Environmental life cycle assessment of production of the high intensity sweetener steviol glycosides from Stevia rebaudiana leaf grown in Europe: The SWEET project.

Purpose: There is an increasing interest in the use of non-nutritive sweeteners to replace added sugar in food and beverage products for reasons of improving consumer health. Much work has been done to understand safety of sweeteners, but very little on sustainability. To address that gap, this study presents the results of a life cycle assessment (LCA) of production of rebaudioside A 60%, 95% pure (RA60) steviol glycoside mix from Stevia rebaudiana leaf grown in Europe. Methods: An attributional cradle-to-factory-gate life cycle assessment was conducted on growing of stevia leaves and extraction of steviol glycosides in Europe. Primary data were used from a case study supply chain. Results are reported in impact categories from the ReCiPe 2016 (H) method, with focus given to global warming potential, freshwater eutrophication, water consumption, and land use. Impacts are expressed both in terms of production mass and sweetness equivalence, a common metric for understanding high intensity sweetener potency. Sweetness equivalence of RA60 is typically 200 to 300 times that of sugar. Comparison of environmental impact is made to sugar (sucrose) produced from both cane and beets. The research is part of the EU project SWEET (sweeteners and sweetness enhancers: impact on health, obesity, safety, and sustainability). Results and discussion: Global warming potential for production of RA60 was found to be 20.25 kgCO2-eq/kgRA60 on a mass basis and 0.081 kgCO2-eq/kgSE on a sweetness equivalence basis. Field production of stevia leaves was found to be the main source of impact for most impact categories, and for all four focus categories. Extraction of the RA60 was the main source of impact for the others. Leaf processing and seedling propagation were minor contributors to life cycle impact. Removal of international transport from the supply chain reduced global warming potential by 18.8%. Compared with sugar on a sweetness equivalence basis, RA60 has approximately 5.7% to 10.2% the impact for global warming potential, 5.6% to 7.2% the impact for land use, and is lower across most other impact categories. Conclusion: This is the first LCA of steviol glycoside mix RA60 produced from leaf in Europe. The results indicate that RA60 can be used to reduce environmental impact of providing a sweet taste by replacing sugar across all impact categories. However, it is important to note that specific formulations in which RA60 is used will have a bearing on the final environmental impact of any food or beverage products. For solid foods, this requires further research. Supplementary Information: The online version contains supplementary material available at 10.1007/s11367-022-02127-9.

Influence of type of dairy matrix micro- and macrostructure on in vitro lipid digestion.

Recent research indicates that the food matrix can influence digestion kinetics and uptake of nutrients, thus affecting human health. The aim of this study was to obtain knowledge on how variations in microstructure and texture of foods represented by four dairy products; (i) cheddar cheese, (ii) a homogenized cheddar cheese, (iii) a micellar casein and cream drink or (iv) a micellar casein and cream gel, all of identical nutrient ratios of protein : fat and calcium : fat, affect the in vitro digestibility kinetics of lipids. Rheology of the four dairy structures was measured at 10 °C and 37 °C before digestion, and during the gastric phase of in vitro digestion. During digestion cheddar cheese was most resistant to enzymatic and mechanical disintegration, followed by homogenized cheese, while both the drink and gel had low resistance and dissolved in the gastric juice. Particle size, fat droplet size and microstructure were assessed by light scattering and confocal microscopy during digestion. Significantly larger fat droplets were observed during digestion of the cheddar cheese sample. The release of free fatty acids during the initial intestinal digestion showed cheddar cheese to provide a significantly lower release than homogenized cheese, whereas the drink and gel both had significantly higher free fatty acid release. The results suggest that the cheese matrix resistance to degradation and its large fat droplets were responsible for a slower fat digestion.

The association of dietary animal and plant protein with putative risk markers of colorectal cancer in overweight pre-diabetic individuals during a weight-reducing programme: a PREVIEW sub-study.

