Desirable intakes of polyunsaturated fatty acids in Indonesian adults.

A Indonesian Advisory Group on Fatty Acid Nutrition and Health was established in 2004 to consider the increasing incidence of nutritionally-related cardiovascular disease in Indonesia. Emerging international recommendations, often focused on dietary fat and may not have been relevant to the national situation. Traditional dietary patterns were apparently protective against ischaemic heart disease often with fat derived dominantly from a particular source like coconut, soy, peanut or fish. These fats were used in ways which promoted the use of potentially cardioprotective foods like legumes, vegetables, fruits and aquatic food. Optimal intakes of polyunsaturated fatty acids in Indonesia are likely to reflect both absolute intakes and the relationships between n-3 and n-6 fatty acids of longer chain lengths. This leaves some issues for active and continuing review, like the intakes of trans fatty acids, and the regulatory and food labelling implications. Some studies underway and others which need implementation will enable the Advisory Group to prepare a second report with more basis in Indonesian evidence. In the meantime, the Advisory Group has recommended that the AHA (American Heart Association) and ISSFAL (International Society for the Study of Fatty Acids and Lipids) recommendations obtain until the end of 2007.

Effect of cardiopulmonary bypass on lactate metabolism.

OBJECTIVE: We have investigated the role of cardiopulmonary bypass on lactate metabolism in patients undergoing uncomplicated surgery for elective coronary artery bypass grafting (CABG). DESIGN: Prospective non-randomized observational study. SETTINGS: National Cardiovascular Center. PATIENTS. Three independent groups were studied: preoperative ( n=20), postoperative with bypass (CPB, n=20) and postoperative without bypass (NO-CPB, n=20). INTERVENTIONS: Lactate metabolism was investigated with the use of an exogenous lactate challenge test (2.5 mmol Na-lactate/kg body weight in 15 min). Blood lactate was sequentially determined after the end of infusion. Lactate clearance and endogenous production were estimated from the area under the curve, and a bi-exponential fitting permitted modeling the lactate-decay into two compartments. MEASUREMENTS AND MAIN RESULTS: Lactate metabolism parameters (basal lactate, clearance, endogenous production and half-lives [HL] I and II) were not different between the NO-CPB and preoperative groups. In the CPB group, as compared to the other two groups, basal lactate and endogenous production were not significantly affected while lactate clearance (CPB: 6.02+/-0.97 versus preoperative: 9.41+/-0.93 and NO-CPB: 9.6+/-0.8 ml/kg per min) and HL-I (CPB: 10.6+/-1.4 versus preoperative: 17.2+/-2.3 and NO-CPB: 18.8+/-2.5 min) were decreased ( p<0.001) and HL-II was increased (CPB: 171+/-41 versus preoperative: 73+/-12 and NO-CPB: 48+/-2.9 min, p<0.01). CONCLUSION: While surgery and anesthesia per se do not seem to alter lactate metabolism, CPB significantly decreased lactate clearance, this effect being possibly related to a mild liver dysfunction even in uncomplicated elective surgery.