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In spite of poor evidence, many patients with gastro-oesophageal reflux are advised to avoid fat and spices. We therefore measured gastro-oesophageal reflux after fatty and spicy meals. During three 24-h pH monitoring sessions, eight volunteers ate two identical, low fat and mild beef stews, or a hot and fatty Indian curry for lunch. Meals for dinner were the beef stew, the hot Indian curry or a mild curry. Day-time acid exposure was significantly longer after the hot curry (7.5 % [1.4 - 27.1]) than after the beef stews (2.3 % [0.4 - 9.8] and 2.5 % [0.7 - 15.7]). Night-time acid exposure was also significantly shorter after the beef stew (1.3 % [0 - 9]) than after the mild curry (2.9 % [0 - 19.1]) or the hot curry (4.6 % [0.2 - 22.5]). Within two hours postprandially, reflux was not different between the meals. The number of episodes, however, that occurred more than two hours after lunch was significantly lower after the beef stews (4 [2 - 14] and 4.5 [2 - 10]) than after the hot curry (9 [5 - 16]). The same phenomenon was observed after beef stew (0.5 [0 - 2]), mild curry (2 [0 - 4]) and hot curry (2 [1 - 9]) for dinner. We conclude that meals high in fat can provoke reflux, possibly through delayed gastric emptying. Additional spices, however, do not further increase reflux.

Background: Congenital intestinal lymphangiectasia is a rare disease in childhood, which may already cause protein-losing enteropathy in newborns., Patient, Methods and Results: This is a case report of an infant with generalized edema and protein-losing enteropathy, in whom intestinal lymphangiectasia was diagnosed at the age of two months. Following repetitive intravenous albumin und gamma globulin infusions, the elimination of long-chain fats from the diet and the substitution with medium-chain triglycerides (MCT) led to an improvement of the protein-losing enteropathy., Conclusion: In newborns with low level of serum protein and edema protein-losing enteropathy caused by congenital lymphangiectasia might be considered as a differential diagnosis.

General non-drug measures today form the accepted basis for every antihypertensive treatment. WHO identifies the most important of these as weight reduction, salt restriction and moderation in the use of alcohol. These measures can effectively lower raised blood pressure and normalize grade I hypertension, especially in borderline cases. The target of these efforts is a weight reduction of at least 5%, restriction of salt to 5-6 g/day and alcohol consumption not exceeding 20 g/day for women and 25 g/day for men. No negative effects are to be expected from these restrictions, which are really nothing more than a return to "normal portions" with regard to eating and drinking habits.

In ancient times, the main problem was to get food. Nowadays the difficulty is to decide for or against some foodstuff. In industrialized countries, this abundance led to the fact that people eat differently from what they should. Traditional populations were subject to periods of feast and famine. Those with a metabolism which stored energy with high energetic efficiency had a survival advantage. This is called the 'thrifty' genotype hypothesis. With the secured supply of calories, coupled with a sedentary lifestyle, the thrifty genotype becomes disadvantageous, causing obesity. Industrialization or 'cola-colonization' also leads to a dramatic increase in obesity and non-insulin dependent diabetes mellitus in developing countries. The spread of fast food restaurants all over the world has changed modern nutrition fundamentally. Influence begins early in childhood. Advertising concentrates on the selling of image over substance. However, fast food contains high levels of fat, especially trans fatty acids. Higher consumption of trans fatty acids was associated with a higher incidence of and mortality from coronary heart disease.

There is convincing evidence that nutrition affects colorectal carcinogenesis in a complex fashion. Dietary components either promote or inhibit the carcinogenic process. The composition of dietary fats seems to be less important as a promoting factor than a positive energy balance, especially in combination with low physical activity. Excessive consumption of red meat is associated with increased risk, which may be due to the heme contained in myoglobin. Alcohol stimulates cell proliferation in the rectum and may thus increase cancer risk. Complex carbohydrates (e.g., dietary fiber) are degraded in the colon to short-chain fatty acids which exhibit protective effects in experimental models of carcinogenesis. The putative protection from vitamins and trace elements merits further attention.

