Calorie and nutrient intakes of elderly and young subjects measured under identical conditions

The calorie and nutrient intakes of elderly and young healthy males and females were monitored for four days at the MIT Clinical Research Center. Subjects were free to select foods for meals and snacks from among a variety of high protein and high carbohydrate foods; when necessary, fat was added to make the foods isocaloric. The elderly subjects consumed significantly fewer calories, carbohydrates, and fat than the young subjects, both absolutely and when adjusted for differences in body weight (p less than .001). Mealtime protein intake when adjusted for body weight was similar among males of both age groups and significantly greater than the intakes of both young and elderly females (p less than .001). However, young males consumed more protein from snacks than young females or older adults and thus exhibited the highest daily protein intakes. The two age groups differed significantly in their pattern of food intake from meals and snacks. Elderly adults consumed almost 85% of their total calories from meals, whereas the younger adults consumed about 72% (p less than .001) from meals. Both groups snacked mainly on carbohydrate-rich foods. The elderly subjects consumed significantly fewer snacks than the young; their daily average consumption was 2.2 and that of the young, 4.5 (p less than .001). The persistence of different patterns of food intake between young and elderly individuals when measured under identical clinical conditions suggests that age per se, in addition to age-associated lifestyle changes, may affect eating behavior.     

Westernized food habits and concentrations of serum lipids in the Japanese

To investigate the association of westernized food habits and concentrations of serum lipids in the Japanese, we studied 1200 healthy Japanese living in Hiroshima prefecture and 1483 ethnic Japanese from Hiroshima prefecture living in the Hawaii Islands and Los Angeles. The nutritional assessments were made by the same dietitians. No major difference was observed in the total energy intake between the Japanese and the Japanese-Americans in both males and females. However, the intake of animal fat and simple carbohydrates (especially fructose) were markedly greater, and that of complex carbohydrates lower, in the Japanese-Americans compared with the Japanese. The mean serum cholesterol (CH), LDL-CH and serum triglyceride (TG) levels were significantly higher in the Japanese-Americans in both sexes. The mean HDL-CH concentration was similar between the two groups in males, but it was approximately 7 mg/dl higher in Japanese-American females. Using the 75 percentile values of CH and TG in the Japanese in Hiroshima, the frequency of WHO types IIa and IIb hyperlipidemia was about twice as high in the Japanese-Americans. These results suggest that westernized food habits in the Japanese include qualitative changes in animal fat, simple carbohydrate and complex carbohydrate diet rather than an increase in the total energy intake. These changes are associated with marked increases in the concentrations of serum CH and TG and increased prevalence of types IIa and IIb hyperlipidemia.     

Diclonal gammopathy (IgG kappa, IgA lambda) with nephrotic syndrome terminating into IgA lambda myeloma after three years--report of a case

A 43-year-old man was admitted to our hospital because of legs edema and periorbital edema in Dec. 1983. Laboratory findings showed massive proteinuria (3.7 g/day), Bence Jones protein (BJP) in urine, and hypoproteinemia. Peripheral blood examinations were normal and a bone marrow aspiration showed hypocellularity with slight increase of monocytes and plasma cells. Serum immunoelectrophoresis showed two M-components (IgG kappa, IgA lambda). Serum IgG was 1,690 mg/dl, IgA 379 mg/dl and IgM 160 mg/dl. No remarkable findings were obtained in bone survey, Ga-scintigraphy and rectal biopsy, and a diagnosis of diclonal gammopathy with nephrotic syndrome was made. In Aug. 1986, serum IgA started to increase rapidly with concomitant decrease IgG. He died of pneumonia due to pancytopenia in Dec. 1986, when serum IgG was 450 mg/dl, IgA 1,014 mg/dl, and IgM less than 39 mg/dl. Immunoelectrophoresis showed two M-components (IgG kappa, IgA lambda) in serum and BEP (kappa, lambda), IgG (kappa) and IgA (lambda) in urine. An autopsy showed massive infiltration of myeloma cells which were positive for lambda light chain in bone marrow, suggesting a development of myeloma from a diclonal gammopathy in about 3 years.     