PURPOSE: Diets with increased protein content are popular strategies for body weight regulation, but the effect of such diets for the colonic luminal environment is unclear. We aimed to investigate the associations between putative colorectal cancer-related markers and total protein intake, plant and animal proteins, and protein from red and processed meat in pre-diabetic adults (> 25 years). METHODS: Analyses were based on clinical and dietary assessments at baseline and after 1 year of intervention. Protein intake was assessed from 4-day dietary records. Putative colorectal cancer-related markers identified from 24-h faecal samples collected over three consecutive days were: concentration of short-chain fatty acids, phenols, ammonia, and pH. RESULTS: In total, 79 participants were included in the analyses. We found a positive association between change in total protein intake (slope: 74.72 ± 28.84 µmol per g faeces/E%, p = 0.01), including animal protein intake (slope: 87.63 ± 32.04 µmol per g faeces/E%, p = 0.009), and change in faecal ammonia concentration. For change in ammonia, there was a dose-response trend from the most negative (lowest tertile) to the most positive (highest tertile) association (p = 0.01): in the high tertile, a change in intake of red meat was positively associated with an increase in ammonia excretion (slope: 2.0 ± 0.5 µmol per g faeces/g/day, p < 0.001), whereas no such association was found in the low and medium tertile groups. CONCLUSION: Increases in total and animal protein intakes were associated with higher excretion of ammonia in faeces after 1 year in overweight pre-diabetic adults undertaking a weight-loss intervention. An increase in total or relative protein intake, or in the ratio of animal to plant protein, was not associated with an increase in faeces of any of the other putative colorectal cancer risk markers. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01777893.

Reductions in body weight and insulin resistance are not associated with changes in grey matter volume or cortical thickness during the PREVIEW study.

INTRODUCTION: The effect of changes in body weight or insulin resistance on grey matter volume and cortical thickness change are unclear. The present observational study assessed effects of an 8-week weight loss period (≥8% of body weight), and a subsequent 22-month weight maintenance period on grey matter volume and cortical thickness. METHODS: A total of 24 participants (12f/12 m; age 52.8 ±â€¯10.6 years) with overweight/obesity and pre-diabetes were recruited. T1-weighted magnetic resonance imaging was used to determine grey matter volume and cortical thickness at baseline, after the weight loss period and after a medium to high dietary protein weight maintenance period. RESULTS: At baseline, global grey matter volume was inversely associated with HOMA-IR, adjusted for sex and age (r = -0.42; p = .049). During the weight loss period participants decreased their BMI (32.1 ±â€¯3.3 to 28.1 ±â€¯2.8 kg/m2, p < .01), body-fat (41.6 ±â€¯6.4 to 35.0 ±â€¯8.0%, p < .01) and insulin resistance (HOMA-IR: 4.0 ±â€¯2.0 to 1.8 ±â€¯0.9, p < .01). During the 22-month weight maintenance period, these parameters gradually increased again (BMI: 29.3 ±â€¯3.8 kg/m2; body-fat: 37.8 ±â€¯9.3%; HOMA-IR: 2.9 ±â€¯1.4, p < .01). Global grey matter volume and cortical thickness did not change significantly during the weight loss or weight maintenance period. Changes in body weight, body-fat percentage or insulin sensitivity were not associated with changes in global grey matter volume. CONCLUSION: In conclusion, we confirmed that global grey brain matter volume was inversely associated with insulin resistance at baseline, yet an intervention yielding a decrease in insulin resistance did not lead to changes in global grey brain matter volume or cortical thickness. TRIAL REGISTRATION: The trial is registered with ClinicalTrials.gov, NCT01777893.

Long-term effects of increased protein intake after weight loss on intrahepatic lipid content and implications for insulin sensitivity: a PREVIEW study.

