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PubMed1994

Plasma renin predicts success of antihypertensive drug withdrawal.

This study examined the relationship of plasma renin activity (PRA) to the likelihood of maintaining blood pressure control after discontinuation of antihypertensive medication. Patients whose blood pressure was previously treated and controlled in the Hypertension Detection and Follow-up Program were enrolled in the Dietary Intervention Study of Hypertension. After stratification by obesity, patients were randomized to discontinue medication with no dietary intervention, sodium restriction, or weight reduction for the obese. Among 496 subjects in the Dietary Intervention Study of Hypertension, 75 were randomly selected for PRA measurement at 4 months after intervention, and all had their blood pressure under control at that time. Patients were followed up for 56 weeks after randomization. The endpoint was return to antihypertensive medication due to elevated diastolic blood pressure. Kaplan-Meier survival analysis showed that subjects with PRA < or = 53.3 ng/100 mL/h, the median level, had a lower cumulative success rate for remaining off antihypertensive drug than those with PRA above the median (P = .046). In Cox regression analysis controlling for 24-h urinary sodium level, baseline diastolic blood pressure, age, sex, race, obesity, and dietary intervention group, a unit decrease in log PRA was associated with a 2.78-fold increase in risk of returning to drug (P = .006); this inverse relationship was independent of dietary intervention and change in diastolic blood pressure in the first 4 months before PRA was measured. The data indicate that patients with low PRA are less likely to maintain blood pressure control without drugs than patients with high PRA.

Age Factors↗

PubMed1989

Exercise inhibits progressive growth of the Morris hepatoma 7777 in male and female rats.

Male and female rats were either trained to swim for a 6-week period or they remained sedentary. Rats were implanted with Morris hepatoma 7777 after 3 weeks of swimming and were sacrificed after a further 3 weeks. Exercised rats of both sexes showed a significant reduction in tumour weight at sacrifice, compared with sedentary controls (p less than 0.01). Similarly, when rats were first implanted with tumours and then placed on an exercise program of 3 weeks duration, tumour growth was also reduced (p less than 0.05). These results suggest that the tumour may be sensitive to exercise at more than one point in its development. Tumour growth was inhibited to a similar extent whether the total swimming time was 10, 20, or 30 h over the 3-week period. Although sedentary, tumour-bearing rats were anorexic; both male and female rats showed significant improvement of appetite during the period of tumour growth, in response to exercise. Tumour implantation was associated with significant losses of whole body and muscle protein. The progression of this wasting was not significantly altered by exercise.

Animals↗

PubMed1997

Cardiovascular risk factor screening and intervention in African American adults.

The Cardiac Health and Rehabilitation program of St. Thomas Hospital in Nashville, Tennessee, has developed a project to assess the effectiveness of a community-based cardiovascular risk assessment and intervention program directed at African American adults. The specific aim of this program is to assess the feasibility of implementing a community-based cardiovascular disease risk factor reduction program directed at African American adults. Its ultimate goal is to be able to teach African American adults cost-efficient, simple methods of exercise, nutrition, and weight management; smoking cessation; and blood pressure control. The program is expected to raise the African American community's awareness of the importance of modifiable cardiovascular disease risk factors and their effect on cardiac morbidity and mortality. The program is also expected to be able to evaluate the success of cardiovascular disease risk factor intervention and patient satisfaction with the program.

Adolescent↗

PubMed1991

Reversibility of fixed atherosclerotic lesions with aggressive risk factor modification.

