Sodium intake and mortality.
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Energy Intake↗
Biomedical subjects
K Engelman
Publications and source records attributed to K Engelman.
Palatability and dietary restraint: effect on cephalic phase insulin release in women.
The palatability of food has been shown to influence the cephalic phase reflexes. To determine if food palatability affects the magnitude of cephalic phase insulin release (CPIR) in humans, normal-weight women were asked to list foods that they found palatable and unpalatable. Subjects then stayed overnight in the hospital on two separate days. On each morning following an overnight fast, an intravenous line was inserted and arterialized venous blood drawn for the measurement of plasma insulin and glucose. Blood samples were taken prior to and following a modified sham-feed. Subjects sham-fed the palatable or unpalatable foods (that they had previously identified) for a 2-min period. Foods were administered in a counterbalanced order. During the protocol, hunger and food palatability were monitored. The Three Factor Eating Questionnaire was administered to assess eating attitudes. No significant difference in the magnitude of cephalic phase insulin release was found between the two treatments. However, a statistically significant correlation (r = 0.61, p < 0.05) was found between an individual's degree of dietary restraint as measured by the Three Factor Eating Questionnaire and the magnitude of CPIR. These data suggest that the sensory attributes of food may play less of a role in modulating CPIR than an individual's psychological attitude towards food.
Adult↗
Oral sensory stimulation improves glucose tolerance in humans: effects on insulin, C-peptide, and glucagon.
In animals, bypassing the oropharyngeal receptors by intragastric administration of glucose results in glucose intolerance. To determine whether the absence of oral sensory stimulation alters glucose tolerance in humans, we monitored plasma levels of glucose and hormones after intragastric administration of glucose, with and without subjects tasting food. Plasma glucose area under the curve (AUC) was significantly lower after oral sensory stimulation (3,433 +/- 783 vs. 5,643 +/- 1,397 mg.dl-1. 195 min-1; P < 0.03; n = 8). Insulin and C-peptide AUCs were higher during the first one-half of the sampling period (insulin, 5,771 +/- 910 vs. 4,295 +/- 712 microU. ml-1.75 min-1; P < 0.05; C-peptide, 86 +/- 10 vs. 66 +/- 9 ng.ml-1. 75 min-1; P < 0.03) and lower during the second one-half of the sampling period compared with the control condition (1,010 +/- 233 vs. 2,106 microU.ml-1. 120 min-1; P < 0.025; 31 +/- 8 vs. 56 +/- 18 ng.ml-1. 120 min-1; P < 0.05; insulin and C-peptide, respectively). Oral sensory stimulation markedly increased plasma glucagon compared with the control condition (1,258 +/- 621 vs. -2,181 +/- 522 pg.ml-1. 195 min-1; P < 0.002). These data provide evidence in humans that oral sensory stimulation influences glucose metabolism and suggest that the mechanisms elicited by this cephalic stimulation are necessary for normal glucose homeostasis.
Adult↗
Sweet taste: effect on cephalic phase insulin release in men.
To determine whether sweet-tasting solutions are effective elicitors of cephalic phase insulin release (CPIR) in humans, two studies were conducted using nutritive and nonnutritive sweeteners as stimuli. Normal weight men sipped and spit four different solutions: water, aspartame, saccharin, and sucrose. A fifth condition involved a modified sham-feed with apple pie. The five stimuli were administered in counterbalanced order, each on a separate day. In study 1, subjects tasted the stimuli for 1 min (n = 15) and in study 2 (n = 16), they tasted the stimuli for 3 min. Arterialized venous blood was drawn to establish a baseline and then at 1 min poststimulus, followed by every 2 min for 15 min and then every 5 min for 15 min. In both study 1 and study 2, no significant increases in plasma insulin were observed after subjects tasted the sweetened solutions. In contrast, significant increases in plasma insulin occurred after the modified sham-feed with both the 1 min and 3 min exposure. These results suggest that nutritive and nonnutritive sweeteners in solution are not adequate stimuli for the elicitation of CPIR.
Adolescent↗
Cannabinoids and appetite stimulation.