The aim of this study was to assess the effects of a weight maintenance period comprising two diets differing in protein intake, after weight loss, on intrahepatic lipid content and implications for insulin sensitivity. A total of 25 participants [body mass index (BMI): 31.1 (3.5 kg/m2; intrahepatic lipid (IHL): 8.7 (8.3%; fasting glucose: 6.4 (0.6 mmol/l; homeostatic model assessment for insulin resistance (HOMA-IR): 3.7 (1.6; Matsuda index: 3.4 (2.9] started an 8-wk low-energy diet followed by a 2-yr weight maintenance period with either high protein or medium protein dietary guidelines. At baseline, after 6 mo, and after 2 yr, IHL, visceral adipose tissue (VAT), and subcutaneous adipose tissue (SAT) were determined by magnetic resonance spectroscopy/imaging. Glucose and insulin concentrations, determined during an oral glucose challenge, were used to assess the HOMA-IR and Matsuda insulin sensitivity index (ISI). Protein intake was measured with 24-h urinary nitrogen excretion. Protein intake, BMI, IHL, VAT, SAT, HOMA-IR, and ISI did not change differently between the groups during the intervention. In the whole group, BMI, IHL, VAT, SAT, HOMA-IR, and ISI were favorably changed at 6 mo and 2 yr compared with baseline ( P < 0.05). Mixed-model analysis showed that independent of BMI, protein intake (g/d) at 6 mo was inversely related to IHL (coefficient: -0.04; P < 0.05) and VAT (coefficient: -0.01; P < 0.05). Overall, IHL was positively related to HOMA-IR (coefficient: 0.10; P < 0.01) and inversely related to ISI (coefficient: -0.17; P < 0.01), independent of BMI. A 2-yr medium- to high-protein energy-restricted diet reduced IHL and VAT. Independently of changes in BMI, IHL was inversely related to insulin sensitivity.

Biochemical control and toxicity for favorable- and intermediate-risk patients using real-time intraoperative inverse optimization prostate seed implant: Less is more!

PURPOSE: To report the biochemical control rate and clinical outcomes with real-time inverse planning (inverse optimization prostate seed implant [IO-PSI]) for favorable-risk (FR) and intermediate-risk (IR) prostate adenocarcinoma in a community practice setting. This analysis is an extended followup of our initial report, with favorable early biochemical control rate (biochemical nonevidence of disease) of 97% at 4 years. METHODS AND MATERIALS: Three hundred fifty-seven evaluable patients with FR and IR prostate cancer underwent real-time IO-PSI (iodine-125/145 Gy or palladium-103/120 Gy) between 2001 and 2013. RESULTS: With a median followup of 54 months (range, 24-110 months), the absolute biochemical failure free survival of disease was 96%. The 8-year actuarial probability of prostate-specific antigen failure-free survival for FR and IR cohorts was 92.4% and 87%, respectively. Late genitourinary and gastrointestinal toxicity remained low. Late Grade 2 and Grade 3 genitourinary toxicity was 19% and 1%, respectively. Late Grade 2 and 3 rectal bleeding rates were 1% and 0%, respectively. No difference in biochemical control was observed with preimplant short course androgen deprivation or between Gleason score 3 + 4 vs. 4 + 3 patients. No dosimetric parameter was predictive of biochemical failure. Patients with FR had a significantly decreased risk of failure (hazard ratio = 0.26; 95% confidence interval = 0.09-0.78; p = 0.02) compared with those with IR. Patients with a prostate-specific antigen nadir >0.4 ng/mL had an increased risk of failure (hazard ratio = 1.37; 95% confidence interval = 1.27-1.47; p < 0.0001). CONCLUSIONS: Our initial biochemical and clinical outcomes using real-time IO-PSI persisted with extended followup and support our original hypothesis for use of a reduced number of sources, needles, and total activity, suggesting that with IO, less is more.

The role of higher protein diets in weight control and obesity-related comorbidities.

