, or orbital pseudotumor. The patient's general appearance may suggest an underlying chromosomal, endocrinological, or metabolic disorder. For instance, the disfiguring frontal bossing and enlargement of the mandible and hands are characteristic of acromegaly associated with a growth hormone-secreting pituitary adenoma. The heart rate, blood pressure, and carotid and cardiac examinations are important in any patient with a possible ischemic event. Patients with pseudotumor cerebri tend to be young females with obesity or a history of recent weight gain. Skin lesions such as erythema migrans (Lyme disease) or malar rash (systemic lupus erythematosus), and abnormal discolorations, such as cafe(c)-au-lait spots and axillary freckling (neurofibromatosis), or hypopigmented ash-leaf spots (tuberous sclerosis) also may be helpful in guiding the evaluation of patients with visual...

Cardiovascular Physiology

In the first three months of pregnancy, a woman's blood volume rises rapidly. This increase continues into mid-pregnancy, then slows down. The average overall increase in blood volume is 50 percent but varies among individuals and is connected to fetal weight, placental size, and maternal weight gain. As a result, larger increases are seen

The Null Hypothesis State of the Science

* This issue is commonly known as selection bias in epidemiology while sometimes easily identified it can be difficult to assess. For example, an investigator who studies BMI in woman would quickly run into difficulty by generalizing the results to men, since the distribution of BMI is different in men. However, does a study executed in Europe that demonstrates the identification of a relationship between exposure to weight loss pill ingestion and primary pulmonary hypertension not apply to patients in the US simply because no US patients were included In this case, the selection issue is clear (only European patients were selected). However, the central question is whether differences between the Europeans and Americans are so great that a relationship observed in one group does not automatically translate to a relationship in the other. In this case, even though there are important cultural differences between the two peoples, the mechanism of action of the diet drug, and the method...

Risk factor blood pressure

In most countries, up to 30 of adults suffer from high blood pressure and a further 50 to 60 would be in better health if they reduced their blood pressure, by increasing physical activity, maintaining an ideal body weight and eating more fruits and vegetables. In people aged up to 50 years, both DBP and SBP are associated with cardiovascular risk above this age, SBP is a far more important predictor. Blood pressure usually rises with age, except where salt intake is low, physical activity high, and obesity largely absent. Most natural foods contain salt, but processed food may be high in salt in addition, individuals may add salt for taste. Dietary salt increases blood pressure in most people with hypertension, and in about a quarter of those with normal blood pressure, especially with increasing age. A high intake of salt independently increases the risk of CVD in overweight persons.

Subjects And Methods Subjects

The subjects were 163 males and 161 females aged between 20-59 in Toyama, Japan. Japan is divided into 9 districts, Toyama City where the subjects are living is situated in the Hokuriku district. On the Japanese map, Toyama City is marked with a star (Fig 1). According to the Ministry of Health and Welfare in Japan, fish and shellfish intake in the Hokuriku district is the third highest among the 9 districts in Japan. The highest fish and shellfish intake is in the Hokkaido district, and the second highest is the Tohoku district. The bar graph shows the difference from average of dietary fish and shellfish intake and dietary meat intake in Japan. The centerline shows the average in Japan. The 3 districts with the highest fish and shellfish intake are just above the average. However, the dietary meat intakes of the highest 3 districts are below the average. On the other hand, in the Kyusyu district with the lowest fish and shellfish intake, dietary meat intake was the highest in Japan....

Assessment Of Status

Assessment of riboflavin status should include direct and indirect biochemical measures, as well as dietary intake data (Table 4.1). While the degree of urinary riboflavin excretion is a direct reflection of tissue saturation, urinary excretion is not a sensitive marker of very low riboflavin intakes.16 More appropriately, riboflavin status is determined by an oxidation-reduction reaction in which oxidized glutathione is reduced by GSSH in an FAD-dependent glutathione reductase reaction.1718 Specifically, riboflavin status is obtained by determining the erythrocyte riboflavin

Physical And Nutritional Status Of Subjects

Table 1 shows the mean of body mass index of the subjects, and for nutritional status of the subjects shows mean of energy intake, protein intake, animal protein intake, fish and shellfish intake and meat intake, respectively. Animal protein intake is about half the total protein intake, and fish and shellfish intake is higher than meat intake. This is standard in Japan. Our survey had a similar result.

