Energy density of foods affects energy intake across multiple levels of fat content in lean and obese women.

BACKGROUND: The results of previous studies indicated that energy density, independent of fat content, influences energy intake. In most studies, however, both fat content and energy density were lower than in typical American diets. OBJECTIVE: We examined the influence of energy density on intake when fat content was above, below, or similar to the amount of fat typically consumed and when energy density was closer to that of American diets. DESIGN: Lean (n = 19) and obese (n = 17) women consumed all meals daily in our laboratory during 6 experimental sessions. The main entrées, consumed ad libitum, were formulated to vary in fat content (25%, 35%, and 45% of energy) and energy density (5.23 kJ/g, or low energy density, and 7.32 kJ/g, or high energy density) but to have similar palatability. RESULTS: Energy density influenced energy intake across all fat contents in both lean and obese women (P < 0.0001). Women consumed less energy in the low (7531 kJ) than in the high (9414 kJ) energy density condition. Despite this 20% lower energy intake, there were only small differences in hunger (7%) and fullness (5%). Women consumed a similar volume, but not weight, of food daily across conditions. Differences in intake by weight, but not volume, occurred because for some versions of manipulated foods, weight and volume were not directly proportional. CONCLUSIONS: Energy density affected energy intake across different fat contents and at levels of energy density comparable with those in typical diets. Furthermore, our findings suggest that cues related to the amount of food consumed have a greater influence on short-term intake than does the amount of energy consumed.

Ecological biochemistry and its development.

The concept that chemistry and biochemistry may play significant roles in ecological relationships is not a new one. It is only within the last quarter of a century, however, that this concept has gained general acceptance and ecological biochemistry has become a well defined interdisciplinary subject in its own right. Examples are given of different types of biochemical relationships involving plants and animals and reference to other areas of the subject are made.

Increasing the volume of a food by incorporating air affects satiety in men.

BACKGROUND: Previous research indicated that increasing the volume of food by adding water can lead to reductions in energy intake. However, the addition of water affects not only the volume but also the energy density (kJ/g) of foods. No studies have examined the effect of volume independent of energy density on intake. OBJECTIVE: We examined the effect of food volume independent of energy density on satiety. DESIGN: In a within-subjects design, 28 lean men consumed breakfast, lunch, and dinner in the laboratory 1 d/wk for 4 wk. On 3 d, participants received a preload 30 min before lunch and on 1 d no preload was served. Preloads consisted of isoenergetic (2088 kJ), yogurt-based milk shakes that varied in volume (300, 450, and 600 mL) as a result of the incorporation of different amounts of air. Preloads contained identical ingredients and weighed the same. RESULTS: The volume of the milk shake significantly affected energy intake at lunch (P < 0.04) such that intake was 12% lower after the 600-mL preload (2966 +/- 247 kJ) than after the 300-mL preload (3368 +/- 197 kJ). Subjects also reported greater reductions in hunger and greater increases in fullness after consumption of both the 450- and 600-mL preloads than after the 300-mL preload. CONCLUSIONS: Changing the volume of a preload by incorporating air affected energy intake. Thus, the volume of a preload independent of its energy density can influence satiety.

Dietary approaches to the treatment of obesity.

According to the National Institute of Health guidelines for the treatment of overweight and obesity, the most important element in a weight loss program is the reduction in energy intake. Reducing the fat content of the diet and increasing physical activity without restricting energy intake are relatively inefficient methods of weight loss. Because individuals tend to consume a constant weight of food, the decrease in energy intake on a reduced-fat diet is likely related to the lower energy density of the diet. Diets of low energy density, which are typically low in fat and rich in complex carbohydrates, allow individuals to consume satisfying portions of food while reducing their energy intake. Because a wide variety of foods can be included in a diet that is low in energy density, this type of diet encourages the adoption of life-long eating habits that are integral to the maintenance of weight loss and the prevention of weight gain.

Effects of dietary fat, nutrition labels, and repeated consumption on sensory-specific satiety.

