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PubMed1994

Comparable effects of diet and exercise on body composition and lipoproteins in older men.

Changes in body composition, fat distribution and lipoprotein lipids in response to weight loss elicited by a 10-month program of hypocaloric diet (HD) therapy alone or combined with aerobic exercise training (AEX+HD) were examined in sedentary obese older males. Body composition was assessed by hydrodensitometry and fat distribution was evaluated with skinfold thickness and circumference measures. The HD group underwent a dietary/behavioral modification program to reduce caloric intake. The AEX+HD group underwent a similar dietary modification program combined with aerobic exercise training. Following completion of the study, 15 subjects from each group were individually pair matched based on age (57.1 +/- 1.7 vs 61.3 +/- 2.4 yrs) and their reduction in body mass (-7.6 +/- 1.3 vs -8.0 +/- 1.1 kg). Reductions in fat and fat-free mass and skinfold thickness and circumferences were similar in both groups. In both the AEX+/HD and HD groups there were significant reductions in the ratio of low-density lipoproteins to high-density lipoproteins (HDL-C) and triglycerides and a significant increase in HDL2-C. There were no differences in final values or absolute and relative changes in the various lipoprotein values between the two groups. These results suggest weight loss induced by diet alone or combined with aerobic exercise cause similar changes in body composition and lipoprotein lipids.

Analysis of Variance↗

PubMed2003

Cardiometabolic syndrome: pathophysiology and treatment.

The cardiometabolic syndrome, an interesting constellation of maladaptive cardiovascular, renal, metabolic, prothrombotic, and inflammatory abnormalities, is now recognized as a disease entity by the American Society of Endocrinology, National Cholesterol Education Program, and World Health Organization, among others. These cardiovascular and metabolic derangements individually and interdependently lead to a substantial increase in cardiovascular disease (CVD) morbidity and mortality, making the cardiometabolic syndrome an established and strong risk factor for premature and severe CVD and stroke. Established and evolving treatment strategies including moderate physical activity, weight reduction, rigorous blood pressure control, correction of dyslipidemia, and glycemic control have proven beneficial in reversing these abnormal responses and decreasing the CVD risk.

Albuminuria↗

PubMed2004

Thyroid hormones induce unique and potentially beneficial changes in cardiac myocyte shape in hypertensive rats near heart failure.

We examined the effects of thyroid hormones (THs) on left ventricular (LV) function and myocyte remodeling in rats with spontaneously hypertensive heart failure (SHHF). SHHF rats were treated with three different TH doses from 20-21 mo of age. In terminal experiments, LV function (as determined by echocardiography and catheterization) and isolated myocyte shape were examined in SHHF rat groups and age-matched Wistar-Furth control animals. Compared with Wistar-Furth rats, the ratio of alpha- to beta-myosin was reduced in untreated SHHF rats. The alpha-to-beta-myosin ratio increased in all TH groups, which suggests a reversal of the fetal gene program. Low-dose TH produced no changes in LV myocyte size or function, but high-dose TH produced signs of hyperthyroidism (e.g., increased heart weight, tachycardia). The chamber diameter-to-wall thickness ratio declined with increasing dose due to reduced chamber diameter and increased wall thickness. This resulted in a 38% reduction in LV systolic wall stress in the middle- and high-dose groups despite sustained hypertension. Isolated myocyte data indicated that chamber remodeling and reduced wall stress were due to a unique alteration in myocyte transverse shape (e.g., reduced major diameter and increased minor diameter). Based on our present understanding of ventricular remodeling and wall stress, we believe these changes are likely beneficial. Results suggest that TH may be an important regulator of myocyte transverse shape in heart disease.

Animals↗

PubMed2005

[Evolution of the nutritional status of six years old Chilean children (1987-2003)].

BACKGROUND: As a consequence of the epidemiological transition in Chile, the nutritional status of the population has changed notoriously. AIM: To study the changes in the nutritional status of six years-old Chilean children from 1987 to 2003. MATERIAL AND METHODS: The computer data base of a government institution in charge of the School Lunch Program (JUNAEB) was used. It contains data on weight, height, sex and date of birth of six years old children, in the years 1987, 1990, 1993, 1996, 2000, 2001, 2002 and 2003. RESULTS: The data of approximately 80,000 children was analyzed. Both weight and height increased over the study years. There was a significant reduction in the number of children with weight deficit but also an increase in the proportion of children with obesity. Stunting was also reduced. The proportion of children with HAZ over 2 SD increased from 0.76 in 1987 to 2.2% in 2003. The prevalence of obesity has not increased since the year 2000. CONCLUSION: The stabilization in the prevalence of obesity is a positive finding, considering its adverse consequences for health.