LIPID AND LIPOPROTEIN RESPONSES OF HYPERTRIGLYCERIDÆMIC OUTPATIENTS TO A LOW-CARBOHYDRATE MODIFICATION OF THE A.H.A. FAT-CONTROLLED DIET

13 non-obese men with hypertri-glyceridæmia were followed monthly during a year of dietary treatment. During the last six months a diet designed to lower serum levels of both triglyceride and cholesterol was prescribed. Carbohydrate intake was low (30% of total calories), cholesterol intake was low (259 mg. daily), and total fat intake was high (50% of calories) with a high polyunsaturated/saturated (P/S) ratio (3/2). Compared with baseline values, the diet caused significant reductions in the mean levels of triglyceride (by 96 mg. per dl.), cholesterol (by 28 mg. per dl.), pre-β-lipo-protein (by 65 mg. per dl.), and β-lipoprotein (by 84 mg. per dl.). Weight fell significantly (by 2 kg.) despite attempts to prevent this, but the triglyceride response appeared to be unrelated to the weight loss. These events are compared with the effects of the standard American Heart Association (A.H.A.) fat-controlled diet during the first six months in the same subjects, and during twelve months of treatment in a group of 28 men with normal serum-triglyceride concentrations. The chief effect of the standard A.H.A. diet appears to be a reduction of the level of 3-lipoprotein and that of carbohydrate restriction a lowering of pre-β-lipoprotein concentration. Our low carbohydrate modification of the standard A.H.A. diet is acceptable to outpatients and has a sustained capacity to lower serum triglyceride and cholesterol concentrations.     

Activity, dietary intake, and anthropometry of an informal social group of Thai elderly in Bangkok

Socio-demographic, anthropometric assessment, dietary pattern, lifestyle of 384 Thai elderly (55 males and 329 females) aged 60–94 years, who were members of an informal social activity group, were investigated. The 3-day dietary record was determined with the help of food models by random sampling of the group (seven males and 25 females). Most of the males investigated were married (88.9%), whereas 42.9% of the females were widowed. Nearly all of the elderly investigated lived with their relatives. Only 3% of the elderly had never attended school. More elderly males than females smoked or had smoked in the past, and this applies also to their drinking habits. The health situation of the individuals investigated seemed to be satisfactory. The most frequent diseases found among the elderly were chronic diseases, such as hypertension, hyperlipidemia and diabetes mellitus. No statistically significant difference in body mass index (BMI), arm circumference (AC), and hip circumference was found between males and females. Weight, height, mid-arm muscle circumference (MAMC), arm span, waist, waist/hip ratio and blood pressure of the males were significantly higher than those of the females. Tricep skin-fold thickness (TSF) and subscapular skin-fold thickness (SST) were lower for males than for females. A total of 54.5% of the males and 50.5% of the females were found to be over-nourished. Less than 2% of all the individuals investigated were undernourished. No significant differences were observed for all nutrients between the males and females. Intake of dietary energy from food for males and females was 69.8 and 75.5%, respectively, compared with the Thai RDA. When calculating the intake of macro-nutrients as percentage of total calorie intake, about 17% of the total calorie intake was attributed to fat, 13% to protein and 70% to carbohydrate for the males. For the females, the figures were 17, 15, and 68%, respectively. Intake of calcium, phosphorus, vitamin B1, B2 and niacin seem to be inadequate for both sexes.     

The relationship between dietary ascorbic acid intake and serum lipid concentration in the aged]

The aim of this study was to investigate the relationship between dietary ascorbic acid intake and serum lipid concentration in the aged. The amount of dairy food intake for three consecutive days were measured and the serum levels of total-cholesterol (TC), triglyceride (TG), HDL-cholesterol (HDLC) were determined 279 subjects (135 males and 135 females), 65 years and over living in one community. The LDL-cholesterol (LDLC) was calculated by (TC-HDLC)-TG x 0.2. Dietary ascorbic acid intake showed no significantly difference between males and females, but had a significantly positive correlation with HDLC, the intake of carbohydrates and protein and total fat. However it had a significantly negative correlation with LDLC and LDLC/HDLC. Multiple regression analysis showed that dietary ascorbic acid intake had a statistically significant relationship with HDLC, LDLC and LDLC/HDLC. Since HDLC, which is known to be an anti-atherogenic, was related to increase in the dietary ascorbic acid intake, and LDLC, which is known to be an atherogenic, was related to its decrease, it was suggested that dietary ascorbic acid intake might have an important effect on the genesis and prevention of atherogenic diseases.     

