Margarines Fortified with α-Linolenic Acid, Eicosapentaenoic Acid, or Docosahexaenoic Acid Alter the Fatty Acid Composition of Erythrocytes but Do Not Affect the Antioxidant Status of Healthy Adults

We aimed to investigate the effects of increased intake of α-linolenic acid (ALA), EPA, or DHA incorporated into a food matrix on the fatty acid composition of erythrocytes and on biomarkers of oxidant/antioxidant status. To this end, a controlled dietary study was conducted in 74 healthy men and women. The participants were randomly assigned to 1 of 3 interventions in which margarines fortified with either 10 weight percent ALA, EPA, or DHA ethyl esters replaced their normal spread for 6 wk. The total intakes of ALA, EPA, and DHA were 4.4, 2.2, and 2.3 g/d, respectively. Consuming EPA increased the erythrocyte proportion of EPA (394%) and the omega-3 index (sum of EPA and DHA, 38%). Consumption of DHA increased erythrocyte DHA (91%), the omega-3 index (98%), and EPA (137%). The omega-3 index increased to a significantly greater extent in the DHA group than in the EPA group. ALA did not increase erythrocyte EPA or the omega-3 index. We found no change in plasma uric acid or antioxidant capacity in any of the groups. Plasma malondialdehyde (MDA) increased with the EPA and DHA interventions. All 3 interventions decreased erythrocyte linoleic acid hydroperoxides but did not affect their MDA concentrations. In conclusion, the intake of both isolated EPA and DHA incorporated into margarine resulted in an enhanced incorporation of EPA and DHA into erythrocytes. Our findings indicate that DHA is quantitatively superior to EPA in view of the EPA+DHA tissue incorporation and also that 4 g/d ALA is not sufficient to increase the omega-3 index over a 6-wk period.     

The Evidence for α-Linolenic Acid and Cardiovascular Disease Benefits: Comparisons with Eicosapentaenoic Acid and Docosahexaenoic Acid

Our understanding of the cardiovascular disease (CVD) benefits of α-linolenic acid (ALA, 18:3n–3) has advanced markedly during the past decade. It is now evident that ALA benefits CVD risk. The expansion of the ALA evidence base has occurred in parallel with ongoing research on eicosapentaenoic acid (EPA, 20:5n–3) and docosahexaenoic acid (DHA, 22:6n–3) and CVD. The available evidence enables comparisons to be made for ALA vs. EPA + DHA for CVD risk reduction. The epidemiologic evidence suggests comparable benefits of plant-based and marine-derived n–3 (omega-3) PUFAs. The clinical trial evidence for ALA is not as extensive; however, there have been CVD event benefits reported. Those that have been reported for EPA + DHA are stronger because only EPA + DHA differed between the treatment and control groups, whereas in the ALA studies there were diet differences beyond ALA between the treatment and control groups. Despite this, the evidence suggests many comparable CVD benefits of ALA vs. EPA + DHA. Thus, we believe that it is time to revisit what the contemporary dietary recommendation should be for ALA to decrease the risk of CVD. Our perspective is that increasing dietary ALA will decrease CVD risk; however, randomized controlled clinical trials are necessary to confirm this and to determine what the recommendation should be. With a stronger evidence base, the nutrition community will be better positioned to revise the dietary recommendation for ALA for CVD risk reduction.     

Do We Have the Spark?

Upgrading any system is challenging. Neglecting continuous monitoring and evaluation might impose solutions that worsen the situation. Primary orientation toward increasing productivity is the main reason for the tremendous decline in the accessibility of outpatient services in Slovenia since 2015, in addition to additional funds from the state budget. In the actual ‘fee-for-service’, providers are incentivised to deliver more expensive services, not first visits. Although the stakeholders are not to blame, it is high time for an orientation towards patients’ needs: a breakaway from inefficient technical solutions, an acceptance of patients as active participants in decision-making, measurement of their treatment outcomes, and the adoption of already proven advanced payment models, such as population-based payments. The journey towards value-based healthcare must start!     

What Do the Theories of Egon Brunswik Have to Say to Medical Education?

