Coronary Heart Disease in Tribal Aborigines—The West Kimberley Survey

Summary: Two-hundred-and-forty-eight full-blood tribal Aborigines from the West Kimberley region of Western Australia were surveyed for the prevalence of coronary heart disease, and compared with the known prevalence in whites in the country town of Busselton, WA. The prevalence was found to be greater among the Aborigines, with 7% of men, and 11% of women being found to have "probable" coronary heart disease. Seven per cent of the population had electrocardiographic changes characteristic of frank ischaemia. The major risk factors contributing to this high prevalence were hypertension, diabetes mellitus, and obesity. Thirty-seven per cent of the Aborigines were hypertensive, and 17% had diabetes mellitus.     

Lack of association between plasma homocysteine and angiographic coronary artery disease in the era of fortification of cereal grain flour with folic acid

Homocysteine is associated with coronary disease (CAD). However, the strength of the association after accounting for traditional and emerging risk factors is unclear, particularly since flour fortification with folate was mandated in the USA. We analyzed the association between traditional and emerging risk factors and CAD in 504 patients undergoing clinically-indicated angiography between July 1998 and January 1999. Significant CAD (> or =50% stenosis in > or =1 artery) was present in 271 patients (54%). Mean homocysteine (micromol/l) was 9.36+/-3.07; hyperhomocysteinemia (>13 micromol/l) was present in 7.9% of patients. Mean homocysteine was 9.29+/-3.02 in patients with no disease (no stenoses or stenoses <10%), 9.09+/-2.47 in patients with mild disease (stenoses 10-50%), 9.12+/-2.39 in patients with one vessel disease (VD) (>50% stenosis in one coronary artery), 9.28+/-3.19 in patients with two VD, and 10.1+/-3.89 in patients with three VD (P=0.0793). Multivariate analysis that included age, gender, smoking, LDL, HDL, Lp(a), apo A1, and apo B revealed no independent association between quartile of homocysteine and odds ratio (OR) for CAD. In summary, we found no association between homocysteine and CAD on angiography. The homocysteine-lowering effect of folate-fortified flour, or the inclusion of many traditional and emerging risk factors in multivariate analysis, are potential explanations.     

Prevalence of mild fasting hyperhomocysteinemia in renal transplant versus coronary artery disease patients after fortification of cereal grain flour with folic acid.

Cereal grain flour products fortified with 140 microg folic acid per 100 g flour became widely available in southeast New England by July 1997. We hypothesized that improved folate status secondary to this fortification policy would have a much more limited impact on the prevalence of mild fasting hyperhomocysteinemia in renal transplant versus coronary artery disease patients. Between October 1997 and October 1998, fasting plasma total homocysteine (tHcy), folate and vitamin B12 levels were determined in a total of 86 renal transplant patients with stable allograft function, and 175 coronary artery disease patients whose serum creatinine was (1.4 mg/dl). All subjects lived in the Providence, RI, metropolitan area, and were either non-users of any supplements containing folic acid, vitamins B6 or B12, or had refrained from using such supplements for > or = 6 weeks. Geometric mean fasting tHcy levels were 88.0% higher (15.6 vs. 8.3 micromol/l; P < 0.001), and the prevalence of fasting tHcy levels > or = 12 microM (69.8% vs. 10.9%, P < 0.001) was markedly increased in the renal transplant patients, despite a much younger mean age and a relative preponderance of women. In the era of folic acid fortified flour, hyperhomocysteinemia is much more common in stable renal transplant versus coronary artery disease patients. As a result, renal transplant patients are a preferable high risk target population for controlled trials evaluating the tenable hypothesis that lowering total homocysteine levels will reduce cardiovascular disease outcomes.     

