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Biomedical subjects

Ian Chapman

Publications and source records attributed to Ian Chapman.

12 recordsLinked to original sources
PubMed2006

The hypotensive response to oral fat is comparable but slower compared with carbohydrate in healthy elderly subjects.

The objective of the present study was to determine the comparative hypotensive responses to drinks containing predominantly fat and carbohydrate (CHO) in healthy elderly subjects. Using a randomised, cross-over study, the participants, twelve elderly subjects, six of them female (72.2 (sd 5.7) years), were investigated. On three separate days, blood pressure (BP) and heart rate were measured following ingestion of 300 ml drinks containing: (1) CHO (75 g glucose and 93 g Polyjoule (CHO polymer) providing 2732 kJ (653 kcal)); (2) 88 % fat (cream blended with milk providing 2732 kJ (653 kcal)); (3) water. Systolic BP decreased following the CHO drink (P<0.001) and the high-fat drink (P<0.001) but not water; there was no difference in the magnitude of the decrease between the CHO drink and the drink containing fat (13.4 v. 15.6 mmHg). However, the onset of the fall was slower after the fat-containing drink (13.0 v. 26.5 min (P=0.01); area under the curve for 0-30 min for CHO drink -6.5 v. fat-containing drink 125.4 mmHg x min (P=0.043)). We conclude that ingestion of a high-fat drink results in a comparable fall in BP to a CHO drink although the onset is relatively slower. These observations may have implications for the management of postprandial hypotension.

Administration, Oral↗
PubMed2004

Effect of 12 month oral testosterone on testosterone deficiency symptoms in symptomatic elderly males with low-normal gonadal status.

BACKGROUND: Relative androgen deficiency in ageing males is assumed to have adverse health effects. This study assessed the effect of 12 months' standard dose, oral testosterone, on symptoms attributed to testosterone deficiency in older men with plasma testosterone levels in the low-normal range for young men. METHODS: Testosterone undecanoate (TU, 80 mg bid) or placebo was administered for one year to 76 healthy men, 60 years or older, with a free testosterone index (FTI) of 0.3-0.5 and significant symptoms on a questionnaire designed to evaluate androgen deficiency (ADAM). The ADAM was completed at baseline, 6 and 12 months. Hormone and safety data were collected at baseline, 1, 3, 6 and 12 months. RESULTS: After 12 months, plasma total testosterone was unchanged in both groups and sex hormone binding globulin decreased in the testosterone group (P = 0.01). FTI and calculated bioavailable testosterone (cBT) were greater in the testosterone group as compared with the placebo group (P = 0.021 and 0.025, respectively). There was no significant difference in total symptom score between testosterone and placebo groups after 12 months of oral TU. However, there were trends toward improvements in sadness/grumpiness (P = 0.063), reduced erection strength (P = 0.059) and decreased work performance symptoms (P = 0.077), particularly in men with baseline cBT levels below 3.1 nmol/l. CONCLUSIONS: This study concludes that 80 mg bid oral TU does not improve overall ADAM questionnaire scores in older men with low-normal gonadal status. Oral TU may preserve mood and erectile function, as assessed by this questionnaire, particularly in men with the lowest testosterone levels.

Administration, Oral↗
PubMed2004

Blood pressure responses in healthy older people to 50 g carbohydrate drinks with differing glycaemic effects.

