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PubMed2004

Effectiveness of multidisciplinary patient counselling in reducing cardiovascular disease risk factors through nonpharmacological intervention: results from the Healthy Heart Program.

BACKGROUND: The value of lifestyle modification in reducing physiological cardiovascular disease (CVD) risk factors remains controversial because changes in patient behaviour following CVD prevention counseling have failed to correlate with or impact reductions in physiological variables. OBJECTIVES: To determine whether nonpharmacological CVD prevention counselling significantly reduces behavioural and physiological risk factors, and to examine correlations between changes in these variables. METHODS: At baseline, dyslipidemic individuals with or at risk of developing CVD completed CVD risk factor questionnaires. At baseline and three months, participants submitted dietary logs, self-classified their readiness for behaviour change for eight lifestyles, and had their blood lipid profiles, weight and height assessed. Following CVD risk factor screening, lower and higher risk participants were recommended for multidisciplinary group counselling (GC) or group plus individual counselling (GIC), respectively. A prospective time series design assessed behavioural and physiological risk factor changes. RESULTS: Participants progressed forward (P<0.01) through the stage of change continuum for all behaviours. GIC participants progressed to a higher average stage of behaviour change for achieving optimal body weight (P<0.01), drinking less alcohol (P<0.05) and controlling blood pressure (P<0.05). Significant reductions in body mass index (2.1% and 1.9%), total cholesterol (7.0% and 5.5%), low density lipoprotein cholesterol (6.2% and 5.4%), total cholesterol to high density lipoprotein cholesterol ratio (5.1% and 3.8%) and triglyceride levels (10.8% and 8.5%) were observed in GC and GIC participants, respectively. Furthermore, significant correlations were observed between concurrent changes in lifestyle behaviour and physiological risk factors. CONCLUSIONS: Multidisciplinary CVD prevention counseling positively influenced participant readiness for lifestyle behaviour change which translated into significant reductions in several physiological risk factors.

Adult↗

PubMed1987

Effects on in vitro brain protein synthesis of a translational inhibitor isolated from rabbit brain following intravenous administration of LSD.

Inhibition of brain protein synthesis following intravenous administration of d-lysergic acid diethylamide (LSD) is accompanied by generation of a translational inhibitor protein in the postribosomal supernatant of cerebral hemispheres. Addition of an enriched preparation of this factor to a brain cell-free translation system resulted in a selective reduction in the level of phosphorylation of proteins of molecular weight 55K, 41K, and 25K. A similar set of changes was also observed in a brain cell-free system prepared 1 hr subsequent to drug injection. The brain inhibitor reduced the translational capacity of a messenger RNA-dependent reticulocyte lysate programmed with brain polysomes isolated from saline-injected animals however little effect was apparent when polysomes were prepared from LSD-treated animals. The translational inhibitor did not affect the spectrum of translation products from either set of polysomes.

Animals↗

PubMed1982

Impaired absorptive capacity for carbohydrate in the aging human.

Breath hydrogen (H2) analysis was utilized to determine whether intestinal absorption of carbohydrate might decline with age. Twenty-one healthy subjects (aged 65-89 years, mean age 79.1) and 19 control subjects (aged 20-64 years, mean age 35.6) were fed a meal containing 100 g carbohydrate after an overnight fast. Breath H2 concentrations were analyzed in samples collected intermittently by the end-expiratory technique. A rise in breath H2 concentration of 20 ppm over baseline was considered evidence of intestinal carbohydrate malabsorption: 7 of 21 aged and 0 of 19 control subjects excreted excess H2 (P less than 0.02). Further testing of subjects with meals containing 25-200 g carbohydrate demonstrated a progressive reduction in absorptive capacity with advancing age, while young controls absorbed up to 200 g carbohydrate in a meal. In the group of older subjects carbohydrate malabsorption was not accompanied by clinical determinants of undernutrition. Subtle carbohydrate malabsorption should be considered when evaluating weight loss in old age and in fashioning nutritional programs for the elderly.

Aged↗

PubMed1986

Obesity and hypertension. Demonstration of a "floor effect".