Effects of Short-Term Ethanol and Nutrition on the Hepatic Microsomal Monooxygenase System in a Model Utilizing Total Enteral Nutrition in the Rat

The majority of studies examining the effects of ethanol on the hepatic microsomal monooxygenase system, (HMO), have utilized the liquid diet regimen of Lieber and DeCarli. While much has been learned with this useful model, there are some concerns associated with diminished nutrient intake. Decreased food intake in the presence of high levels of ethanol could give rise to at least three effects; primary ethanol effects, primary nutritional effects and/or effects resulting from interactions between nutritional deficiencies and ethanol (i.e., synergistic effects). A model similar to that developed by Tsukomoto and French is used in the current study, in which ethanol is infused directly into the stomach as part of a total enteral nutrition system (TEN). This assured that nutrients sufficient for normal growth were consumed. Two clinically relevant diets were selected for study. One diet is very similar to that used for intravenous feeding of human patients (diet A) and the other similar to that used for intragastric feeding of patients (diet B). The present study was conducted to determine the effects of different diets on HMO and to determine whether ethanol has demonstrable effects in the presence of dietary sources that promote normal growth rates. The effects of the two liquid diets alone or of TEN where 35% of the total calories in the diets were replaced by ethanol for 8 days were examined on HMO of adult male Sprague-Dawley rats. HMO substrates examined included testosterone, the alkoxyresorufins, carbon tetrachloride, and p-nitrophenol. Levels of cytochrome P-450 apoproteins were studied by Western blot analysis.(ABSTRACT TRUNCATED AT 250 WORDS)     

Effects of restricting pub closing times on night‐time assaults in an Australian city

Aims In March 2008 the New South Wales judiciary restricted pub closing times to 3 a.m., and later 3.30 a.m., in the central business district (CBD) of Newcastle, Australia. We sought to determine whether the restriction reduced the incidence of assault. Design Non‐equivalent control group design with before and after observations. Setting Newcastle, a city of 530 000 people. Participants People apprehended for assault in the CBD and nearby Hamilton, an area with a similar night‐time economy but where no restriction was imposed. Measurements Police‐recorded assaults in the CBD before and after the restriction were compared with those in Hamilton. Cases were assaults occurring from 10 p.m.–6 a.m. from January 2001–March 2008, with April 2008–September 2009 as the post‐restriction period. We also examined changes in assault incidence by time of night. Negative binomial regression with time, area, time × area interaction terms and terms for secular trend and seasonal effects was used to analyse the data. Autocorrelation was examined using generalized estimating equations. Findings In the CBD, recorded assaults fell from 99.0 per quarter before the restriction to 67.7 per quarter afterward [incidence rate ratio (IRR): 0.66, 95% confidence interval (CI): 0.55–0.80]. In the same periods in Hamilton, assault rates were 23.4 and 25.5 per quarter, respectively (IRR: 1.02, 95% CI: 0.79–1.31). The relative reduction attributable to the intervention was 37% (IRR = 0.63, 95% CI: 0.47–0.81) and approximately 33 assault incidents were prevented per quarter. Conclusion This study indicates that a restriction in pub closing times to 3/3.30 a.m. in Newcastle, NSW, produced a large relative reduction in assault incidence of 37% in comparison to a control locality.     

Effects of Nutrition and Alcohol on Albumin Synthesis

Albumin synthesis was studied in the isolated perfused rabbit liver under the influence of the stresses of fasting and acute alcohol and acetaldehyde exposure. Fasting clearly depressed albumin production and disaggregated the endoplasmic membrane-bound polysomes. Acute exposure to alcohol produced the same results. Acetaldehyde 2 mg% resulted in a depression of albumin synthesis but the polysomes were not disaggregated. The metabolism of alcohol was necessary for polysome disaggregation. The acute effects of ethanol and fasting were quite similar and it might be considered that the alcohol was acting like a pharmacologic fast. Employing the liver from a fasted donor specific amino acids infused into the liver at levels of 10 mM reversed the acute effects of fasting and the acute effects of exposure to ethanol. However when the two stresses of fasting and alcohol were combined the same amino acids were not effective. In studying albumin synthesis and/or secretion it is necessary to carefully define the nutritional status of the experimental model.     

