[Recommendations for the prevention of atherosclerosis and ischemic heart disease. Detection and treatment of persons with increased lipids in adulthood].
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Biomedical subjects
Publications and source records attributed to P Hrabák.
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One-month treatment of obese patients (body mass index, 39.44 +/- 0.94, measured in kg/m2) with a very-low-calorie diet (VLCD) resulted in a significant weight loss, which was higher in men than in women. In contrast, the decrease of percent fat content was higher in gynoid obese women than in men or women with android fat distribution. In females fat mobilization was depressed at the thigh region where a substantially lower percent decrement of thigh skinfold thickness was demonstrated in comparison with males. VLCD treatment positively affected blood pressure and concentrations of total cholesterol, triglyceride, insulin, and cortisol. Total cholesterol-high-density-lipoprotein (HDL) cholesterol ratio remained unchanged and HDL cholesterol in serum significantly declined. Indexes of body fat distribution were not significantly influenced by the short-term treatment by VLCD except waist-hip ratio, which declined in android obese females. VLCD does not decrease a tolerance of physical exercise, as the metabolic response to submaximal workload on a cycle ergometer as well as the responses of cortisol, growth hormone, and prolactin remained unchanged after the treatment.
To evaluate a long-term efficacy of very-low-calorie-diet (VLCD) treatment, 42 obese patients were reexamined 1 y after the initiation of the weight reduction by VLCD treatment for 1 mo. All the subjects participating in the long-term outpatient weight-reduction regime were divided into weight losers and regainers according to the weight change achieved at the end of 1-y follow-up. A final body weight decrease in weight losers was followed by a significant decline of total cholesterol-high-density-lipoprotein (HDL) cholesterol ratio together with significant rise of serum HDL cholesterol whereas almost all skinfold thicknesses declined. In weight regainers the sum of 10 skinfold thicknesses was the same at the end of follow-up as at the beginning of VLCD treatment, but body fat distribution was shifted towards the gynoid type when individual skinfold thicknesses were assessed. However, among the generally employed indexes of body fat distribution only waist-thigh ratio significantly decreased in weight losers. Nonsignificant differences in serum concentrations of total cholesterol, HDL cholesterol, and triglycerides between weight regainers and weight losers at the end of long-term follow-up suggest that some kind of adherence to weight reduction regime including physical exercise may favorably affect the lipid profile as well as body fat distribution independently on the body weight regained.
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A group of 28 patients with primary hyperlipoproteinaemia [19X lipoprotein (LP) type IIA, 8X type IIB and 1X a normolipidaemic patient with concurrent hyperapoB lipoproteinaemia] were given for a period of three weeks a dietetic preparation containing phytosterols - 12 g/day. This led to a significant drop of total cholesterol and LDL-cholesterol in plasma. The cholesterol concentration in HDL and both its fractions increased, the differences however were not significant. The triglyceride levels did not change. There was a significant drop of the apolipoprotein B (apo-B) concentration in LDL, the apo-A-I in plasma did not change. There was a significant drop of atherogenic indexes TC/HDL-C, LDL-C/HDL-C and apo-B/-A-I. During investigation of the LCAT activity the authors observed a significant rise of the fractional esterification rate associated with a highly significant drop of the free cholesterol concentration in plasma as a result of treatment. Discrimination analysis of parameters of the lipoprotein metabolism and the patients' body weight before treatment helps to assess a function by means of which it is possible in 92.3% of the subjects to predict the success of treatment before the administration of beta-sitosterol.
