Search

Purpose of review The aim of this study was to summarize current contributions affecting knowledge and predictions about the nutritional adequacy of plant-free diets, contextualized by historical accounts. Recent findings As demonstrated in recent experiments, nutrient interactions and metabolic effects of ketogenic diets can impact nutritional needs, sometimes resulting in nutrient-sparing effects. Other studies highlight conflicting hypotheses about the expected effect on metabolic acidosis, and therefore mineral status, of adding alkaline mineral-rich vegetables. Summary A carnivore diet is a newly popular, but as yet sparsely studied form of ketogenic diet in which plant foods are eliminated such that all, or almost all, nutrition derives from animal sourced foods. Ketogenic diets are already nutritionally controversial due to their near-complete absence of carbohydrate and high dietary fat content, but most ketogenic diet advocates emphasize the inclusion of plant foods. In this review, we discuss the implications of relying solely on animal sourced foods in terms of essential nutrient status.

PURPOSE This study aimed to determine whether interrupting prolonged sitting with three different walking-bout schedules improves glycemic metabolism relative to continuous prolonged sitting in sedentary adults. METHODS In a randomized, crossover trial, 16 inactive healthy adults (7 men, 24 ± 3 yr old) completed four 26-h laboratory sessions, including 22.5 h in an energy expenditure (EE)-testing calorimeter chamber. The four 9-h intervention periods were as follows: 9-h uninterrupted sitting (SIT), 30-min sitting/3-min brisk (60% V˙O2max) treadmill walk (WALK3), 45-min sitting/5-min (WALK5), or 60-min sitting/8-min (WALK8). Coprimary outcomes included the difference in the mean interstitial glucose concentration, total area under the curve (tAUC), and incremental area under the curve (iAUC) for the entire 26 and 9 h (intervention period) during three activity-bout conditions compared with SIT. RESULTS Compared with SIT, the 26-h mean glucose concentration was attenuated in WALK8 (Δmean -0.22 mmol·L [95% confidence interval = -0.43 to -0.001], P = 0.048) without adjustment for EE and attenuated in WALK3 (Δ-0.47 mmol·L [-0.75 to -0.10]), WALK5 (Δ-0.47 mmol·L [-0.83 to -0.10]), and WALK8 (Δ-0.53 mmol·L [-0.92 to -0.13]) after adjustment for EE (all P < 0.01). The 26-h tAUC was reduced in WALK3 (Δ-11.18 mmol·L per 26 h [-20.07 to -2.29]), WALK5 (2.12.67 mmol·L per 26 h [-22.54 to -2.79]), and WALK8 (Δ-13.85 mmol·L per 26 h [-24.60 to -3.10]) (all P < 0.01), as well as the iAUC (all P < 0.05), only after adjustment for EE. The 9-h mean glucose concentration, tAUC, and iAUC decreased in the three activity-break conditions regardless of EE adjustment (all P < 0.05). CONCLUSIONS All three walking-bout conditions improved glycemic metabolism compared with SIT, independent of EE, in inactive, healthy adults.

Diuretics are listed in hypertension guidelines as one of three equally weighted first-line treatment options. In order to differentiate between antihypertensives, a lot of discussion has been directed at side effect profiles and as a result, has created a perhaps disproportionate fear of the metabolic effects that can be associated with diuretics. Data, however, show that the risk of a clinically meaningful change in laboratory parameters is very low, whereas the benefits of volume control and natriuresis are high and the reductions in morbidity and mortality are clinically significant. Moreover, as clinically significant differences in safety and efficacy profiles exist among diuretics, several international guidelines have started making a distinction between thiazides (hydrochlorothiazide) and thiazide-like (chlorthalidone, indapamide) diuretics; and some of them now recommend longer acting thiazide-like diuretics. In time, pending more data, chlorthalidone and indapamide may need to be subdivided further into separate classifications.

To describe current findings on sugar intake in children worldwide, including sugar sources and their impact on child health focusing on cardiometabolic alterations usually associated to obesity.In children less than 4 years, intakes of added sugars across countries ranged from 9.8 to 11.2% of total energy; in children 4-10 years, it ranged from less than 3-18%; and in adolescents, it ranged from 13.6 to 16.6%. For most countries, intakes of added sugars were greater than the recommended upper limit of 10% of total energy for children and adolescents and less or around 10% in infants. In most studies, soft drinks and fruit-based drinks accounted for the greatest proportion of the added sugars intake, followed by milk products and sweet bakery products. High added sugar intake has been associated with increased obesity risk and fat deposition in the liver, contributing to dyslipidemia, high blood pressure, insulin resistance and cardio-metabolic risk.As a high added sugar intake is associated with cardio-metabolic conditions in children and adolescents, the current scenario supports the need for stronger targeted long-term policies that prevent the excessive sugar intake in young populations.