Seven patients with atherosclerotic coronary artery disease documented by coronary angiography and exercise stress testing were treated with the American Heart Association Step II Diet, a walking program, and combination drug therapy with niacin, cholestyramine, gemfibrozil, and/or lovastatin. As a result of this intervention, there was a mean weight loss of 24.7 pounds, a mean reduction in cholesterol from 297 mg% to 167 mg%, a mean increase in high density lipoprotein cholesterol from 33 mg% to 55 mg%, and a mean reduction in triglyceride levels from 248 mg% to 58 mg%. Repeat exercise stress testing and coronary angiography were performed 2 years after the initial catheterization. Photographs of end-diastolic frames were compared utilizing the same views with the same magnification. In six of the seven patients, there was a mean increase in luminal area at the greatest stenosis of 1.3 mm2 in eight lesions present at initial catheterization. In four of these six patients, there was evidence for improvement in coronary blood flow manifested by improvement in electrocardiogram (ECG) exercise stress testing and/or exercise thallium stress testing. In one patient, there was a mean decrease in luminal area at greatest stenosis of 1.35 mm2 in two lesions and the development of an additional plaque in an area which was previously normal. In addition, this patient had evidence for progression by ECG exercise stress testing. Aggressive risk factor modification can reverse what were previously considered "fixed" atherosclerotic lesions in selected patients.

Aged↗

PubMed1983

Absence of cardiac arrhythmias during a very-low-calorie diet with high biological quality protein.

Fourteen women who were at least 50 lb (22.7 kg) overweight entered the 15 week study which included 4 weeks of 1200 cal (5028 J) balanced diet followed by 7 weeks on a very-low-calorie diet (VLCD) and 4 weeks of refeeding. During the VLCD high biological quality protein (poultry, fish) and recommended supplements of vitamins, minerals and water were used. With the exception of week 5 and 14, 25-h Holter monitorings were done weekly. During the initial 4 weeks, 2 patients showed disturbances of cardiac rhythm and were discharged from the study. Twelve patients completed the trial without any clinically significant changes in cardiac rhythm. The 12 lead ECGs remained normal in all patients throughout the study. The average weight loss was 46 lb (20.9 kg) and the whole program was well tolerated. It is concluded that seven weeks of VLCD with high biological quality protein and recommended supplements appears to be a safe method for weight reduction for severely obese patients.

Adult↗

PubMed1994

Physical performance is maintained in women consuming only foods used on the U.S. Space Shuttle.

In-flight reductions in caloric intake, body weight, lean body mass (LBM), aerobic capacity, and other measures of physical performance have been consistent findings in the U.S. and Russian space programs. The diet provided for astronauts in space has been suggested as a possible contributor to these changes because food selection, preparation, and storage facilities are limited on spacecraft. In this ground-based study, consuming only foods used on the Space Shuttle for 28 d did not affect aerobic capacity, LBM, or measures of muscle strength or endurance in 12 healthy women (ages 28-47 years). However, normal consumption patterns were affected by restriction to the Space Shuttle diet, namely a proportional increase in carbohydrate consumed, with compensatory decreases in protein and fat. These results suggest that physical performance and LBM can be maintained under normal gravity conditions in active women who consume a Space Shuttle food-system diet for 28 d.

Adult↗

PubMed1996

Three-year follow-up of participants in a commercial weight loss program. Can you keep it off?

BACKGROUND: One third of Americans are obese, according to the 1988-1991 National Health and Nutrition Endpoint Survey III survey. Obesity increases the risk of death and a variety of chronic diseases. Numerous commercial weight loss programs demonstrate short-term success. OBJECTIVE: To assess maintenance of weight loss achieved during dieting. METHODS: We surveyed 192 participants in the Sandoz Nutrition (Sandoz Pharmaceuticals, Minneapolis, Minn) diet program approximately 3 years after participation. Initial date were supplied by the diet clinics and follow-up data, including weight at various points after the program, participation in other weight loss programs, and lifestyle variables, such as exercise, smoking, and television watching, were collected by a mailed questionnaire. RESULTS: On average, the group lost 22 kg during the diet program. After the follow-up period, the mean weight (mean, 102.6 kg) was only modestly less than the group's original weight at the start of the diet (mean, 105.9 kg). Twelve percent of the subjects maintained 75% of their weight loss after leaving the diet program, 57% maintained at least 5% of the loss, and 40% gained back more than they had lost during the diet. The frequency of exercise after the diet program was the strongest predictor of weight loss maintenance, while television viewing predicted a gain in weight. CONCLUSION: Given the apparent lack of substantial, long-term success at weight reduction, perhaps greater emphasis should be placed on prevention of obesity.

