The dietetic side of liver disease management.
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Polynutrient deficiency in essential amino acids and vitamins A, C and E led to induction of liver tissue microsomal monooxygenase system in male rats of WAG strain within first 2 hrs and to inhibition of the induction within the subsequent hours after a single dose administration of a pesticide lindane (18 mg/kg) as compared with control animals maintained on a normal diet. The deficiency in essential nutrients caused also a delay in the monooxygenase induction in rats treated daily within 3 months with lindane at a dose of 0.9 mg per kg of body mass. No distinct nutritionally-dependent differences in the rate of the monooxygenase induction were observed after 6 months of the chronic treatment with the pesticide. Activity of monooxygenases in nutritionally-deprived and lindane-treated rats was decreased as compared with the similarly treated rats which were maintained on a normal diet. The induction of monooxygenases in experimental rats was accompanied by an increase in relative mass of liver tissue. The increase in liver tissue mass appears to occur as an adaptive response to the polynutrient deficiency and the effect of xenobiotics in order to maintain the enzymatic system at an adequate functional level.
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The status of water- and fat-soluble vitamins was prospectively evaluated in 23 patients (13 men, 10 women, mean age 33 +/- 3 yr) admitted to the hospital with acute or subacute attacks of inflammatory bowel disease. Protein-energy status was also assessed by means of simultaneous measurement of triceps skinfold thickness, mid-arm muscle circumference, and serum albumin. Fifteen patients (group A) had extensive acute colitis (ulcerative or Crohn's colitis), and eight cases (group B) had small bowel or ileocecal Crohn's disease. Eighty-nine healthy subjects (36 men, 53 women, mean age 34 +/- 2 yr) acted as controls. In both groups of patients, the levels of biotin, folate, beta-carotene, and vitamins A, C, and B1 were significantly lower than in controls (p less than 0.01). Plasma levels of vitamin B12 were decreased only in group B (p less than 0.01), whereas riboflavin was lower in group A (p less than 0.01). The percentage of patients at risk of developing hypovitaminosis was 40% or higher for vitamin A, beta-carotene, folate, biotin, vitamin C, and thiamin in both groups of patients. Although some subjects had extremely low vitamin values, in no case were clinical symptoms of vitamin deficiency observed. Only a weak correlation was found between protein-energy nutritional parameters and vitamin values, probably due to the small size of the sample studied. The pathophysiological and clinical implications of the suboptimal vitamin status observed in acute inflammatory bowel disease are unknown. Further studies on long-term vitamin status and clinical outcome in these patients are necessary.
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To combat vitamin deficiencies in populations whose dietary staple is maize, the fortification of maize meal with riboflavin and nicotinamide has been recommended. Subsequently, part of the milling industry has voluntarily fortified the meal with these two vitamins. In the present study, the concentrations of added riboflavin and nicotinamide were determined by high-performance liquid chromatography in 43 samples from a wide area. With the exception of three samples, concentrations of these vitamins were below the recommended level, and most were less than half this amount. Fortification programmes require regular monitoring by an independent authority.
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The content of vitamins C, E, A and beta-carotene was studied in the blood serum of 404 workers and employees of the Kuzbass industrial enterprises. Insufficient providing of the body with ascorbic acid, tocopherol and beta-carotene has been revealed. The number of workers and employees with vitamin C deficiency comprises at an average 95%, with vitamin E deficiency--9%, and with beta-carotene deficiency--34%. Industrial enterprises characterized by hard physical labor and occupational health hazard have been found to be most unfavourable with respect to providing with vitamins. The results of the investigations conducted have evidenced the necessity of correcting the vitamin nutrition of the subjects studied.
Chronically ill elderly patients who are unable to eat independently and often refuse food are threatened by malnutrition, even under conditions of long-term tube feeding. As the daily requirement of energy, protein, and vitamins varies according to the health of the patients, the higher need for food in conditions often seen in elderly patients such as decubital ulcers, infectious diseases, carcinomas, and after surgery should not be overlooked. The possibilities of modifying food supply require a knowledge of eating habits and of the exact composition of nutrients per volume of the preparation used for tube feeding.
Vitamin B1, B2, B6, C, A, and E status was assessed by combining determination of dietary intake with biochemical indices in 55 young male athletes. When compared with 20 matched sedentary controls, a similar number of individuals with biochemical deficiency was found in both groups for vitamins B1, B6, and E despite a higher mean dietary intake of these three vitamins in young athletes. Markedly reduced levels of pyridoxal 5'-phosphate, the biologically active form of the vitamin B6 compounds, were found in both populations. Supplementation administered for one month improved the vitamin status of the control subjects but not entirely those of the young athletes.
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Marked weight loss is the major nutritional defect in chronic pancreatitis. Inadequate food intake owing to recurrent or near continuous pain usually accounts for the initial 10 to 20 per cent of loss of body weight, which decreases again with the onset of diabetes and is often precipitous with the development of steatorrhea. Treatment of pain, control of diabetes, and intensive pancreatic replacement therapy for steatorrhea usually causes weight gain, but seldom to ideal weight. It appears that the patient's body weight gets set at a new "weight-stat." Although isolated abnormalities of small bowel function tests can be elicited and deficiencies of fat-soluble vitamins, calcium, zinc, selenium, and so forth may be demonstrated, these rarely lead to clinical syndromes, as with demonstrable low B12 uptake in some 10 to 15 per cent of patients. In the late stage of the disease and particularly in NATP, extreme protein-calorie malnutrition may occur, which may not be correctable even by hyperalimentation. Although the mortality of the disease was reportedly higher in areas of socioeconomic deprivation, it appears from recent studies in Switzerland and other developed countries that mortality during a 12-year period may be in the region of 50 per cent worldwide.
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Differences in absolute nutrient intakes, nutrient densities, and nutritional status between more physically active and more physically inactive elderly persons were analyzed from data of the Heidelberg-Michelstadt-Berlin Study. Comparisons were made in the different sex groups for older persons, the same comparisons were made for a group of younger persons. Although there was no significant statistical difference, the active persons had higher absolute energy intakes compared with inactive persons in all groups, except in the younger female group. Active older women have statistically significant higher vitamin B2, iodine, and calcium intakes than less active older women. Active older men have higher energy, carbohydrate, carotene, vitamin E, vitamin C, and calcium intakes than the less active older men. A totally different pattern of intakes is seen in the group of younger persons. The more active younger women show lower absolute intakes of vitamin A, vitamin E, vitamin B1, niacin, vitamin B6, vitamin B12, and sodium in comparison with the less active young women. Active young men show higher iodine intakes compared with the inactives. The differences in intakes however are not reflected in the nutritional status. The nutritional status of more active people is therefore neither endangered nor improved in comparison with less active.