Effect of milk protein intake and casein-to-whey ratio in breakfast meals on postprandial glucose, satiety ratings, and subsequent meal intake.

Whey and casein proteins differentially affect postprandial blood glucose and satiety mechanisms, with relevance for type 2 diabetes and obesity. Therefore, the purpose of this work was to investigate the effect of the casein-to-whey protein ratio and total protein concentration of milks consumed with cereal on postprandial blood glucose, appetite ratings, and subsequent food intake in a randomized, controlled, double-blinded study with healthy young adults (n = 32, 23.4 ± 3.1 yr, body mass index = 22.2 ± 2.5 kg/m2). Fasted participants consumed milk (250 mL) with either 80:20 or 40:60 (modified) casein-to-whey protein ratios at commercially normal (3.1%, wt) or high protein (9.3%, wt) concentration, or control (water with whey permeate), each along with 2 servings of oat-based breakfast cereal. Blood glucose concentrations were determined from finger prick blood samples and appetite was assessed using visual analog scales. Participants consumed a measured ad libitum pizza lunch at 120 min and blood glucose determination and appetite assessment continued following the lunch meal (140-200 min) to observe the second meal effect. Pre-lunch (0-120 min) incremental area under the curve (iAUC) and mean change from baseline blood glucose were reduced with consumption of all milk treatments relative to control. However, we found no differences between all treatments on pre-lunch appetite change from baseline and total area under the curve (tAUC) or lunch meal food intake. In terms of protein concentration results, high protein (9.3%, wt) treatments contrasted to normal protein (3.1%, wt) treatments lowered blood glucose change from baseline and iAUC, and post-lunch appetite change from baseline and tAUC. Protein ratio showed a modest effect in that modified (40:60) protein ratio lowered pre-lunch blood glucose change from baseline but not iAUC, and normal (80:20) protein ratio lowered pre-lunch appetite change from baseline but not tAUC. Therefore, high-carbohydrate breakfast meals with increased protein concentration (9.3%, wt) could be a dietary strategy for the attenuation of blood glucose and improved satiety ratings after the second meal.

Accurate and semi-automated analysis of bacterial association with mammalian cells.

To efficiently and accurately quantify the interactions of bacteria with mammalian cells, a reliable fluorescence microscopy assay was developed. Bacteria were engineered to become rapidly and stably fluorescent using Green Fluorescent Protein (GFP) expressed from an inducible Tet promoter. Upon application of the fluorescent bacteria onto a monolayer, extracellular bacteria could be discriminated from intracellular bacteria by antibody staining and microscopy. All bacteria could be detected by GFP expression. External bacteria stained orange, whereas internalised bacteria did not. Internalised bacteria could thus be discriminated from external bacteria by virtue of being green but not orange fluorescent. Image acquisition and counting of various fluorophore-stained entities were accomplished with a high-content screening platform. This allowed for semi-automated and accurate counting of intracellular and extracellular bacteria.

Metabolic and anthropometric changes in female weight cyclers and controls over a 1-year period.

OBJECTIVE: Women who diet to lose weight often regain the weight over time, and the cycle repeats itself. The objective of this study was to identify a group of female weight cyclers and to match them with a control group who had never consciously tried to lose weight. For 1 year, weight patterns, eating habits, metabolic parameters, and body composition were assessed to determine whether there was a relationship between weight cycling and these variables. DESIGN: Measurements were done at baseline and at 6 and 12 months. Changes in weight, diet, and exercise were monitored throughout the year. SETTING: All testing was done at a university physiology laboratory. SUBJECTS/SAMPLES: Nine weight cyclers with a notable history of dieting and food restriction were recruited. Subsequently, nine control subjects were selected and matched for age, height, weight, lean body mass, and exercise habits. MAIN OUTCOME MEASURE: The observational study included measures of 3-day diet records, skinfold and girth, serum glucose, insulin and triiodothyronine, and resting energy expenditure. STATISTICAL ANALYSES PERFORMED: The main variables were analyzed using a 2 x 3 (diet group x time) analysis of variance with repeated measures on the time factor. Comparison of the means was done by Tukey post hoc test. RESULTS: A 7-point satisfaction scale indicated that the weight cyclers were dissatisfied with their weight compared with the noncyclers (P = .03). Otherwise, there were no differences between groups in dietary intakes or the physiologic variables. APPLICATIONS/CONCLUSIONS: In the parameters measured, a history of weight cycling did not affect the metabolic profiles of the weight cyclers compared with the noncyclers.

Diagnostic judgments of nurse practitioners providing primary gynecologic care: a quantitative analysis.

OBJECTIVES: To determine the accuracy of experienced nurse practitioners' judgments of the probability of chlamydial infection of the cervix, to identify the clinical factors ("cues") related to the judgments, and to discern likely sources of judgment error. DESIGN: Cross-sectional study with prospective data collection. SETTING: Urban hospital-based clinic. PATIENTS: 492 nonpregnant women receiving primary gynecologic care. INTERVENTIONS: Four nurse practitioners recorded clinical data, tested women for chlamydial infection, and judged the probability of chlamydial infection using six categories: less than 1%, 1-4%, 5-9%, 10-24%, 25-50%, and greater than 50%. MEASUREMENTS AND MAIN RESULTS: Chlamydial infection was detected by immunofluorescent assay in 31 (6%) of the 492 women. Although the median probability judgment was 5-9%, judgments were only weakly related (p = 0.08) to actual rates of infection. In a multivariate analysis, eight clinical cues were independently (p less than 0.05) related to nurse practitioners' probability judgments: age less than 20 years; past chlamydial or gonococcal infection; new sex partner; partner with suspected genital infection; genito-urinary symptoms; cervicitis, purulent vaginal discharge; and malodorous vaginal discharge. A linear model based on the eight cues, weighted according to their regression coefficients, predicted chlamydial infection more accurately than did the nurse practitioners' actual judgments (ROC curve areas 0.69 vs. 0.58, respectively; p less than 0.05). However, only two of the eight cues (age less than 20 years and purulent vaginal discharge) were actually related to chlamydial infection in a second multivariate model; this model bad accuracy similar to that of an empirically derived prediction rule (ROC curve areas 0.77 and 0.80, p = 0.27). CONCLUSIONS: Nurse practitioners were often inaccurate in their diagnostic judgments. Our analyses suggest that this inaccuracy stemmed from both the inconsistent use of clinical cues and the use of cues that were not related to chlamydial infection. Therefore, interventions such as algorithms that promote consistency and accuracy in diagnostic use of relevant cues would be likely to improve their diagnostic judgments.