Introduction: Long-term exposure to human immunodeficiency virus (HIV) associated immune dysregulation and adverse metabolic effects of highly active antiretroviral therapy could increase the risk for developing atherosclerotic cardiovascular disease (CVD). Previous prospective studies have also identified HIV infection as an independent risk factor for the development of heart failure (HF), though results remain inconsistent. We conducted a systematic review and meta-analysis of prospective studies to assess the association between HIV infection and incident HF. Hypothesis: We hypothesized that HIV infection would increase the risk of incident HF, though this association may be modified by other demographic or clinical characteristics. Methods: We performed a literature search of PubMed, EMBASE and Web of Science through June 1 st , 2020 to identify prospective studies which examined the association between HIV infection and incident HF among adults (age≥18 years). Study-specific risk estimates were combined using a random-effects model to calculate the pooled relative risk (RR) and 95% confidence intervals (CI). Results: Eight records with a total of 8,949,448 participants with 101,335 incident cases of HF (1,941 among HIV+ individuals and 99,394 among HIV- individuals) were included for meta-analysis. In our overall analysis, HIV infection was positively associated with incident HF, RR (95% CI): 1.80 (1.51-2.15), I 2 =85.6% ( Figure 1 ). This association was largely consistent among individuals without a history of CVD, RR (95% CI): 1.89 (1.51-2.37). HIV infection status tended to be a stronger risk factor for HF among younger adults (age3 ) count. Conclusions: Our meta-analysis provides additional support that HIV may be an independent risk factor for HF, with potentially important clinical and public health implications for primary prevention.

Introduction: Obesity is associated with increased epicardial adipose tissue (EAT). It is unknown if this ectopic fat deposit has direct cardiotoxic paracrine effects on regional systolic function. We have previously shown that EAT mediates diastolic dysfunction via systemic effects, rather than localized effects. We similarly hypothesized regional EAT deposits would have no effect on the left ventricular (LV) strain of adjoining myocardial segments. Methods: We studied 28 obese healthy adults (mean age 48 ± 5 yrs, BMI 38.2 ± 5.0 kg/m 2 ). EAT was quantified on each individual MRI slice from base to apex and summed to obtain total volume. It was then separated into anterior, lateral, and inferior regions corresponding to the adjacent LV segments. Using MRI feature tracking, global longitudinal LV strain (GLS) and peak regional anterior, inferior, and lateral LV strain were quantified. Associations between total EAT and GLS, and between regional EAT and corresponding regional strain were determined by linear regression. Results: Mean total EAT volume was 69.6 ± 29.8 mL and mean GLS was -19.4 ± 2.0%. Individual data points for EAT and longitudinal strain are shown in the figure. Greater total EAT volume was modestly associated with decreased GLS (r2 = 0.127). However, anterior, lateral, and inferior EAT volume did not correlate with a decrease in corresponding regional strain (r2 = 0.003, r2 = 0.088, r2 = 0.016, respectively). Conclusion: In obese adults, total EAT volume was associated with a decrease in global LV systolic function measured by GLS. There was no association between regional EAT depots and corresponding regional LV function to suggest localized metabolic cardiotoxic effect. These preliminary results support our previous findings that EAT has little paracrine effect on cardiac function. Rather, EAT likely represents an additional depot of ectopic fat reflective of a general metabolic abnormality.

Ratamess, NA, Kang, J, Kuper, JD, O'Grady, EA, Ellis, NL, Vought, IT, Culleton, E, Bush, JA, and Faigenbaum, AD. Acute cardiorespiratory and metabolic effects of a sandbag resistance exercise protocol. J Strength Cond Res 32(6): 1491-1502, 2018-The purpose of this study was to examine the acute cardiorespiratory and metabolic effects of a sandbag (SB) resistance exercise protocol and compare the responses to time-matched treadmill running protocols. Eight healthy, resistance-trained men (21.1 ± 1.0 years; 86.1 ± 7.8 kg) completed 4 protocols of equal duration in random sequence: (a) SB, (b) treadmill running at 60% of V[Combining Dot Above]O2 reserve (60V[Combining Dot Above]O2R), (c) treadmill running at 80% of V[Combining Dot Above]O2 reserve (80V[Combining Dot Above]O2R), and (d) a control protocol. The SB protocol was 16 minutes in duration and consisted of 3 circuits of 8 multiple-joint exercises (with 11-, 20-, or 48-kg SBs) performed for as many repetitions as possible for 20 seconds followed by a 10-second rest interval before beginning the next exercise. Two minutes of rest was allowed between circuits. Breath-by-breath oxygen consumption (V[Combining Dot Above]O2) and heart rate (HR) were recorded throughout each protocol and for 30 minutes postexercise (PE) and blood lactate was determined before and immediately after each protocol. Blood lactate was significantly higher after SB compared with 60V[Combining Dot Above]O2R and 80V[Combining Dot Above]O2R. Mean and peak HR in SB was significantly higher than 60V[Combining Dot Above]O2R but not different from 80V[Combining Dot Above]O2R. Mean V[Combining Dot Above]O2 and energy expenditure (EE) in SB was significantly lower than 60V[Combining Dot Above]O2R and 80V[Combining Dot Above]O2R during each protocol but significantly higher after SB compared with 60V[Combining Dot Above]O2R and 80V[Combining Dot Above]O2R PE. Compared with 60V[Combining Dot Above]O2R and 80V[Combining Dot Above]O2R, respiratory exchange ratio was significantly higher during SB and through 5 minutes PE, but was significantly lower at 25-30 minutes PE after SB. Sandbag, as performed in this study, provides a superior metabolic stimulus to treadmill running during the PE period; however, the SB results demonstrate inferior EE compared with running at 60V[Combining Dot Above]O2R and 80V[Combining Dot Above]O2R.

