Plasma choline metabolites associate with metabolic stress among young overweight men in a genotype-specific manner.

OBJECTIVES: We aimed to test the hypotheses that (i) plasma choline metabolites differ between normal (body mass index (BMI)<25 kg m(-2)) and overweight (BMI 25 kg m(-2)) men, and (ii) an elevated BMI alters associations between plasma choline metabolites and indicators of metabolic stress. DESIGN: This was a cross-sectional study. A one-time fasting blood sample was obtained for measurements of the choline metabolites and metabolic stress indicators (that is, serum alanine aminotransferase (ALT), glucose, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides and homocysteine), and for genotype determination. SUBJECTS: The analysis was conducted with 237 Mexican American men with a median age of 22 years. RESULTS: Compared with men with a normal BMI (n=98), those with an elevated BMI (n=139) had 6% lower (P=0.049) plasma betaine and an 11% lower (P=0.002) plasma betaine to choline ratio. Among men with an elevated BMI, plasma betaine and the plasma betaine to choline ratio positively associated (P0.044) with a favorable serum cholesterol profile, and inversely associated (P=0.001) with serum ALT, a marker of liver dysfunction. The phosphatidylethanolamine N-methyltransferase (PEMT) 5465GA (rs7946) genotype interacted (P0.007) with the plasma betaine to choline ratio to modulate indicators of metabolic stress with stronger inverse associations observed among overweight men with the PEMT 5465GG genotype. CONCLUSIONS: Plasma choline metabolites predict metabolic stress among overweight men often in a genotype-specific manner. The diminished betaine among overweight men coupled with the inverse association between betaine and metabolic stress suggest that betaine supplementation may be effective in mitigating some of the metabolic insults arising from lipid overload.

Effect of n-3 fatty acid enriched eggs and organic eggs on serum lutein in free-living lacto-ovo vegetarians.

BACKGROUND/OBJECTIVE: Lutein is a xanthophyll found in the chloroplasts of dark green leafy vegetables, chromoplasts of fruits, and egg yolk. Dietary, serum and macular lutein are inversely related to the risk of age-related macular degeneration. Although the lutein from egg is known to be more bioavailable than that from spinach, not much is known about lutein bioavailability from n-3 fatty acid enriched eggs and organic eggs, both of which are increasingly available to consumers. SUBJECTS/METHODS: We determined the effects of feeding n-3 fatty acid-enriched eggs and organic eggs on serum lutein, zeaxanthin and ß-carotene in 20 healthy lacto-ovo-vegetarian (LOV) adults using a single-blind, randomized, crossover study design with a 4-week washout between treatments: six organic eggs or six n-3 fatty acid enriched eggs per week or no egg control for 8 weeks each. RESULTS: Serum lutein was significantly higher in both egg treatments (P<0.009) compared with the control, but was not different between the two egg treatments. Serum ß-carotene was also higher in the egg groups compared with control but only approached significance (P=0.066). Serum zeaxanthin increased in both egg treatments compared with control but did not reach statistical significance (P=0.139). CONCLUSION: n-3 fatty acid enriched eggs and organic eggs may both significantly increase serum lutein in healthy LOV consuming a predominately plant-based diet.

Children's acceptance, nutritional, and instrumental evaluations of whole grain and soluble fiber enriched foods.

The Dietary Guidelines for Americans 2005 report recommends 3 or more daily ounce-equivalents of whole grains (WG), and the FDA suggests consumption of 25 g of total dietary fiber (TDF) and 6 g of soluble fiber (SF) for a 2000-calorie diet. Efforts to increase the consumption of WG and SF among elementary school-aged children are needed. The objectives of this study were to examine the consumption of WG- and SF-enriched burritos and cookies among elementary school-aged children and to perform a quality evaluation of all products. Children in grades K to 6 from a local elementary school consumed control (CTR) products made with refined flour along with the test products (TRT) over a 13-wk period. TRT burritos and cookies contained 51% and 100% WG, respectively. CTR and TRT products were served on 3 and 4 different Fridays, respectively. Children's consumption was determined via plate waste. Quality parameters such as texture, color, water activity, weight, and product dimensions were also measured. No significant differences in consumption between CTR and TRT burritos and cookies were found (36% and 90%, respectively). Texture (area) was higher for CTR burritos compared with TRT burritos (1.31 and 0.66 kg-s, respectively). CTR burritos were lighter than TRT burritos with L* values of 80.04 and 64.61, respectively. CTR cookies required a higher breaking force (3.14 compared with 0.58 kg), were lighter than TRT cookies (63.18 compared with 50.27), and had lower water activity (0.5 compared with 0.71).

Use of vitamins, minerals and herbs: a survey of patients attending family practice clinics.