Commerce↗

PubMed2006

Programmed cell death in flight muscle histolysis of the house cricket.

We have characterized the process of flight muscle histolysis in the female house cricket, Acheta domesticus, through analysis of alterations of tissue wet weight, total protein content, and percent shortening of the dorsal longitudinal flight muscles (DLMs). Our objectives were to (1) define the normal course of histolysis in the cricket, (2) analyze the effects of juvenile hormone (JH) removal and replacement, (3) determine the effects of cycloheximide treatment, and (4) examine patterns of protein expression during histolysis. Our results suggest that flight muscle histolysis in the house cricket is an example of an active, developmentally regulated cell death program induced by an endocrine signal. Initial declines of total protein in DLMs indicated the JH signal that induced histolysis occurred by Day 2 and that histolysis was essentially complete by Day 3. Significant reductions in tissue weight and percent muscle shortening were observed in DLMs from Day 3 crickets. Cervical ligation of Day 1 crickets prevented histolysis but this inhibition could be reversed by continual topical treatments with methoprene (an active JH analog) although ligation of Day 2 crickets did not prevent histolysis. A requirement for active protein expression was demonstrated by analysis of synthesis block by cycloheximide and short-term incorporation of (35)S-methionine. Treatment with cycloheximide prevented histolysis. Autofluorographic imaging of DLM proteins separated by electrophoresis revealed apparent coordinated regulation of protein expression.

Animals↗

PubMed1983

A comprehensive psychological approach to obesity.

Many different treatments for obesity have proven somewhat successful, with none emerging as clearly superior to the others. Surgical approaches, although usually successful at achieving and maintaining weight loss, are accompanied by varied and often harmful side effects. Unless new, safer procedures are developed, treatment may continue to be as hazardous as the obesity itself. Because medical treatment alone has not achieved beneficial, lasting results, research aimed at finding new procedures should be encouraged. Our five-year experience in working with obese patients has led us to the following conclusions: 1. The management of obesity must be a joint venture between psychiatry and medicine. Because of the complex nature of this illness, neither discipline alone can successfully and safely achieve significant initial weight loss coupled with successful long-term maintenance. The use of adjunctive psychological programs in a medical setting can be a successful alternative. 2. Fasting, weight loss, and realimentation must be accompanied by an effort at lifestyle change. Otherwise, patients will continue their self-destructive habits, which will ultimately lead to failure in yet another attempt at sustained weight reduction. The behavioral approach has provided a fairly effective treatment of obesity, sometimes with immediate results. Recent studies support the maintenance effect of behavioral treatments. However, longer studies with follow-ups are needed to better assess the overall effectiveness of these treatments. 3. Despite much false optimism that weight loss is a simple road to happiness, most patients experience some very real problems during the fasting part of the program. Crisis intervention can prove very helpful in terms of reducing stress and preventing dropouts. Group therapy, individual therapy, family therapy, and hypnosis have attained some very limited positive results when used alone; greater success has been reported from combining therapies. Patients generally became more socially effective, physically active, and mentally proficient when exposed to individual therapy together with group and family therapies. 4. Family environment appears to significantly affect compliance and completion. A conflict-laden family environment hampers the patient's ability to deal with the psychological changes encountered in weight loss programs. 5. Many obese patients lack a fundamental knowledge of nutrition, exercise, and health. In addition, most are poorly socialized and require assistance in learning assertiveness and other interpersonal skills. A behaviorally oriented component is very effective in providing these skills.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗

PubMed1998

An exercise training combined with dietary program for patients with hypertension.

