Effects of an isocaloric healthy Nordic diet on insulin sensitivity, lipid profile and inflammation markers in metabolic syndrome -- a randomized study (SYSDIET).

BACKGROUND: Different healthy food patterns may modify cardiometabolic risk. We investigated the effects of an isocaloric healthy Nordic diet on insulin sensitivity, lipid profile, blood pressure and inflammatory markers in people with metabolic syndrome. METHODS: We conducted a randomized dietary study lasting for 18-24 weeks in individuals with features of metabolic syndrome (mean age 55 years, BMI 31.6 kg m(-2) , 67% women). Altogether 309 individuals were screened, 200 started the intervention after 4-week run-in period, and 96 (proportion of dropouts 7.9%) and 70 individuals (dropouts 27%) completed the study, in the Healthy diet and Control diet groups, respectively. Healthy diet included whole-grain products, berries, fruits and vegetables, rapeseed oil, three fish meals per week and low-fat dairy products. An average Nordic diet served as a Control diet. Compliance was monitored by repeated 4-day food diaries and fatty acid composition of serum phospholipids. RESULTS: Body weight remained stable, and no significant changes were observed in insulin sensitivity or blood pressure. Significant changes between the groups were found in non-HDL cholesterol (-0.18, mmol L(-1) 95% CI -0.35; -0.01, P = 0.04), LDL to HDL cholesterol (-0.15, -0.28; -0.00, P = 0.046) and apolipoprotein B to apolipoprotein A1 ratios (-0.04, -0.07; -0.00, P = 0.025) favouring the Healthy diet. IL-1 Ra increased during the Control diet (difference -84, -133; -37 ng L(-1) , P = 0.00053). Intakes of saturated fats (E%, beta estimate 4.28, 0.02; 8.53, P = 0.049) and magnesium (mg, -0.23, -0.41; -0.05, P = 0.012) were associated with IL-1 Ra. CONCLUSIONS: Healthy Nordic diet improved lipid profile and had a beneficial effect on low-grade inflammation.

A diet high in fatty fish, bilberries and wholegrain products improves markers of endothelial function and inflammation in individuals with impaired glucose metabolism in a randomised controlled trial: the Sysdimet study.

AIMS/HYPOTHESIS: Low-grade inflammation and endothelial dysfunction may play a role in the pathogenesis of type 2 diabetes and cardiovascular disease. We evaluated whether a diet high in fatty fish, bilberries and wholegrain products (Healthy Diet) improves biomarkers reflecting inflammation and endothelial dysfunction in individuals with impaired glucose metabolism. METHODS: We recruited individuals with impaired glucose metabolism and features of the metabolic syndrome into a 12 week, parallel design, dietary intervention trial conducted at the Department of Clinical Nutrition, University of Eastern Finland (Kuopio, Finland). Randomisation was performed by matching according to sex and medians of age, BMI and fasting plasma glucose of the study population at screening. The primary endpoint in the present study was the change in plasma inflammatory markers and the measurements were performed blinded to group assignment. High-sensitivity (hs) C-reactive protein (CRP) and E-selectin responses were also analysed separately in participants not using statins (n = 76). RESULTS: Altogether, 131 individuals were assigned to either the Healthy Diet (n = 44), a whole-grain-enriched diet (WGED) (n = 42) or a control (n = 45) diet, and 104 participants (mean ± SD: age 59 ± 7 years; BMI 31.1 ± 3.5 kg/m(2)) who had completed the study, were analysed (Healthy Diet n = 36, WGED n = 34 and control diet n = 34). Plasma E-selectin decreased only in the Healthy Diet group. This occurred in all group participants (p < 0.05) and also after excluding participants using statins (p < 0.05). Plasma hsCRP levels decreased in the Healthy Diet (median -17%, p < 0.05) and WGED (median -27%, p < 0.01) groups in participants not using statins. Controlling for confounding factors, including BMI or insulin sensitivity, did not alter the results. A greater increase in plasma concentration of very-long-chain n-3 fatty acids and in the intake of fibre during the study was associated with a greater decrease in plasma E-selectin (p < 0.05). The intake of test breads consumed during the Healthy Diet and WGED interventions was inversely associated with the change in hsCRP levels (p < 0.001). CONCLUSIONS/INTERPRETATION: Our results suggest that the combined effect of fatty fish, bilberries and wholegrain products may improve endothelial dysfunction and inflammation in overweight and obese individuals at high risk of developing diabetes.