The importance of the relative dietary content of protein, carbohydrate and the type of carbohydrate (that is, glycemic index (GI)) for weight control under ad libitum conditions has been controversial owing to the lack of large scale studies with high diet adherence. The Diet, Obesity and Genes (DioGenes) European multicentre trial examined the importance of a slight increase in dietary protein content, reduction in carbohydrate and the importance of choosing low (LGI) vs high GI (HGI) carbohydrates for weight control in 932 obese families. Only the adults underwent a diet of 800 kcal per day for 8 weeks, and after losing ~11kg they were randomized to one of five energy ad libitum diets for 6 months. The diets differed in protein content and GI. The high-protein (HP) diet groups consumed 5.4% points more energy from protein than the normal protein (NP) groups, and the LGI diet groups achieved 5.1% lower GI than the HGI groups. The effect of HP and LGI was additive on weight loss and maintenance, and the combination was successful in preventing weight regain and reducing drop-out rate among the adults after the 11kg weight loss. This diet also reduced body fatness and prevalence of overweight and obesity among their children and had consistent beneficial effects on blood pressure, blood lipids and inflammation in both parents and children. After 1 year, mainly the HP effects were maintained. Putative genes have been identified that suggest this diet to be particularly effective in 67% of the population. In conclusion, the DioGenes diet has shown to be effective for prevention of weight regain and for weight reduction in overweight children under ad libitum conditions. The less-restrictive dietary approach fits into a normal food culture, and has been translated into popular diet and cook books in several languages.

The effect of the triple monoamine reuptake inhibitor tesofensine on energy metabolism and appetite in overweight and moderately obese men.

BACKGROUND: Tesofensine (TE) is a new drug producing twice the weight loss in obese individuals as seen with currently marketed drugs. It inhibits the presynaptic reuptake of the neurotransmitters noradrenaline, dopamine and serotonin, and is thought to enhance the neurotransmission of all three monoamines. The mechanisms by which it produces weight loss in humans are unresolved. OBJECTIVE: The aim of this study is to investigate the mechanism(s) behind weight reduction by measuring energy expenditure and appetite sensations in overweight and obese individuals. DESIGN: Thirty-two healthy, overweight or moderately obese men were treated with 2.0 mg TE daily for 7 days followed by an additional 7 days with 1.0 mg TE daily or corresponding placebo (PL) in a randomized, controlled trial. They were instructed to maintain habitual food intake and physical activity throughout. Twenty-four-hour energy expenditure (24-h EE), fat oxidation and spontaneous physical activity were measured in a respiration chamber before and after treatment. Body composition was assessed by dual-energy X-ray absorption and appetite was evaluated by visual analogue scales in conjunction with a standardized dinner. RESULTS: Despite efforts to keep body weight and composition constant, TE induced a 1.8 kg weight loss above PL after 2 weeks' treatment (P<0.0001). TE also induced higher ratings of satiety and fullness and concomitantly lower prospective food intake than placebo. No significant effect of TE on total 24-h EE could be demonstrated compared with PL, but higher energy expenditure was observed during the night period (4.6%; P<0.05) when adjusted for changes in body composition. Furthermore, TE increased 24-h fat oxidation as compared with PL (18 g; P<0.001). CONCLUSION: TE has a pronounced effect on appetite sensations and a slight effect on energy expenditure at night-both effects can contribute to the strong weight-reducing effect of TE.

Whole flaxseeds but not sunflower seeds in rye bread reduce apparent digestibility of fat in healthy volunteers.

OBJECTIVE: The aim of this study was to measure the apparent digestibility of fat and the transit time upon addition of whole sunflower seeds (SU) or flaxseeds (FL) to rye breads consumed as part of a whole diet. METHOD: In a randomized crossover study, gross intake and faecal excretion of fat and energy were measured in 11 young healthy men aged 24.6+/-2.7 years. During each 7 days intervention periods, the subjects received a basal diet plus 300 g of one of four rye breads: (1) rye bread; (2) rye bread with SU; (3) rye bread with FL; (4) low extraction rate rye bread with SU and FL. Fat binding properties of rye breads (1) and (3) were determined by in vitro digestion. RESULTS: Addition of whole SU or FL to breads increased daily gross intake of fat and energy (P<0.001). The amounts of apparently digested fat (g/day) and energy were lowered when subjects consumed the SU or FL rye bread (P<0.001). The effect on energy digestibility of FL was more pronounced than that of SU. The in vitro fat digestibility of rye breads and whole diets show fat-binding properties of FL when compared to the rye bread diet (P<0.05). CONCLUSIONS: Enrichment of bread with whole FL does not appear to result in increased fat and energy intake when added to breads, but the results rather indicate an impairment of nutrient utilization.

