Effect of ethnicity on glycaemic index: a systematic review and meta-analysis.

OBJECTIVES: Low glycaemic index (GI) foods are recommended to improve glycaemic control in diabetes; however, Health Canada considers that GI food labeling would be misleading and unhelpful, in part, because selected studies suggest that GI values are inaccurate due to an effect of ethnicity. Therefore, we conducted a systematic review and meta-analysis to compare the GI of foods when measured in Caucasians versus non-Caucasians. METHODS: We searched MEDLINE, EMBASE and Cochrane databases for relevant articles. GI differences were aggregated using the generic inverse variance method (random effects model) and expressed as mean difference (MD) with 95% confidence intervals (95% CI). Study quality was assessed based on how well studies complied with official international GI methodology. RESULTS: Review of 1288 trials revealed eight eligible studies, including 28 comparisons of GI among 585 non-Caucasians and 971 Caucasians. Overall, there was borderline significant evidence of higher GI in non-Caucasians than Caucasians (MD, 3.3 (95% CI, -0.1, 6.8); P=0.06) with significant heterogeneity (I(2), 46%; P=0.005). The GI of eight types of rice was higher in non-Caucasians than Caucasians (MD, 9.5 (95% CI, 3.7, 23.1); P=0.001), but there was no significant difference for the other 20 foods (MD, 1.0 (95% CI, -2.5, 4.6); P=0.57). MD was significantly greater in the four low-quality studies (nine comparisons) than the four high-quality studies (19 comparisons; 7.8 vs 0.7, P=0.047). CONCLUSIONS: With the possible exception of rice, existing evidence suggests that GI values do not differ when measured in Caucasians versus non-Caucasians. To confirm these findings high-quality studies using a wide range of foods are required.

No differences in growth or body composition from age 12 to 24 months between toddlers consuming 2% milk and toddlers consuming whole milk.

OBJECTIVE: To determine whether consumption of 2% milk during the second year of life leads to reduced growth or lower percentage body fat compared with consumption of whole milk. SUBJECTS: Subjects were healthy toddlers who participated in a larger trial examining the effects of the timing of introduction of solid foods on growth. DESIGN: Three-day diet diaries, anthropometric measurements, and body composition determined by dual-energy x-ray absorptiometry were assessed at 12, 18, and 24 months of age. At age 12 months, the toddlers were similar in length, weight, percentage body fat, and total energy intake. From 12 to 24 months of age, milk consumption consisted of whole milk exclusively in one group (n = 23) and 2% milk exclusively in another group (n = 28). STATISTICAL ANALYSES: Differences between the 2 groups in anthropometric measurements, changes in anthropometric measurements, and dietary intakes were determined by Student t tests. Mean differences were considered significant at the P = .05 level. Data are presented as mean +/- standard deviation. RESULTS: Despite lower intakes of total fat and saturated fat in the 2% milk group, there were no differences in height, weight, and percentage body fat. Total energy intake was not reduced in the 2% milk group. APPLICATIONS: Reductions in total fat and saturated fat intake in toddlers can be achieved through the use of 2% milk without compromising growth.

Pregnant adolescent and adult women have similarly low intakes of selected nutrients.

OBJECTIVE: To examine the dietary intake of pregnant adolescents during the second and third trimester of pregnancy, and to compare their nutrient intake with that of pregnant adults. DESIGN: Two 7-day food records (14 days) from subjects participating in a larger randomized clinical calcium trial: the first at 19 to 21 weeks and the second between 29 and 31 weeks gestation. Intake of energy and selected nutrients were calculated and compared with dietary standards. SUBJECTS/SETTING: Fifty-nine pregnant adolescents and 97 pregnant adults recruited from prenatal clinics at a metropolitan university hospital. STATISTICAL ANALYSES: Two sample t tests, equality of variances, and repeated measures (analysis of variance). RESULTS: There was no difference in mean nutrient intakes between the second and third trimesters. Using two 7-day food records, we found mean intakes for energy, iron, zinc, calcium, magnesium, folate, and vitamins D and E to be below recommended standards in both groups. Other nutrients examined met or exceeded reference values. Total daily intakes for energy and 11 nutrients were significantly higher in the adolescent compared to the adult diets (P < .05). These differences were not evident when nutrient values were corrected for energy, indicating that increased energy intake in the teen-aged population was contributed by nutrient-dense foods. APPLICATIONS: This study indicates the need for continued dietary monitoring of pregnant adolescents and pregnant adults, including nutrition guidance that stresses food sources of calcium, magnesium, zinc, iron, fiber, folate, and vitamins D and E, the nutrients found deficient in their diets.