Body Height↗

PubMed1989

Lipids: impact on dietary prescription in diabetes.

The rate of death from coronary artery disease is two to three times higher among individuals with diabetes than among their age- and sex-matched peers. In diabetes, many factors may affect blood lipid levels and complicate formulating an effective dietary prescription. Both Type I and Type II diabetes may have an independent effect on lipids. This article discusses metabolic derivations in carbohydrate and lipid metabolism that contribute to lipid abnormalities. The National Cholesterol Education Program Guidelines, which include dietary recommendations for lowering blood lipid levels by modifying fat intake, are discussed in regard to their effect on blood lipids in diabetes and their effect on other variables, such as blood glucose control. Other treatment approaches common in diabetes and lipid management include low-calorie diets and weight reduction, a change in the fatty acid composition of the diet, and high-carbohydrate diets. An evaluation of the etiologies of lipid abnormalities and interventions directed toward lipid levels and other indexes of diabetes management may lead to improved lipid levels, improved blood glucose control, and avoidance of unnecessary, ineffective, or deleterious dietary prescriptions for individuals with diabetes.

Coronary Disease↗

PubMed1996

Benefits from a teen pregnancy program: neonatal outcomes potential cost savings.

These data demonstrated that participants in our teen pregnancy program had better birth outcomes than comparable teens who did not participate in the program. Based on number of NICU admissions and lengths of stay, we estimate that this program provided, through the reduction of poor birth outcomes, potential cost savings of $890,000 over four years.

Adolescent↗

PubMed2004

Time-course changes in macronutrient metabolism induced by a nutritionally balanced low-calorie diet in obese women.

The use of low-calorie diets is a common strategy for body-weight reduction purposes, but the time-course of the metabolic changes induced by moderately energy-restricted, otherwise balanced, diets is still poorly known. The aim of this nutritional intervention design was to study in obese women the effect of a balanced low-calorie diet on the metabolic rate, and metabolic fuel utilization changes during the weight loss process through the application of breath tests with stable isotope-labeled tracers. Seven obese (body mass index >30 kg/m(2)) women were assigned to a 10-week dietary hypoenergetic intervention regime supplying 55% of energy as carbohydrate, 30% as fat and 15% as protein. Metabolic rate and substrate utilization were evaluated for 6 h in separate occasions during the weight loss program by indirect calorimetry and after 13C-labeled glucose, triolein and leucine administration. Body weight loss after 10 weeks was 4.2+/-1.1 kg, while the percent body fat decrease was about 5%. Slimming was accompanied by a marked decrease in fasting leptin (about 25%). Postprandial carbohydrate utilization after the administration of a test meal with the same macronutrient distribution as the experimental low-energy diet was decreased (24.1%, P<0.05) as a consequence of the dietary restriction, which was associated with lower insulin plasma levels (P<0.05). Although protein and lipid oxidation were not significantly different after weight reduction (day 1 versus day 70), the metabolic utilization of these substrates tended to increase. Moreover, marginally significant indications obtained on days 15 and 45 suggest that the weight and body composition changes are attributable to a shift in endogenous and exogenous glucose utilization in favor of lipid burning. The breath tests determinations, which were performed on different occasions along the experimental trial, confirmed that the cumulative 13C output decreased for labeled tracers with time, being only statistically significant for the glucose utilization between days 15 and 45. In summary, the weight and fat mass losses were associated with a lower carbohydrate oxidation, which were probably compensated by an increase in lipid oxidation without major changes in protein mobilization.

Adipose Tissue↗

PubMed1998

The antiatherogenic role of high-density lipoprotein cholesterol.