No effect of inhibition of insulin secretion by diazoxide on weight loss in hyperinsulinaemic obese subjects during an 8-week weight-loss diet.

AIM: Obesity is positively associated with hyperinsulinaemia, and it has been suggested that hyperinsulinaemia may contribute to maintain the obese state in insulin-resistant obese individuals. The aim of the present study was to investigate the effect of inhibition of insulin secretion by diazoxide on weight loss in obese, normoglycaemic (fasting plasma glucose of > or =6.1 mmol/l), hyperinsulinaemic (fasting plasma insulin of > or =100 pmol/l) adults during a 2.5 MJ/day energy-deficient diet. METHODS: In an 8-week, double-blind, placebo-controlled parallel design, 35 overweight and obese subjects (age: 23-54 years, body mass index: 27-66 kg/m(2)) were randomized either to 2 mg/kg/day (maximum 200 mg/day) of oral diazoxide or to placebo. Body composition and resting energy expenditure (REE) were measured before and after the intervention. Blood samples, and appetite sensations by visual analogue scales, were collected during fasting, during an oral glucose tolerance test (OGTT) and 4 h postprandially after a test meal. Subsequently, an ad libitum meal was given. RESULTS: Thirty-one subjects completed the protocol. Eight weeks of diazoxide decreased incremental area under the response curve (iAUC) for insulin (iAUC(insulin)) and for C-peptide (iAUC(C-peptide)) and increased iAUC for glucose (iAUC(glucose)) during the OGTT and the test meal compared with the use of placebo (p < 0.003). No differences in changes between the groups in body weight, body fat, REE or appetite were observed during the 8-week trial. CONCLUSION: These findings do not suggest that hyperinsulinaemia per se contributes to maintenance of the obese state, and insulin secretion inhibition seems not a promising drug target.

Overweight men's motivations and perceived barriers towards weight loss.

OBJECTIVE: To explore motivation and perceived barriers towards weight loss among Danish men. DESIGN: The study was of an explorative nature, using qualitative focus group interviews as a method. SETTING: Copenhagen, Denmark. SUBJECTS: Twenty-two overweight men, at the age of 25-44 years and motivated for weight loss, were recruited and distributed into four focus groups. The men were primarily unskilled workers. Overall 13 men participated and each group contained three or four participants. INTERVENTION: The interview guide was partly structured, partly unstructured and the themes of the interviews were motives and perceived barriers towards weight loss. RESULTS: Main barriers for losing weight appeared to be lack of motivation and the perception of the slimming diet. The men had a desire to have a lean appearance and avoid illness, but in all the interviews it appeared that the strongest motive for losing weight was a strong desire to become more effective and a greater asset for one's workplace. Overweight subjects were considered less effective and attractive for the labour market. CONCLUSION: This study indicates that if men from lower socioeconomic backgrounds are to be motivated to weight loss the focus should not be on leanness and good health but rather on increased effectiveness and performance, and the arena should include the working place. SPONSORSHIP: The Royal Veterinary and Agricultural University supplied the necessary equipment and conference rooms.

Different effects of whole milk and a fermented milk with the same fat and lactose content on gastric emptying and postprandial lipaemia, but not on glycaemic response and appetite.