Weight loss has a role in the treatment of essential hypertension. With the use of a medically supervised protein-sparing supplemented fast and a behavioral program, the changes in blood pressure as a result of weight loss in 135 obese hypertensive subjects were examined. Subjects' weight, blood pressure, and antihypertensive medication intake were recorded at baseline, at conclusion of supplemented fast, and at follow-up. Significant weight loss accompanied by decrements in blood pressure occurred in all subjects. Reductions in the number of antihypertensive medications also occurred. Although the correlations between changes in weight and blood pressure were significant, their moderate size suggests the amount of weight loss accounted for a relatively small part of the blood pressure reduction. Given the large weight losses in the majority of subjects, there appears to be a degree of weight loss beyond which further decrements in blood pressure will not occur ("floor effect"). Maintenance of blood pressure reductions at realimentation/follow-up suggests that weight loss, and not the supplemented fast, results in decreased blood pressure and medication level.

Adult↗

PubMed2006

A cognitive/behavioral group intervention for weight loss in patients treated with atypical antipsychotics.

Obesity and diabetes have caused problems for individuals with schizophrenia long before atypical antipsychotic agents. The prevalence of obesity, insulin resistance, impaired glucose tolerance, type 2 diabetes mellitus, dyslipidemia, and the Metabolic Syndrome has increased in people with schizophrenia as compared to the general population. Risk reduction studies for persons with obesity, diabetes, and cardiovascular disease indicate that cognitive/behavioral interventions that promote motivation and provide strategies to overcome the barriers in adherence to diet and activity modification are effective interventions for weight management and risk reduction. In the landmark multi-center randomized-controlled trial study, the Diabetes Prevention Project (DPP), a cognitive/behavioral intervention, was more successful in producing weight loss and preventing diabetes than the drugs metformin, troglitazone or placebo. This pilot study examined the effectiveness of a cognitive/behavioral group intervention, modified after the DPP program, in individuals with schizophrenia or schizoaffective disorder taking atypical antipsychotics in a large urban public mental health system. Outcome measures included body weight, body mass index, waist-hip ratios, and fasting glucose levels. Both groups demonstrated elevated fasting glucose levels and were obese with a mean BMI of 33. The group that received the cognitive/behavioral group intervention lost more weight than the treatment as usual group. The CB group participants lost an average of 5.4 lb or 2.9% of body weight, and those in the control group lost 1.3 lb or 0.6% body weight. The range of weight loss for the treatment group was from 1 to 20 lb. This pilot study has demonstrated that weight loss is possible with cognitive/behavioral interventions in a population with a psychotic disorder.

Adult↗

PubMed1999

Qigong and hypertension: a critique of research.

Research studies have pointed to various health-related positive effects of qigong; however, problems in much of the current qigong research methodology have limited interpretation of the potential benefits of qigong. Examples of research on qigong and hypertension are used to bring to light some of these methodological issues. In a review of 30 representative studies, various areas of concern are addressed, including: the sources of studies, lack of random assignment, selection biases, treatment effects, placebo response issues, expectancy biases, blinded outcome assessment, adherence to treatment, reliability of blood pressure measurements, regression to the mean, publication biases, and lack of consistency of measurement. One of the longest term studies, conducted by Kuang et al. (1991) and updated by Wang et al. (1993) is examined in greater detail to illustrate these issues. This study took place over 20 years and reported significant differences between a group practicing qigong and a control group in a variety of measures including a reduction of total mortality rate. The weight of evidence suggests that practicing qigong may have a positive effect on hypertension. Whether qigong alone can affect hypertension is not necessarily the most important question. Further research will be required to better assess and understand the effect of adding qigong into an integrated, multifaceted program that selectively incorporates diet, moderate aerobic exercise, relaxation training, and social and psychological dimensions.

Breathing Exercises↗

PubMed1994

Effect of level and source of dietary fiber on food intake in the dog.