This study investigated whether energy from fat, nutrition information, and/or repeated consumption of a palatable snack food affects the development of sensory-specific satiety (SSS). Participants (51 males and 44 females) ate an afternoon snack of potato chips in a laboratory for two 10-day (Monday-Friday) sessions in a repeated measures, cross-over design. In one 10-day session, participants were given regular, full-fat potato chips (22.2 kJ/g; 150 kcal/oz) and, in the other, they were given potato chips made with olestra (11.8 kJ/g; 80 kcal/oz), a non-absorbable fat replacer. Information about the fat and energy content of the chips was provided to half the participants, while the other half was not informed. In both sessions, participants were instructed to consume the potato chips ad libitum. Initial ratings of sensory properties of the two types of chips did not differ significantly. In SSS tests, participants rated sensory properties of the chips and four test foods (turkey, strawberry yogurt, cookie, and carrot) on days 1, 5, and 10 of the 10-day sessions. Following consumption, ratings of pleasantness of taste and texture and prospective consumption of both types of chips declined compared to the test foods. Further analyses showed that the development of SSS was not affected by the fat and energy content of the chips, the provision of nutrition information, or repeated consumption.

Water incorporated into a food but not served with a food decreases energy intake in lean women.

BACKGROUND: Previous research showed that decreasing the energy density (kJ/g) of foods by adding water to them can lead to reductions in energy intake. Few studies have examined how water consumed as a beverage affects food intake. OBJECTIVE: This study examined the effects of water, both served with a food and incorporated into a food, on satiety. DESIGN: In a within-subjects design, 24 lean women consumed breakfast, lunch, and dinner in our laboratory 1 d/wk for 4 wk. Subjects received 1 of 3 isoenergetic (1128 kJ) preloads 17 min before lunch on 3 d and no preload on 1 d. The preloads consisted of 1) chicken rice casserole, 2) chicken rice casserole served with a glass of water (356 g), and 3) chicken rice soup. The soup contained the same ingredients (type and amount) as the casserole that was served with water. RESULTS: Decreasing the energy density of and increasing the volume of the preload by adding water to it significantly increased fullness and reduced hunger and subsequent energy intake at lunch. The equivalent amount of water served as a beverage with a food did not affect satiety. Energy intake at lunch was 1209 +/- 125 kJ after the soup compared with 1657 +/- 148 and 1639 +/- 148 kJ after the casserole with and without water, respectively. Subjects did not compensate at dinner for this reduction in lunch intake. CONCLUSION: Consuming foods with a high water content more effectively reduced subsequent energy intake than did drinking water with food.

Pyloric channel stricture secondary to high-dose ibuprofen therapy in a patient with cystic fibrosis.

OBJECTIVE: To describe a case of pyloric channel stricture secondary to high-dose ibuprofen therapy in a pediatric patient with cystic fibrosis. CASE SUMMARY: A 12-year-old white girl started taking high-dose ibuprofen to treat the pulmonary manifestations of cystic fibrosis. The peak plasma concentration at dose initiation was within the accepted therapeutic range. Approximately one month later, the patient developed emesis and intolerance of solid foods, which persisted for several months and resulted in a weight loss of seven kilograms. The patient was referred to a pediatric gastroenterologist, who performed an upper endoscopy and subsequently diagnosed a pyloric channel stricture. The patient's pyloric channel was successfully dilated with two balloons. It is felt that the pyloric stricture developed from healing antral/pyloric channel ulcers. Ibuprofen was discontinued and omeprazole therapy was begun. Over the course of the following year, the patient was asymptomatic. Follow-up upper gastrointestinal barium swallows were normal. DISCUSSION: When used for analgesia and fever in the pediatric population, ibuprofen has been shown to be a relatively safe drug. While it is known that ibuprofen may cause gastrointestinal adverse effects, the pediatric population is at lower risk; however, large doses of ibuprofen increase the risk of gastrointestinal adverse effects. The use of large doses of ibuprofen in the treatment of cystic fibrosis is a relatively new therapy. Limited data thus far in cystic fibrosis patients do not suggest increased risk of gastrointestinal complications. CONCLUSIONS: Limited data to date indicate that ibuprofen, when used in large doses to treat the pulmonary manifestations of cystic fibrosis, is relatively safe. However, because of the potential risks to the gastrointestinal tract of high-dose ibuprofen therapy, clinicians should be aware of its possible complications.

Intake of fat and carbohydrate: role of energy density.

In this review, we consider two hypotheses which could explain why high-fat foods are overeaten. The first hypothesis is that fat is overeaten because it affects satiety and satiation less than carbohydrate. In several studies which have evaluated the effects of fat on satiety and satiation, fat differed little from carbohydrate when both the palatability and energy density of the test foods were matched. Therefore it is unlikely that the effects of fat on satiety or satiation provide the primary explanation for why it is overeaten. The second hypothesis is that the high energy density of fat facilitates its overconsumption. Support for this view comes from recent studies in which energy density significantly influenced intake when both the macronutrient content and palatability of the test foods were matched. For example, when individuals were fed diets varying in energy density and could eat as much food as they liked, they ate the same amount of food (by weight) so energy intake varied directly with energy density. Furthermore, when participants consumed foods of low energy density, they felt satisfied, despite reductions in energy intake. These findings show that energy density is a key determinant of energy intake in that cognitive, behavioral, and sensory cues related to the volume or weight of food consumed can interact with or override physiological cues associated with food intake.