Effects of diets high in simple sugars on urinary chromium losses

Thirty-seven subjects, 19 men and 18 women, consumed reference diets for 12 weeks formulated by nutritionists to contain optimal levels of protein, fat, carbohydrate, and other nutrients; the following 6 weeks, subjects consumed high sugar diets. The reference diets contained 35% of total calories from complex carbohydrates and 15% from simple sugars while the high sugar diets contained 15% complex carbohydrates and 35% simple sugars. Chromium contents of the reference and high sugar diets were both approximately 16 micrograms per 1000 calories. Compared to the reference diets, consumption of the high sugar diets increased urinary Cr losses from 10% to 300% for 27 of 37 subjects. Urinary Cr excretion of males and females was similar, and there was no significant difference in Cr absorption (calculated from urinary excretion divided by intake times 100) between sexes when adjusted for the increased caloric intake of males. These data demonstrate that consumption of diets high in simple sugars stimulates Cr losses; this coupled with marginal intake of dietary Cr may lead to marginal Cr deficiency, which is associated with impaired glucose and lipid metabolism.     

Apolipoprotein E levels in vegetarians

Vegetarians are known to have low lipoprotein lipid and apolipoprotein AI and B levels. Since dietary cholesterol has recently been shown to have important effects on apolipoprotein E (apo E) metabolism, we measured plasma apo E levels in three groups of vegetarians. Group I (n = 36) consumed < 10 mg cholesterol daily and 42% of calories as fat (P:S ratio 2.6). Group II (n = 10) and Group III (n = 18) consumed 97 and 179 mg cholesterol daily, and 35% of calories as fat (P:S ratios 0.7 and 0.9) respectively. Compared to control values, vegetarian plasma cholesterol and triglyceride levels were decreased by 10%–30% and 30%–55%. Plasma apo E levels were decreased equally in all groups by 35% (2.4 ± 0.1 mg/dl versus 3.6 ± 0.1 mg/dl, p < .001). Plasma apo E levels were increased in parallel with lipid levels in pregnant vegetarians but were not different from non-lactating vegetarians in postpartum lactating women. Decreased apo E levels did not correlate with relative body weight, P:S ratio or intake of fat, carbohydrates or protein. Since all vegetarian diets studied were low cholesterol diets, decreased cholesterol intake may contribute to the low apo E levels. The apparent modification of apo E metabolism by vegetarian diets may be important in mediating effects of lipid lowering diets on atherogenesis.     

Nutrient intake: Relationships with lipids and lipoproteins in 6–19-year-old children—The Princeton School District study

Relationships between nutrient intakes and plasma lipids and lipoproteins were studied in 949 randomly selected children, ages 6–19, in the biracial, suburban, Princeton School District. While nutrient intake increased with age in males, such age-associated increases in nutrient ingestion were much less consistent or were not significant for females. Primarily in the 6–9 and 10–12 yr age groups, white children ingested more total calories, more saturated fat, and a lower ratio of polyunsaturated to saturated ($\text{P}\text{S}$) fat, more total carbohydrates, sucrose, starch, and other carbohydrates, and more protein than black children. After adjusting for age, race, sex, weight, and height, several nutrient-lipid and lipoprotein partial correlation coefficients were significant, but of relatively low magnitude. There were weak but significant inverse correlations between dietary $\text{P}\text{S}$ ratios and dietary carbohydrates with both total (r = ?.07, ?0.7) and low-density lipoprotein cholesterol (C-LDL), (r = ?.07, ?.08). Plasma high-density lipoprotein cholesterol (C-HDL) was inversely and significantly correlated with dietary sucrose (r = ?.07); plasma triglyceride correlated positively with dietary sucrose (r = .08). Potential relationships between nutrients and lipids-lipoproteins were also examined in children at the extremes of, and in the middle of, lipid-lipoprotein distributions. After covariance adjustment for age, sex, race, and Quetelet index, children having the highest levels of C-HDL had the lowest intake of dietary carbohydrate and total calories. After further covariance adjustment for total calories, children at the highest end of the plasma cholesterol distribution had a greater intake of cholesterol and total protein than did children in the lowest end of the distribution. Nutrient intake may play a small but significant role relative to lipids and lipoproteins in children, and as such, may have importance relative to pediatric precursors of atherosclerosis.     