There is increasing concern that dietary fructose may contribute to the development of noncommunicable diseases. This review identifies major new findings related to fructose's physiological or adverse effects. Fructose is mainly processed in splanchnic organs (gut, liver, kidneys) to glucose, lactate, and fatty acids, which can then be oxidized in extrasplanchnic organs and tissues. There is growing evidence that splanchnic lactate production, linked to extrasplanchnic lactate metabolism, represents a major fructose disposal pathway during and after exercise. Chronic excess fructose intake can be directly responsible for an increase in intrahepatic fat concentration and for the development of hepatic, but not muscle insulin resistance. Although it has long been thought that fructose was exclusively metabolized in splanchnic organs, several recent reports provide indirect that some fructose may also be metabolized in extrasplanchnic cells, such as adipocytes, muscle, or brain cells; the quantity of fructose directly metabolized in extrasplanchnic cells, and its physiological consequences, remain however unknown. There is also growing evidence that endogenous fructose production from glucose occurs in humans and may have important physiological functions, but may also be associated with adverse health effects. Fructose is a physiological nutrient which, when consumed in excess, may have adverse metabolic effects, mainly in the liver (hepatic insulin resistance and fat storage). There is also concern that exogenous or endogenously produced fructose may be directly metabolized in extrasplanchnic cells in which it may exert adverse metabolic effects.

Cancer therapies often result in the 'late effect of cancer treatment' whereby secondary health complications emerge years after radiotherapy and chemotherapy. This review focuses on endocrine and metabolic consequences in adult cancer survivors as late treatment effects.Endocrine and metabolic disorders are among the most common late effects. Endocrine disorders include hypopituitarism, which leads to growth hormone deficiency, hypogonadism, adrenal insufficiency and hypothyroidism and related clinical manifestations. Hypogonadism in particular is associated with a wide range of health complications requiring input from the like of endocrine and fertility specialists. Immune checkpoint inhibitors are novel anticancer agents, some of which are uniquely associated with hypophysitis which requires early recognition and management, including steroid replacement. Metabolic syndrome, a significant risk for cardiovascular disease, is highly prevalent. Although the effects of cranial irradiation on the hypothalamic-pituitary system are more apparent, the relationship between chemotherapy and endocrine/metabolic disorders remains to be elucidated. There exist published guidelines for monitoring endocrine and cardiometabolic risk in cancer survivors, but the extent of monitoring appears insufficient.Regular monitoring and early management of endocrine/metabolic disorders is required to prevent the elevated rates of health complications after cancer treatment, and thereby improve cancer survivorship.

Introduction: Temperature manipulation to decrease metabolism is commonly after acute brain injury. Preclinical data suggest metabolism decreases 7-8% for each degree C drop in core temperature. We hypothesized similar results would be found in healthy individuals. Methods: Following informed consent and physical screening, we administered a 1mcg/kg bolus of dexmedetomidine followed by 20cc/kg of cold (4C) saline bolus. We cooled subjects using surface pads (emcools (Austria)). Dexmedetomidine infusion was titrated to effect (max dose Results: Median age in the 9 enrolled subjects was 30 (SD 10) years and most (78%) were male. Median height was 173 (IQR 168, 180) cm and median weight was 77 (IQR 72, 83) kg. Baseline VO2 was 3.4 (IQR 3.0, 3.8) ml/kg/min and baseline energy expenditure was 1692 (IQR 1579, 1845) kcal/day. Both VO2 and energy expenditure decreased with core temperature (p=0.017 and p=0.027) (Table). Conclusion: Metabolic rate decreases with core temperature manipulation. The largest change occurs between 37C and 36C with smaller changes thereafter.