The Hungarian cardiovascular mortality statistics are very unfavourable. We performed a screening programme to establish risk factors for coronary heart disease in Méhkerék, a rural community of 2400 inhabitants in the country of Békés, Hungary. 778 of the adults participated and the data were evaluated. The risk factor profile was compared with results obtained in western Europe (Prospective Cardiovascular Münster (PROCAM) Study in Germany). The prevalence of hypertension and diabetes mellitus was similar in Hungary and Germany. In all female age groups smoking was less common in Hungary, in men between 35 and 44 years of age smoking was more frequent. Total serum cholesterol levels were comparable in men; in three age groups of the women the cholesterol concentration was even lower in the Hungarian community than in Germany. The most striking difference was observed in the body mass index where, with the exception of 25-34 year old males, significantly higher values were measured in both men and women in Méhkerék. The high incidence of obesity is related to nutritional factors and especially, the excessive intake of saturated lipids of animal origin. In the Hungarian village most households cook exclusively with animal fat and, in addition, the consumption of meat with a high content of fat (bacon, sausages) is extremely popular. It is concluded that, in addition to socioeconomic factors in post-communist societies, nutritional factors might explain the high cardiovascular mortality in Hungary. Consequently, interventions aimed at a modification of dietary habits and style of living might improve the cardiovascular risk profile.

Three saturated fatty acids (C 12:0, C 14:0, C 16:0) raise LDL cholesterol but also HDL cholesterol levels. Replacement of these fatty acids by monounsaturated or omega-6 polyunsaturated fatty acids will lower LDL cholesterol as well as HDL cholesterol levels. Fat modified diets therefore may not improve the ratio of LDL to HDL cholesterol. Linoleic acid enhances sterol excretion but also increases cholesterol synthesis so that total body cholesterol is not diminished. Moreover various potentially adverse effects have been reported for n-6 polyunsaturated fatty acids. Recent cross-cultural ecologic studies as well as all major within-population cohort studies have not been able to find an association between cholesterol raising saturated fatty acids of animal fat and risk of Coronary Heart Disease (CDH). On the other hand several cohort and case control studies have shown an increase in CHD risk with increasing consumption of partly hydrogenated vegetable margarines. Meta-analyses of controlled intervention studies reveal that cholesterol lowering diets have failed to lower risk of CHD or total mortality. Yet controlled studies implementing a high level of antioxidants in the diet or increasing the n-3 unsaturated fatty acid content have been able to lower CHD and total mortality. It is time to discuss whether the concept of dietary intervention with the "classic" cholesterol lowering diet is still justified.

A scientific assessment of dietary risks encounters great difficulties, since reliable prospective studies are hardly possible, and the various forms of retrospective studies are associated with considerable error probabilities. Nevertheless, on the basis of the similar results obtained with numerous investigations, it is possible to make statements about definite or potential risks. Thus, the correlation between high levels of dietary fat and meat and colorectal cancer, and that between high levels of fat and mammary carcinoma, have been adequately demonstrated. Alcohol is a proven risk factor for numerous carcinomas of the gastrointestinal tract, in particular for tumors of the oropharynx and larynx, the esophagus and liver. But it may also be a possible risk factor for breast cancer and other gynecological tumors. Conversely, with respect to protective factors it is accepted that what is generally recognized to be a healthy diet (fruit, vegetables, fiber) can apparently offer a certain degree of protection from malignant disease.

Both the levels of fat and cholesterol in the diet and its fatty acid composition influence the CAD risk. In recent years, it has been recognized, however, that a high percentage of polyunsaturated fatty acids can have a negative effect, for example on the immune system. It is therefore recommended that 7-10% of dietary energy be consumed in the form of polyunsaturated and saturated fatty acids, but 10-15% as mono-unsaturated fatty acids. In view of the associated favorable effect on CAD mortality, an increase in consumption of sea fish can now be recommended, while the benefits of consuming high doses of fish oil has not been proven. The positive effect of a fiber-rich diet is largely due to the associated decrease in consumption of saturated fatty acids. An additional cholesterol-lowering effect has been demonstrated only for particular substances, for example oat bran. Numerous other dietary constituents, such as alcohol, salt or antioxidants, may also have effects on atherogenesis.

Increased body weight is one of the most important cardiovascular risk factors. Increased body weight is often associated with high blood pressure, dyslipidemia and also impaired glucose tolerance; therefore, the control of the body weight is of crucial importance in primary prevention. The substrate balance of the different energy substrates are regulated very differently, so that in a healthy person body weight can increase only in the case of an excess ingestion of dietary fat, but not in case of an excess of carbohydrates and/or proteins. Avoiding the ingestion of fat is the major dietary strategy for the control of body weight. Eating a low-fat/high-carbohydrate diet will stabilize the body weight and in the case of overweight lead to a slow but constant decline in body weight. A low-fat diet is also the major dietary strategy for the control of dyslipidemias. A low-fat diet is characterized by a low energy density and a high nonenergy nutrient density. The increased intake of vitamins, especially antioxidative vitamins, is an additional advantageous mean for primary prevention of free-radical damage.