The effects of dietary fiber on challenge meal intake and on the perception of hunger in dogs were evaluated. A program of testing variants of a standard low energy diet, to which one of five fiber containing raw materials was added, was undertaken. Diets were fed to a group of six dogs for 12-d periods in a latin square design and in amounts that corresponded to the food allowance for weight reduction. Behavioral characteristics of dogs were recorded on videotape for 30-min periods after introduction of test diets. On two occasions during each 12-d feeding period dogs were presented with a challenge meal. At the end of each 12-d feeding period all dogs entered a 6-d washout period. There was no significant effect of diet on the intake of the challenge meal or on intake of food during the subsequent washout period. In addition, diet had no apparent effect on the perception of hunger, as represented by behavioral characteristics during the 30-min period after presentation of test diets. It was concluded that inclusion of moderate levels of raw materials, composed primarily of insoluble fiber, in a commercial low energy diet had no apparent beneficial effects on satiety, when fed to dogs on an energy intake corresponding to allowances for weight reduction.

Animal Feed↗

PubMed2001

Do genetic factors contribute to the association between birth weight and blood pressure?

OBJECTIVES: To evaluate whether genetic factors contribute to the association between low birth weight and increased blood pressure among adolescents. DESIGN: Historical cohort study of twin pairs. It was evaluated whether (1) a negative association between birth weight and systolic blood pressure was found in the overall twin sample and (2) whether the intrapair difference in birth weight correlated with the intrapair difference in systolic blood pressure-thereby controlling for the effect of genetic factors (all in monozygotic and on average half in dizygotic pairs). SETTING: The Minnesota Twin Family Study. PARTICIPANTS: 1311 pairs of adolescent twins. MAIN RESULTS: A negative association between birth weight and systolic blood pressure was retrieved in the overall sample. The regression coefficient after controlling for current weight was -1.88 mm Hg/kg (SE 0.61), which corresponds to results from previous studies of singleton adolescents. The regression coefficient fell to -0.64 mm Hg/kg (SE 0.86) when the intrapair analyses were used. The largest reduction was observed among monozygotic twins: from -2.44 mm Hg/kg (SE 0.75) in the overall monozygotic twin sample to -1.06 mm Hg/kg (SE 1.14) in the analyses of the within monozygotic pair differences. CONCLUSION: The association between low birth weight and increased blood pressure later in life is well established. "The fetal programming hypothesis" suggests that the association is caused by intrauterine malnutrition while a new hypothesis "the fetal insulin hypothesis" proposes that genetically determined insulin resistance also contributes significantly to the association. A recent twin study of middle aged twins showed no evidence for an influence of genetic factors while this larger study provides support for the fetal insulin hypothesis: the association between birth weight and blood pressure attenuated among adolescents when genetic factors were controlled. Together this suggests an important contribution of genetic factors to the association between fetal growth and systolic blood pressure in adolescence.

Adolescent↗

PubMed1996

Toxicity of insecticides to Toxorhynchites splendens and three vector mosquitos and their sublethal effect on biocontrol potential of the predator.

Toxicity of six larvicides ie fenthion, temephos, malathion, deltamethrin, alphamethrin (Fendona), OMS 3031 and five adulticides ie malathion, fenitrothion, propoxur, deltamethrin, permethrin to Aedes aegypti, Culex quiquefasciatus, Anopheles stephensi and the predator, Toxorhynchites splendens was studied for evaluating safety margin. Concentrations of alphamethrin that killed 50% larvae of T. splendens were 53 and 12 times more than that which killed Cx. quinquefasciatus and Ae. aegypti. In case of deltamethrin, concentrations required to kill 50% larvae of T. splendens were 14 and 5 times more than that required against other two species. Other larvicides tested were equally toxic to both T. splendens and vector mosquitos. There was no significant difference in the toxicity of larvicides to T. splendens and An. stephensi. Deltamethrin was 25-132 times less toxic to adults of T. splendens in comparison to vector mosquitos. For other adulticides the range was 1-10. Immature developmental time of T. splendens was not affected by any of the insecticides tested. However, predation rate was lowered when larvae of Ae. aegypti previously exposed to fenthion and temephos were offered. Whereas, alphamethrin and OMS 3031 did not affect the feeding rate of the predator. There was a significant reduction in the pupal weight and pupation as a result of the predator feeding on the insecticide treated prey. There was a significant negative relationship between rate of pupation and dosage. The present study indicates that synthetic pyrethroids owing to their higher safety margin can be used in an integrated vector management program.