A controlled clinical trial was conducted to determine whether combined exercise training and diet alone reduce blood pressure (BP), body weight and body mass index (BMI) in three weeks. Twenty eight patients with diastolic BP < or = 110 mmHg were assigned to a hypertensive group and another 28 subjects with diastolic BP < or = 90 mmHg were subjected to the same intervention as control group (normotensive group). Exercise training and diet reduced diastolic BP by 24.7 mmHg and systolic BP by 32.8 mmHg in hypertensive group. There was a mean decreased of 5.3 mmHg in the diastolic BP in the normotensive group (P < 0.001). The systolic BP decreased only minimally. The weight loss ranged from 1 kg to 3 kg in hypertensive and 1 kg to 2 kg in the normotensive group. The mean weight loss was 1.6 kg (0.7) in hypertensive and 1.5 kg (0.5) in the normotensive group. In both the groups the weight reduction was highly significant (P < 0.001) and moderately positive correlation was also noted with the fall of BPs. The mean fall of BMI was 0.61 kg/m2 (0.21) and 0.51 (0.2) kg/m2 in the hypertensive and normotensive groups respectively. The findings indicated that a combined exercise training and dietary program could lower BP in patients with mild to moderate hypertension, but its long-term consequences on morbidity and mortality remain to be determined.

Adult↗

PubMed1989

Nutrition education and social learning interventions for type II diabetes.

Two diabetes education programs were compared to a control condition. Seventy-eighty type II (non-insulin-dependent) diabetic outpatients were randomly assigned to nutrition education, nutrition education plus social learning intervention, or wait-list control conditions. Both interventions involved five weekly meetings that focused on reducing calorie intake, increasing dietary fiber, and decreasing fat consumption. The social learning condition also included individualized goal setting and feedback and training in problem-solving and relapse prevention. Within-group analyses and between-group comparisons generally revealed greater improvement in targeted goals (e.g., calorie intake, fat reduction) among intervention conditions than the control condition. There were few differences in more distal measures of outcome such as weight or glycosylated hemoglobin. The social learning component did not improve outcome more than the nutrition education program. Possible reasons for the observed findings and the advantages and limitations of focused time-limited diabetes education efforts are discussed.

Diabetes Mellitus, Type 1↗

PubMed1992

The reduction of black infant mortality: an eighteen month evaluation of three Tennessee Black Health Care Task Forces' demonstration projects.

The problem of low birth weight has emerged as the single most important cause of infant death or subsequent handicaps in infancy and childhood. Although low birth weight babies (below 5.5 pounds) represent a small percentage of all babies born, well over half of all infant deaths occur among this group. The problem is even more serious for tiny infants. The relationship between infant mortality/morbidity and low birth weight has been known for many years and despite dramatic overall changes and medical advances, the incidence of low birth weight among high-risk populations continues to be a perennial problem. Efforts have been made nationally to develop programs that identify the conditions which increase the risk of having a low birth weight infant; programs that seek to reduce the risk of low birth weight; and research on new approaches to prevent premature labor as well as promoting the normal growth and development of a fetus. Since 1987, the Black Health Care Task Force, established by the Tennessee Department of Health and Environment has funded three infant mortality reduction pilot projects (Alton Park/Dodson Avenue Health Care in Hamilton County, Memphis Health Center and, Memphis-Shelby County Health Department) that operated in the two Tennessee counties where the Black infant mortality rates were extremely high. The projects goals were (1) to improve birth weight and survival rates of black infants born to indigent and Medicaid women; (2) to reduce maternal morbidity among indigent and Medicaid women; (3) to enhance the participation of indigent and Medicaid maternity clients in the appropriate and timely prenatal intrapartum and postpartum services; (4) to reduce the incidence of unplanned pregnancies among adolescents; and (5) to increase the utilization of family planning services by indigent and Medicaid women. Data will be reported and analyzed to assess whether or not the projects had a positive effect on birth outcome and a subsequent reduction in infant mortality. The data for this analysis is based on enrollment data provided by the projects, and linked birth and infant death certificates for project and nonproject comparisons, as retrieved from the Department of Health and Environment's Vital Records.

