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PubMed1987

Nonpharmacologic treatment of hypertension: does it work?

Abundant clinical and epidemiological data suggest that hypertension, or high blood pressure is a disease of high prevalence in industrialized societies, with cardiovascular morbidity and mortality directly related to the level of blood pressure. Although efficacious pharmacologic approaches to the control of high blood pressure are available, concern about risk versus benefit in the use of antihypertensive drug therapy for patients with mild hypertension has led to renewed interest in nonpharmacologic interventions. In the U.S.A. the National High Blood Pressure Education Program, an organization comprised of research scientists and a variety of other professionals concerned with the control of high blood pressure, has through a consensus process, recommended some nonpharmacologic approaches to the treatment of hypertension. The pros and cons of nutritional interventions, exercise and biobehavioral treatments are discussed. Nonpharmacologic recommendations in the treatment of hypertension for which there appear to be sufficient requisite data include weight reduction for the obese, moderate sodium restriction (although this is controversial) and restriction of alcohol consumption to less than 57 g of ethanol daily.

Animals↗

PubMedDate not supplied

Trends in maternal and infant health in poor urban neighborhoods: good news from the 1990s, but challenges remain.

OBJECTIVES: During the 1990s, numerous public policy changes occurred that may have affected the health of mothers and infants in low-income neighborhoods. This article examines trends in key maternal and child health indicators to determine whether disparities between high-poverty neighborhoods and other neighborhoods have declined. METHODS: Using neighborhood-level vital statistics and U.S. Census data, we categorized "neighborhoods" (Census tracts) as being high poverty (greater than 30% of population below the federal poverty level in 1990) or not. We compared trends in four key indicators--births to teenagers, late prenatal care, low birth-weight; and infant mortality--over the 1990s among high-poverty and other neighborhoods in Cuyahoga County, Ohio; Denver, Colorado; Marion County, Indiana; and Oakland, California. RESULTS: In all four metropolitan areas, trends in high-poverty neighborhoods were more favorable than in other neighborhoods. The most consistently positive trend was the reduction in the rate of teen births. The metropolitan areas with the most intensive programs to improve maternal and child health--Cuyahoga County and Oakland-saw the most consistent improvement across all indicators. Still, great disparities between high-poverty and other neighborhoods remain, and only Oakland shows promise of achieving some of the Healthy People 2010 maternal and child health goals in its high-poverty neighborhoods. CONCLUSIONS: While there has been a reduction in maternal and infant health disparities between high-poverty and other neighborhoods, much work remains to eliminate disparities and achieve the 2010 goals. Small area data are useful in isolating the neighborhoods that should be targeted. Experience from the 1990s suggests that a combination of several intensive interventions can be effective at reducing disparities.

Adolescent↗

PubMed1993

Strategies for improving maintenance of weight loss. Toward a continuous care model of obesity management.

The management of obesity represents an important objective in the care of many NIDDM patients. In recent years, progress has been made in increasing initial weight reductions, but poor long-term maintenance of weight loss remains a vital clinical concern. This article reviews the challenge of weight-loss maintenance and recommends the adoption of a continuous care model of obesity management. Strategies to improve the long-term maintenance of weight loss are described, and empirical tests of their effectiveness are reviewed. Collectively, the findings suggest that, after treatment for obesity, multifaceted programs comprised of continued professional contact, skills training, social support, and exercise, can enhance the long-term maintenance of weight loss.

Continuity of Patient Care↗

PubMed1973

Blood pressure reduction in "borderline" hypertensives following physical training.

One hundred and sixty-five middle-aged, apparently normal men were submitted to a six-month conditioning program. On the basis of a casual blood pressure measurement during the pre-training evaluation, 37 individuals (23%) were classified as "borderline" hypertensive. The remaining subjects (n = 128) were normotensive. At the conclusion of the program both groups exhibited significant reductions in systolic and diastolic blood pressures at rest and after submaximal work. Moreover, the reductions of the resting systolic and diastolic and of the exercise (300 kg.m./min.) systolic blood pressures were significantly greater for the hypertensives.

Adult↗

PubMed1996

Growth screening in schools: an evaluation of the programme in one district.