Appetite stimulation by cannabinoids is highly variable. Four within-subject design studies explored the effects of age, gender, satiety status, route of drug administration, and dose on intake. One study involved a single oral administration of active drug (15 mg males, 10 mg females) or placebo to an age and gender stratified sample of 57 healthy, adult light marijuana users. Eleven subjects received single doses by oral, sublingual, and inhaled routes in a second study. In the third study, 10 subjects ingested a single oral dose in fasted and fed states. A 2.5 mg dose was administered b.i.d. for 3 days by oral and rectal suppository routes in the fourth study. Mean daily energy intake was significantly elevated following chronic dosing by rectal suppository, but not oral capsule, relative to all acute dosing regimens except inhalation. Total daily energy intake was comparable on fed and fasted days, suggesting satiety mechanisms were not impaired by the drug. Subject age, gender, reported "high," and plasma drug level were not significantly associated with drug effects on food intake.
Adult↗
Effects of cannabinoids (marijuana) on taste intensity and hedonic ratings and salivary flow of adults.
Cannabinoids purportedly improve taste responsiveness and enhance the sensory appeal of foods. These properties and a commonly cited oral drying effect were evaluated in a series of studies with 'light' marijuana users. The first was a double-blind, placebo-controlled, acute oral dosing trial, involving an age and gender stratified sample of 57 adults. An influence of route of drug delivery was explored in another 11 individuals who were administered a single dose orally, sublingually and via cigarette. To explore effects following chronic administration, six additional individuals were dosed twice per day for 3 days orally and by rectal suppository. Taste intensity and hedonic responses for sweet, sour, salty and bitter food stimuli were monitored at baseline, 2, 4 and 6 hours post-dosing in the acute studies, and daily in the chronic study. Stimulated saliva samples were collected at these same times. Salivary flow rate was significantly negatively correlated with plasma drug levels, and reported 'high' 2 and 4 h post-dosing. No effects of the drug were observed on taste responses. Self-reported shifts in taste responsiveness and hedonics may be related to alterations of memory and cognition, rather than gustatory function.
Administration, Inhalation↗
Cephalic-phase insulin in obese and normal-weight men: relation to postprandial insulin.
Cephalic-phase insulin release (CPIR) and its relation to postprandial insulin release were examined in 18 normal-weight and 15 obese men. When the insulin data were expressed as absolute differences from baseline values, obese subjects exhibited significantly greater CPIR than normal-weight subjects (normals, 8.7 +/- 2.1 microU/mL/10 min; obese, 13.4 +/- 4.3 microU/mL/10 min; P < .01). Obese subjects were then separated into groups depending on their fasting insulin levels. This showed that only those subjects with elevated fasting insulin levels exhibited greater CPIR than normal subjects, and suggested that previous reports of exaggerated CPIR in the obese are merely a reflection of a basal hypersecretion of insulin. However, when insulin values were expressed as percentages of baseline, no significant differences between normal-weight and obese subjects were found, although a trend toward an attenuated response was observed in the obese group as a whole (normals, 81.6 +/- 19.1 microU/mL/10 min; obese, 51.3 +/- 16.1 microU/mL/10 min). A significant correlation between cephalic-phase and postprandial insulin release was found in normal-weight subjects (r = .62, P < .05), but not in obese subjects (r = .02, P < .9).
Adult↗
Bypassing the first-pass effect for the therapeutic use of cannabinoids.
An oral formulation of delta-9-tetrahydrocannabinol (THC) in sesame oil (Marinol) is at present used for the management of chemotherapy-related nausea and emesis. However, due partly to poor bioavailability, its efficacy is variable. To circumvent possible metabolism in the gut and a first-pass effect by the liver, a suppository formulation of THC hemisuccinate ester was prepared. Administration of the suppository containing 11.8 mg of the hemisuccinate ester (equivalent to 9 mg THC) to three adult females (two of whom had previously exhibited low plasma drug levels following a 10-mg dose of the oral formulation) led to a marked and sustained elevation of plasma drug levels. Areas under the curves for plasma THC were more than 30-fold higher than after oral dosing. The suppository was well tolerated. The higher and more sustained plasma drug level achieved with this new formulation should enhance its antiemetic efficacy.
Adult↗
Oral sensory stimulation in men: effects on insulin, C-peptide, and catecholamines.