Evaluate the long-term effects of bariatric surgery on type 2 diabetes (T2DM) remission and metabolic risk factors.Although the impressive antidiabetic effects of bariatric surgery have been shown in short- and medium-term studies, the durability of these effects is uncertain. Specifically, long-term remission rates following bariatric surgery are largely unknown.Clinical outcomes of 217 patients with T2DM who underwent bariatric surgery between 2004 and 2007 and had at least 5-year follow-up were assessed. Complete remission was defined as glycated hemoglobin (A1C) less than 6% and fasting blood glucose (FBG) less than 100 mg/dL off diabetic medications. Changes in other metabolic comorbidities, including hypertension, dyslipidemia, and diabetic nephropathy, were assessed.At a median follow-up of 6 years (range: 5-9) after surgery (Roux-en-Y gastric bypass, n = 162; gastric banding, n = 32; sleeve gastrectomy, n = 23), a mean excess weight loss (EWL) of 55% was associated with mean reductions in A1C from 7.5% ± 1.5% to 6.5% ± 1.2% (P0.001) and FBG from 155.9 ± 59.5 mg/dL to 114.8 ± 40.2 mg/dL (P0.001). Long-term complete and partial remission rates were 24% and 26%, respectively, whereas 34% improved (1% decrease in A1C without remission) from baseline and 16% remained unchanged. Shorter duration of T2DM (P0.001) and higher long-term EWL (P = 0.006) predicted long-term remission. Recurrence of T2DM after initial remission occurred in 19% and was associated with longer duration of T2DM (P = 0.03), less EWL (P = 0.02), and weight regain (P = 0.015). Long-term control rates of low high-density lipoprotein, high low-density lipoprotein, high triglyceridemia, and hypertension were 73%, 72%, 80%, and 62%, respectively. Diabetic nephropathy regressed (53%) or stabilized (47%).Bariatric surgery can induce a significant and sustainable remission and improvement of T2DM and other metabolic risk factors in severely obese patients. Surgical intervention within 5 years of diagnosis is associated with a high rate of long-term remission.

The effects of dietary sugar on risk factors and the processes associated with metabolic disease remain a controversial topic, with recent reviews of the available evidence arriving at widely discrepant conclusions.There are many recently published epidemiological studies that provide evidence that sugar consumption is associated with metabolic disease. Three recent clinical studies, which investigated the effects of consuming relevant doses of sucrose or high-fructose corn syrup along with ad libitum diets, provide evidence that consumption of these sugars increase the risk factors for cardiovascular disease and metabolic syndrome. Mechanistic studies suggest that these effects result from the rapid hepatic metabolism of fructose catalyzed by fructokinase C, which generates substrate for de novo lipogenesis and leads to increased uric acid levels. Recent clinical studies investigating the effects of consuming less sugar, via educational interventions or by substitution of sugar-sweetened beverages for noncalorically sweetened beverages, provide evidence that such strategies have beneficial effects on risk factors for metabolic disease or on BMI in children.The accumulating epidemiological evidence, direct clinical evidence, and the evidence suggesting plausible mechanisms support a role for sugar in the epidemics of metabolic syndrome, cardiovascular disease, and type 2 diabetes.

Improved means to monitor and guide interventions could be useful in the intensive care unit. Metabolomic analysis with bioinformatics is used to understand mechanisms and identify biomarkers of disease development and progression. This pilot study evaluated plasma proton nuclear magnetic resonance spectroscopy as a means to monitor metabolism following albumin administration in acute lung injury patients.This study was conducted on plasma samples from six albumin-treated and six saline-treated patients from a larger double-blind trial. The albumin group was administered 25 g of 25% human albumin in 0.9% saline every 8 hrs for a total of nine doses over 72 hrs. A 0.9% concentration of saline was used as a placebo. Blood samples were collected immediately before, 1 hr after, and 4 hrs after the albumin/saline administration for the first, fourth, and seventh doses (first dose of each day for 3 days). Samples were analyzed by proton nuclear magnetic resonance spectroscopy, and spectra were analyzed by principal component analysis and biostatistical methods.None.After 1 day of albumin therapy, changes in small molecules, including amino acids and plasma lipids, were evident with principal component analysis. Differences remained 3 days after the last albumin administration. Analysis of data along with spectra from healthy controls showed that spectra for patients receiving albumin had a trajectory toward the spectra observed for healthy individuals while those of the placebo controls did not.The data suggest that metabolic changes detected by proton nuclear magnetic resonance spectroscopy and the bioinformatics tool may be a useful approach to clinical research, especially in acute lung injury.