Aedes↗

PubMed1975

Treatment of massive obesity with rice/reduction diet program. An analysis of 106 patients with at least a 45-kg weight loss.

One hundred six massively obese patients, who each lost at least 45 kg, were treated as outpatients with the rice/reduction diet, exercise, and motivational enhancement under daily supervision. Average weight loss was 63.9 kg. Forty-three patients achieved normal weight. Men lost weight at a greater rate than women. Concomitant with weight reduction, there were significant decrements in blood pressure; fasting and two-hour postprandial blood glucose, serum triglyceride, and serum uric acid levels, and heart-chest ratio as evidenced on chest x-ray film. Electrocardiographic and retinal venous changes improved. Serum cholesterol level did not change significantly. This study demonstrates that massively obese persons can achieve marked weight reduction, even normalization of weight, without hospitalization, surgery, or pharmacologic intervention. Accompanying cardiovascular risk factors show great decrements concomitant with weight loss.

Adolescent↗

PubMed1989

A low-cost competitive approach to weight reduction in a Native American community.

Native Americans from two Indian communities, Zuni and Pine Hill, New Mexico, participated in a weight loss competition that utilized promotional, educational and motivational techniques to bring about changes in dietary and exercise behaviors. This evaluative study documents the impact of age, sex, tribal affiliation, initial weight, educational level, employment status, dietary attitude and exercise patterns on program completion and goal attainment. Of 271 participants, 122 (45 percent) completed the competition and lost five pounds or more ('finishers/goal weight achievers'); 127 (47 percent) completed the competition but failed to lose five pounds ('finishers/non-goal achievers'); and 22 (8 percent) did not complete the competition ('non-finishers'). Non-finishers had significantly fewer years of formal education and were more likely to be self-employed or unemployed than finishers. Finishers/goal weight achievers had a significantly greater proportion of males, a greater initial weight and an increased compliance with record-keeping compared to finishers/non-goal achievers. The relative success of the Zuni-Pine Hill 'Eat Right' weight loss competition establishes its importance as a public health model for health behavior change in communities with similar population profiles.

Adult↗

PubMed2004

A review of incisional hernia repairs: preoperative weight loss and selective use of the mesh repair.

At the Shouldice Clinic pre-operative weight loss is used prior to incisional hernia repairs. Mesh repair is selectively used, based on specific hernia characteristics. A series of 236 patients were reviewed and followed up for 36 months. Data were available on 188 patients (80%). There were 15 recurrences (8%). The number of obese patients was reduced from 67 (35.6%) to 25 (13.3%) through the weight loss program. The hernia diameter, gastrointestinal complications, and surgical site infection were significantly related to recurrence but not the type of repair, obesity, location, or previous recurrences. The risk factors of incisional hernias include size, intestinal complications and infections. A selective use has a comparable result to the exclusive use of mesh repair. Weight reduction has yet to be shown to affect the rate of recurrence, and further prospective studies are required.

Adult↗

PubMed2004

Diabetes self-management training program in a community clinic improves patient outcomes at modest cost.

Stringent glycemic control reduces complications and health care costs for people with diabetes. This study assessed the effectiveness of a diabetes self-management training (DSMT) program at a community clinic. Education and a glucometer were provided to 70 people with type 2 diabetes in a 4-hour class, followed by individual dietitian consults and monthly support meetings. Most participants were Hispanic or African American with mean age of 49+/-10 years and mean body mass index of 34+/-9. Body weight, glycosylated hemoglobin (A1C), medications, and follow-up attendance were monitored. After 2 to 12 months of program participation, mean A1C improved from 9.7+/-2.4% to 8.2+/-2.0% (P<.001); 61% experienced positive medication outcomes. The cost of community clinic DSMT was approximately $280 per person per year, $185 for each point reduction in A1C. This study indicated that community clinic DSMT can improve glycemic control at modest cost.