It has been recommended that all children should have their height and weight measured at school entry, although the disadvantages associated with screening and the benefits, in terms of a change in outcome, have not been fully established. The measuring equipment used in schools, recording of anthropometric data and adherence to local guidelines were assessed across one district. Few schools had the recommended equipment, problems with accuracy were common and screening coverage was low. The achievement of optical outcome will require a reduction in the gap between local practice and recommended policy: guidelines should recognize difficulties encountered in the field.

Anthropometry↗

PubMed2005

Effect of lean system 7 on metabolic rate and body composition.

OBJECTIVE: This study evaluated whether a commercial weight-loss product (Lean System 7) would result in less reduction in resting metabolic rate (RMR) in overweight subjects on a calorie-restricted diet and exercise regimen than in subjects using diet and exercise alone. METHODS: In this randomized, double-blind, placebo-controlled study, healthy overweight adults were given three capsules of a commercial weight-loss product twice daily or an identical placebo and followed a calorie-restricted diet and an exercise program for 8 wk. RMR, body weight, body mass index, waist and hip circumferences, and body composition by dual-energy x-ray absorptiometry were measured at baseline and week 8. An intention-to-treat analysis was performed. RESULTS: Of 47 adults enrolled, 35 completed the study. Subjects taking the commercial weight-loss product had a significant (P = 0.03) increase in RMR, 7.2% increase versus 0.7% decrease in the placebo group. Subjects taking the commercial weight-loss product also had a significant (P = 0.04) decrease in hip circumference, 3.78 cm versus 2.07 cm in the placebo group. There were no other statistically significant differences in any other outcome variable, diet composition, exercise compliance, or adverse events. CONCLUSION: The results of this study showed that administration of a commercial weight-loss product to overweight adults in conjunction with a calorie-restricted diet and moderate exercise program effectively reverses the decrease in RMR associated with calorie restriction within this study population. The commercial weight-loss product was well tolerated, and there were no serious adverse events over the 8 wk studied.

Absorptiometry, Photon↗

PubMed1997

The role of low-fat diets and fat substitutes in body weight management: what have we learned from clinical studies?

The introduction of low-fat, high-complex carbohydrate diets far the prevention and treatment of obesity was based on the causal link established between dietary fat and body fatness. Observational and mechanistic studies show that because fat possesses a lower satiating power than carbohydrate and protein, a diet rich in fat can increase energy intake. The propensity to gain weight is enhanced in susceptible persons, particularly sedentary people who have a genetic predisposition to obesity. Low-fat diets cause weight loss proportional to pretreatment body weight in a dose dependent manner; that is, weight loss is correlated positively to the reduction in dietary fat content. A reduction of 10% fat energy produces an average 5-kg weight loss in obese persons. As with traditional caloric counting diets, obese persons lose weight only if they adhere to the prescribed low-fat diet. Failure to achieve a weight loss and to maintain it may be attributed in part to lack of adherence to the diet. After a major weight loss, an ad libitum low-fat diet program appears to be superior to caloric counting in maintaining the weight loss 2 years later. Replacing some fat with protein instead of carbohydrate may increase the weight loss further. Moreover, fat substitutes may make it easier to prevent and treat obesity by making the diet palatable. More randomized, controlled, long-term dietary intervention studies are warranted to identify the optimal diet composition for the treatment of obesity.

Appetite↗

PubMed1977

Effect of infection on food intake and the nutritional state: perspectives as viewed from the village.

Data from a prospective study of a Guatemalan village population revealed an exceedingly high force of infection which may effect nutrition and growth from gestation onward. Maternal morbidity was higher and fetal antigenic stimulation was more frequent than in industrial societies. Infection of the young child was a common occurrence and although a great many infections were silent, morbidity rates were extremely high, particularly during the protracted weaning period (6 to 24 months). Infectious disease was found to be an important cause of weight loss, arrest in height, and impaired physical growth. Also, it was a common precipitating factor of severe malnutrition and death. Analysis of the dietary data of fully weaned children did not reveal a deficit in protein intake. Most children, however, had very low calorie intakes. Infectious disease was a common cause of anorexia and of marked reduction in calorie intake, followed by weight loss and impaired physical growth. A strong inverse correlation was detected between infectious disease and calorie intake in the 2nd year of life, when children were being weaned. Infection is the most important isolated factor in the causation of malnutrition in the village. A reorientation of health and nutrition policies seems in line in view of failures of food supplementation programs, particularly with protein, in many parts of the world.