Does Breastfeeding Affect The Risk For Coeliac Disease

Abstract Coeliac disease, or permanent gluten sensitive enteropathy, has emerged as a widespread health problem. It is considered an immunological disease, possibly of autoimmune type, albeit strictly dependent on the presence in the diet of wheat gluten and similar proteins from rye and barley. There are reasons to believe that the aetiology of coeliac disease is multifactorial, i.e. that other environmental exposures than the mere presence in the diet of gluten affect the disease process. Our studies have shown that prolonged breastfeeding, or perhaps even more important, ongoing breast-feeding during the period when gluten-containing foods are introduced into the diet, reduce the risk for coeliac disease. The amount of gluten consumed is also of importance in as much as larger amounts of gluten-containing foods increase the risk for coeliac disease, while it still is dncertain if the age for introducing gluten into the diet of infants is important. Thus, a challenging possibility,...

Breastfeeding And Gluten Introduction

A major finding in the two larger Swedish case-referent studies was the significant protective effect of introducing gluten containing foods while breast-feeding was still ongoing,1435 and in the former study this effect remained after adjustment both for age at introduction of dietary gluten and for quantity of gluten consumed during this period (to be published). In the Swedish family study based on silent disease this was not confirmed.36 However, the latter study was small (8 cases) and the referents were siblings ofthe cases, with the risk ofmatching for dietary habits. Furthermore, taking our increased knowledge about the immunological impact of breast-milk into account,38 it is biologically plausible that introduction of dietary gluten while the child is still breast-fed might increase the possibility of developing oral tolerance to gluten.

Age At Introduction Of Gluten

In the 1950s Dicke et al showed that presence of gluten in the diet is a prerequisite for developing coeliac disease.39 It has been discussed ifthe age at introduction of gluten into the diet affects the age at which the coeliac enteropathy develops, and, more importantly, if it has an impact on the overall risk ofcontracting the disease. Comparing English coeliac disease patients in the 1950s and 1960s, respectively, it was suggested that earlier introduction of dietary gluten resulted in earlier presentation ofthe disease.40 However, in clinical studies which also took differences in breast-feeding duration into account, no relation was found between age at introduction of dietary gluten and presentation of disease.30,31 Based on a national ecological approach it was suggested that a later introduction of gluten into the diet of infants may have contributed to the decline in incidence in England, Scotland and Ireland in the 1970s.22-24 In contrast, postponed introduction of gluten...

Hypothesis Testing in Intervention Studies

In our previous BMI example, the researcher was interested in assessing whether the mean body mass index of males was different then expected. He introduced no intervention to reduce or otherwise influence the BMI's. He simply measured them, comparing his results to what was expected. There was no intervention.

What Can Be Learnt From The Swedish Epidemic

We analysed this further using an ecological study design, and explored any temporal relationships between changes in early feeding patterns and changes in disease occurrence (Figure). The period of rapidly increasing incidence was preceded by i) about half the infants being breast-fed at six months of age, ii) a twofold increase in the average daily consumption of the total amount of wheat, rye and barley provided by follow-on formula, and iii) a new national recommendation at the end of 1982 to postpone introduction of gluten from four until six months of age. The rapid decline in incidence rate started in 1995, and the period of interest with respect to exposure was characterised by i) a continuous increase from 54 to 76 in the proportion ofinfants still breast-fed at six months ofage, ii) the average daily consumption ofthe total amount of wheat, rye and barley from follow-on formula decreasing, starting in 1995, by one third, and iii) a change in the national recommendation in...

Use Of Endogenous Routes

(20), who used horseradish peroxidase-conjugated OX-26 to investigate cyto-chemical approaches. Since the neurological abnormalities that result from the inadequate absorption of dietary vitamin E can be improved by the oral administration of pharmacological doses of vitamin E, Traber and Kayden

In Vivo Function of the Oestrogen Receptors

The development of mice lacking the ERa (aERKO) or ERft (ftERKO) gene have proved to be valuable tools in evaluating the in vivo function of these receptors. The aERKO mice were generated in 1993, and the disruption of ERa expression not only caused infertility in both sexes, but also had profound effects on behaviour (Couse and Korach, 1999). Specifically, pre- and neonatal development of female reproductive organs such as uterus, ovary and mammary gland was almost normal, but maturation of these organs during and after puberty was severely impaired. The aERKO females also failed to display sexual receptivity when treated with the hormonal regime of oestrogen and progesterone that normally induces receptivity in wild-type mice. Surprisingly, adult aERKO males have significantly fewer epididymal sperm than heterozygous or wild-type males, caused by the disruption of spermatogenesis and degeneration of the seminiferous tubules, which becomes apparent 10 weeks after birth. Furthermore,...