Longitudinal studies indicate that milk and fermented milk products lower basal plasma cholesterol concentrations, despite their high content of saturated fat, and therefore have favourable health effects. However, there have been few studies on the postprandial effects of milk products. The present study compared the effect of whole milk with a fermented milk, A-38, on postprandial carbohydrate and lipid metabolism, gastric emptying and appetite. Eight healthy young men participated. On the two test days, they arrived fasting for collection of baseline values before consuming the meals, which for a 75 kg subject consisted of 1.4 litre milk or fermented milk, plus 165 mg [13C]acetate (for later determination of gastric emptying by a [13C]acetate breath test). Lactose (15 g) was added to the A-38 meal to equalize the lactose content. Postprandially the A-38 meal resulted in a slower gastric emptying rate than milk (P<0.001). Furthermore, the A-38 meal resulted in a greater increase and a quicker decrease of the triacylglycerol content in all lipoprotein fractions (LDL-fraction, P<0.05; other fractions, P<0.001) and of the gastrointestinal hormones (cholecystokinin and peptide YY, P<0.05; gastric inhibitory polypeptide and glucagon-like polypeptide-1, P<0.001). There were no significant differences in appetite sensations (measured by visual analogue scale) or in the glucose and insulin response (P>0.10). The slower emptying rate of the liquid phase after the A-38 meal is probably due to the higher viscosity of A-38. The lower and more prolonged triacylglycerol response after the milk meal might be caused by coagulation of milk in the stomach.

Micronutrient intake in overweight subjects is not deficient on an ad libitum fat-reduced, high-simple carbohydrate diet.

OBJECTIVE: To investigate whether subjects consuming a fat-reduced, high-simple carbohydrate diet (SCHO) are at greater risk of micronutrient inadequacy than subjects consuming a fat-reduced, high-complex carbohydrate (CCHO) or a normal-fat diet (control, CD). DESIGN: A 6-month randomised controlled dietary intervention trial with a parallel design. METHODS: In total, 46 overweight (BMI: 24.4-36.3 kg/m(2)) subjects (19 males, 27 females) aged 21-54 y consumed one of three ad libitum diets: SCHO, CCHO, or CD. Nutrient intake was assessed by a 7-day weighed food record. RESULTS: Self-reported energy intake did not differ between diet groups. The lowest intake of vitamin B(12) was found in the SCHO group vs CCHO (P=0.025) and vs. CD (P=0.012). In men, zinc intake was lower on the SCHO diet compared to the CD diet (P=0.018). The recommendations for zinc and vitamin B(12) were, however, met by all the diet groups. No other diet differences were observed. Intake of several micronutrients were insufficient in all three diet groups, although in most cases comparable to average Danish intakes. CONCLUSION: Zinc intake in men and vitamin B(12) intake in the combined gender groups were lower on a fat-reduced, simple carbohydrate-rich diet compared to a habitual, normal-fat diet, but not below recommended levels.

Effect of sensory perception of foods on appetite and food intake: a review of studies on humans.

OBJECTIVE: How much do the sensory properties of food influence the way people select their food and how much they eat? The objective of this paper is to review results from studies investigating the link between the sensory perception of food and human appetite regulation. CONTENT OF THE REVIEW: The influence of palatability on appetite and food intake in humans has been investigated in several studies. All reviewed studies have shown increased intake as palatability increased, whereas assessments of the effect of palatability using measures of subjective appetite sensations have shown diverging results, for example, subjects either feel more hungry and less full after a palatable meal compared to a less palatable meal, or they feel the opposite, or there is no difference. Whether palatability has an effect on appetite in the period following consumption of a test meal is unclear. Several studies have investigated which sensory properties of food are involved in sensory-specific satiety. Taste, smell, texture and appearance-specific satieties have been identified, whereas studies on the role of macronutrients and the energy content of the food in sensory-specific satiety have given equivocal results. Different studies have shown that macronutrients and energy content play a role in sensory-specific satiety or that macronutrients and energy content are not a factor in sensory-specific satiety. Sensory-specific satiety may have an important influence on the amount of food eaten. Studies have shown that increasing the food variety can increase food and energy intake and in the short to medium term alter energy balance. Further knowledge about the importance of flavour in appetite regulation is needed, for example, which flavour combinations improve satiety most, the possible connection between flavour intensity and satiety, the effect of persistence of chemesthetic sensation on palatability and satiety, and to what extent genetic variation in taste sensitivity and perception influences dietary habits and weight control.

No effect of physiological concentrations of glucagon-like peptide-2 on appetite and energy intake in normal weight subjects.