The reduction of modifiable risk factors in hyperlipidemic patients with coronary heart disease (CHD) receiving standard medical care in Germany has not been evaluated before. We identified all patients < 65 yrs of age with marked hyperlipidemia (Cholesterol (Chol) > 250 mg/dl, HDL < 20% Chol) among all patients who underwent PTCA during defined periods 1991/92 in the Cardiology department of the Heinrich-Heine-University. The study patients (n = 93, age 54 +/- 8 yrs, 75 men, 18 women) were evaluated 13 +/- 2 months after PTCA for modification of their risk factors, treatments, knowledge, medications and dietary habits with a structured questionnaire and a 5-day dietary protocol. At follow-up Chol and LDL were significantly reduced from 299 +/- 47 to 253 +/- 43, and from 228 +/- 47 to 189 +/- 42 mg/dl, respectively (p < 0.001). 10% of patients had an LDL < 135 mg/dl. In contrast, HDL (43 +/- 9 mg/dl) and triglycerides (242 +/- 138 mg/dl), the percentage of smokers (40%), of overweight patients (38%) and of patients with elevated blood pressure (43%) remained unchanged. During the observation period the number of contacts with physicians was high (12 (1-40)). 32% of patients participated in dietary counselling by a dietician and 42% in an in-patient rehabilitation programme. In 2/3 of patients the knowledge related to hyperlipidemia and a lipid-lowering diet was good. However, according to the dietary protocols the fat intake was high (37 +/- 7% of total calories). Lipid lowering drugs had been prescribed in 68% of patients, predominantly as monotherapy and in low dosage.(ABSTRACT TRUNCATED AT 250 WORDS)

Experimental investigations have shown alterations of the ileal mucosal surface after specific fat diets resembling early changes in Crohn's disease. An animal experiment in pigs has been conducted. After creation of an anisoperistaltic segment these were fed either a specific fat diet containing chemically processed, partially hydrogenated fats or a low fat control diet over a period of 3 months. Defined areas of the ileal lamina propria were examined by transmission electron microscopy with the underlying question to what extent ultrastructural alterations could be compared to Crohn's disease. In comparison to the control group these areas were characterized by a dense infiltration of "inflammatory" cells like lymphocytes, histiocytes, macrophages and plasma cells indicating a hyperplasia and activation of lympho-plasmocytotic cells. Additionally, a focal prominent infiltration of mast cells with degranulation was observed as well as a dilatation of axons with depletion of axonal organelles in half of the animals after fat-feeding. Compared to patients with Crohn's disease the results show obvious similarities. It is concluded, that chemically processed fats could cause direct stimulation of immunologically-specific and non-specific cells in the lamina propria mucosae or directly injure the intestinal mucosa with secondary infiltration of inflammatory cells into the lamina propria.

Owing to the methodological difficulties involved, none of the studies so far published on the influence of diet on human osteo-arthritis has been fully comprehensive. We have therefore compiled a series of experimental observations--including some of our own--in the mouse and other species that have a bearing on this subject. Fats with a high content of saturated fatty acids, such as pork fat, greatly favored the development of spontaneous osteo-arthritis in the mouse, as also did cholesterol. Cottonseed oil and olive oil showed less tendency to do so. The highly unsaturated linoleic acid antagonized the effect of pork fat. Other vegetable oils and also fish oil exerted an anti-inflammatory and antinociceptive action in experimental animals. Foodstuffs rich in carbohydrates only promoted the development of degenerative joint disease in predisposed mice. Hyperglycemia (diabetes mellitus) constitutes a risk factor for the development of osteo-arthritis in humans as well as in mice and rats. A low-protein diet led to dysplasia of the hip joint in the dog; a high-protein diet inhibited the development of osteo-arthritis in the mouse, but promoted inflammation in volunteers. Disturbances of protein metabolism such as alkaptonuria can initiate degenerative processes in the joints of humans and animals.