To investigate the effect of oral sensory stimulation on cephalic phase insulin release (CPIR) and other compounds associated with glucose metabolism, a modified sham feed was used in which male subjects (n = 15) tasted, chewed, and then expectorated the food stimulus. Subjects remained fasted, sham fed, or ingested food on separate days over a 5-day period. After four baseline blood samples, poststimulus samples were taken every 2 min for 14 min and then every 15 min for 2.25 h. Increases in plasma insulin and C-peptide were found during the cephalic phase time period (0-10 min poststimulus) on the sham-fed and fed conditions when compared with fasted values. Glucose, norepinephrine, epinephrine, and free fatty acids were not affected by oral sensory stimulation or food ingestion during the cephalic phase period. The magnitude and profile of CPIR were similar after sham feeding and food ingestion. This study demonstrates that oral sensory stimulation can elicit CPIR in humans independently of changes in blood glucose.
Adult↗
Effects of combined hydrochlorothiazide and amiloride versus single drug on changes in salt taste and intake.
Hydrochlorothiazide stimulates salt intake without altering salivary or gustatory function. Amiloride reportedly reduces salivary sodium levels and salt taste. It was hypothesized that these unintended drug actions would be attenuated by concurrent use of these 2 diuretics. Normotensive adults (n = 23) were administered placebo for 2 weeks, active combination drug Moduretic for 4 weeks, and placebo again for 2 weeks in a double-blind protocol. Salivary flow, gustatory function and sodium intake were monitored at the end of each period, together with selected physiologic measures (i.e., plasma aldosterone, plasma renin activity, body composition, blood pressure and heart rate). No significant changes were observed for salivary flow, salt taste or sodium intake. These findings indicate that amiloride and hydrochlorothiazide used in combination can reduce drug effects that may compromise the efficacy of either drug when used alone.
Adult↗
Cephalic phase insulin release in normal weight males: verification and reliability.
The existence and reliability of cephalic phase insulin release (CPIR) were tested in 20 normal weight males. Each subject was challenged three times with the same food stimulus over a 5-day period. Four baseline blood samples were taken at 5-min intervals before food ingestion and then every 2 min for 16 min postingestion. Significant increases in plasma insulin were found at 4 min postingestion on each trial day. CPIR was found to be highly reproducible between trials (r = 0.83; P less than 0.001). Fifty percent of the subjects exhibited a significant increase of plasma insulin above their own baseline mean on the first trial, whereas 75 and 72% exhibited increases on trials 2 and 3, respectively. Only two subjects (10%) did not demonstrate a response on any trial. A significant decline in plasma glucose was observed at 4 min postingestion on trials 2 and 3. No significant changes in plasma glucagon were found during any trial day. This study confirms a reliable CPIR in normal weight males.
Adult↗
Naltrexone, an opioid blocker, alters taste perception and nutrient intake in humans.
To test the hypothesis that reduced food intake produced by opioid blockade is due to a reduction in the pleasant aspects of tastes, 18 fasted male college students rated the intensity and pleasantness of soup that contained various concentrations of NaCl and of Kool-Aid that contained various concentrations of sucrose at hourly intervals after ingesting either naltrexone (50 mg) or a placebo in a double-blind study. Hunger, fullness, nausea, and current mood state were also assessed. Lunch followed and food intake was recorded. After placebo, the pleasantness of the salted soup increased as lunchtime approached. After naltrexone, however, soup pleasantness remained unchanged across time. Similar changes were obtained for perceived sweetness and pleasantness of Kool-Aid and for the perceived saltiness of soup. Naltrexone also blocked the increases in hunger ratings that occurred across time in the placebo condition. Nausea was higher after naltrexone. After naltrexone, subjects consumed approximately 500 kcal less at lunch than after placebo. Analysis of covariance suggested that decreased hunger (but not nausea or taste pleasantness) accounted for the naltrexone-induced reduction of food intake.
Adult↗
High salt intake. Sensory and behavioral factors.
Salt (NaCl) is a ubiquitous component of diets in developed countries. A major reason for this is that people judge many salted foods as more palatable than the same foods without salt. Because recent evidence indicates that an acceptable salt substitute is unlikely, an understanding of the behavioral and sensory factors involved in maintaining high salt preference is a prerequisite to successful programs aimed at reducing intake. Although little evidence exists for a genetic determination of individual differences in consumption and preferred level of salt, more research in this area is necessary. Considerable data support the view that the optimal level of salt in the diet is determined in part by the level an individual is currently consuming; increasing or decreasing customary salt intake, as long as the salt is tasted, increases or decreases the preferred level of salt in food. Although these data are consistent with a hypothesis that optimal salt preferences are learned, other data, from both animal models and human developmental studies, suggest that salt preference has an innate component. Furthermore, early experience with low or high salt diets may have a long-term impact on preferred salt levels. Liking for salt, similar to liking for sweets, has an innate basis that can be modified by individual experience.