Pre-analytical factors and measurement uncertainty.

Pre-analytical factors are an important source of variation or errors in clinical laboratory measurements. Based on the new accreditation standards, medical and laboratory professions now seek to develop tools to deal systematically with these diverse factors. Several obvious pre-analytical uncertainty components were estimated in pragmatic experiments and combined with data on analytical variation and literature knowledge on biological variation, to estimate the measurement uncertainty of most common chemical and haematological examinations in clinical laboratories. The main aim was to assess quality specifications for regional laboratory services. The expanded measurement uncertainties (level of confidence 95%) of serum cholesterol, albumin and potassium remained within 13-16%. The major uncertainty component for cholesterol was biological variation, whereas those for albumin and potassium were sample collection and pretreatment. The measurement uncertainties for serum free thyroxin, thyrotropin and C-reactive protein, 20%, 42% and 125% respectively, were largely due to their biological variation. The measurement uncertainties of basic erythrocyte parameters (erythrocyte count and mean corpuscular volume, blood haemoglobin concentration) were less than 10%. Larger measurement uncertainties were obtained for thrombocyte and leukocyte counts, 24 and 31%, respectively, and for the reticulocyte fraction, 41%.

Key elements of the implementation of a quality system in three Finnish clinical laboratories.

The aim of the study was to discover how an implemented quality system succeeded in fulfilling the personnel and management expectations and to identify the factors that facilitate or hinder quality management implementation in clinical laboratories. The concepts assessed include leadership (commitment and change management), clear and common goals, human recourses focus, client focus, management by fact and process improvement. The quality process in the laboratories had not, even after 3-4 years, reached a level of acceptance allowing its use as a daily development tool. The factors that predict a success of the quality system include willingness to improve the laboratory services and to keep the process going and good atmosphere at work. However, the study showed that the senior managers of the laboratory should take a more visible role in leading the change, and emphasize more explicitly the long-term goals. The middle managers (physicians, biochemists and head technologists) should arrange opportunities for the staff to participate in the system and disseminate the information on, and practical applications of, the quality principles and tools. The staff should be more active in finding new information and in participating in the system.

Saline PCO2 is an important source of error in the assessment of gastric intramucosal pH.

OBJECTIVE: To determine whether the measurement error of saline PCO2, using blood gas analyzers, is relevant for the interpretation and clinical use of the gastric intramucosal pH measurement. DESIGN: A comparison of four different blood gas analyzers (ABL-520, Ciba Corning, IL-1302, and Nova), using tonometered saline as the reference. SETTING: Clinical laboratory of a university hospital intensive care unit. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The bias and the precision of each blood gas analyzer was determined for measurements of PCO2 in saline samples. These samples had been balanced to PCO2 levels of 30, 45, and 68 torr (4, 6, and 9 kPa, respectively). In addition, the effect of buffering the saline was evaluated. The bias of the PCO2 measurement increased (p < .001) at the higher PCO2 levels. The bias ranged from -5.2 to -25.9 torr (-0.69 to -3.45 kPa) at a PCO2 of 45 torr (6 kPa) and from -5.2 to -33.1 torr (-0.69 to -4.41 kPa) at a PCO2 of 68 torr (9 kPa), and there was a significant (p < .001) analyzer-PCO2 level interaction. The type of the analyzer also influenced the bias (p < .001). The Nova analyzer underestimated the PCO2 by 50% to 60%. The other analyzers underestimated the PCO2 by 5% to 19%. The use of the buffer reduced the bias of all analyzers (p < .001). Based on the precision of the saline PCO2 measurement, a difference in gastric intramucosal pH of 0.06 pH units can be reliably detected at a PCO2 of 45 torr (6 kPa) by all analyzers, with the exception of the Nova analyzer. CONCLUSIONS: Measurement of saline PCO2 is an important source of error in the assessment of gastric intramucosal pH, and the error depends on both the analyzer used and the actual PCO2 level. Direct comparison of pH values obtained by different analyzers is not valid. Changes in gastric intramucosal pH of 0.06 pH units can be detected by most analyzers in the clinically relevant PCO2 level.