Purpose of review Bariatric surgery is gaining acceptance as an effective and well tolerated treatment of morbid obesity in adults yet experience in obese children is still lacking. The purpose of this review is to highlight recent findings in this exciting field and identify the knowledge gaps. Recent findings One randomized controlled trial and several case series have been published in the last 2 years regarding bariatric surgery for obese adolescents. These studies demonstrate relative safety along with significant weight loss. In addition, the vast majority of obesity-related comorbidities are resolved following these procedures. Adverse psychological effects of these procedures are probably more common than those in adults and need to be addressed. Summary These publications indicate that bariatric surgical procedures, mainly gastric banding and gastric bypass, when performed on the right patients by skilled surgeons along with the appropriate ancillary staff, show positive metabolic effects and are well tolerated. Precise patient selection criteria, choice of the procedure and the extent of the multidisciplinary preoperative and postoperative care, are yet to be defined.

Despite the success of intraaortic balloon counterpulsation, data on physiologic indices and optimal inflation/deflation timing control of chronic counterpulsation devices are unclear. This study explored the acute hemodynamic and metabolic efficacy of a novel 40-ml stroke volume paraaortic blood pump (PABP) versus a standard intraaortic balloon pump (IABP). Acute porcine model was used with eight pigs randomly divided into PABP (n = 4) and IABP (n = 4) groups. Hemodynamic and metabolic measurements were obtained with and without mechanical assistance. In one pig, the inflation/deflation control was adjusted to different settings, with corresponding performance indices measured. The PABP significantly improved classical counterpulsation indices (p ≤ 0.05) and achieved an average beneficial effect on these indices 1.5-3.5 times greater than that of the IABP. Classical metabolic indices (tension time index and endocardial viability ratio [EVR]), and indices new to chronic counterpulsation research (coronary perfusion, left ventricular stroke work (SW), and a newly derived EVR) were also used in assessment. Both IABP assistance and PABP assistance improved these physiologic indices, with a trend toward PABP superiority in reducing left ventricular SW (p = 0.08). An optimal PABP deflation timing occurs during systole (25 milliseconds after the R-wave) and can minimize coronary regurgitation.

Fructose is consumed in significant amounts in Western diets. An increase in fructose consumption over the past 10-20 years has been linked with a rise in obesity and metabolic disorders. Fructose/sucrose produces deleterious metabolic effects in animal models. This raises concern regarding the short-term and long-term effects of fructose and its risk in humans.In rodents, fructose stimulates lipogenesis and leads to hepatic and extrahepatic insulin resistance, dyslipidaemia and high blood pressure. Insulin resistance appears to be related to ectopic lipid deposition. In humans, short-term fructose feeding increases de-novo lipogenesis and blood triglycerides and causes hepatic insulin resistance. There is presently no evidence for fructose-induced muscle insulin resistance in humans. The cellular mechanisms underlying the metabolic effects of fructose involve production of reactive oxygen species, activation of cellular stress pathways and possibly an increase in uric acid synthesis.Consuming large amounts of fructose can lead to the development of a complete metabolic syndrome in rodents. In humans, fructose consumed in moderate to high quantities in the diet increases plasma triglycerides and alters hepatic glucose homeostasis, but does not appear to cause muscle insulin resistance or high blood pressure in the short term. Further human studies are required to delineate the effects of fructose in humans.

Purpose of Review: The purpose of this paper is to review the recent literature about alterations of lipid and glucose metabolism in patients treated with second generation antipsychotics. This article also addresses possible underlying mechanisms of these changes and discusses ways of preventing these side-effects as well as their management. Recent Findings: There is a considerable number of reports on this issue but very few prospective controlled trials dealing with this very important subject. This review further focuses on the question of whether there is a difference with respect to such alterations between the available new generation antipsychotics, depending on their receptor profiles. Summary: As adverse metabolic effects have a high impact on the physical health of schizophrenia patients as well as on their treatment adherence, this is a topic of major clinical relevance, with implications for public health.

We compared the metabolic effects of allowing women isotonic "sport drinks" rather than water to drink during labor. The effect of these drinks on gastric residual volume was also evaluated. Sixty women in early labor (cervical dilation5 cm) were randomized to receive either isotonic sport drinks or water only. Plasma beta-hydroxybutyrate, nonesterified fatty acids, and glucose were measured in early labor and at the end of the first stage of labor. Residual gastric volume was assessed within 45 min of delivery by use of an ultrasound scanner. The incidence and volume of vomiting was recorded. At the end of the first stage of labor, plasma beta-hydroxybutyrate (P = 0.000) and nonesterified fatty acids (P = 0.000) had increased and plasma glucose (P = 0.007) had decreased significantly in the Water-Only group. Gastric antral cross-sectional area after delivery was similar in the two groups. The incidence of vomiting and the volume vomited during labor and within the hour of delivery were also similar. There was no difference between the groups in any maternal or neonatal outcome of labor. In conclusion, isotonic drinks reduce maternal ketosis in labor without increasing gastric volume.Solid foods may endanger a woman's life if consumed during labor. Isotonic sport fluids were evaluated as a nutritional alternative. Results demonstrate that mothers who have not received parenteral opioids can safely drink isotonic drinks in active labor.