Behavior↗
Experimental sodium depletion and salt taste in normal human volunteers.
To examine the sensory effects of extreme sodium depletion in humans, 10 normal volunteers were fed a very-low-sodium diet and were treated with diuretics for 10 d. Urine samples were collected and blood was drawn for hormone analyses. Taste tests included threshold and intensity judgments of salt (NaCl) and sucrose and preferences for salt and sucrose in foods. Subjects also rated the pleasantness of 29 foods listed on a questionnaire. Substantial sodium depletion was induced in all subjects. Salt thresholds decreased in a majority of the subjects whereas preference judgments for salt in foods tended to be greater during the depletion period. The changes in pleasantness of the 29 foods revealed that saltier foods were substantially more attractive during the depletion period than during the pre- and postdepletion periods. These data indicate that experimental sodium depletion in humans is followed by moderate sensory changes and an increased preference for salty foods.
Adult↗
Effects of hydrochlorothiazide and amiloride on salt taste and excretion (intake).
The effects of hydrochlorothiazide (HCTZ) and amiloride on salt excretion (intake) and taste were examined in 73 normotensive adults (aged 18 to 56) who were randomly assigned to receive 50 mg/day of HCTZ (n = 24), 5 mg twice daily of amiloride (n = 24) or placebo (n = 25) for 8 weeks. Two and three week placebo periods preceded and followed active treatment, respectively. Relative to baseline, significant increases in sodium excretion (intake) of 31%, 53% and 30% were observed in subjects receiving HCTZ after 2, 4 and 8 weeks of treatment, respectively. An identical follow-up study with 16 subjects replicated the sodium excretion (intake) findings, but failed to reveal the source of the extra dietary sodium. Doubling the dose of amiloride in 11 additional subjects led to higher aldosterone excretion relative to thiazide-treated subjects, but did not increase salt excretion (intake) over a four week period. Only amiloride-treated subjects displayed significant increases in salt taste sensitivity. The increased sodium intake in HCTZ-treated patients may partially offset the desired effects of therapy and exacerbate potassium wasting.
Adolescent↗
Perivesicle pheochromocytoma: the role of iodine-131-MIBG imaging.
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3-Iodobenzylguanidine↗
Localization of pheochromocytoma: MIBG [correction of MIGB], CT, and MRI correlation.
Nineteen patients (8 M, 11F) ranging in age from 15 - 67 yr old (mean = 39 yr) with clinically diagnosed pheochromocytomas were prospectively evaluated with 131I metaiodobenzyl-guanidine (MIBG) scintigraphy (n = 19), computed tomography (CT) (n = 19), and magnetic resonance imaging (MRI) (n = 17) in order to determine their relative diagnostic efficacy. Pathologic confirmation was obtained in all 19 patients: 13 intraadrenal and six extraadrenal with metastases in five (Table 1). All three imaging modalities were in agreement in 11 of 14 completed examinations (79%). MIBG and CT agreed in 16 of the 19 patients in whom both were performed (84%). MIBG/MR and CT/MR results were concordant in 12 of 14 (86%) and 13 of 14 (93%) jointly completed examinations, respectively. There was one false-negative (FN) MIBG scan, two FN CT scans, and one FN MR scan. MIBG, CT, and MRI are complementary procedures with MIBG providing more specific functional information and the latter two superior anatomic detail. MIBG scintigraphy is recommended as the initial localizing study of choice (especially for the detection of extraadrenal disease and postoperative recurrence), as a guide for CT and/or MR and specific functional confirmation of their findings. Although MRI is capable of imaging in multiple planes (without exposure to ionizing radiation or the need for i.v. contrast material) with superior contrast compared to CT, it is expensive and has poor patient cooperation. However, it may be capable of differentiating pheochromocytomas from other adrenal masses on the basis of signal characterization.
3-Iodobenzylguanidine↗