Every day physicians make judgments about patient management and diagnosis based on less than perfect information from many different sources. Judgment and decision-making research has taught us a great deal about such decisions, but these insights rarely find their way into the medical curriculum. One productive line of investigation in the study of judgment and decision making has followed the insights and theories developed by the psychologist, Egon Brunswik. His theories are becoming increasingly relevant to modern judgment problems. In this paper, I outline Brunswik’s theories, trace their development over the last 50 years and speculate on what role they should play in medical education.     

Does Adherence to the Mediterranean Diet Have a Protective Effect against Asthma and Allergies in Children? A Systematic Review

Dietary pattern may potentially impact on the pathogenesis of asthma and allergies. The Mediterranean Diet (MD) has significant health benefits due to its antioxidant and anti-inflammatory properties. The aim of this systematic review was to investigate the effectiveness of adherence to the MD against asthma and allergies in childhood. Hence, a systematic literature search was conducted on PubMed, ESBCO (Cinahl), Scopus, and the Cochrane Library databases up to 26 January 2022. The total number of articles obtained, after the initial search on the databases was conducted, was 301. Twelve studies were included, after the removal of duplicates and screening for eligibility. Our findings indicated a protective role of the MD against childhood asthma, but they also imply that the MD probably does not affect the development of allergies. Nevertheless, the heterogeneity and limitations of the studies highlight the need for randomized controlled trials that will focus on the pediatric population and hopefully provide more robust evidence.     

When and Why Do Heart Attacks Occur? Cardiovascular Triggers and Their Potential Role

Abstract

Coronary heart disease affects 7.6% of the population in the United States, where > 900 000 myocardial infarctions (MIs) occur annually. Approximately half of all MIs have an identifiable clinical trigger. Myocardial ischemia, MI, sudden cardiac death, and thrombotic stroke each occur with circadian variation and peak after waking in the morning. In addition, physical exertion and mental stress are common precipitants of MI. Waking in the morning, physical exertion, and mental stress influence a number of physiologic parameters, including blood pressure, heart rate, plasma epinephrine levels, coronary blood flow, platelet aggregability, and endothelial function. Upregulation of sympathetic output and catecholamines increase myocardial oxygen demand and can decrease myocardial oxygen supply and promote thrombosis. Ischemia ensues when myocardial oxygen demand exceeds supply. Increases in blood pressure and ventricular contractility increase intravascular shear stress and may cause vulnerable atherosclerotic plaques to rupture, forming a nidus for thrombosis that can precipitate MI. Numerous clinical triggers of MI have been identified, including blizzards, the Christmas and New Year's holidays, experiencing an earthquake, the threat of violence, job strain, Mondays for the working population, sexual activity, overeating, smoking cigarettes, smoking marijuana, using cocaine, and particulate air pollution. Avoiding clinical triggers or participating in therapies that prevent clinical triggers from precipitating cardiac events could potentially postpone clinical events by several years and improve cardiovascular morbidity and mortality. Direct or indirect evidence suggests that the risk of triggered MIs is reduced with β-blockers, aspirin, statins, stress management, and transcendental meditation.     

Men Sex Workers and Other Men Who Have Sex With Men: How Do Their HIV Risks Compare in New Zealand?

Sex workers have their perspective on HIV transmission, claiming that in general they are more similar than different from other people in HIV status and the practice of safe sex. Such an assertion of similarity goes against public and professional opinion that prostitution is a major vector in the spread of AIDS. Taking the sex workers' similarity claim seriously, this paper considers the conditions under which it would be valid. We focus on those factors that make a population more or less vulnerable to HIV and how they affect its spread into the sex work population. Data from New Zealand comparing men sex workers and other men who have sex with men is used to evaluate these ideas. Data partially support the hypothesis in that these two groups of men are similar with regard to their HIV status. We do find the sex workers to be different, however, in their being less likely to engage in safe sex practices. We provide an explanation for why this has not lead to their having a higher rate of seropositivity.     

Smoking Bans in the Home and Car: Do Those Who Really Need Them Have Them?