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The energy economy induced by a reducing diet and manifested by a reduced energy output at rest threatens greatly the long-term success of reducing regimes. The authors investigated the effect of a four-week therapy of obese patients by a low energy protein diet with an energy value of 1560 kJ on the resting metabolic rate (RMR), the serum concentration of thyroid hormones and TSH and on the Achilles tendon reflex time. Four weeks' treatment with a low energy protein diet caused a significant drop of the energy output at rest in the control group of obese men (by 17.5%), as well as in the control group of obese women (by 16.9 per cent). In the group of obese women who were given during the last two weeks of treatment depot methyl xanthine derivative, Euphilline (Byk Gulden), the energy output at rest did not decline as a result of dietetic treatment and the decline of the BMI was significantly higher than in the control group of obese women, although the two groups did not differ in the initial BMI, mean age and the degree of physical activity during treatment. With the exception of the control group of men where the serum triiodothyronine level declined, in the investigated obese subjects no significant changes of the investigated thyroid function parameters were recorded. The syndrome of low T3 thus does not participate in a substantial way in the drop of the metabolism at rest during treatment with a low energy protein diet, obviously due to the intake of 50 g carbohydrate per day.(ABSTRACT TRUNCATED AT 250 WORDS)
The effects of polyunsaturated fatty acids of the omega-3 family (PUFA n-3), (addition of fish oil), on the molecular composition of cholesteryl esters and triglycerides in plasma and liver perfusate of rats were studied. Rats fed a diet rich in saturated fatty acids (addition of lard) served as controls. Supplemention with PUFA n-3 not only decreases the plasma concentrations of free cholesterol, cholesteryl esters, and triglycerides, it also significantly alters the plasma composition of cholesteryl esters and triglycerides. Analyses of liver perfusate indicate a decrease in triglycerides secretion by in vitro perfused liver and reciprocal changes in relative contents of cholesteryl esters fractions with C(16) and C(20) acyl chains. This finding may be a result of chain-shortening of long-chain fatty acids probably in peroxisomal beta-oxidative system. Alterations in plasma cholesteryl esters and triglycerides composition of the fish oil group could be affected further by additional factors such as increased plasma cholesterol esterification activity and presence of triglyceride species of intestinal origin.
The low-energy protein diet providing 1559 kJ is the first accurately defined diet for the treatment of obesity in the CSSR. The daily amount contains 4.0 g fat, 33.0 g protein, 50.0 g carbohydrate, 5.6 g fibre and daily recommended allowances of vitamins. The diet is enriched with potassium, magnesium and iron. The low-energy protein diet was used for a period of 28 days in the treatment of 49 obese patients aged 40.49 +/- 1.39 years whose initial weight was 110.14 +/- 3.41 kg and the BMI 39.44 +/- 1.13. The therapeutic regime comprised in addition to the diet adequate physical exercise of aerobic character and training of correct eating behaviour. Four weeks treatment led to a significant decline of body weight (by 10.60 +/- 0.46 kg) and a significant drop of the BMI (by 3.65 +/- 0.16). Men lost more weight than women. In women a substantial drop of the body weight (90.5%) was due to reduction of body fat, while in men adipose tissue participated by 60.0% in the loss. During the fourth week of treatment a positive nitrogen balance was achieved, obviously due to adequate physical exercise. The waist/hip ratio was not affected by treatment in either group. The therapeutic regime influenced favourably some risk factors of ischaemic heart disease. In addition to a significant drop of the systolic and diastolic blood pressure a significant decline of total cholesterol, triacylglycerols and serum insulin occurred. There was a concurrent decline of the urinary C-peptide excretion. The therapeutic regime involving the low-energy protein diet was well tolerated by the patients. The incidence of side effects during treatment was less frequent than in treatment by intermittent fasts. No disorders of the cardiac rhythm were recorded during treatment.
The Czechoslovak low-energy protein diet contains 1559 kj per day, incl. 33.0 g protein, 50 g carbohydrate, 4.0 g fat, 6.0 g fibre and recommended vitamin and mineral allowances. The diet was administered to 75 subjects with a mean age of 39.88 +/- 1.21 years and a body weight of 112.57 +/- 2.89 kg, and a body weight index (BMI) of 39.44 +/- 0.94, for 28 days. During treatment the body weight declined by 9.67 +/- 0.41 kg and the BMI by 3.74 +/- 0.20. At the same time there was a significant decline of the total cholesterol (p less than 0.001), LDL cholesterol (p less than 0.001), HDL cholesterol (p less than 0.01) and triacylglycerols (p less than 0.05). In 20 subjects with hyperlipidaemia similar changes of the total cholesterol and LDL cholesterol were recorded, while the decrease of HDL cholesterol (p less than 0.001) and triacylglycerols (p less than 0.001) was more marked. The nitrogen balance became during the fourth week on the diet positive (+0.64 g), there was a transitory decline of the total protein concentration. The serum amino acid concentration did not change significantly with the exception of isoleucine, the level of which increased. The serum immunoglobulin concentration did not change significantly. It may be concluded that the low-energy protein diet has a favourable impact on the lipid metabolism, without a marked negative effect on the protein metabolism.