OBJECTIVE: To examine the effect of a GLP-2 infusion on appetite sensations and ad libitum energy intake in healthy, normal weight humans. DESIGN: The experiment was performed in a randomised, blinded, and placebo-controlled crossover design. Placebo or GLP-2 was infused (infusion rate of 25 pmol/kg body wth) for 4.5 h. SUBJECTS: A total of 18 healthy, normal weight young subjects participated; eight women and 10 men. MEASUREMENTS: During the infusion, subjects recorded their appetite sensations every 30 min using visual analogue scales, and blood was sampled frequently. After 2 h of infusion, an ad libitum meal, consisting of sandwiches, was served. RESULTS: The concentration of GLP-2 was significantly higher during the GLP-2 infusion compared with placebo (P<0.0001) and increased further in both conditions in response to the meal. Neither appetite sensations, nor palatability of the test meals, or energy intake were different on the two occasions. Glucose, GLP-1, insulin, and GIP responses were also unaffected by the infusion, whereas glucagon levels were higher during the GLP-2 treatment (P<0.05). CONCLUSION: Circulating GLP-2 in physiological concentrations does not seem to play a significant role in human appetite regulation.

Achieving "proper" satiety in different social contexts--qualitative interpretations from a cross-disciplinary project, sociomaet.

In nutritional research, the sensations of appetite have mostly been studied as a physiological phenomenon. However, in order to understand the significance of appetite for everyday eating habits, it is pertinent to include the social dimension. In a qualitative interview study, using qualitative semi-structured in-depth interviews, we investigated how appetite was experienced and handled in the context of everyday life among 20 men and women. This report examines how qualitative dimensions of appetite are experienced and conceptualised in everyday life. Achieving what was described as proper satiety was found to be of decisive importance for daily eating habits. The experience of being full up, the duration of satiety and the sensuous pleasure of eating were all found to be central dimensions of proper satiety, the definition of which varied according to different social contexts. Whether one ate one's fill in the company of others, alone, at work or in one's spare time turned out to be of decisive importance. A more elaborate understanding of the social dimensions of appetite may help to improve endeavours to prevent overweight and obesity.

Should obese patients be counselled to follow a low-glycaemic index diet? No.

In diabetes research the glycaemic index (GI) of carbohydrates has long been recognized and a low GI is recommended. The same is now often the case in lipid research. Recently, a new debate has arisen around whether a low-GI diet should also be advocated for appetite- and long-term body weight control. A systematic review was performed of published human intervention studies comparing the effects of high- and low-GI foods or diets on appetite, food intake, energy expenditure and body weight. In a total of 31 short-term studies (< 1 d), low-GI foods were associated with greater satiety or reduced hunger in 15 studies, whereas reduced satiety or no differences were seen in 16 other studies. Low-GI foods reduced ad libitum food intake in seven studies, but not in eight other studies. In 20 longer-term studies (< 6 months), a weight loss on a low-GI diet was seen in four and on a high-GI diet in two, with no difference recorded in 14. The average weight loss was 1.5 kg on a low-GI diet and 1.6 kg on a high-GI diet. To conclude, there is no evidence at present that low-GI foods are superior to high-GI foods in regard to long-term body weight control. However, the ideal long-term study where ad libitum intake and fluctuations in body weight are permitted, and the diets are similar in all aspects except GI, has not yet been performed.

A phase II trial of surgical resection and adjuvant high-dose hemithoracic radiation for malignant pleural mesothelioma.