Background. This paper addresses the question of whether individuals who are most in need of household and car smoking bans, such as individuals with children living at home or who have many friends who smoke, are the ones who have them.Method. A representative sample of 6985 California adults ages 18 and older participated in telephone interviews.Results. Overall, 76% of adults report having home smoking bans and 66% have car smoking bans. Being a smoker or African American, not having children in the home, having more friends who smoke, and lower household income were associated with lower prevalence of both home and car smoking bans (P < 0.01). In multivariate analyses, nonsmokers were 7.9 (95% CI = 3.56, 17.31) times more likely to have a home smoking ban when none of their friends were smokers compared to when most of their friends were smokers. Among smokers, there was an interaction between having children at home and the proportion of friends who smoke. Only 27 to 55% of smokers had home smoking bans unless most of their friends were smokers, then the odds of having a ban were 6.1 (95% CI = 2.76, 13.68) times higher for smokers with children (67% with home bans) than for smokers without children at home (25% with home bans).Conclusions. Efforts to increase home and car smoking bans for nonsmokers who have friends who smoke and smokers with children living at home are needed.     

Do genetic factors contribute to the association between birth weight and blood pressure?

OBJECTIVES: To evaluate whether genetic factors contribute to the association between low birth weight and increased blood pressure among adolescents. DESIGN: Historical cohort study of twin pairs. It was evaluated whether (1) a negative association between birth weight and systolic blood pressure was found in the overall twin sample and (2) whether the intrapair difference in birth weight correlated with the intrapair difference in systolic blood pressure-thereby controlling for the effect of genetic factors (all in monozygotic and on average half in dizygotic pairs). SETTING: The Minnesota Twin Family Study. PARTICIPANTS: 1311 pairs of adolescent twins. MAIN RESULTS: A negative association between birth weight and systolic blood pressure was retrieved in the overall sample. The regression coefficient after controlling for current weight was -1.88 mm Hg/kg (SE 0.61), which corresponds to results from previous studies of singleton adolescents. The regression coefficient fell to -0.64 mm Hg/kg (SE 0.86) when the intrapair analyses were used. The largest reduction was observed among monozygotic twins: from -2.44 mm Hg/kg (SE 0.75) in the overall monozygotic twin sample to -1.06 mm Hg/kg (SE 1.14) in the analyses of the within monozygotic pair differences. CONCLUSION: The association between low birth weight and increased blood pressure later in life is well established. "The fetal programming hypothesis" suggests that the association is caused by intrauterine malnutrition while a new hypothesis "the fetal insulin hypothesis" proposes that genetically determined insulin resistance also contributes significantly to the association. A recent twin study of middle aged twins showed no evidence for an influence of genetic factors while this larger study provides support for the fetal insulin hypothesis: the association between birth weight and blood pressure attenuated among adolescents when genetic factors were controlled. Together this suggests an important contribution of genetic factors to the association between fetal growth and systolic blood pressure in adolescence.     

Potential complications of neonatal cephalhaematoma in the community: when to refer to the paediatric team?

Neonatal cephalhaematoma is commonly seen after a minor birth trauma, e.g. from vacuum-assisted deliveries. It is usually considered benign and resolves spontaneously without any treatment. Considerable parental anxiety may be associated with this condition and thus primary health care professionals play a significant role in providing reassurance to the new parents. Complications, although rare, are known to occur and can be potentially serious. A degree of uncertainty is often seen among primary health care professionals about whether to refer such cases to hospital. Recognition of the complications by primary health care professionals and early involvement of the paediatric services are essential to prevent serious complications such as meningitis and osteomyelitis. A case of bilateral cephalhaematoma is presented which was suspected to be infected and needed in-patient hospital care. The potential complications of a cephalhaematoma are discussed and guidelines provided for expediting early and appropriate referral of complicated cases to the paediatric services.     

Functionality of Fatty Acid Chemoreception: A Potential Factor in the Development of Obesity?

Excess dietary fat consumption is recognized as a strong contributing factor in the development of overweight and obesity. Understanding why some individuals are better than others at regulating fat intake will become increasingly important and emerging associative evidence implicates attenuated fatty acid sensing in both the oral cavity and gastrointestinal (GI) tract in the development of obesity. Functional implications of impaired fatty acid chemoreception include diminished activation of the gustatory system, the cephalic response and satiety. This review will focus on knowledge from animal and human studies supporting the existence of oral fatty acid chemoreception including putative oral detection mechanisms, and how sensitivity to fatty acids is associated with fat consumption and fatty food preference.