Effects of a sustained heroin shortage in three Australian States

BACKGROUND: In early 2001 in Australia there was a sudden and dramatic decrease in heroin availability that occurred throughout the country that was evidenced by marked increases in heroin price and decreases in its purity. AIM: This study examines the impact of this change in heroin supply on the following indicators of heroin use: fatal and non-fatal drug overdoses; treatment seeking for heroin dependence; injecting drug use; drug-specific offences; and general property offences. The study was conducted using data from three Australian States [New South Wales (NSW), Victoria (VIC) and South Australia (SA)]. METHODS: Data were obtained on fatal and non-fatal overdoses from hospital emergency departments (EDs), ambulance services and coronial systems; treatment entries for heroin dependence compiled by State health departments; numbers of needles and syringes distributed to drug users; and data on arrests for heroin-related incidents and property-related crime incidents compiled by State Police Services. Time-series analyses were conducted where possible to examine changes before and after the onset of the heroin shortage. These were supplemented with information drawn from studies involving interviews with injecting drug users. RESULTS: After the reduction in heroin supply, fatal and non-fatal heroin overdoses decreased by between 40% and 85%. Despite some evidence of increased cocaine, methamphetamine and benzodiazepine use and reports of increases in harms related to their use, there were no increases recorded in the number of either non-fatal overdoses or deaths related to these drugs. There was a sustained decline in injecting drug use in NSW and VIC, as indicated by a substantial drop in the number of needles and syringes distributed (to 1999 levels in Victoria). There was a short-lived increase in property crime in NSW followed by a sustained reduction in such offences. SA and VIC did not show any marked change in the categories of property crime examined in the study. CONCLUSIONS: Substantial reductions in heroin availability have not occurred often, but in this Australian case a reduction had an aggregate positive impact in that it was associated with: reduced fatal and non-fatal heroin overdoses; reduced the apparent extent of injecting drug use in VIC and NSW; and may have contributed to reduced crime in NSW. All these changes provide substantial benefits to the community and some to heroin users. Documented shifts to other forms of drug use did not appear sufficient to produce increases in deaths, non-fatal overdoses or treatment seeking related to those drugs.     

Nutrition standards for away‐from‐home foods in the USA

Away‐from‐home foods are regulated with respect to the prevention of food‐borne diseases and potential contaminants, but not for their contribution to dietary‐related chronic diseases. Away‐from‐home foods have more calories, salt, sugar and fat, and include fewer fruits and vegetables than recommended by national nutrition guidelines. Thus, frequent consumption of away‐from‐home foods contributes to obesity, hypertension, diabetes, heart disease, and cancer. In light of this, many localities are already adopting regulations or sponsoring programs to improve the quality of away‐from‐home foods. We review the rationale for developing nutritional performance standards for away‐from‐home foods in light of limited human capacity to regulate intake or physiologically compensate for a poor diet. We offer a set of model performance standards to be considered as a new area of environmental regulation. Models for voluntary implementation of consumer standards exist in the environmental domain and may be useful templates for implementation. Implementing such standards, whether voluntarily or via regulations, will require addressing a number of practical and ideological challenges. Politically, regulatory standards contradict the belief that adults should be able to navigate dietary risks in away‐from‐home settings unaided.     

Nutrition in the elderly

Older people are growing in prevalence and their nutrition-related concerns adversely impact upon health, function, and life quality. Changes in body composition and organ system function alter nutrient requirements. The purpose of this review is to examine changes in nutritional requirements with aging and to highlight practical approaches to nutritional screening, assessment, and intervention. A multidisciplinary approach with individualized care is recommended. Health care providers who work with older people must be attentive to nutrition, because appreciable comorbidity and unfavorable outcomes may accompany either under- or overnutrition.