Body fat distribution reference standards in Spanish adolescents: the AVENA Study

OBJECTIVE: To present body fat patterning reference standards to identify children with a predominant distribution of body fat in the abdominal or truncal region of the body. DESIGN: Cross-sectional study in a representative sample of Spanish adolescents aged 13-18 years. SUBJECTS: A total of 2160 adolescents with a complete set of anthropometric measurements (1109 males and 1051 females). MEASUREMENTS: Weight, height, body mass index, skinfold thickness (biceps, triceps, subscapular, suprailiac, thigh, calf) and waist and hip circumferences. RESULTS: In the majority of the age groups, subscapular/triceps skinfolds ratio, trunk-to-total skinfolds percent (TTS%)and waist circumference values were significantly higher in males than in females; hip circumference was higher in females than in males, except at 15.5 years. In males, age showed a significant effect for all the body fat distribution indices; however, in females, the effect was only significant for triceps skinfold, waist and hip circumferences and waist-to-hip ratio. Smoothed age- and sex-specific triceps skinfold, subscapular skinfold, subscapular/triceps skinfolds ratio, TTS%, waist circumference and hip circumference, waist-to-hip and waist-to-height ratio percentile values for male and female adolescents have been established. CONCLUSION: These reference data for waist circumference and the other fat patterning indices, together with data from other countries, will help to establish international central obesity criteria for adolescents. The presented percentile values will give the possibility to estimate the proportion of adolescents with high or low regional adiposity amounts.     

Nutritional habits and serum lipid levels in a low-fat intake Chinese population sample

The dietary intake of macronutrients and of specific minerals and vitamins was measured in a low-fat intake adult population living in a rural area in northwestern China. The total intake of fat amounted to +/- 12% of total energy. The P/S ratio was 2.5 and the U/S ratio 3.8. Carbohydrates provide about 75% of total energy. The mean total serum cholesterol was 148 mg/dl in men and 163 mg/dl in women. The mean HDL-cholesterol level was 38.6 mg/dl in men and 39.4 mg/dl in women, confirming the absence of a significant sex difference in HDL-cholesterol in low-fat consuming populations. Triglyceride levels were similar to those of Western populations. For both sexes taken together a positive correlation was found between the serum cholesterol level and saturated fat intake (p < 0.001) and a negative correlation with the P/S ratio (p < 0.05). Calcium intake was low: 346 mg/d in men and 245 mg/d in women.     

Dietary fat and cholesterol intake in young children compared with recommended levels

PURPOSE: The National Cholesterol Education Program (1991) recommended that children 2 years of age or more derive less than 30% of their daily energy intake from total fat, less than 10% from saturated fat, up to 10% from polyunsaturated fat, and 10% to 15% from monounsaturated fat, and that they consume less than 300 mg/day of cholesterol. The purpose of this study was to assess whether preadolescent children were following these dietary guidelines in 1994 and to determine the relationship of diet to obesity. METHODS: This cross-sectional study was performed in elementary schools in southeast Baltimore, Maryland. The subjects were 468 children, grades 2 through 5 (mean age, 8.9 +/- 0.8 years). The main outcome measures were a 24-hour diet record, body mass index, and skinfold thickness. RESULTS: Mean percentage of total daily energy (TDE) from fat was 31.1%; saturated fat, 11.0%; monounsaturated fat, 10%; and polyunsaturated fat, 4.9%. Mean dietary cholesterol was 199.1 mg/day. Although the means for total and saturated fat are at recommended levels, the distribution of the dietary responses indicates that 50% of the children exceeded these targets. Twenty-five percent exceeded 35% of TDE derived from fat, and 25% exceeded 13% TDE derived from saturated fat. Fifty percent of children consumed below the desired level of monounsaturated fat, and almost no children consumed the desired 10% of polyunsaturated fat. Although mean dietary cholesterol was at a desired level, 16% of the children consumed more than 300 mg/day and 10% more than 377 mg/day. The negative correlation for sum of skinfold measurements with TDE (r = -0.14; P < 0.05), suggesting that fatter children consume fewer calories than thinner children, was the only correlate among dietary components and obesity. CONCLUSION: A substantial percentage of children in the United States are still not meeting recommended levels for dietary intake of fat and cholesterol. The trend for fatter children to consume fewer daily calories suggests that obesity is not entirely a result of overconsumption.     

Association of inflammation with raised serum IgA in ankylosing spondylitis.