OBJECTIVE: To examine the use of vitamin, mineral and herbal supplements in patients attending family practice clinics. DESIGN: A prospective 1-year cohort study. SETTING: Sixteen family practices in Calgary. PARTICIPANTS: One hundred and eighteen patients (more than 18 years of age) were initially interviewed; 12 patients were lost to follow-up. MAIN OUTCOME MEASURES: Number and type of supplements used, duration of use, sources of patient information, beliefs about supplement efficacy and safety, reporting use to physicians, costs and changes in pattern of use over 1 year. RESULTS: Supplement use was unrelated to age, but more women (73%) used supplements than men (44%). Relative to age, more patients younger than 50 years believed supplements were safer than prescription medications (82% v. 43%, p = 0.0005). Younger patients were less likely than those over 50 years old to have received supplement information from physicians (10% v. 37%, p = 0.0008) and were less compliant than older patients with manufacturers' recommended dosages (p = 0.02). Whereas 74% of those over the age of 50 years informed their physician that they used supplements, only 30% of younger patients did so (p = 0.0006). At 1-year follow-up, the number of supplements taken per patient increased (p < 0.05), and there was a tendency for more patients to take supplements (61% v. 70%, p = NS). CONCLUSIONS: The majority of patients attending family practices in Calgary use vitamin, mineral or herbal supplements, and monitoring of supplement use by health care professionals is minimal. Young patients, in particular, tend not to report their use of supplements. They also believe the supplements are safer and more effective than prescription medications and obtain information from nonmedical sources. Physicians should enhance patient understanding of these products and include supplement use in all medical histories. In particular, younger patients require more reliable information on supplements.

Lifestyle modifications to prevent and control hypertension. 5. Recommendations on dietary salt. Canadian Hypertension Society, Canadian Coalition for High Blood Pressure Prevention and Control, Laboratory Centre for Disease Control at Health Canada, Heart and Stroke Foundation of Canada.

OBJECTIVE: To provide updated, evidence-based recommendations concerning the effects of dietary salt intake on the prevention and control of hypertension in adults (except pregnant women). The guidelines are intended for use in clinical practice and public education campaigns. OPTIONS: Restriction of dietary salt intake may be an alternative to antihypertensive medications or may supplement such medications. Other options include other nonpharmacologic treatments for hypertension and no treatment. OUTCOMES: The health outcomes considered were changes in blood pressure and in morbidity and mortality rates. Because of insufficient evidence, no economic outcomes were considered. EVIDENCE: A MEDLINE search was conducted for the period 1966-1996 using the terms hypertension, blood pressure, vascular resistance, sodium chloride, sodium, diet, sodium or sodium chloride dietary, sodium restricted/reducing diet, clinical trials, controlled clinical trial, randomized controlled trial and random allocation. Both trials and review articles were obtained, and other relevant evidence was obtained from the reference lists of the articles identified, from the personal files of the authors and through contacts with experts. The articles were reviewed, classified according to study design and graded according to level of evidence. In addition, a systematic review of all published randomized controlled trials relating to dietary salt intake and hypertension was conducted. VALUES: A high value was placed on the avoidance of cardiovascular morbidity and premature death caused by untreated hypertension. BENEFITS, HARMS AND COSTS: For normotensive people, a marked change in sodium intake is required to achieve a modest reduction in blood pressure (there is a decrease of 1 mm Hg in systolic blood pressure for every 100 mmol decrease in daily sodium intake). For hypertensive patients, the effects of dietary salt restriction are most pronounced if age is greater than 44 years. A decrease of 6.3 mm Hg in systolic blood pressure and 2.2 mm Hg in diastolic blood pressure per 100 mmol decrease in daily sodium intake was observed in people of this age group. For hypertensive patients 44 years of age and younger, the decreases were 2.4 mm Hg for systolic blood pressure and negligible for diastolic blood pressure. A diet in which salt is moderately restricted appears not to be associated with health risks. RECOMMENDATIONS: (1) Restriction of salt intake for the normotensive population is not recommended at present, because of insufficient evidence demonstrating that this would lead to a reduced incidence of hypertension. (2) To avoid excessive intake of salt, people should be counselled to choose foods low in salt (e.g., fresh fruits and vegetables), to avoid foods high in salt (e.g., pre-prepared foods), to refrain from adding salt at the table and minimize the amount of salt used in cooking, and to increase awareness of the salt content of food choices in restaurants. (3) For hypertensive patients, particularly those over the age of 44 years, it is recommended that the intake of dietary sodium be moderately restricted, to a target range of 90-130 mmol per day (which corresponds to 3-7 g of salt per day). (4) The salt consumption of hypertensive patients should be determined by interview. VALIDATION: These recommendations were reviewed by all of the sponsoring organizations and by participants in a satellite symposium of the fourth International Conference on Preventive Cardiology. They have not been clinically tested. SPONSORS: The Canadian Hypertension Society, the Canadian Coalition for High Blood Pressure Prevention and Control, the Laboratory Centre for Disease Control at Health Canada, and the Heart and Stroke Foundation of Canada.

The health interview: automated assessment in a multidisciplinary outpatient hypertension treatment program.

We studied patients' acceptance of a computer-administered health assessment and educational program at an outpatient hypertension clinic. The program was designed to be user-friendly and minimized the need for keyboard skills. Thirty patients > or = 50 years of age participated. The computer assessment took an average of 39 minutes to complete. Completion time was related to age but not to other demographic factors such as sex, education, or previous computer use. The program was well accepted by patients. Its personalized risk-factor summary and life style advice were particularly well received. We conclude that automated history-taking and educational programs can be used in this health care setting.

Developing a hospital policy for clinical pathways.

Clinical pathways are used for planning, coordinating and facilitating the continuum of patient care from before admission to after discharge. They rapidly are changing the provision of healthcare services through improved patient care and cost containment, but they also have raised questions about possible legal ramifications. If sound policies and procedures for clinical pathways are developed and consistently adhered to by healthcare facilities, the potential for liability may be minimized while patient care is improved. This article describes a multidisciplinary task force's work to develop such policies and procedures.