BACKGROUND: Surgical resection of malignant pleural mesothelioma is reported to have up to an 80% rate of local recurrence. We performed a phase II trial of high-dose hemithoracic radiation after complete resection to determine feasibility and to estimate rates of local recurrence and survival. METHODS: Patients were eligible if they had a resectable tumor, as determined by computed tomographic scanning, and adequate cardiopulmonary function for extrapleural pneumonectomy or pleurectomy/decortication. After complete resection, patients received hemithoracic radiation (54 Gy) and then were followed up with serial computed tomographic scanning. RESULTS: From 1995 to 1998, 88 patients (73 men and 15 women; median age, 62.5 years) were entered into the study. The operations performed included 62 extrapleural pneumonectomies (70%) and 5 pleurectomies/decortications; procedures for exploration only were performed in 21 patients. Seven (7.9%) patients died postoperatively. Adjuvant radiation administered to 57 patients (54 undergoing extrapleural pneumonectomy and 3 undergoing pleurectomy/decortication) at a median dose of 54 Gy was well tolerated (grade 0-2 fatigue, esophagitis), except for one late esophageal fistula. The median survival was 33.8 months for stage I and II tumors but only 10 months for stage III and IV tumors (P =.04). For the patients undergoing extrapleural pneumonectomy, the sites of recurrence were locoregional in 2, locoregional and distant in 5, and distant only in 30. CONCLUSION: Hemithoracic radiation after complete surgical resection at a dose not previously reported is feasible. This approach dramatically reduces local recurrence and is associated with prolonged survival for early-stage tumors. Stage III disease has a high risk of early distant relapse and should be considered for trials of systemic therapy added to this regimen of resection and radiation.

[Antibiotic resistance of E coli isolated from healthy persons]. / Antibiotikaresistens hos E. coli isoleret fra raske normalpersoner.

INTRODUCTION: The aim of the study was to determine the antibiotic susceptibility of E. coli isolates in stools from healthy Danes. METHODS: Sixty-nine persons from Copenhagen participated in the study. Three faecal samples from each participant were examined by culture for each of three periods. E. coli was isolated selectively and tested for sensitivity against sulfamethizole, trimethoprim, the combination of sulfamethizole and trimethoprim, ampicillin, mecillinam, cefuroxime, nitrofurantoin, and ciprofloxacin. RESULTS: Altogether, 184 strains of E. coli were isolated from 66 of the 69 persons. Fifty-eight (31.5%) of the strains isolated from 30 persons (43.5%) were resistant to sulfamethizole, 32 (17.4%) strains isolated from 18 persons (26.1%) were resistant to trimethoprim, 31 (16.8%) strains isolated from 17 persons (24.6%) were resistant to trimethoprim + sulfamethizole, 57 (31%) strains from 31 persons (44.9%) were resistant to ampicillin, 29 (15.8%) of the strains from 24 persons (34.8%) were resistant to nitrofurantoin, two (1.1%) strains from two persons (2.9%) were resistant to cefuroxime, whereas none of the strains was resistant to mecillinam and ciprofloxacin. DISCUSSION: The high prevalence of resistance to sulfamethizole, ampicillin, trimethoprim, and nitrofurantoin is surprising, as none of the persons had been treated with antibiotics, but it may reflect the widespread use of antibiotics in animals for food production. The consequences of the results for empiric antibiotic treatment of, for instance, urinary tract infection are discussed.

IMRT: high-definition radiation therapy in a community hospital.

A multileaf collimator (MLC)-based intensity-modulated radiation therapy (IMRT) program was implemented successfully at Monmouth Medical Center, a community hospital at Long Branch, New Jersey. Our clinical experience gained in the treatment of over 80 patients using IMRT for prostate, head and neck, and brain is reviewed, and some of the clinical issues are also, discussed. Implementation of the IMRT requires a treatment planning system, computer-controlled beam-shaping aperture, electronic record and verify system, and a good physics quality assurance program. These components, by grouping them efficiently, have created a seamless workflow for our complete radiotherapy process of IMRT. Each of these radiotherapy processes are discussed for clarity and the clinical importance is also evaluated. Of particular interest is inverse treatment planning that will impact treatment delivery such as beam orientation, treatment ports, and organ motion of IMRT. A checklist for physics and departmental quality assurance is suggested, with the intention of providing systematic workflow, making IMRT feasible at a community medical center setting. This is especially important because most of our cancer patients received radiation therapy locally. Lastly, the reimbursement issue affecting the implementation of IMRT at our medical center is also discussed to justify this new treatment protocol for future clinical outcomes.