Breast Feeding↗

PubMed1999

Effects of nandrolone decanoate therapy in borderline hypogonadal men with HIV-associated weight loss.

Serum testosterone concentrations are frequently in the low-normal range (lowest quartile, <500 ng/dl) in men with AIDS-wasting syndrome (AWS) and in other chronic wasting disorders. The response of patients in this group to androgen treatment has not been determined, however. Eighteen men with AWS (mean +/- standard error [SE]: 87% +/- 1% usual body weight; CD4 count 90 +/- 24) and borderline low serum testosterone concentrations (382 +/- 33 ng/dl) completed a 21-day placebo-controlled inpatient metabolic ward study comparing intramuscular (i.m.) placebo (n = 7) with low-dose (65 mg/week; n = 4) and high-dose (200 mg/week; n = 7) nandrolone decanoate, a testosterone analogue. Nitrogen balance, stable isotope-mass spectrometric measurement of de novo lipogenesis (DNL), resting energy expenditure, and gonadal hormone levels were measured. Both low-dose and high-dose nandrolone resulted in significant nitrogen retention (33-52 g nitrogen/14 days, representing gains of 0.5 to 0.9 kg lean tissue/week) compared with placebo (loss of 11 g nitrogen/week). This was reflected biochemically in a borderline significant reduction of high DNL (p < .06). Serum testosterone and gonadotropins were suppressed whereas resting energy expenditure was unchanged by nandrolone treatment. In 10 study subjects completing a 12-week open-label follow-up phase, body weight increased by 4.9 +/- 1.2 kg, including 3.1 +/- 0.5 kg lean body mass, and treadmill exercise performance also improved. In summary, nandrolone decanoate therapy in the absence of an exercise program in borderline hypogonadal men with AWS caused substantial nitrogen retention compared with placebo, similar in extent to the nitrogen retention previously achieved with recombinant growth hormone. It is reasonable to expand the criteria for androgen treatment in AWS to include at least patients in the lowest quartile of serum testosterone.

Adult↗

PubMed2005

Physical development of Belarussian children.

Anthropological research on children from Minsk was carried out within the framework of medical ecological monitoring. Besides the wide anthropometrical program, a study of the ecological conditions in the areas where the children examined reside and train was carried out. Comparison of the basic parameters of physical development in various age groups and the analysis of annual increases shows intensification of growth among modern children despite some decrease in the rates of acceleration. Some increase in body length and decrease of body weight as well as the reduction of chest circumference is common. Regional studies, particularly in the radiation control zones, show the dependence of physical development on the ecological situation.

Age Factors↗

PubMedDate not supplied

Antihypertensive treatment in patients with peripheral vascular disease.

BACKGROUND: Some specific treatment goals are indicated for patients with hypertension complicated by peripheral vascular disease. OBJECTIVE: To review the available information about treating hypertension in patients with atherosclerosis or aneurysms of the aorta or peripheral arteries. SUMMARY: Patients with peripheral vascular disease and hypertension should be treated according to the general guidelines for all patients with hypertension. However, specific treatment goals include improvement or stabilization of intermittent claudication and associated conditions such as coronary artery disease, hyperlipidemia, and diabetes mellitus. The ideal therapy for most of these conditions is nonpharmacologic: achievement of ideal body weight, a diet low in cholesterol, saturated fat, and salt, and a regular exercise program will improve blood pressure control, lipid values, blood glucose control, insulin sensitivity, symptoms of intermittent claudication, and long-term survival. Patients who smoke should stop. Patients with aneurysms should receive beta blockers. CONCLUSIONS: Antihypertensive therapy in patients with peripheral vascular disease should be part of a general program of risk-factor reduction.

Aneurysm↗

PubMed1996

Preventive behaviours in the Hutterite community following a nurse-managed cholesterol screening program.

In this study we examined the effect of a nurse-managed cholesterol screening program on the preventive health behaviours (e.g., diet changes, weight loss, medical surveillance) of 534 Hutterites. Hutterites are the largest single rural ethnic group in Canada and they have been found to be at high risk for heart disease. Eighty-one percent of the participants engaged in at least one preventive behaviour. Ongoing cholesterol surveillance was reported by 34.5% of the participants. Weight loss and dietary fat reduction were reported by 31% and 62% of the respondents, respectively. Seven percent of the respondents began lipid-lowering pharmacologic therapy. Screening cholesterol levels and age were significantly related to all of the outcomes except weight loss. This study provides evidence that community-based screening accompanied by counselling and referral by nurses can positively affect preventive behaviours.