Energy density but not fat content of foods affected energy intake in lean and obese women.

BACKGROUND: Studies have shown that energy intake increases when both the fat content and energy density of the entire diet increases. When the fat content and energy density vary independently of one another, however, energy density, but not fat content, influences intake. OBJECTIVE: The present study examined whether energy intake in lean and obese women is affected when either the energy density or the fat content of a portion of the diet is manipulated and palatability is held constant. DESIGN: In a within-subjects design, 17 lean and 17 obese women consumed meals in the laboratory for four, 4-d test periods. In 3 of these test periods the energy density (4.4 and 6.7 kJ/g) or the fat content (16% and 36% of energy) of compulsory entrees representing 50% of each subject's usual energy intake was manipulated. Additional self-selected foods were consumed ad libitum at meals and as snacks. RESULTS: There were no systematic differences in palatability of the manipulated foods across conditions. Obese and lean participants responded similarly to the dietary manipulations. Intake of self-selected foods at meals was reduced significantly by 16% for both lean and obese subjects in the low- compared with the high-energy-density condition. The fat content of the compulsory foods had no significant effect on energy intake. Ratings of hunger did not differ between diets. CONCLUSION: These results indicate that when a portion of the diet was manipulated, the energy density, but not the fat content, of the foods affected total energy intake at meals in both lean and obese women.

Wartime stressors and health outcomes: women in the Persian Gulf War.

This descriptive correlational study of war time stressors and stress responses of women from the Persian Gulf War examined numerous stressors both physical and psychological. The psychological stressors more directly impacted postwar physical and psychological symptoms than did physical stressors. These findings add to our understanding of women's reactions to wartime stress and the types of stressors affecting women. The study provides more data to support the contention that sexual harassment is widely prevalent in the military. The study did not find data to support concerns about maternal guilt on leaving children, nor any significant evidence of stress symptomology from this situation. The results of this study confirmed the call by Wolfe, Brown, Furey, and Levin (1993) for more precise evaluation of wartime stressors in view of the changing gender composition of military forces and the subsequent increase of women in combat roles. Clinicians should be alerted to recognize gender-specific experiences. Education of military women about stressors and coping mechanisms should be broadened to address the development issue of intimacy versus isolation. Nurses, both military and civilian, must understand the effect of isolation and discrimination on women both in combat and in other high stress situations. The need for continued study of the problem of sexual harassment is confirmed. Understanding the scope of the problem and the health care outcomes strengthens the role of prevention and intervention for nurses and their clients.

Energy density of foods affects energy intake in normal-weight women.

This study examined the effect of energy density, independent of fat content and palatability, on food and energy intakes. With use of a within-subjects design, normal-weight women (n = 18) were provided with meals for 2 d during each of three test sessions. During lunch, dinner, and an evening snack, subjects were given free access to a main entree varying in energy density (low, medium, or high). The manipulated main entrees were similar in palatability to their counterparts across conditions. Low-energy compulsory (consumption required) side dishes accompanied each meal. Subjects also consumed a standard, compulsory breakfast. Results showed that subjects consumed a similar amount of food (by weight) across the three conditions of energy density. Thus, significantly more energy was consumed in the condition of high energy density (7532 +/- 363 kJ, or 1800 +/- 86 kcal) than in the medium- (6356 +/- 281 kJ, or 1519 +/- 67 kcal) and low- (5756 +/- 178 kJ, or 1376 +/- 43 kcal) energy-density conditions (P < 0.0001). There were no differences in hunger or fullness before meals, after meals, or over the 2 d across conditions. The results from this study indicate that energy density affects energy intake independent of macronutrient content or palatability, suggesting that the overconsumption of high-fat foods may be due to their high energy density rather than to their fat content.

Evidence of osteolathyrism among patients suffering from neurolathyrism in Bangladesh.