Malnutrition as the cause of developing atherosclerosis is undoubtedly of major importance. For that reason, proper nutrition and eating habits among the population is of specific significance in preventive medicine. In order to establish a more pronounced food consciousness among the population of Styria, a questionnaire was issued to 1.354 persons attending the Graz Autumn Fair in 1991. The results showed above all that approximately 40% of the subjects investigated presented a disease due to malnutrition and metabolic disorder, mainly hyperlipidemia. The choice of various foods varied according to male and female tastes; roasted pork was more often a men's favourite dish (p < 0.001) while women had a prediction for vegetarian food (p < 0.001). There was, however, no difference in the choice of eating habits in persons with or without metabolic disorders. Thus, women in general do pursue a healthier consciousness was not so pronounced in man. Yet, it could not be established by means of the questionnaire that subjects with metabolic disorders showed different eating habits with respect to their disease.

As in all forms of food, contaminants can also be present in meat. Because of the growing awareness of ecological and health issue, more tests with sophisticated equipment are now being implemented, thus reducing the risk of consuming contaminated meat. Meat has become the most heavily inspected form of food. In contrast to vegetable matter, animals can discharge many contaminants. Meat, with the exception of the liver and kidneys, is therefore less likely to be contaminated than vegetables. Facts show that meat is a highly nutritious food which, if consumed moderately, can contribute to our well-being. Meat contains the right combination of amino acids for protein synthesis in the human body, and especially it contains plenty of essential amino acids. Above all, meat contains many vitamins, trace elements, and iron. Large amounts of these substances are particularly necessary for growing children and people who are doing hard physical work. A reduction of meat consumption is only necessary in the case of a few illnesses. Some other illnesses actually require an increase in protein, and thus an increase in meat in the diet.

Regarding the unknown pathogenesis of Crohn's disease repeatedly the importance of diet has been accentuated. Epidemiological, biochemical and animal experimental results have focused on a possible relationship between the consumption of chemically processed, partial hydrogenated fats and the development of regional enteritis. In this context an experimental animal model in pigs was designed to analyze, whether transmission electron microscopic alterations of ileal mucosa could be induced by forage of chemically processed fats. By creation of a retroperistaltic ileal segment the contact time between chyme and intestinal mucosa was prolonged. Our underlying question was to what extent disorders of the intestinal barrier function could be compared to Crohn's disease. Present study concentrates on the epithelial-cell-layer. It was shown that in comparison to the control animals the lamina epithelialis mucosae of all animals after fat-feeding was characterized by: sublethal lesion of the enterocytes/crypt-epithelial cells (shortening and alteration of the microvilli, degeneration of mitochondria, formation of autophagocytic vacuoles); goblet cell hyperplasia and increased production of mucus; focal appearance of intraepithelial lymphocytes as well as presence of polymorphonuclear granulocytes in the epithelium; widening of the intercellular-space locally up to total loss of the functional structure of the epithelial-cell-layer. In total the picture can be evaluated as an inflammatory process of the ileal mucosa. It can be concluded, that chemically processed fats as used in the described experimental conditions could induce this process. The feature of mucosal damage shows obvious similarities to ultrastructural findings in Crohn's disease if compared.

This intervention program investigated the applicability and the effects of intensive physical exercise and low-fat diet on the progression of coronary atherosclerotic lesions and stress induced myocardial ischemia in patients with stable angina pectoris. Patients participating in this study were recruited following routine coronary angiography for angina pectoris. Inclusion criteria were male sex, stable symptoms, a willingness to participate in the study for at least twelve months, and coronary artery stenoses well documented by angiography. Exclusion criteria were unstable angina pectoris, left main coronary artery stenosis greater than 25% luminal diameter reduction, severely depressed left ventricular ejection fraction (less than 35%), significant valvular heart disease, insulin-dependent diabetes mellitus, primary hypercholesterolemia (type II hyperlipoproteinemia, low-density lipoprotein greater than 210 mg/dl), and conditions precluding regular physical exercise. 18 patients participated in this program for one year; they consumed a low-fat, low-cholesterol diet (less than 20 energy % fat, cholesterol less than 200 mg/day) and exercised for more than 3 h/week. Myocardial oxygen consumption was estimated from maximum rate-pressure product at peak exercise; it was correlated to stress induced myocardial ischemia, as measured by 201Tl-scintigraphy. Results were compared with those of 18 matched patients on "usual care". In the intervention group, physical work capacity (161 +/- 34 W vs. 194 +/- 42 W) and maximum rate pressure product (25.0 +/- 6.3 x 10(3) vs. 27.2 +/- 5.3 x 10(3)) increased significantly (p less than 0.01). Patients willing to devote time and effort to intensive physical exercise and to comply with a low-fat diet may benefit from this form of therapy.(ABSTRACT TRUNCATED AT 250 WORDS)