Landmark clinical studies in the past 5 years that demonstrated diminished mortality and first coronary events following lowering of low-density lipoprotein (LDL) cholesterol stimulated considerable interest in the medical community. Yet, high-density lipoprotein (HDL) cholesterol, which transports circulating cholesterol to the liver for clearance, clearly also exerts antiatherogenic effects. The Framingham Heart Study produced compelling epidemiologic evidence indicating that a low level of HDL cholesterol was an independent predictor of coronary artery disease (CAD). Emerging experimental and clinical findings are, collectively, now furnishing a solid scientific foundation for this relation. First, the reverse cholesterol transport pathway--including the roles of nascent (pre-beta) HDL, apolipoprotein A-I, lecithin-cholesterol acyltransferase (LCAT), cholesteryl ester transport protein, and hepatic uptake of cholesteryl ester from HDL by liver--is better understood. For example, the identification of a hepatic HDL receptor, SR-BI, suggests a mechanism of delivery of cholesteryl ester to liver that differs from the receptor-mediated uptake of LDL. Second, apolipoprotein A-I, the major protein component of HDL, and 2 enzymes on HDL, paraoxonase and platelet-activating factor acetylhydrolase appear to diminish the formation of the highly atherogenic oxidized LDL. Third, lower levels of HDL cholesterol are associated in a dose-response fashion with the severity and number of angiographically documented atherosclerotic coronary arteries. Fourth, low HDL cholesterol predicts total mortality in patients with CAD and desirable total cholesterol levels (<200 mg/dL). Fifth, low HDL cholesterol concentrations appear to be associated with increased rates of restenosis after percutaneous transluminal coronary angioplasty. In terms of elevating HDL cholesterol, cessation of cigarette smoking, reduction to ideal body weight, and regular aerobic exercise all appear important. Most medications used to treat dyslipidemias will raise HDL cholesterol levels modestly; however, niacin appears to have the greatest potential to do so, and can increase HDL cholesterol up to 30%. Recognizing these data, the most recent report of the National Cholesterol Education Program identified low HDL cholesterol as a CAD risk factor and recommended that all healthy adults be screened for both total cholesterol and HDL cholesterol levels.

1-Alkyl-2-acetylglycerophosphocholine Esterase↗

PubMed1997

Renal depressor mechanisms of physical training in patients with essential hypertension.

To clarify characteristics of the patients in whom exercise training lowers blood pressure and to elucidate the mechanisms by which exercise training lowers blood pressure, we evaluated 24-h blood pressure, glomerular filtration rate (GFR), renal blood flow (RBF), filtration fraction (FF), plasma renin activity (PRA), plasma aldosterone concentration (PAC), plasma norepinephrine concentration (PNE), and incremental area of insulin/glucose (sigmaI/sigmaG) during 75 g oral glucose tolerance test, and assessed arterial baroreceptor function (BSI) before and after a 3-week exercise training program (four 6-min sessions daily at 75% VO2 max). Patients were classified as responders (n = 15) if they showed statistically significant reduction in the multiple comparison of 24-h mean arterial pressure (MAP), or as nonresponders (n = 15) if they did not. Although there were no significant differences between responders and nonresponders in age, weight, MAP, GFR, RBF, RPF, FF, PNE, sigmaI/sigmaG, or BSI before exercise, renal vascular resistance (RVR; P < .05), PRA (P < .05), and PAC (P < .05) were significantly higher in responders than in nonresponders. The fractional excretion of sodium (FENa) (P < .05) were significantly lower in responders than in nonresponders. After exercise training, FF (P < .01), RVR (P < .05), PNE (P < .05) PRA (P < .01), and sigmaI/sigmaG (P < .05) decreased significantly only in responders. The decrease in MAP significantly correlated with the reductions in FF (r = 0.46, P < .05), PNE (r = 0.52, P < .01) and RVR (r = 0.40, P < .05). Thus, in patients who have higher RVR and PRA, exercise training lowered blood pressure in parallel to a reduction in RVR associated with decreases in sympathetic tone and improvement of insulin resistance. Our results suggest that exercise-induced changes in renal hemodynamics may contribute to the reduction in blood pressure in these patients.

Adult↗

PubMed2002

Inertization of hazardous dredging spoils.

Vitrification and production of ceramics materials starting from sediment excavated from Venice lagoon is described. This sediment is classified as toxic waste because contains several heavy metal ions and organic pollutants and was successfully vitrified at 1200-1350 degrees C. Twenty weight percentage of glass cullet, coming from a community glass recycling program, was added to the raw materials, previously calcined at 900 degrees C, as a way of adjusting the variations of composition of the individual sediment batches. Chemical durability (leaching) tests showed that the optimized glass compositions are inert, and thus not only volume reduction but also inertization of the waste was obtained by this process. Moreover, the economics of the entire process was analysed. The valorization of the waste was accomplished by the subsequent processing of the glass derived from the inertization. Glass ceramic materials were produced by viscous phase sintering of pressed glass powders which crystallized during the densification process. Sintered glass ceramic products had good mechanical characteristics (HV = 7.5 GPa, bending strength 150 +/- 8 MPa), making them suitable for applications in the building industry.

Ceramics↗

PubMed1999

Is knowledge about signs and symptoms of preterm labor related to low birth weight?