Adult↗

PubMed1991

Effects of Chinese herbal drug, dai-saiko-to on plasma lipids, lipoproteins and liver lipid contents in guinea pig.

Effects of Chinese herbal drug, Dai-saiko-to, on plasma lipids, lipoproteins and liver lipid contents were investigated in guinea pig with/without cholesterol feeding. Guinea pigs were divided into 4 groups (Group 1: normal chow (N) diet, Group 2: N + 1% Dai-saiko-to (D) diet, Group 3: 1% cholesterol (C) diet, Group 4: 1% C+ 1% D diet), and were treated for 5 weeks. Significant body weight reductions were observed in Groups 3 and 4 compared to Groups 1 and 2. Significant reductions of plasma triglyceride (TG) and very low and low density lipoproteins [(V) LDL]-TG were found in Group 3 compared to Groups 1, 2, and 4. (HDL)-TG significantly decreased in Groups 3 and 4 compared to Groups 1 and 2, but no significant difference was noted between Groups 1 and 2, and Groups 3 and 4. Liver lipid contents analysis showed no significant changes between Groups 1 and 2, and Groups 3 and 4, respectively, but the distribution of lipid droplets as pathologically determined using a computer program showed Group 4 had less lipid deposition compared to Group 3. These data suggest that Dai-saiko-to acts on triglyceride metabolism in hypercholesterolemic guinea pigs.

Alanine Transaminase↗

PubMed1991

Cholesterol reduction in the workplace and in community settings.

Recent emphasis has been placed on the role of serum cholesterol in the development of cardiovascular disease and on reducing high serum cholesterol levels through a screening followed by a behavioral intervention. However, evidence about the effectiveness of this technique in reducing cholesterol has yet to be evaluated. A review of the biomedical and allied health literature was conducted to determine the effectiveness of reducing serum cholesterol levels in the general population through the use of a screening to identify those at risk followed by a behavioral intervention. Only worksite and community based studies published from 1980-89 were reviewed. Seven worksite and four community studies were identified. All studies used total serum cholesterol as the dependent variable while some included other physiological measures. The majority of studies used a multicomponent intervention involving dietary education, exercise, smoking cessation, or weight reduction components. The interventions tested lasted from 14 weeks to five years and varied from low intensity to high intensity. The methods of intervention ranged from face-to-face interaction to mail and telephone counseling. Although many of the studies reviewed contain methodological flaws, certain findings are evident. The studies show that cholesterol can be reduced through a screening followed by a behavioral intervention, the multicomponent program is the most effective intervention, and low intensive interventions are as equally effective as high intensive interventions. Program implications and future research directions are discussed.

Cholesterol↗

PubMed2002

Inpatient and partial hospital treatment for adolescent eating disorders.

The eating disorders are complex illnesses that tend to have a chronic relapsing course with severe morbidity and high mortality rates. Outcome seems to be best when the disorders are recognized early, brought to treatment quickly, the family is involved, and the first episode of care results in full return and maintenance of weight and menstruation. Adolescents who reach the point of needing hospitalization should be treated aggressively. In this article the authors have tried to outline some key treatment principles not just for the hospital stay, but elements that should be carried throughout the entire program of recovery for adolescents with eating disorders: from medical evaluation, through inpatient stay, partial hospitalization, intensive outpatient program, and follow-up outpatient therapy. Recent reductions in insurance authorizations and decreased lengths of stay in the psychiatric hospital make the already difficult challenge of recovery from AN and BN even more daunting. Despite these difficulties, we are still able to get a high proportion of youths better and eventually fully recovered.

Adolescent↗

PubMed1996

Relationship between weight loss maintenance and changes in serum leptin levels.