Adolescent↗

PubMed1997

RESEARCH: Optimizing the Mix of Strategies for Control of Vehicular Emissions

/ A number of strategies for the control of vehicular emissions are being considered by the Philippine government to address Metropolitan Manila's air quality problem. An analytical tool is needed for optimizing criteria pollutant reductions given the budgetary constraints. The simplest approach is to take costs and pollutant removals to be linear with each strategy's scale of activity, and this is readily solved as a linear programming problem. Another approach is to use a dynamic system of weights which shift with progressive improvements in pollutant emissions. The two approaches yield somewhat different results, suggesting the sensitivity of the solution to the assumed weights. The study also illustrates the importance of a sound methodology for evaluating priorities given to different air quality goals. One such methodology may involve a polling of expert panels and the public to gain insight into the relative importance given to competing emissions reduction goals. An informal polling of resource agency staff was conducted and discussed in this paper. The authors take the position that proper planning involves tracing intermediate steps to the final outcome and not just focusing on the latter.KEY WORDS: Vehicular emissions; Urban air quality; Emissions control; Optimization; Manila; Environmental systems analysis

Journal Article↗

PubMed2001

Changes in eating disorder symptoms with pediatric obesity treatment.

OBJECTIVE: To evaluate the effects of behavioral, family-based treatment on disordered eating and child behavior problems for obese 8- to 12-year-old children. STUDY DESIGN: We examined disordered eating in children and parents using the Kids' Eating Disorder Survey (KEDS) and the Binge Eating Scale, respectively; and psychologic problems in children and their parents using the Child Behavior Checklist and Symptom Checklist-90, respectively, in 47 families who participated in a family-based obesity treatment program. RESULTS: Obese children showed significant decreases (-12.5 +/- 13.5) in percent overweight, internalizing problems (-7.0 +/- 7.3), and total behavior problems (-4.8 +/- 6.6) and increases in behavioral competence (3.7 +/- 5.0) over 2 years of measurement; and their parents showed significant decreases in weight (-5.0 +/- 8.3 kg) and reductions in parental distress (-2.3 +/- 7.6) and in disturbed eating and weight-related cognition (-3.2 +/- 5.3). No significant changes were observed in total KEDS (-0.2 +/- 1.9), weight dissatisfaction (-0.3 +/- 1.7), or purging/restricting (0.2 +/- 0.6) scores. Decreases in total KEDS were related to decreases in total behavior problems and externalizing behavior problems. CONCLUSIONS: These results document improvements in child behavior problems and competence and no change in symptoms of disordered eating in a standardized behavioral weight control program.

Body Mass Index↗

PubMed1999

[Pediatric liver transplantation: now the patients are different and the problems are different as well].

AIM: 1. To show how in a program of pediatric liver transplantation (PLT) with 12 years of experience, the continuous use of technical innovations has allowed to improve the results and to treat the most complex cases. 2. To point out that when the immediate results of the transplant improve and the evolution time get longer, the late complications become the main source of concern. MATERIAL AND METHODS: The graft survival and the incidence of early surgical complications was compared between the first 100 PLT and the last 100 PLT (Total 235 PLT). The patients survival was also compared between the first and the last 5 years. In every case it was analyzed the age and weight of the children at the time of the transplant and the type of graft (full or reduced liver). The incidence of late complications in the global series was also analyzed, especially the posttransplant lymphoproliferative disease (PTLD) and the late biliary and vascular complications. RESULTS: There are significant differences between the first 100 PLT and the last 100 PLT in relation with the age of the patients (6.8 +/- 0.6 vs 4.2 +/- 0.5 years), the number of children younger than 1 year (4 vs 28), weight (22.4 +/- 1.2 vs 16.9 +/- 1.7 kg), number of PLT in children under 10 kg (7 vs 43), use of reduction techniques (7 vs 49), rate of hepatic artery thrombosis (12% vs 3%), and rate of early biliary complications (13% vs 4%). The 5 years survival of the graft was 51% in the first 100 PLT vs 65% in the last 100 PLT, and the 5 years patients survival was 70.1% in the first 5 years of the program vs 79.6% in the last 5 years. Among the late complications in the global series, 13 cases of PTLD (2 deaths) have special relevance, 6 cases of late anastomotic biliary stricture, 4 cases of portal stenosis, 1 arterial thrombosis, 1 death due to a fulminant sepsis and another death because of a colitis with multiple hepatic abscess. CONCLUSIONS: 1. The result of PLT improve, despite of the fact that in the last years the difficulty of the surgical procedures have increased (the patients are younger, with less weight and the reduction techniques are used more frequently). 2. The late complications have a significant influence in the prognosis, being that influence not completely established yet.