Background: Increasing evidence suggests that factors beyond calorie balance may affect fat deposition (consider environmental obesogens like bisphenol A). Trans fats are prooxidant, proinflammatory, have shown adverse metabolic effects and increased fat deposition in animals. Goal: To assess the relation of dietary trans fatty acid ( dTFA ) consumption to BMI in humans. Method: Subjects were 1018 adult men and women clinical trial screenees (age 20-85, without known diabetes, CVD, with screening LDL 115-190mg/dL). Height and weight were measured at screening and BMI calculated. The Fred Hutchinson Food Frequency Questionnaire provided data on dTFA (gm/d) and calories. Surveys elicited activity, and chocolate consumption (times/week, previously linked favorably in this sample to BMI). Mood (adversely linked to dTFA in this sample and in literature) was assessed by the CES-D (depression scale). Regression assessed the relation of BMI (outcome) to dTFA, unadjusted and in models adjusted for age and sex, calories and activity, chocolate consumption, and mood. Results: Higher dTFA was linked with higher BMI across adjustment models, with strong statistical significance. The coefficient was strengthened, not attenuated, when calories and activity were considered. Each additional gram/day of dTFAs was associated with around 0.4 points greater BMI. Discussion: These findings extend adverse metabolic associations of dTFA, and comport with evidence suggesting that composition of calories, as well as their number, has relevance to BMI.

Background: According to recent national health surveys (2010-2013), diabetes mellitus (DM) is more prevalent in East Asian populations (11.6% in China, 11.3% in Japan) compared with Western populations (4.5% in UK and 8.3% in US), even though body weight and body mass index (BMI) are much lower in East Asian populations (mean ≈ 22-23 kg/m2 in China/Japan vs. ≈ 27-28 kg/m2 in UK/US, WHO 2008 report). Consumption of total available carbohydrate (CHO) (%kcal) in Eastern countries is higher than in Western countries. The patterns of CHO intake, dietary glycaemic Index (GI)/glycaemic Load (GL), may be important in accounting for these differences and their metabolic effects. Data on GI/GL of Asian foods are, however, limited. Objectives: To develop systematic methodology for assigning GI values to East Asian foods, and to identify East Asian foods contributing most to total GL, using data from the International Collaborative Study on Macro-/Micronutrients and Blood Pressure (INTERMAP). Methods: The INTERMAP Study is a cross-sectional epidemiologic investigation with standardized quality-controlled methods; it accrued four in-depth 24-hour dietary recalls, 2 timed 24-hour urine collections, 8 BP measurements and questionnaire data. National and International GI databases were used to develop a standardized algorithm for assigning GI values to the INTERMAP data on East Asian foods. “GL contribution of a food”, defined as the GI value of this food multiplied by total amount of available CHO contained in this food as consumed on average by all participants, was used to estimate total influence of each food on blood glucose, including absolute levels and relative percentages. Results: GI values of total of 2,928 East Asian individual food codes (2,030 Japanese food codes and 898 Chinese food codes) were assigned using this newly developed algorithm. Foods assigned with GI>0 using this algorithm contributed 92% (Japan) and 98% (China) of total CHO intake per day. Among Japanese foods, high GI foods were sweet red bean paste (Monaka, GI=91), rice cookie (GI=91), and rice cracker (GI=91). Among Chinese foods, high GI foods were flour and flour products (e.g., Mantou, steamed bread, fried dough sticks, and noodles, GI=88) and glutinous rice (GI=87). Foods contributing most to GL in Japan were white rice (54%), white bread (5%), sugar, syrup and preserves (3%); for Chinese foods: flour and flour products (25%), white rice (21%), and baked products (10%). Conclusion: With the algorithm we developed, it was feasible to assign GI values to East Asian foods. The composition of top GL contributors is different between China and Japan.

Continuous blood membrane interactions during continuous renal replacement therapy cause bioincompatibility and low grade inflammatory reactions with potentially adverse consequences on protein metabolism and immunocompetence. In designing a nutritional program for patients receiving this treatment, these adverse metabolic effects, especially the loss of nutritional substrates, must be considered. This review provides a practical overview of nutritional support in acute renal failure, including assessment techniques, determination of nutrient needs, and appropriate intervention for patient support.