Effect of daytime protein restriction on nutrient intakes of free-living Parkinson's disease patients.

Studies have shown that severe daytime restriction of dietary protein improves the efficacy of L-dopa and reduces response fluctuations in some Parkinson's disease (PD) patients. This study investigated the nutritional adequacy of the daytime restricted-protein diet. Eleven free-living PD patients suffering from unpredictable response fluctuations to L-dopa were counseled to limit protein intake to approximately 10 g before 1700. Three sets of 6-d food records obtained during the 8-wk study showed that while on the test diet, mean intakes of most nutrients remained above the recommended nutrient intakes, although significant decreases occurred in protein, calcium, iron, phosphorus, riboflavin, and niacin intakes. The impact of the test diet on nutritional status as evaluated by changes in body weight and serum prealbumin was small. We conclude that healthy and highly motivated patients can maintain adequate intakes of most nutrients while restricting daytime protein intake. However, nutrient intakes might be compromised in patients whose regular diets are marginally adequate.

Benefits of exercise training for men with insulin-dependent diabetes mellitus.

Twelve healthy men with IDDM participated in a 12-week walking/jogging exercise program. Pre- and postexercise assessment of dietary intakes, body composition, biochemical measures, and exercise performance indicators were completed. Subjects exercised either 3 or 5 days per week for 1 hour at 60% to 80% of estimated maximal heart rate. Dietary intakes showed a voluntary reduction in fat intake as a percent of total energy from 40% +/- 7% (mean +/- SD) to 37% +/- 8% (P = .053). No change occurred over time in body composition measures except for a significant reduction in the waist-to-hip ratio from 0.87 +/- 0.04 to 0.86 +/- 0.04 (P = .007). Fasting serum glucose and lipid levels did not change over time. Exercise capacity improved, as shown by an increased time to exhaustion on a treadmill run from 7.9 +/- 3.7 minutes to 9.7 +/- 3.8 minutes (P less than .001); and a lower heart rate at a constant work load--from 183 +/- 18 beats per minute preexercise to 175 +/- 20 beats per minute postexercise (P = .022). The study showed that healthy male subjects with IDDM can benefit from regular exercise with a redistribution of body fat and improved exercise capacity.

Hospital ethics committees in Quebec: an overview.

In June 1989, La Direction de la Sante physique (ministere de la Sante et des Services sociaux) (MSSS) undertook a major research project focusing on ethics committees in Quebec, in cooperation with Laval University's Groupe de recherche en Ethique Medicale (GREM). Initially, three major objectives were set out: to prepare a faithful overview of ethics committees in Quebec; to inform all those involved of the available resources, and to collect the data required to eventually carry out in-depth research on ethics committees. A number of government documents refer to the existence of ethics committees, whether to request their cooperation or to entrust mandates to them; moreover, the Law Reform Commission of Canada recently published a document that proposed establishing a Canadian Advisory Council on Biomedical Ethics. The MSSS, therefore, had to study the situation in Quebec with regard to ethics committees in order to be in a position to clarify its position in future discussions. This overview is the outcome of the first stage of this research project. Essentially, it represents the first of three main sections of a single document. It [1] presents general data on ethics committees, [2] contains a description of each committee by socio-sanitary region and type of committee, and in section three it deals with the principal resources available in bioethics in Quebec, Canada, and throughout the world.

A new diagnostic index for predicting cervical infection with either Chlamydia trachomatis or Neisseria gonorrhoeae.

OBJECTIVE: To develop and test a diagnostic index for estimating the probability of cervical infection with either Chlamydia trachomatis or Neisseria gonorrhoeae. DESIGN: Prospective, cross-sectional study in two phases: 1) to develop a diagnostic index based on independent predictors of cervical infection; 2) to test the index. SETTINGS: A hospital-based clinic and a student health service. PATIENTS: Development phase: 190 nonpregnant women seen in the gynecology clinic; testing phase: 588 women seen in the gynecology clinic (n = 372) or the student health service (n = 216). INTERVENTIONS: Experienced clinicians recorded historical, physical, and microscopic findings on standard forms and tested women for chlamydial and gonococcal infections. RESULTS: Three independent predictors of cervical infection were identified and weighted: age (two points if less than 20 years and one point if 20-29 years); a new sex partner or one suspected of having a genital infection (one point); purulent vaginal discharge (one point). In the testing groups, cervical infection was present in none of 62 women with no points, seven of 269 (3%) with one point, 14 of 188 (7%) with two points, and 19 of 69 (28%) with three or four points (p less than 0.001). The index estimated the probability of infection more accurately (p less than 0.01) than did clinicians, performed well in each site, and remained accurate when C. trachomatis and N. gonorrhoeae were considered separately. CONCLUSION: The diagnostic index accurately estimates the probability of cervical infection with either C. trachomatis or N. gonorrhoeae and may be useful in selecting women for definitive diagnostic testing.