Age Factors↗

PubMed1995

Sertraline and relapse prevention training following treatment by very-low-calorie diet: a controlled clinical trial.

This study examined the combination of sertraline, a selective serotonin reuptake inhibitor, and relapse prevention training in the maintenance of weight loss following treatment by a very-low-calorie diet. A total of 53 women who had lost a mean (+/- SD) of 22.9 +/- 7.1 kg from a pretreatment weight of 103.1 +/- 17.8 kg were randomly assigned to a 54-week weight maintenance program that was combined with either: 1) 200 mg/d of sertraline; or 2) placebo. During the first 6 weeks, sertraline subjects lost significantly more weight and reported significantly greater reductions in hunger and preoccupation with food than did subjects on placebo. After this time, however, women in both conditions regained weight steadily. The 13 sertraline subjects who completed the 54-week study regained 17.7 +/- 10.6 kg of their original 26.3 +/- 7.6 kg loss, equal to a regain of 70.9 +/- 41.7%. The 17 placebo completers regained 11.8 +/- 9.0 kg of their 23.4 +/- 7.8 kg loss, equal to a 46.5 +/- 34.6% regain. End-of-treatment differences between groups in weight change were not statistically significant. Nor were there significant differences between the two conditions at any time in changes in fat-free mass, resting metabolic rate or dysphoria, all of which tended to increase with weight regain. The results are discussed in relation to findings from other long-term studies that combined diet and medication.

1-Naphthylamine↗

PubMed2002

Patient management after LAP-BAND placement.

Severe obesity is a chronic disease requiring continuing care. Optimal outcomes of laparoscopic adjustable gastric banding using the LAP-BAND (INAMED Health, Santa Barbara, CA) depend on accurate placement of the band and excellent postplacement care, which requires a long-term commitment from both the patient and the bariatric surgical team. Adjustability is a key feature of the LAP-BAND system, and knowing when and how much to adjust requires careful judgment. Two methods of approaching the art of adjustment are described: the office adjustment and the radiologic adjustment. A properly placed and adjusted band produces prolonged satiety after a small meal, facilitating a major reduction in dietary intake leading to weight loss. Healthy food choices, increased activity and exercise, and the behavioral changes necessary to achieve these are essential elements of all weight loss programs. The LAP-BAND program is no exception. Follow-up requires monitoring of the comorbidities of obesity and metabolic and nutritional status. Communication and collaboration with the patient's primary care provider are important. All of the elements above are necessary to provide the comprehensive care that contributes to optimal patient outcomes.

Diet↗

PubMed1989

An assessment of the nutritional status of preschool children in Western Papua New Guinea, 1978 to 1986.

This paper reports the results of a cross-sectional survey of nutrition in children 0-5 years old carried out in Balimo District of southern Western Province, Papua New Guinea, between December 1985 and February 1986, and compares the level of undernutrition found in this survey with previous levels. The purpose of this comparison was to determine the effect of the National Food and Nutrition Policy introduced in 1978 and, more specifically, the Balimo Nutrition Education Program introduced in 1980. The major findings are that there has been a marked reduction in the level of undernutrition in children 0-5 years old, as determined by weight for age. In 1978, 44.6% of children were less than 80% of the standard, whereas in 1986 the corresponding figure was 22.3%. The level of undernutrition in the 0-12 month old age group was significantly lower than that of all other age groups, which correlates with the period of breastfeeding. The increase of undernutrition after this age can be partly accounted for by an inadequate weaning diet, an area in which further education is required. The level of attendance at maternal and child health clinics has not altered significantly between 1982 and 1986, being still only 45% of children enrolled in the clinics. This needs to be improved if possible by the local health centres.

Anthropometry↗