The aim of the present study was to determine the effects on blood pressure response of 50 g carbohydrate drinks with differing glycaemic effects in ten healthy elderly subjects (age > 65 years; randomized crossover design). Systolic (SBP), diastolic (DBP) and mean arterial (MAP) blood pressure, heart rate and plasma glucose levels were determined following ingestion of equal volumes (379 ml) of water and 50 g carbohydrate drinks with differing reported glycaemic indices (GI) (surrogate marker for glycaemic effect): (1) low-GI: Apple & Cherry Juice; (2) intermediate-GI: Fanta Orange; (3) high-glucose. Glucose (SBP and DBP P < 0.001; MAP P = 0.005) and Fanta Orange (SBP P = 0.005; DBP and MAP P < 0.001) ingestion caused a significant decrease in BP whilst blood pressure increased (SBP P = 0.008; MAP P = 0.005) from baseline following Apple & Cherry Juice ingestion. Water had no significant effect on postprandial blood pressure. Fanta Orange and Apple & Cherry Juice caused similar (P = 0.679) glycaemic effects, which were significantly greater than water, but lower than glucose (P < 0.001). There was no significant correlation between the glycaemic effect of the carbohydrate drinks and there was no change in blood pressure from baseline (SBP r - 0.123, P = 0.509; DBP r - 0.051, P = 0.784; MAP r - 0.069, P = 0.712). Apple & Cherry Juice and Fanta Orange had similar glycaemic effects, but differing effects on blood pressure. Therefore, it is unlikely that the glycaemic effect of a drink can be used to predict the subsequent cardiovascular response.

Aged↗
PubMed2004

Nutritional screening of older people in a sub-acute care facility in Australia and its relation to discharge outcomes.

OBJECTIVES: To determine the prevalence of under-nutrition using brief screening methods and to determine the relation between these results and (1) those of a more standard nutritional assessment and (2) discharge outcomes. DESIGN: Prospective study. SUBJECTS: 65 (21 males) patients older than 65 years. SETTING: Sub-acute care facility. MEASUREMENTS: The Mini Nutritional Assessment, standard nutritional assessment, 'rapid screen' and discharge outcome. RESULTS: The prevalence of under-nutrition was high, ranging from 35.4% to 43.1%, depending on the screening method used. Compared to the standard nutritional assessment the 'rapid screen' consisting of (1) body mass index <22 kg/m(2); and/or (2) reported weight loss of >7.5% over the previous 3 months and the two-tiered Mini Nutritional Assessment process (at risk subjects (46% of total) further evaluated using standard nutritional assessment) had sensitivities of 78.6 and 89.5% and specificities of 97.3 and 87.5% respectively in diagnosing under-nutrition. Under-nourished patients as identified by the standard nutritional assessment (50.0% (under-nourished) versus 21.6% (nourished); P = 0.017), the two-tiered Mini Nutritional Assessment process (50.0% (under-nourished) versus 21.6% (nourished); P = 0.017) and the rapid screen (56.5% (under-nourished) versus 21.4% (nourished); P = 0.004) were more likely to be discharged to an acute hospital or an accommodation with increased support (poor discharge outcomes) than nourished patients. CONCLUSION: All screening methods identified patients more likely to have a poor discharge outcome. The highly specific but less sensitive 'rapid screen' may be the best method in facilities with limited resources as it can be easily incorporated into nursing/medical admissions and avoids biochemical investigations in all patients. The more sensitive two-tiered Mini Nutritional Assessment is better if resources permit.

Aged↗
PubMed2004

Energy intake and appetite are related to antral area in healthy young and older subjects.

BACKGROUND: Gastric distension reduces food intake, and antral, rather than proximal, gastric distension may be the dominant mechanism in the induction of appetite-related sensations. Healthy aging is associated with reduced appetite. OBJECTIVE: We examined the effects of different energy preloads on appetite, plasma cholecystokinin, antral area, and subsequent energy intake in healthy older and young subjects. DESIGN: On 3 separate days, 12 young and 12 older subjects consumed 400 mL of a drink containing either 0 kcal (water), 250 kcal, or 750 kcal 70 min before a buffet-style meal. RESULTS: Hunger was less in the older than in the young subjects (P < 0.001). Both nutrient preloads reduced hunger and increased fullness more than did water (P < 0.02), and older subjects were more full than were the young (P < 0.05). Antral area was greater after the nutrient preloads than after water (P = 0.001) and greater in the older than in the young subjects (P = 0.005). In both groups, food intake was suppressed in an energy-dependent manner (P = 0.008). Plasma cholecystokinin was greater in the older than in the young subjects (P = 0.003). Immediately before the meal, hunger (r = -0.59) and energy intake (r = -0.90) were inversely related and fullness (r = 0.66) was directly related to antral area (all: P < 0.001). Antral area, but not plasma cholecystokinin, was a predictor of subsequent energy intake. CONCLUSION: In healthy young and older subjects, the suppression of subsequent energy intake by a liquid preload is nutrient dependent and comparable, and both satiation and satiety are related to antral area and (presumably) antral distension.