Black People↗

PubMed2003

Weight loss and total lipid profile changes in overweight women consuming beef or chicken as the primary protein source.

OBJECTIVE: Conflicting recommendations are prevalent regarding the appropriateness of red meat versus white meat consumption for individuals aiming to reduce body weight and cardiovascular disease risk. METHODS: We examined changes in body weight and lipid profiles in a 12-wk, randomized, controlled trial, in which overweight women followed a hypocaloric diet with lean beef or chicken as the primary protein source, while participating in a fitness walking program. Sedentary non-smoking females (n = 61), age 43.4 +/- 7.8 years, with body mass indexes of 32.1 +/- 3.4 kg/m(2) (means +/- standard deviation), followed calculated-deficit diets (-500 kcal daily) and were randomly assigned to the beef-consumption or chicken-consumption dietary group, while following a fitness walking program. Body weight, body composition (by hydrodensitometry), and blood lipid profiles were measured at baseline and 12 wk. RESULTS: Weight loss was significant within (P < 0.05) but similar between (P > 0.05) the beef-consumption (5.6 +/- 0.6 kg, mean +/- standard error) and the chicken-consumption (6.0 +/- 0.5 kg) groups. Both groups showed significant reductions in body fat percentage (P < 0.05) and total (P < 0.05) and low-density lipoprotein (P < 0.05) cholesterol, with no significant differences between groups. High-density lipoprotein cholesterol did not change significantly in either group. CONCLUSIONS: These findings demonstrated that weight loss and improved lipid profile can be accomplished through diet and exercise, whether the dietary protein source is lean beef or chicken.

Adult↗

PubMed1984

Transchondral talar dome fractures: not just a sprained ankle.

Transchondral talar dome fractures are a rare but not unknown cause of continued disability following a "sprained ankle." The diagnosis is made with standard ankle roentgenograms and an awareness of the lesion. Surgical treatment is recommended in acute and chronic cases, based on the amount of displacement of the fracture and on the persistence of symptoms after nonoperative treatment. Nine patients were surgically treated for symptomatic transchondral talar dome fractures at Brooke Army Medical Center between July 1980 and July 1982. Seven of the nine injuries were initially misdiagnosed as a sprain. Average follow-up for the group was 15.5 months. Seven patients were treated with excision of the fracture fragment, curettement of the donor site, and multiple K-wire drilling of the fracture bed. One patient was treated with open reduction and internal fixation of the fracture fragment. Another was treated with multiple drilling of the cartilage-covered fracture fragment in situ. Postoperatively, all patients were kept non-weight-bearing for six weeks and did active range of motion exercises. After six weeks the patients participated in a supervised functional rehabilitation program. Results were scored by points for functional activity and range of motion. Eight of nine patients had good results and one had a fair result. There were no poor results.

Ankle Joint↗

PubMed2005

Gender specificity of programmed plasma hypertonicity and hemoconcentration in adult offspring of water-restricted rat dams.

OBJECTIVE: We studied the impact of maternal water-restriction during rat pregnancy on newborn plasma composition, and determined the persistence of plasma composition alterations in adult offspring. METHODS: Maternal dams were water-restricted from 10 days of pregnancy until term (21 days) and throughout lactation to increase plasma sodium levels by approximately 6 mEq/L. At 21 days of age, offspring were weaned, and subsequently maintained on ad libitum food and water until 12 weeks of age. Daily water and food intake was monitored. Blood samples and organs were collected from 1-day- and 12-week-old offspring. Hematocrit, plasma osmolality, sodium, and arginine vasopressin (AVP) levels were analyzed. Because water-restriction led to concomitant reduction in maternal food intake (ie, dehydration anorexia), henceforth these dams and their offspring are referred to as "water-deprived/food-reduced" rats. RESULTS: Water-deprived/food-reduced dams had significantly increased plasma sodium levels, reduced food intake, and lower body weight gain during pregnancy and lactation as compared to control dams. One-day-old newborns of water-deprived/food-reduced dams weighed 17% less and had increased plasma sodium levels, osmolality, and hematocrit. At 12 weeks of age, males exhibited 11% and females 19% reduction in body weight from controls. Notably, male offspring of water-deprived/food-reduced dams showed significantly elevated plasma sodium levels, osmolality, and hematocrit. Additionally, males demonstrated reduced adrenal growth and decreased water intake. Conversely, the female offspring had similar plasma osmolality with decreased sodium levels, though a persistently elevated hematocrit. No differences were evident in plasma AVP levels. CONCLUSIONS: Maternal water deprivation/food reduction is associated with increased newborn plasma osmolality and sodium levels and long-term physiologic changes in the offspring. The gender-specificity of programmed hyperosmolality, though not hemoconcentration, implicates differing pathways/mechanisms for these phenotypic alterations. The contributions of pregnancy hypertonicity versus nutrient restriction in the mechanism for programmed offspring phenotype remain to be elucidated.