Retrograde ureteroscopic endopyelotomy using the holmium:YAG laser.

PURPOSE: We defined the safety and efficacy of retrograde ureteroscopic endopyelotomy using the holmium:YAG laser. METHODS AND MATERIALS: Between July 1996 and December 1999 a total of 28 renal units in 21 women and 6 men 7 to 75 years old (mean age 43.5) with ureteropelvic junction obstruction were treated at our institution with retrograde ureteroscopic endopyelotomy. Ureteropelvic junction obstruction was bilateral in 1 case, primary in 20 and secondary in 8. Endoluminal ultrasound was done before endopyelotomy in all cases. Patients with renal calculi underwent antegrade percutaneous nephrostolithotomy and traditional cold knife endopyelotomy. Endoluminal ultrasound revealed posterior and lateral crossing vessels in 5 patients, who did not undergo the endoscopic approach. Retrograde endopyelotomy was performed using the holmium:YAG laser in 23 cases and electrode incision with pure cutting current in 5. Postoperatively a ureteral stent remained indwelling for an average of 6 weeks. Thereafter patients were followed with serial ultrasound, excretory urography and renal scan at 3 to 6-month intervals. RESULTS: We evaluated 28 upper urinary tracts, including 19 (67.9%) with high insertion ureteropelvic junction obstruction and 9 with an annular stricture. As directed by ultrasound images, the incision location was posterolateral, posterior, lateral and posteromedial in 16, 5, 4 and 3 cases, respectively. Followup was available in all cases at a mean of 10 months (range 3 to 35). Success, defined as improved drainage on radiographic study and absent clinical symptoms, was achieved in 19 of the 23 patients (83%) treated with the holmium:YAG laser. Repeat laser incision resulted in a successful outcome in 2 of the 4 treatment failures. There were no acute surgical complications. CONCLUSIONS: Retrograde ureteroscopic endopyelotomy with the holmium:YAG laser is safe and minimally invasive therapy for primary and secondary ureteropelvic junction obstruction. Endoluminal ultrasound aids in decision making when retrograde endopyelotomy is done.

Urodynamic findings in adults with the tethered cord syndrome.

PURPOSE: We evaluated bladder function in adults with the tethered cord syndrome using multichannel urodynamics. MATERIALS AND METHODS: A total of 21 patients a mean 39.6 years old (range 20 to 62) with a tethered cord were evaluated. Of the patients 13 were diagnosed with a tethered cord as an adult and 8 had undergone previous spinal surgery. The tethered cord syndrome was diagnosed by magnetic resonance imaging in 20 patients and computerized tomography myelogram in 1. All patients underwent complete neurological and urological evaluation, including multichannel urodynamics. Needle electromyography and video urodynamics were performed in select cases. Microsurgical release of the tethered cord was performed in 19 patients and 2 refused surgery. Urodynamics were done before surgery in 16 of 19 patients and a median of 12.5 months (range 1 to 40) after surgery in 14. In addition, intraoperative urodynamic monitoring and nerve root stimulation were done in 14 patients to prevent nerve root injury at surgery. RESULTS: At presentation urgency (67%) and urge incontinence (50%) were the most common findings in 18 patients with urinary symptoms. Pretreatment urodynamics in 18 of 21 patients revealed hyperreflexia in 13 (72%), external detrusor-sphincter dyssynergia in 4 (22%), decreased sensation in 4 (22%), decreased compliance in 3 (17%) and hypocontractile detrusor in 2 (11%). Postoperative urodynamic findings were improved in 4 patients (29%) and unchanged in 10 (71%). Preoperative external detrusor-sphincter dyssynergia in 4 patients resolved postoperatively in 3 and was unchanged in 1. Urinary symptoms were improved in 19% of patients (4), unchanged in 76% (16) and worse in 5% (1). To date 7 patients require anticholinergics, 4 require clean intermittent catheterization and 1 is taking an alpha-blocker. CONCLUSIONS: Adults with the tethered cord syndrome are less likely to have urodynamic or symptom improvement after cord release and most often present with irreversible findings which rarely become worse after surgery. These patients need to have careful and continuous followup, including urodynamic studies, due to possible re-tethering with time.