Serum leptin concentrations are higher in obese humans than in lean and are decreased by initial weight loss. This study examined the effects of maintenance of weight loss on leptin concentrations and tested whether leptin concentrations at baseline or after initial weight loss are related to the ability to maintain a reduced body weight. Fifty-two overweight women [body mass index (kg/m2) averaging 31.3] were studied before and after a 4 month weight loss program and at 6 month follow-up. Subjects lost 8.1 kg over the 4 month program, and leptin concentrations decreased from 30.1 to 20.4 ng/ml. Initial leptin level per unit body mass index (r = -0.61, p < 0.0001) and weight loss during months 0 to 4 (r = 0.39, p = 0.004) were both significantly associated with initial changes in leptin, and together explained 60% of the variance in change in leptin. Subjects who maintained their weight losses over the 6-month follow-up maintained their reductions in leptin levels; again, weight changes during follow-up were correlated with changes in serum leptin levels (r = 0.41, p = 0.003). There was no evidence that baseline leptin concentration (or leptin/body mass index) or the changes in leptin which accompanied initial weight loss were predictive of subsequent weight regain. Thus, changes in leptin concentration during weight loss track with changes in weight. However, neither baseline concentrations nor initial changes in leptin predict success at weight loss or maintenance.

Adult↗

PubMed2003

Nurses' observational study on the practice of secondary prevention in a cardiovascular department.

BACKGROUND: Although interventional studies have established the prognostic importance of the control of risk factors in patients with cardiovascular disease, reviews invariably show that the implementation of secondary prevention in patients with cardiovascular disease during hospitalization for acute manifestations or interventions is unsatisfactory. The aim of this study was to observe secondary prevention practice in a cardiovascular department, as part of a quality assurance program. METHODS: Two hundred and twenty patients discharged from the intensive coronary care unit, cardiac surgery unit and vascular surgery unit were prospectively included. Data were extracted from medical records and discharge documents. One hundred and eleven patients with at least one modifiable risk factor which was previously not corrected, were interviewed at discharge and were reassessed 3 months later. RESULTS: Written prescriptions about smoking cessation and weight reduction were given to 7 and 3% of smokers and overweight patients respectively. In 17% of patients no lipid measurement was reported, and in 49% of patients with low-density lipoprotein (LDL) cholesterol levels > 129 mg/dl statins were not prescribed. In patients with a history of infarction, aspirin and beta-blockers were prescribed in 90 and 64% respectively. In diabetics, statins were prescribed to 48% and angiotensin-converting enzyme inhibitors to 31%. Less than 40% of patients were able to refer appropriate levels for their blood pressure, weight, and cholesterol, and 30% fully comprehended the importance of smoking cessation. At the 3-month follow-up visit, 37% of patients had LDL cholesterol levels > 129 mg/dl--in half of these patients despite statins. In 61% of diabetics glycemic control was poor, and one third of smokers had not stopped smoking. CONCLUSIONS: These observations by the nurses have shown pitfalls in the implementation of guidelines, due to incomplete risk assessment, insufficient drug treatment and ineffective patient education. These data are the starting point for upcoming actions of quality improvement in the cardiovascular department of our hospital.

Aged↗

PubMedDate not supplied

Health promoting behaviors among African American women with faith-based support.

UNLABELLED: The purpose of this qualitative exploratory study was to document health perceptions, beliefs and attitudes, intentions and social pressures that influence health promoting behaviors as expressed by community level aggregates of African American women with faith support. Twenty-six African American women from two large urban congregations with an active health ministry program participated in this study. Focus group interviews guided by the Theory of Planned Behavior (Ajzen & Fishbein, 1980 & 1991) were used to identify salient health perceptions, beliefs and attitudes, intentions, and social pressures influencing health-promoting behaviors in African American women with faith-based support. Positive health perceptions, attitudes, and beliefs were identified as important to engaging in a healthy lifestyle. Exercise, well balanced diets, weight reduction and stress management were the most salient health concerns among the respondents. Key referents identified included the pastor, congregational nurses, physicians, and church/family members. Control beliefs among these women reflected salient spiritual and fatalistic beliefs concerning health-promoting behaviors. Trusting relationships, open communication, safe, comfortable, and familiar environments were identified as important considerations when planning health promotion interventions for an African American faith community. CONCLUSIONS: Health beliefs, attitudes, and behaviors are not developed outside of social systems, therefore, the facilitation of healthy lifestyle behaviors may be best assessed and influenced within a context of reciprocal social interaction such as in a faith-based community. In the context of a community level aggregate with faith-based support, behaviors to promote a healthy lifestyle may be positively influenced.

Adult↗