Epidemiological studies demonstrate an association between insulin resistance, hypertension and cardiovascular morbidity. Over the past decade, evidence has accumulated indicating that short-term insulin administration, in addition to its metabolic effects, also has important cardiovascular actions. The sympathetic nervous system and the L-arginine-nitric oxide pathway have emerged as central players in the mediation of insulin's cardiovascular actions. The underlying mechanisms and the factors that may govern the interaction between insulin and these two major cardiovascular regulatory systems have been studied extensively in healthy people and insulin-resistant subjects. Here we summarize the current understanding and gaps in knowledge on insulin's cardiovascular actions in humans, and discuss possible pathophysiological consequences of their alteration. Based on recent new insight, we propose that a genetic and/or acquired defect of nitric oxide synthesis could represent a central defect triggering many of the metabolic, vascular and sympathetic abnormalities characteristic of insulin-resistant states, all of which may predispose to cardiovascular disease.

Today's IUDs are an extremely safe and effective method of contraception. The progesterone-containing system is associated with diminished menstrual blood loss; however, it must be removed and reinserted annually. The copper-containing IUD is effective for up to 10 years, and is protective against ectopic pregnancy. When used for at least 18 months, the copper IUD is the most cost-effective of all contraceptive methods available in the U.S. (37). There are low rates of adverse events associated with IUD use, with no systemic metabolic effects. There is a rapid return to previous fertility, comparable to other contraceptive methods, including oral contraceptives. In addition, in the event that a woman does become pregnant when using an IUD, the IUD does not increase the risk of congenital abnormalities. Finally, when inserted into appropriate candidates, there is a low risk of pelvic inflammatory disease.The two IUDs currently available in the US--the progesterone-containing device and the copper T380A--are among the most effective contraceptive methods. The progesterone-containing IUD has an efficacy rate of 2.9 pregnancies per 100 women-years and a continuation rate of 80% after one year. The copper T380A has an annual pregnancy rate of less than 1 per 100 users constant over its 10-year life span and first-year continuation rates in the range of 77-86%. The copper device has a significant deleterious effect on sperm and their motility and confers protection against ectopic pregnancy. When used for at least 18 months, the copper IUD is the most cost-effective contraceptive method available in the US. The risk of pelvic inflammatory disease (PID) is related specifically to the IUD insertion process and the woman's risk of acquiring a sexually transmitted disease. The relative risk of PID among IUD users who have 1 sexual partner is approximately 1.1% and decreases with increasing duration of use. Finally, in the event a woman does become pregnant when using an IUD, the device does not increase the risk of congenital abnormalities.

Human immunodeficiency virus (HIV) infection is associated with reduced muscle mass and adverse metabolic effects. We evaluated the impact of HIV infection on longitudinal exercise performance in US Air Force (USAF) members with HIV infection. USAF members perform standardized fitness assessments every 6 to 12 months with a composite score comprised of abdominal circumference, push-ups, sit-ups, and 1.5-mile run. Fitness tests between 2004 and 2014 for male USAF members with HIV infection (n = 172) were compared with male HIV-negative controls (∼10 per case; n = 1636) matched by age and rank category at service entry. Fitness tests for cases (n = 1821) were divided into 2 groups, before (pre-HIV) and after (post-HIV) diagnosis, and compared with control fitness assessments (n = 30,443) by paired t tests. Random-effects regression analyses were also performed to compare fitness components. Mean composite scores for cases were higher post-HIV (87.06 ± 9.10) compared with pre-HIV (84.92 ± 8.36; P = 0.004) and did not differ from respective controls. Compared with pre-HIV, mean push-up (51.50 ± 9.67 vs 50.35 ± 11.18; P = 0.018) and sit-up (51.66 ± 7.81 vs 50.57 ± 9.19; P

Using variant B16 metastatic melanomas, attempts were made to explore the effects of both genetic and metabolic environmental factors in vivo as well as in vitro, on specific steps in the metastatic process. Metastases of the progenitor tumour in black C57BL/6J mice arose from a stable, heritable, non-random, pre-existing subpopulation of metastatic cells. In vitro, the environment influenced both pigmentary and metastatic phenotypes of variant B16 metastatic melanomas. The possibility that cells from different strains may express a phenotype following reinoculation into syngeneic mice was also explored. The experimental results suggested that new, enhanced, heritable, metastasis-related characteristics can develop as a result of genetic changes in yellow Ay/a and C57BL/6J mice that are accompanied by pigmentary changes. Such genetic changes can determine unstable non-random and random epigenetic metastatic effects with enhancement in vivo or disappearance in vitro of spontaneous metastatic ability and of the number of metastases, as monitored by serial transfers of tumour cells in vivo.