Animals↗

PubMed1999

Effects of lifestyle activity vs structured aerobic exercise in obese women: a randomized trial.

CONTEXT: Physical inactivity contributes to weight gain, but only 22% of Americans are regularly active. OBJECTIVE: To examine short- and long-term changes in weight, body composition, and cardiovascular risk profiles produced by diet combined with either structured aerobic exercise or moderate-intensity lifestyle activity. DESIGN: Sixteen-week randomized controlled trial with 1-year follow-up, conducted from August 1995 to December 1996. PARTICIPANTS AND SETTING: Forty obese women (mean body mass index [weight in kilograms divided by the square of height in meters], 32.9 kg/m2; mean weight, 89.2 kg) with a mean age of 42.9 years (range, 21-60 years) seen in a university-based weight management program. INTERVENTIONS: Structured aerobic exercise or moderate lifestyle activity; low-fat diet of about 1200 kcal/d. MAIN OUTCOME MEASURES: Changes in body weight, body composition, cardiovascular risk profiles, and physical fitness at 16 weeks and at 1 year. RESULTS: Mean (SD) weight losses during the 16-week treatment program were 8.3 (3.8) kg for the aerobic group and 7.9 (4.2) kg for the lifestyle group (within groups, P<.001; between groups, P = .08). The aerobic group lost significantly less fat-free mass (0.5 [1.3] kg) than the lifestyle group (1.4 [1.3] kg; P = .03). During the 1-year follow-up, the aerobic group regained 1.6 [5.5] kg, while the lifestyle group regained 0.08 (4.6) kg. At week 16, serum triglyceride levels and total cholesterol levels were reduced significantly (P<.001) from baseline (16.3% and 10.1% reductions, respectively) but did not differ significantly between groups and were not different from baseline or between groups at week 68. CONCLUSIONS: A program of diet plus lifestyle activity may offer similar health benefits and be a suitable alternative to diet plus structured aerobic activity for obese women.

Adult↗

PubMed1994

Managing hypertension among veterans in an outpatient screening program.

This report describes the outcomes of a hypertension screening and management program in an outpatient clinic for veterans (pharmacologic/nonpharmacologic subjects, N = 207) located in the Southeastern United States using a retrospective descriptive research approach. Health care was provided in the clinic by nurse practitioners and physicians in conjunction with classes that emphasize lifestyle changes. Weight was a major risk factor on admission and at subsequent visits. Quetelet Index values indicated pharmacologic patients were significantly more overweight (> 30% over ideal weight) than nonpharmacologic patients (> 20% over ideal weight). Significant reductions in blood pressure were obtained for both groups between admission readings and readings taken at 12 and 24 months (p = .0001). No significant differences in blood pressure were noted between the nonpharmacologic and pharmacologic groups. Reported lifestyle behavior changes incorporating exercise from first to last visit were more significant for the nonpharmacologic group; however, this group also reported increased alcohol consumption during this time. The pharmacologic group reported overall beneficial improvement in both exercise and decreased use of alcohol. The nonpharmacologic group on average required fewer clinic visits. Interventions targeted toward lifestyle behaviors, a common element in the treatment plans for both groups, appear to have therapeutic benefit.

Adult↗