General Characteristics

One explanation of the high frequency of type II DM among these populations is that they developed a highly efficient carbohydrate metabolism under traditional lifestyles of a feast and famine cycle. The thrifty mechanisms of carbohydrate metabolism, however, became detrimental with rapidly changing lifestyles associated with a decrease in physical activity, an increase in energy in the diet, a reduction of dietary fiber, an increase of refined carbohydrates, and an increase in psychosocial stress.

Mucous Membrane Candidiasis

Oral candidiasis (thrush and perleche). Thrush is characterized by creamy white flakes on a red, inflamed mucous membrane. The tongue may be smooth and atrophic, or the papillae may be hypertrophic, as in the condition labeled hairy tongue. Therapy with Mycostatin pastilles (lozenges) or Mycelex troches is effective. Perleche is seen as cracks or fissures at the corners of the mouth and is usually associated with candidal disease elsewhere and rarely a dietary deficiency (usually B12 deficiency). Thrush is seen commonly in immunosuppressed patients.

Timothy M Farrell John G Hunter

Laparoscopy has revitalized debate over the appropriate surgical therapy for morbid obesity refractory to medical and behavioral measures. Several operations from the prelaparoscopic era have been modified to the laparoscopic approach with success, but the appropriate indications for each have not been fully determined. The advantages of a minimally invasive technique are especially apparent in this population. PEPTIC ULCER DISEASE

Conclusions And Implications

There is now sufficient evidence from the Peruvian study and other published studies, to accept reverse causality as the explanation for a negative relationship between growth and prolonged breastfeeding in poor, disadvantaged communities. Breastfeeding did not place the Peruvian children at risk of poor diets dietary intakes were only predicted by families' ability to purchase food. Given the growth benefits noted in children with diets poor in quality and quantity, reduction in morbidity and mortality associatied with continued breastfeeding, health professionals should promote the World Health Organization's recommendation to breastfeed for two years or beyond in addition to promoting optimal complementary feeding atan affordableprice.

Breastfeeding And Growth

Published studies on the relationship between breastfeeding and growth have given conflicting results. Marquis et al found that breastfeeding was associated with faster growth in length (from 12 to 15 months)27 The dependent variable was intensity of breastfeeding, measured as the mean number offeeds per day (from 0-15.3). Thirty-one children were weaned by 12 months and 15 more were weaned during the interval, within the sample of 107. Second, part of the initial sample (27 out of 134 children) was excluded from the analysis because these children with a high diarrheal incidence and low dietary intake from non-breast milk foods were at

Results And Discussion

The various diets listed in table 1 did not affect body weight gain nor did they modify food consumption (Table 2). However, liver weight was significantly increased by high fat high cholesterol diet, either alone or supplemented with taurine (Table 2). Table 2. Body weight gain, Food consumption and Liver weight of hamsters fed on a high fat high cholesterol-diet supplemented with taurine *,** significantly different fromNormal-diet animals (Dunnett's test, P0.05 and P

Subclinical Mastitis As A Risk Factor For Motherinfant Hiv Transmission

Importantly, infants ofwomen with raised milk Na K ratio at either 2 weeks or 3 months gained significantly less weight between these two time points than did infants of women with normal milk sodium.10 Poor weight gain associated with high breast milk sodium has also been observed in American infants.13 A possible mechanism is that poor lactation practice by the mother or weak suckling by the infant results in milk stasis, mammary gland involution,14-15 and consequently both raised milk sodium and poor growth. often occurs unilaterally high milk sodium high milk IL8 high milk pH associated with systemic inflammation decreasedby dietary anti-oxidants

Examining biological plausibility

In a meta-analysis of trials examining the effect of reducing dietary sodium on blood pressure, Midgley et al.26 plotted reduction in blood pressure (clinical outcome) against reduction in urinary sodium (biological marker) for each study and performed a linear regression analysis (Figure 11.3). The plot of difference in diastolic blood pressure (treatment effect) against change in urinary sodium (marker) suggests the possibility of bias. However, the assumption that the marker fully captures the treatment's effect on the clinical outcome may not always be appropriate effects of the intervention not captured by the marker may account for the residual effect.27,28 For example, dietary changes leading to a reduction in sodium intake may also lead to weight loss and hence to a reduction in blood pressure. Figure 11.3 Regression lines, adjusted for the number of sodium excretion measurements, of the predicted change in blood pressure for a change in urinary sodium excretion from...