Adolescent↗
PubMed2004

Malnutrition in older people--screening and management strategies.

BACKGROUND: Malnutrition in older people is not only common, but frequently overlooked. It can result in multiple medical complications, hospitalisation and even death. OBJECTIVE: This article focusses on the consequences, pathophysiology, diagnosis and management of this clinical syndrome. DISCUSSION: Nonphysiological causes of malnutrition include social, psychological, medical and medication related factors. With vigilance, early screening and the institution of simple therapeutic measures of correcting nonphysiological causes and following dietary guidelines for older people, the adverse effects of malnutrition may be minimised.

Aged↗
PubMed2003

Effects of fat digestion on appetite, APD motility, and gut hormones in response to duodenal fat infusion in humans.

The presence of nutrients in the small intestine slows gastric emptying and suppresses appetite and food intake; these effects are partly mediated by the release of gut hormones, including CCK. We investigated the hypothesis that the modulation of antropyloroduodenal motility, suppression of appetite, and stimulation of CCK and glucagon-like peptide-1 secretion by intraduodenal fat are dependent on triglyceride hydrolysis by lipase. Sixteen healthy, young, lean men were studied twice in double-blind, randomized, crossover fashion. Ratings for appetite-related sensations, antropyloroduodenal motility, and plasma CCK and glucagon-like peptide-1 concentrations were measured during a 120-min duodenal infusion of a triglyceride emulsion (2.8 kcal/min) on one day with, on the other day without, 120 mg tetrahydrolipstatin, a potent lipase inhibitor. Immediately after the duodenal fat infusion, food intake at a buffet lunch was quantified. Lipase inhibition with tetrahydrolipstatin was associated with reductions in tonic and phasic pyloric pressures, increased numbers of isolated antral and duodenal pressure waves, and stimulation of antropyloroduodenal pressure-wave sequences (all P < 0.05). Scores for prospective consumption and food intake at lunch were greater, and nausea scores were slightly less, and the rises in plasma CCK and glucagon-like peptide-1 were abolished (all P < 0.05). In conclusion, lipase inhibition attenuates the effects of duodenal fat on antropyloroduodenal motility, appetite, and CCK and glucagon-like peptide-1 secretion.

Adult↗
PubMed2003

Similar effects of foods high in protein, carbohydrate and fat on subsequent spontaneous food intake in healthy individuals.

Pre-loads high in protein, as compared to carbohydrate and fat, produce greater satiety and reduce food intake after a fixed time interval. This study investigated the effect of macronutrient composition on spontaneous eating behaviour. On four separate occasions, 16 fasted, healthy, non-obese men, blinded to the true purpose of the study, consumed iso-energetic ( approximately 3MJ) yoghurt-based pre-loads of equivalent weight ( approximately 0.5 kg), high in fat (40%) [HF], carbohydrate (60%) [HC] or protein (29%) [HP], and no pre-load in a randomized, single-blind fashion. Subjects ate at will from a selection of food items for the remainder of the day (7 h) with the time of food requests (h) and energy content (kJ) and macronutrient distribution (%) of food eaten recorded. The three pre-loads delayed the first spontaneous request for food by 1.5-1.8 h relative to no pre-load. Total spontaneous food intake was suppressed 29% [HP], 20% [HF] and 17% [HC] by the pre-loads. Neither the amount of food eaten per spontaneous eating episode, nor the spontaneous eating frequency differed statistically following ingestion of the different pre-loads or no pre-load. In this study, in subjects who were free to choose when as well as how much they ate, a high-protein pre-load exerted similar effects on satiety as did iso-energetic high-fat and high-carbohydrate pre-loads.

Adolescent↗
PubMed2003

The nutritional status of 250 older Australian recipients of domiciliary care services and its association with outcomes at 12 months.