In a study of 500 patients suffering from neurolathyrism in Bangladesh it was found that 60 (all male) complained of bone pain and showed skeletal deformities suggestive of osteolathyrism. On X-ray examination a failure of fusion in both vertebral and iliac epiphyses was found in two patients. At the age of these patients (30 and 37 years) such failure was considered a clear evidence of osteolathyrism. All 60 patients were accustomed to eating the green parts of Lathyrus sativus, which contain 2-cyanoethyl-isoxazolin-5-one, a compound that chemically and metabolically can produce the osteolathyrogen beta-aminopropionitrile (BAPN), as well as foods made from the seeds of the same plant which contain the neurotoxin 3-N-oxalyl-2,3-diaminopropanoic acid (beta-ODAP).

Nonprotein amino acids from seeds of Cycas circinalis and Phaseolus vulgaris.

Our chemical studies on Cycas circinalis seeds from Guam has provided two new nonprotein amino acids, N-(3'-one-5'-methyl)-hexylalanine and leucine betaine. N-methylisoleucine, previously reported as a component of naturally occurring peptides, has been isolated as a free amino acid from the seeds of Phaseolus vulgaris (pinto bean), together with S-methylcysteine, pipecolic acid and a dipeptide, gamma-glutamyl-leucine.

Fetal complications related to minor maternal trauma.

The active lifestyle of pregnant women, in combination with the increased incidence of violence in society, place women at greater risk for accidental injury during pregnancy. This identification of increased risk has altered the health care management of mother and fetus after injury. The health care provider treating this patient population must perform thorough maternal-fetal assessments and be suspicious of fetal compromise, even in the face of maternal stability.

Mankind and plants: the need to conserve biodiversity.

Only green plants can convert the single carbon units of atmospheric carbon dioxide into the multi-carbon organic molecules on which all forms of life depend. Only green plants can provide the oxygen required by man and other aerobic organisms. In addition to his basic need for preformed organic molecules and oxygen, man also depends on plants to provide him, directly or indirectly, with an array of specific compounds such as vitamins and essential amino acids. Inadequate supplies of these may hinder growth and development or give rise to well defined deficiency diseases. At the present time information concerning the distribution and concentrations of such essential nutrients in plants is largely restricted to those plants that are already used as human foods. Nothing or virtually nothing is known about the chemical composition of approximately 250 000 wild and little-used species. Amongst these there may be many that could provide us with cheap and plentiful new sources of essential nutrients that could be of enormous benefit to those suffering not only from full-blown deficiency diseases but also suffering sub-normal health due to partial deficiencies. The destruction of much of the world's wilderness areas has already deprived us of the opportunity to evaluate the contributions that a great many plant species might have made towards the elimination of deficiency diseases. Many plants used as human foods contain compounds that are toxic to man. If intake is sufficiently high, these toxins may cause disease. Breeding programmes designed to eliminate toxins from crops species or reduce their concentrations to acceptable levels depend on genetic variability within the species or the possibility of producing hybrids with the desired characteristics.(ABSTRACT TRUNCATED AT 250 WORDS)

Treatment of valproic acid-associated hepatic failure with orthotopic liver transplantation.

OBJECTIVE: To report a case of valproic acid (VPA)-induced hepatotoxicity and to discuss the incidence rates, risk factors, possible etiologies, preventive measures, and treatment courses for this severe reaction. DATA SOURCES: Case reports, review articles, and relevant laboratory studies identified by MEDLINE. DATA EXTRACTION: Data were abstracted from pertinent published sources by one author and reviewed by the remaining authors. DATA SYNTHESIS: The case of a 23-year-old woman with VPA-associated hepatic failure was successfully treated with orthotopic liver transplantation. Hepatic failure is a rare, often fatal, adverse effect of VPA. Most cases of VPA-associated hepatic failure have occurred within several months of initiation of therapy. Initial symptoms of presentation often include nausea and vomiting, lethargy, or loss of seizure control. Laboratory values to be monitored include serum concentrations of hepatic enzymes, and, in some patients, tests indicative of the liver's synthetic capabilities. The exact mechanism of VPA-associated hepatic failure has not been clearly established; however, it is postulated to involve the formation of toxic metabolites. Major risk factors include age less than two years and concomitant treatment with more than one anticonvulsant. Other significant risk factors include underlying metabolic or serious neurologic disorders. CONCLUSIONS: Caution should be taken when initiating VPA therapy and clinicians should be familiar with the risk factors and clinical presentation of this reaction.

Measuring affective factors in RN/BSN programs.

Assessment of affective outcomes is needed in nursing education. This study examined changes in professional attitudes in RN/BSN programs and the relationships between selected affective factors and professional attitudes. Implications for nursing education are identified relative to student advising/counseling and curriculum.