Disorders of motor control

Narcolepsy is associated with a variety of parasomnias due to fluctuations in the degree of motor inhibition in REM sleep. Sleep terrors, sleep talking and walking are common, and irregular jerking movements and periodic limb movements may be seen during REM sleep because of a failure of motor inhibition. This also underlies the appearance of REM sleep behaviour disorder. Obstructive sleep apnoeas are more common than in normal subjects, probably because of an alteration in the inhibition of the activity of the dilator muscles of the upper airway and also because of obesity.

Decline in Skeletal Muscle Mitochondrial Function Associated with Aging

A robust improvement in skeletal muscle mitochondrial content and function was found in elderly men and women in response to a program of moderate intensity physical exercise 47,48 . Kelley et al. 7 observed an impaired bioenergetic capacity of skeletal muscle mitochondria in type 2 diabetes and obesity, including smaller mitochondria and reduced electron transport chain activity. The electron transport chain activity in the healthy older participants at baseline was three-fold less than that observed for younger lean individuals but similar to that seen in middle-aged obese participants without type 2 diabetes 67 . In particular, the lower electron transport chain activity in these older men and women was more pronounced in sub-sarcolemmal mitochondria than in inter-myofibrillar mitochondria. In these individuals, exercise training improved mitochondrial content and mitochondrial function however, this improvement was more pronounced in sub-sarcolemmal than in inter-myofibrillar...

Coronary Artery Disease and Mortality from All Cardiac Causes

The risk of thoracic irradiation should be considered in the context of other cardiovascular risk fac-tors,but information on the prevalence of risk factors in comparison populations is generally lacking. One report that did assess other risk factors 26 demonstrated that patients experiencing an MI also had a higher frequency of elevated cholesterol, tobacco use and obesity than the US population as a whole. In fact, each survivor with an event had at least one other known cardiac risk factor 26 . Unfortunately, risk factor information for those without events was not gathered, so further analysis was not possible. Glanzmann et al. 73 evaluated patients with HD for the risk of fatal myocardial infarction associated with modern techniques of mantle irradiation in the context of known cardiac risk factors smoking, hypertension, obesity, hypercholesterolemia and diabetes. The total group of survivors had a significantly high-er-than-expected incidence of fatal myocardial infarctions and...

Of Coronary Artery Disease Risk Factors

All childhood cancer survivors should be screened regularly for coronary artery disease (CAD) risk factors. While those treated with mantle radiation are probably most at risk for CAD, survivors treated with anthracyclines and high-dose cyclophosphamide are also likely to have damaged hearts that can ill afford further damage from a myocardial infarction. Patients who received brain irradiation, especially those with proven growth hormone deficiency or other hypothalamic-pituitary axis dysfunction,may also be at higher risk, compared with other survivors. Risk factors for CAD, such as family history, hypertension, smoking, hyperlipidemia, obesity, diabetes mellitus and a sedentary life-style, should be evaluated at each long-term visit. Counseling to reduce such risk factors is not only appropriate, it is extremely important. Signs and symptoms of pericarditis (fever, dyspnea, pleuritic chest pain, friction rub, ST and T wave changes, decreased QRS voltage), cardiomyopathy, valvular...

Hormonal Influences on Homeostatic Mechanisms

The endocrine pancreas is the gland involved in the modulation of feeding. The islands of Langerhans scattered throughout the pancreas compose its endocrine division. Three different cell types within the islands of Langerhans secrete three hormones involved in regulating the availability of glucose to cells. These are glucagon, which raises blood glucose insulin, which lowers the level of blood glucose by binding with cell membranes throughout the body and brain to permit entry of glucose into the cell and so-matostatin, which appears to regulate the release of glucagon and insulin. Insulin is the hormone of the endocrine pancreas most directly related to eating behavior. Insulin is secreted in response to increased levels of blood glucose. This may occur after a meal or if glucagon is released and circulating glucose increases. Increased insulin levels cause glucose to enter cells more quickly where it is either used for fuel or, in the case of fat cells, is converted to...

Acute Stress Responses Mediators of the Stress Hypertension Relation

In this case, environmental stress is the predictor variable and the pathophysiological changes that result in essential hypertension is the criterion variable. In this relation, a certain amount of variance of the condition of essential hypertension can be explained or predicted by environmental stress. We certainly know that hypertension cannot be explained by stress alone (100 percent explained) many other factors need to be considered in predicting hypertension, including an individual's genetic constellation, body weight, and dietary salt consumption. We also know that the amount of variance of essential hypertension that can be explained by stress is not 0 percent. Based upon the information presented in Chapter 4, there is clearly some relation between stress and hypertension. For purposes of illustration, let's imagine that stress explains 25 percent of the variance of essential hypertension. If a variable operates as a mediator of this...