OBJECTIVES: To identify predictors and consequences of nutritional risk, as determined by the Mini Nutritional Assessment (MNA), in older recipients of domiciliary care services living at home. DESIGN: Baseline analysis of subject characteristics with low MNA scores (<24) and follow-up of the consequences of these low scores. SETTING: South Australia. PARTICIPANTS: Two hundred fifty domiciliary care clients (aged 67-99, 173 women). MEASUREMENTS: Baseline history and nutritional status were determined. Information about hospitalization was obtained at follow-up 12 months later. INTERVENTION: Letters suggesting nutritional intervention were sent to general practitioners of subjects not well nourished. RESULTS: At baseline, 56.8% were well nourished, 38.4% were at risk of malnutrition, and 4.8% were malnourished (43.2% not well nourished). Independent predictors of low MNA scores (<24) were living alone, and the physical and mental component scales of the 36-item Short Form Health Survey. Follow-up information was obtained for 240 subjects (96%). In the ensuing year not well-nourished subjects were more likely than well-nourished subjects to have been admitted to the hospital (risk ratio (RR) = 1.51, 95% confidence interval (CI) = 1.07-2.14), have two or more emergency hospital admissions (RR = 2.96, 95% CI = 1.15-7.59), spend more than 4 weeks in the hospital (RR = 3.22, 95% CI = 1.29-8.07), fall (RR = 1.65, 95% CI = 1.13-2.41), and report weight loss (RR = 2.63, 95% CI = 1.67-4.15). CONCLUSION: The MNA identified a large number of subjects with impaired nutrition who did significantly worse than well-nourished subjects during the following year. Studies are needed to determine whether nutritional or other interventions in people with low MNA scores can improve clinical outcomes.

Aged↗
PubMed2002

Glycemic, hormone, and appetite responses to monosaccharide ingestion in patients with type 2 diabetes.

To investigate the relative effects of fructose and glucose on blood glucose, plasma insulin and incretin (glucagon-like peptide-1 [GLP-1] and gastric inhibitory peptide [GIP]) concentrations, and acute food intake, 10 (6 men, 4 women) patients with diet-controlled type 2 diabetes (diabetic) (44 to 71 years) and 10 age and body mass index (BMI)-matched (6 men, 4 women) nondiabetic, control subjects with varying degrees of glucose tolerance (nondiabetic), were studied on 3 days. In random order, they drank equienergetic preloads of glucose (75 g) (GLUC), fructose (75 g) (FRUCT) or vehicle (300 mL water with noncaloric flavoring [VEH]) 3 hours before an ad libitum buffet lunch. Mean glucose concentrations were lower after FRUCT than GLUC in both type 2 diabetics (FRUCT v GLUC: 7.5 +/- 0.3 v 10.8 +/- 0.4 mmol/L, P <.001) and nondiabetics (FRUCT v GLUC: 5.9 +/- 0.2 v 7.2 +/- 0.3 mmol/L, P <.05). Mean insulin concentrations were approximately 50% higher after FRUCT in type 2 diabetics than in nondiabetics (diabetics v nondiabetics: 23.1 +/- 0.7 v 15.1 +/- 1.3 microU/mL; P <.0001). Plasma GLP-1 concentrations after fructose were not different between type 2 diabetics and nondiabetics (P >.05). Glucose, but not FRUC, increased GIP concentrations, which were not different between type 2 diabetics and nondiabetics (P >.05). Food intake was suppressed 14% by GLUC (P <.05 v CONT) and 14% by FRUC (P <.05 v CONT), with no difference between the amount of food consumed after GLUC and FRUC treatment in either type 2 diabetics or nondiabetics (P >.05). We have confirmed that oral fructose ingestion produces a lower postprandial blood glucose response than equienergetic glucose and demonstrated that (1) fructose produces greater increases in plasma insulin concentration in type 2 diabetics than nondiabetics, not apparently due to greater plasma incretin concentrations and (2) fructose and glucose have equivalent short-term satiating efficiency in both type 2 diabetics and nondiabetics. We conclude that on the basis of improved glycemic control, but not satiating efficiency, fructose may be useful as a replacement for glucose in the diet of obese patients with type 2 diabetes.

Adult↗