A twelve-day reducing regime involving exercise and a reducing diet (2.5 MJ/day), led in 23 obese women to an average loss of body weight of 4.52 +/- 0.35 kg. The loss of adipose tissue during the reducing regime was greater than the total loss of body weight, obviously due to proliferation of lean body mass as a result of exercise. Concurrently a significant decline of the mean morning concentration of thyroxine, triiodothyronine, C-peptide and STH in serum was recorded, while the concentration of TSH, cortisol, prolactin, LH and FSH increased insignificantly and the concentration of insulin and testosterone declined insignificantly. Exercise thus did not prevent a decline of triiodothyronine induced by the low energy diet. The exercise in the morning did not cause a stress conditioned increase of the secretion of cortisol, prolactin and STH at the onset and at the end of the reducing regime. From the metabolic aspect the favourable absence of the stimulating action of exercise on cortisol secretion is due to the character of motor activity (40-50% VO2max). The absence of a stress conditioned rise of prolactin during exercise prevents the inhibiting action of prolactin on gonadal functions. The reducing regime has also a favourable effect on insulin secretion, as on the 12th day of the reducing regime there was a significant decline of the serum level of immunoreactive insulin in the course of exercise.
In clinical evaluation of a new type of automatic sphygmomanometer, a strict comparability of results with the standard indirect auscultatory method is required. We have compared the oscillometric apparatus BP 103 N Nippon Colin (B) with the Hawksley random zero mercury sphygmomanometer (A) in a stratified sample of 26 subjects using a cross-over design of four simultaneous pairs of measurements in both arms by two observers. Mean values obtained by machine B were higher than values obtained by machine A, by 0.56 kPa systolic and by 0.62 kPa diastolic. Analysis of variance showed that the differences between both machines were within the random variability of blood pressure values obtained, and therefore irrelevant at single measurements. In case of blood pressure measurements in an epidemiological study, a correction of values should be done using the regression model B = K. Ac.
A new very low energy formula diet containing 1560 kJ (373 kcal) per day was employed in the treatment of 49 obese patients. The treatment, of 4 weeks duration, included aerobic physical exercise and behavioural intervention. This kind of therapy resulted in a significant decrease (P less than 0.001) of both weight (-10.60 +/- 0.46 kg) and body mass index (-3.36 +/- 0.16). The fat stores represented 90.5 per cent of weight loss in women and 60.0 per cent of weight loss in men. The first very low energy formula diet produced in Czechoslovakia proved to be an efficient and safe tool for the treatment of obesity, positively affecting high blood pressure, lipid and carbohydrate metabolism in the absence of serious side-effects.
In clinical evaluation of a new type of automatic sphygmomanometer, a strict comparability of results with the standard indirect auscultatory method is required. We have compared the oscillometric apparatus BP 103 N Nippon Colin (B) with the Hawksley random zero mercury sphygmomanometer (A) in a stratified sample of 26 subjects using a cross-over design of four simultaneous pairs of measurements in both arms by two observers. Mean values obtained by machine B were higher than values obtained by machine A, by 0.56 kPa systolic and by 0.62 kPa diastolic. Analysis of variance showed that the differences between both machines were within the random variability of blood pressure values obtained, and therefore irrelevant at single measurements. In case of blood pressure measurements in an epidemiological study, a correction of values should be done using the regression model B = K. A degrees.
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The automatic oscillometric Nippon Colin BP-103N blood pressure-monitor was evaluated in comparison with the Hawksley random zero mercury sphygmomanometer using standard methods. The monitor under test was found significantly to over-read mean systolic pressures by 4.2 mmHg and mean diastolic pressures by 4.6 mmHg. The coefficient of variation was 5.4% for systolic and 6.4% for diastolic pressures. Analysis of variance showed that the difference between the two manometers was within the random variability of readings obtained.