To determine the relationship between iv infusion rate, plasma concentrations, and hemodynamic and metabolic actions of norepinephrine.Norepinephrine was administered by using five iv infusion rates (0.01 to 0.2 micrograms/kg/min) for 30 mins each to eight volunteers, for the purpose of constructing cumulative plasma concentration-response curves.Laboratory of the Department of Anesthesiology at a university hospital.Systolic and diastolic BP, heart rate, and the plasma concentrations of norepinephrine, glucose, nonesterified fatty acids, and insulin were measured at the end of each infusion rate. During the highest infusion rate, plasma norepinephrine concentrations increased from 199 +/- 75 to 7475 +/- 1071 pg/mL (1.18 +/- 0.44 to 44.18 +/- 6.33 nmol/L). Typical hemodynamic responses, such as increases in BP and decreases in heart rate, were seen, while the plasma concentrations of glucose and nonesterified fatty acids increased from 92 +/- 10 to 132 +/- 17 mg/dL (5.1 +/- 0.6 to 7.3 +/- 0.9 mmol/L) and 11 +/- 4 to 34 +/- 6 mg/dL (0.11 +/- 0.04 to 0.34 +/- 0.06 g/L), respectively, during the 0.2 micrograms/kg/min infusion rate (p less than .05). Despite the increase in glucose concentration, insulin remained at baseline values. Metabolic and hemodynamic effects occurred at similar plasma concentrations throughout the study.Administration of norepinephrine showed no selective hemodynamic actions. The metabolic responses observed in this investigation were similar to those responses seen during increased endogenous sympathetic nervous system activity, such as stress, exercise, or trauma.

We appreciate the editorial comments by Pimenta and Calhoun1 and the correspondence by Sechi et al2 on our work. Attempts to clarify the discrepancies between available studies on the metabolic effects of hyperaldosteronism are welcome. Indeed, our results challenge the prevailing hypothesis that primary aldosteronism (PA) is associated with clinically meaningful metabolic consequences.3 Pimenta and Calhoun1 appropriately point out several limitations that may threaten the validity of our study. On the other hand and in keeping with our data, Sechi et al2 …

There is controversy about whether N2O increases cerebral blood flow and cortical oxygen consumption (CMRO2) in rats. Cortical and subcortical blood flow and CMRO2 were measured in awake, unrestrained rats while awake and during 70% N2O administration using radioactive microspheres. In the awake state, cortical and subcortical blood flow were 126 +/- 10 and 98 +/- 7 ml.100 g-1.min-1, respectively, and CMRO2 (cortical) was 10.0 +/- 0.6 ml O2.100 g-1.min-1 (mean +/- SE). After 15 min of 70% N2O, cortical and subcortical blood flow increased 100% and 40%, respectively, while CMRO2 did not increase significantly. Cerebral blood flow remained increased after 60 min of N2O exposure, and CMRO2 did not change. These results show that N2O produces cerebrovasodilation in rats that is not related to a change in metabolic demand. Plasma catecholamines do not change during N2O administration, indicating that the increase in blood flow is not due to a general stress response.

We have evaluated the effect of dehydroepiandrosterone (DHEA) replacement therapy in 60- to 70-year-old women (n = 15) who received a single daily percutaneous application of a 10% DHEA cream for 12 months. While anthropometric measurements showed no change in body weight, we observed a 9.8% decrease in subcutaneous skinfold thickness at 12 months (P < 0.05). This was confirmed by measurements of midthigh fat and muscle areas by computed tomography where a 3.8% decrease (P < 0.05) in femoral fat and a 3.5% increase (P < 0.05) in femoral muscular areas were observed at 12 months. There was no significant change in abdominal fat measurements but the waist-to-hip ratio was only 0.83 at the onset of treatment. These changes in body fat and muscular mass were associated with a 11% decrease (P < 0.05) in fasting plasma glucose and a 17% decrease (P < 0.05) in fasting insulin levels. Treatment with DHEA had no adverse effect on the lipid or lipoprotein profile. In fact, an overall trend towards a decrease in total cholesterol and its lipoprotein fractions was observed. Plasma triglycerides were not affected. Plasma high-density lipoprotein (HDL) cholesterol decreased by 8% but the ratio HDL/cholesterol was unchanged by DHEA treatment because of a parallel decrease in total cholesterol. The index of sebum secretion showed a 73% increase (P < 0.05) during the 12 months of DHEA therapy followed by a return to pretreatment values 3 months after cessation of therapy. At the same time, sex hormone-binding globulin levels decreased (P < 0.05) during treatment and returned to pretreatment values 3 months after the end of therapy. Serum gonadotropins were not changed by DHEA treatment. Although not significant, we observed a tendency towards an elevation in serum GH levels. Values of serum IGF-I remained unchanged while plasma IGF-binding protein-3 levels significantly decreased (P < 0.05) during treatment and returned to pretreatment values after cessation of DHEA therapy. The present data clearly indicate the beneficial effects of DHEA therapy in postmenopausal women through its transformation into androgens and/or estrogens in specific intracrine tissues without any significant side effects.