The intent of this study was to explore the relationship of patient knowledge about the signs and symptoms of preterm labor and low birth weight. To this end, 538 women were interviewed in the postpartum period. Five aspects of preterm labor knowledge (abdominal tightness, vaginal discharge, cramping, diarrhea, and bleeding) were sought, along with standard demographic information. Data were analyzed as dichotomous variables and compared using odds ratios. Logistic regression was chosen to calculate adjusted odds ratios, including only those factors found to be associated with low birth weight. Patient knowledge of each varied from 46 to 87% for the five items. Only one third knew all five areas. Knowledge of the importance of abdominal tightness, vaginal discharge, and cramping were associated with a reduction in low birth weight, as was knowledge of all five aspects. However, regression analysis failed to support a significant association with any of the five areas alone or when considered as a group. The low sensitivity of the relationship between patient knowledge and low birth weight and the lack of correlation after regression suggest that programs focusing on enhanced patient education may have limited benefits.

Abdomen↗

PubMed2006

Perinatal maternal undernutrition programs the offspring hypothalamo-pituitary-adrenal (HPA) axis.

There is now compelling evidence, coming both from animal and human studies that an early exposure to undernutrition is frequently associated with low birth weight and programs HPA axis alterations throughout the lifespan. Although animal models have reported conflicting findings arising from differences in experimental paradigms and species, they have clearly demonstrated that such programming not only affects the brain but also the pituitary corticotrophs and the adrenal cortex. In fetuses, maternal undernutrition reduces HPA axis function and implicates a reduction of placental 11beta-HSD2 activity and a greater transplacental transfer of glucocorticoids (GRs). In young adults, usually only fine HPA axis alterations were observed, whereas in older ones, maternal undernutrition was frequently associated with chronic hyperactivity of this neuroendocrine axis. In humans, evidence of HPA axis dysregulation in people who were small at birth has recently emerged. Thus, we suggest that such alterations in adults may be implicated in the aetiology of several disorders related to the metabolic syndrome as well as to immune or inflammatory diseases. To reverse such programming, recent experimental reports have shown that postnatal environmental interventions, dietary modifications and the use of agents modulating the epigenomic state could partly restore physiological functions and thus open new therapeutic strategies.

Adrenocorticotropic Hormone↗

PubMed2002

Can reducing peaks prevent type 2 diabetes: implication from recent diabetes prevention trials.

In recent years, a great deal of discussion has been focused on the role of postprandial hyperglycaemia in terms of development of type 2 diabetes (T2D), coronary heart disease (CHD) and their outcomes in patients with impaired glucose tolerance (IGT). With the incidence of T2D and its projected rise over the next 20 years, both the understanding of the pathophysiology of postprandial hyperglycaemia before development of frank T2D and the efficacy of interventions directed at lowering the postprandial glycaemic load to prevent the development of T2D have gained public health importance worldwide. Clinical trials have demonstrated that postprandial hyperglycaemia carries not only pathophysiological but also prognostic importance with regard to the quality of glycaemic control and forecasts the development of T2D, its complications, and patient mortality. The Diabetes Prevention Program randomised trial has shown that reducing postprandial hyperglycaemic peaks by a combined program of weight loss, improvement of diet, increase of physical exercise and smoking cessation lowers the risk for development of T2D by 58% compared with placebo and is equally beneficial to all patients, regardless of ethnicity, BMI, sex or level of glycaemia. Treatment with metformin was less effective than lifestyle modifications, resulting in an average reduction of risk of T2D of 31% compared with placebo. Postprandial hyperglycaemia plays a central role in the development of CHD in subjects with IGT, and reducing postprandial plasma glucose levels with lifestyle modifications in order to prevent T2D may also extend its benefits towards lower incidences of CHD and CHD-related mortality.

Cardiovascular Diseases↗

PubMed1981

Coronary risk factors in children.

Arteriosclerosis and its complications are the leading cause of death in American adults today. There is ample evidence to show that the pathologic process begins process begins in childhood. In addition, coronary risk factors can be identified in childhood and may be maintained to some degree into adulthood. Thus, prevention should logically begin in the childhood years. A small reduction of serum cholesterol levels in all children by a modest change in diet has the potential for reducing coronary risk. More severe dietary restriction, in some cases in conjunction with medication, is recommended for high-risk pediatric populations only. In addition, surveillance of blood pressure, avoidance of cigarette smoking, weight control, and a program of regular physical exercise are prudent recommendations for all children.

Adolescent↗

PubMed1995

Early extubation: preliminary experience in the cardiothoracic patient population.