Trial on timing of introduction to solids and food type on infant growth.

OBJECTIVE: The optimal time and choice of solid foods to introduce to an infant's diet is unknown. The aim of this randomized trial was to determine whether early versus late introduction of solid foods and commercially prepared versus parent's choice of solid foods affects growth or body composition in the first year. METHODS: White infants (n = 165) were recruited before 3 months of age and were randomized to receive: 1) commercially prepared solid foods (commercial) from 3 to 12 months, 2) commercially prepared solid foods from 6 to 12 months, 3) parent's choice of solid foods (choice) from 3 to 12 months, or 4) parent's choice of solid foods from 6 to 12 months. Anthropometrics and body composition, using dual energy x-ray absorptiometry, were determined at 3, 6, and 12 months. Three-day diet diaries were completed at 3, 6, 9, and 12 months. RESULTS: There were no differences in growth or body composition between infants in early versus late introduction groups or commercial versus choice groups at any age. The total energy intake was not different among infants in the early compared with the late group at any age. Infants in the commercial group consumed less protein calories at 9 months (80 +/- 3 kcal/d vs 88 +/- 3 kcal/d) and 12 months 101 +/- 5 kcal/d vs 148 +/- 5 kcal/d), less fat calories at 12 months (263 +/- 10 kcal/d vs 343 +/- 10 kcal/d), and less total calories at 12 months (884 +/- 24 kcal/d vs 1022 +/- 25 kcal/d) compared with the choice group. CONCLUSION: The early introduction of solid foods to an infant's diet does not alter growth or body composition during the first year of life and results in a displacement of energy intake from formula. Infants consuming commercially prepared foods have a decreased caloric intake from protein and fat; however, despite this difference, there is no effect on growth or body composition.

How accurately do parents collect urine samples from their children? A pilot study in general practice.

Childhood urinary tract infections (UTIs) are of great importance, but few data exist on how accurately parents collect urine samples. By instituting three simple, practical changes we reduced the contamination rate from 27.5% to 13.2%.

Hoffa's disease: arthroscopic resection of the infrapatellar fat pad.

In 11 patients the diagnosis of Hoffa's syndrome with chronic impingement of the fat pad was established by clinical signs and arthroscopic findings. Arthroscopic resection of the fat pad was performed. The patients were assessed using the Cincinnati rating system. There was a significant improvement in their symptoms and function after the surgery at an average follow-up of 76 months. The one poor result was in a patient who subsequently developed a diffused, chronic, inflammatory synovitis.

Experimental reversal of acute coronary thrombotic occlusion and myocardial injury in animals utilizing streptokinase.

Fresh autologous thrombus, 1.0 to 1.5 ml, was injected into the left anterior descending and/or left diagonal coronary arteries of 19 open-chest dogs to produce evolving acute myocardial infarction (AMI). Thrombotic obstruction was documented by coronary angiography. Multilead epicardial ECGs showed ST segment elevations of affected left ventricular (LV) areas within 2 minutes after thrombus injection, and LV segmental wall cyanosis with hypocontraction was observed within 10 minutes in the myocardial areas supplied by the thrombosed artery. Ten animals then received an initial dose of streptokinase (STK), 250,000 U (intravenous), followed by STK, 1000 to 3000 U/min (intracoronary), while nine control dogs untreated with STK received normal saline infusion. All but one STK-treated animal (all nine animals receiving intracoronary STK) had reestablishment of blood flow in the previously occluded vessels within 1 1/2 hours, disappearance of ventricular cyanosis, return of normal LV contractile function, and normalization of elevated ST segments within 1 hour after intracoronary STK therapy. In contrast, in the non-STK-treated control group, all animals had continued coronary obstruction, progressive ST elevations, and worsening LV cyanosis and hypocontraction until death or for more than 3 hours post thrombus; three control animals died of ventricular fibrillation (VF) within 1 hour of thrombus occlusion, three more died of VF within 2 hours post thrombus, and only three survived beyond 2 hours post thrombus. Postmortem examination of non-STK-treated animals revealed extensive residual coronary thrombus. All intracoronary STK-treated animals evidenced absence of residual coronary thrombus at postmortem examination. These data provide clinically relevant evidence that early intracoronary STK effects thrombolysis in AMI by reopening coronary vessels occluded by fresh thrombus, thereby protecting myocardium from further ischemia and necrosis, preserving LV function, and also reversing cardiac muscle injury.