Psychiatric disorders

Excessive daytime sleepiness is common in younger subjects with depression, whereas later in life this more frequently causes insomnia. EDS may persist despite adequate treatment of low mood by anti-depressants and may even be worsened by sedative antidepressants. EDS in depression is usually associated with weight gain whereas depression and weight loss often lead to insomnia. EDS is also a feature of the seasonal affective disorder, which is associated with weight gain.

Feelings and Behaviors

The functional behavioral unit related to hunger and satiety is the meal. Patterns of spontaneous meal sizes and intermeal intervals are biologically organized, as is evident from the characteristic spontaneous eating patterns displayed by humans and other animals and from the predictable changes in meal patterns in response to various physiological and environmental variables. There are also more elementary biological units of eating behavior than meals. For example, neural networks in the brain stem produce patterns of licks, bites, chews, and swallows of food, and these also vary predictably in many states in ways that modify meal size. These units of eating are attracting increasing attention from neuroscientists who are analyzing how the brain produces eating behavior.

Interactions With Nutrients And Drugs

Raw egg white contains the protein avidin, which has great affinity for biotin.83 Binding of biotin to avidin renders biotin unavailable for absorption,67,83 potentially triggering biotin deficiency. Hence, dietary supplements containing raw (spray-dried) egg white might impair biotin status. This may be of importance to athletes ingesting large amounts of protein supplements based on egg white.

Effects On Physical Performance

There is no conclusive evidence that pharmacological doses of pantothenic acid enhance physical performance. Note, however, that acetyl-CoA plays a key role in the regulation of glycogen synthesis. Glycogen is an important source of metabolic energy during exercise. Hence, theoretically, pantothenic acid might affect glycogen homeostasis and physical performance. Indeed, previous studies suggested that pantothenic acid-deficient mice have reduced exercise tolerance and low glycogen stores compared with controls.63 The dietary and supplemental intake of pantothenic acid by athletes is unknown. the expression of the gene encoding glucokinase,84-87 a key enzyme in glycolysis. The dietary and supplemental intake of biotin by athletes is unknown.

Figure 5 Agespecific incidence rates of Hodgkin disease among males Based on data from Ferlay et a Globocan 2000 Cancer

Several forms of cancer, notably cancers of the stomach and uterine cervix, are more frequent in the lower socioeconomic classes, and these observations have led to the development of aetiological hypotheses implicating, respectively, particular dietary patterns (salty foods, inadequate intake of vegetables and fruits), or inadequate hygienic conditions and infrequent utilization of barrier contraceptive methods. Furthermore, occupational mortality statistics have been extremely valuable in pointing out occupations that increase the risk of particular types of cancer.

Regulation Of Absorption

There are two fundamental regulators or determinants of the amount of iron absorbed in humans. The first is the total amount and form of iron compounds ingested (discussed above) and the second is the iron status of the individual (3). Thus, individuals with a high iron status will absorb proportionally less of any amount of iron consumed than will an iron-deficient individual and individuals with a lower iron status will absorb more of any dietary intake. This process of selective absorption is the fundamental mechanism whereby humans regulate iron balance (4). While the details of the regulation are still not yet entirely clear, major discoveries in the last decade have added substantially to our understanding. At supraphysiological levels (as in high-dose iron supplementation), iron can apparently move across the gut by paracellular diffusion following a concentration gradient. At more physiological concentrations, as would be expected with the consumption of food, iron uptake is...

Human milk samples from different countries

The fatty acid composition ofhuman milk from different countries has a similar pattern. Koletzko et al. reported data from several studies of breastfeeding mothers in Europe and Africa which resulted to have comparable median values and ranges for PUFA composition when expressed as weight percentages 13 This finding is rather surprising if one considers the differences in ethnicity, living conditions and dietary intakes. The major PUFA in human milk is always linoleic acid with a median value of 11.0 and 12.0 wt. in different European and African countries, respectively 13. a -Linolenic acid, about one order of magnitude lower than linoleic acid in human milk, is most times the second major PUFA. The linoleic a -linolenic acid ratio is used for the expression of the n-6 n-3 balance, which seems important since both fatty acid families compete for the same enzymes in their pathways of LC-PUFA synthesis. In the above mentioned report this ratio was similar in different counties and...

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