BACKGROUND: Changing trends and economic forces that emphasize reduced length of stay and early discharge have commanded the need for redesign in the perioperative management of cardiovascular surgical patients. In an effort to explore alternative strategies a multidisciplinary group developed an early extubation program. OBJECTIVES: To determine the safety and efficacy of early extubation in terms of patient outcome, satisfaction and psychologic recovery, and cost and resource utilization. METHODS: A prospective analysis was conducted on patients who met eligibility criteria. Data were acquired from the medical record and through patient interviews. RESULTS: Forty-seven patients successfully participated in the early extubation program over a 10-month period; 15% were older than 70 years. The incidence of reintubation, cardiac arrest, or death was zero. The mean postoperative length of stay was 5.8 days. Two thirds of patients completed a one-step transfer model conferring a modest cost reduction and improved resource utilization. Findings also demonstrated reduced weight gain, earlier mobilization, and improved psychologic recovery. CONCLUSIONS: The preliminary findings demonstrate that early extubation is a safe and effective practice in selected cardiovascular surgical patients. Factors such as rising acuity, advanced age, and multisystem disease must be considered. Further research is warranted to validate the continued safety and efficacy of this practice to ensure positive patient outcomes.

Aged↗

PubMed2006

Usefulness of a home-based exercise program for overweight and obese patients with advanced heart failure.

Exercise is an important behavior for long-term weight control in overweight and obese patients. However, little evidence exists confirming such findings in patients with advanced heart failure (HF). Using a prospective, experimental design, the effects of 24 weeks of a low-level, home-based walking program on weight loss were studied in overweight and obese (body mass index > or =27 kg/m(2)) patients with advanced HF who were randomized to exercise (n = 48) and control (n = 51) groups. Weight changes between the 2 groups at baseline and 6 months were compared using repeated-measures analysis of variance. Patients were on average aged 53.3 +/- 10.1 years and predominantly male (75%), Caucasian (57%), and married (55%). Most patients were in New York Heart Association class III or IV (67%), with a mean ejection fraction of 25%. Patients in the exercise group showed significant weight reduction from baseline to 6 months compared with those in the control group (-6.37 +/- 11.7 vs -0.33 +/- 9.3 kg, p = 0.002). No significant differences were noted between the 2 groups in 6-minute walk distance or depression, although the changes were in the anticipated direction. Modest weight losses of >5% were associated with cardiopulmonary exercise test-documented workload levels at 6 months (r = 0.331, p = 0.006), as well as decreased depression (r = -0.315, p = 0.01) and hostility (r = -0.355, p = 0.005). The number of hospital admissions was significantly smaller for patients in the exercise group compared with those in the control group (0.63 +/- 0.94 vs 1.07 +/- 0.95, p <0.05). In conclusion, the findings demonstrate the beneficial effects of a low-level, home-based walking program on weight loss in overweight and obese patients with advanced HF.

Adolescent↗

PubMed1988

The effect of a relaxation technique on coronary risk factors.

This study examined the effect of a relaxation technique on plasma lipids, weight, blood pressure, and blood glucose. Sixteen outpatient males were randomly assigned to control or experimental groups. The experimental group was taught a relaxation technique that they used throughout the study. The control group was started in a reading program. Subjects were followed by a nurse practitioner and dietitian for eight weeks. Results revealed a significant reduction in systolic blood pressure and a marginally significant reduction in low density lipoprotein (LDL) cholesterol in the experimental group. Both control and experimental groups self-reported high compliance with diet and adherence to prescribed intervention. State anxiety was found to be inversely related to changes in total cholesterol and LDL cholesterol.

Aged↗

PubMed1983

The relationship of altered water/feed intake ratios on growth and abdominal fat in commercial broilers.

Three trials were conducted to investigate the relationship of changing water/feed ratios on growth rate and abdominal fat levels of two genetic lines. Water/feed intake ratios were elevated by feed restriction programs (skip-a-day and 70% restriction) from 0 to 4 days of age. Following return to ad libitum feed, compensatory gains were observed in body weights, and the elevated water/feed ratios declined to levels similar to that of controls. The addition of up to 2.4% dietary salt resulted in increased water/feed intake ratios without reductions in feed intake. Early body weights of birds receiving diets containing high levels of salt were larger than body weights of birds receiving the control diet. Peak differences in body weights occurred at 4 days and were larger in males than females. Feed efficiency from 0 to 4 days was higher for birds receiving high salt diets than for birds receiving the control diet. Decreasing the high salt levels resulted in reduced water/feed ratios to levels comparable to controls. Small differences were observed in abdominal fat between the two genetic lines. Abdominal fat weights were significantly (P less than or equal to .05) reduced (17 to 28%) in both lines when birds were fed a 2.4% salt diet. Although abdominal fat weights were similar between sexes, differences in body weights resulted in significant (P less than or equal to .05) differences between males and females in percent abdominal fat. Data indicated that high water/feed intake ratios may be associated with reduced abdominal fat.

Adipose Tissue↗