Eating habits, especially high-fat diets, is a topical subject that was also pointedly discussed by renowned authors at the international oncology convention in Hamburg this year. There is a continuing tendency for the incidence of breast cancer to be high in countries with high fat consumption. However, clinical comparative studies have not been able to definitely confirm any correlation between the two; probably because it is not possible to determine eating habits with a sufficient degree of reliability since these change during our lifetime. On the other hand, there is mounting evidence that overweight, rather than a high-fat diet as the result of consuming too many calories, presents the actual risk factor.

Intolerance of dietary fat, massive hepatomegaly and sensation of right upper Quadrant oppression were clinical symptoms of a bioptically verified rare hepatic amyloidosis. There was no other evidence for amyloid deposition in other organs. Hepatomegaly was slightly progressive over a period of 2 years, accompanied by slight edema of lower legs and ascites detected by sonography.

The importance of nutritional fats as a source of energy declined in the past in industrialized countries due to a decrease of physical activity. On the other hand the association between the intake of particular fats and the development of cardiovascular diseases is generally accepted. Thus, some scientific societies (American Heart Association, NIH Consensus Development Conference) recommend a maximal intake of 30% of total energy by fats. In regards to the quality of fats and their effect on blood levels of lipoproteins, it is accepted that large amounts of polyunsaturated fatty acids lower increased blood levels of low density lipoproteins; however, they lower in a small extent also the antiatherogenic high-density lipoprotein (HDL) particles. Monounsaturated fatty acids also tend to lower increased LDL, without any lowering effect on HDL, W-3-fatty acids (mainly from fish oil) lower increased triglyceride levels and therefore are used a therapeutic dietary regimen. However, their long-term effects are not quite well known.

In animal experiments the fat content in food is reproducibly the most important factor in the development of obesity. Carbohydrates obviously only play a subordinate role. According to the present "hard" data for the significance of sugar in the development of obesity in humans this connection must (depending on the results of epidemiological studies) surprisingly be denied. Opposing opinions, for example, from Yudkin, still cannot be proved by data. A theoretical connection between the sugar-content of the diet and obesity can be made, but an experimental result that shows a clear preference for the incorporation of fructose in glyceridglycerine and also in fatty acids has proven to be an misinterpretation and, therefore, is non-relevant. Whether an increased specific dynamic effect of sugar (especially of the fructose component) in relationship to fat has a role in obesity seems to be rather doubtful. The "hidden" energy content of beverages could be of importance in obesity of humans, but little data for this is available. The "set point" for the body weight and for the regulation of food consumption in humans seems to be predominantly determined by psychological factors. With human beings as well as with laboratory animals the easy availability of tasty, fat-rich foodstuffs ("cafeteria-situation") seems to be an essential factor.

In 979 adipose (236 males and 743 females) test persons and 341 test persons with normal weight (149 males and 192 females) at the age from 18 to 55 years nutrition anamnestic, clinical, biochemical, anthropometrical and social-economic examinations were carried out. Our results on the frequency of coronary insufficiency and hypertension in adipose persons could clearly confirm that this in males as well as in females in all age groups was higher than the frequency in persons with normal weight. In the comparison of the eating habit between test persons with normal weight and overweight with coronary insufficient and hypertension and without these diseases became evident that there is a significant connection between the uptake of energy, the consumption of saturated fatty acids, cholesterol, carbohydrates and the coronary insufficiency and hypertension. Preventive and curative measures for influencing coronary risk factors are therefore necessary.

25 patients who underwent maxillo-facial surgery were given dayly via a nasogastric tube 1500 ml of the instant diet Sokoham for nutrition during the postoperative period. The calory intake averaged about 2000 kcal (= 10050 kJ) per day. In 2 patients the nutrition with Sokoham caused persistent diarrhea and has to be interrupted. In 4 patients slight diarrhea appeared for 1 to 2 days. The mean frequency of defecation was 0.7 +/- 1/24 hours. Bodyweight, hemoglobin content of the blood, hematocrit blood gases serum levels of creatinin, urea-nitrogen, electrolytes transaminases and albumin and the parameters of acid base balance, glucose and fat metabolism did not change significantly. The results of nutrition with Sokoham are compared with the results of other instant formula diets which were tested under similar conditions.