Serum immunoglobulins were measured in 122 patients with ankylosing spondylitis (AS) during various phases of disease activity and compared to those in 58 healthy subjects. The mean serum IgA was 38% higher in patients (306.9 mg/dl) than in controls (222.7 mg/dl) (P < 0.005), but there was no significant difference in IgG and IgM levels. Increased IgA was associated with laboratory parameters of active inflammatory disease. The mean IgA in patients having an erythrocyte sedimentation rate (ESR) equal to or greater than 15 mm/h was 369 mg/dl, 65% higher than in controls (P < 0.001), whereas there was no significant difference between controls and patients with an ESR of less than 15 mm/h. The mean IgA in patients having a C-reactive protein (CRP) level equal to greater than 15 micrograms/ml (15 mg/l) was 387.8 mg/dl, 74% higher than in controls (P < 0.001), and again there was no significant difference between controls and patients with CRP levels less than 15 micrograms/ml. (SI conversion: g/l = mg/dl x 0.01). It is suggested that selective increase of serum IgA occurs predominantly during phases of active inflammatory disease in AS, and this finding is compatible with the concept of a microbial triggering agent acting across an IgA secreting organ such as the gut.     

Serum leptin concentration during the terrestrial phase of the Southern elephant seal Mirounga leonina (Carnivora: Phocidae)

This study aimed to verify the serum leptin concentration during the terrestrial phase of the Southern elephant seal (Mirounga leonina) on Elephant Island (South Shetlands, Antarctica). Sera from 25 adult Southern elephant seals were analyzed. Leptin concentration was determined using the 125I radioimmunoassay method. Total protein, triglycerides, and cholesterol concentration were measured by spectrophotometric methods. Seals were grouped by sex and their physiological status (reproducing or molting seals). In reproducing seals, serum concentrations of leptin, total protein, triglycerides, and cholesterol were, respectively, 9.33+/-1.97 ng/ml, 6.87+/-0.09 g/dl, 98.26+/-2.12 mg/dl, and 232.17+/-41.18 mg/dl in males and 5.30+/-1.36 ng/ml, 6.44+/-0.29 g/dl, 109.01+/-3.34 mg/dl, and 219.20+/-26.65 in females (mean+/-1 SD). In molting seals, these values were 2.35+/-1.51 ng/ml, 7.42+/-0.25 mg/dl, 321.10+/-20.01 mg/dl, and 244.66+/-22.24 mg/dl in males and 2.94+/-1.89 ng/ml, 7.88+/-0.46 mg/dl, 197.54 mg/dl, and 224.55+/-16.70 mg/dl in females. In both males and females, there were no significant differences (P>0.05) in total protein and cholesterol concentration between reproducing and molting seals. However, both males and females showed higher leptin concentration (P<0.05) and lower triglyceride concentration (P<0.05) in the reproductive period than in the molt period. In the reproductive period, it was expected that the Southern elephant seal shows an inhibited hunger sensation, mobilizes stored energy, and stimulates the HPG axis. Results from the present study support this hypothesis and suggest that this strategy may be effected by the hormonal stimulation of leptin.     

Selective immunoglobulin A deficiency in Iranian blood donors: prevalence, laboratory and clinical findings

Selective deficiency of immunoglobulin A (IgA) is the most frequent primary hypogammaglobulinemia. As some IgA-deficient patients have IgA antibodies in their plasma which may cause anaphylactic reactions, blood centers usually maintain a list of IgA-deficient blood donors to prepare compatible blood components. In this study we determined the incidence of selective IgA deficiency (SIgAD) in normal adult Iranian population. 13022 normal Iranian blood donors were included in this study. The assay which we used was adapted to the manual pipetting system and ELISA reader was used for screening. Other classes of immunoglobulins (G, M), as well as secretory IgA and IgG subclasses were tested in IgA deficient cases by ELISA. SPSS was used for statistical analysis.Among 13022 studied cases, 11608 blood donors were males (89.14%) and 1414 were females (10.86%). Their mean (+/-SD) age and weight were 38.5+/-11 years and 82+/-12 Kg respectively. Twenty of the screened samples were found by means of ELISA to be IgA-deficient (less than 5mg/dl), (frequency; 1:651). The data could indicate a compensation for IgA deficiency by serum IgM in one of our IgA deficient cases (Patient 5). We observed a correlation between IgG3 and serum IgA in deficient cases (r=0.498, P=0.025). Our results indicate that in present study the prevalence of S IgA D is in agreement with data from other Caucasians populations (from 1:300 to 1:700). In conclusion, Selective IgA Deficiency could be almost asymptomatic in most cases in general population. Our study suggests that; due to high frequency of IgA deficiency in Iran, it seems necessary to measure IgA levels for every blood donor and blood recipient to find IgA deficient cases.     

Life-style and serum lipids and lipoproteins

In reviewing the trends and influences of life-style in this country on health and disease in the latter half of 20th century, we focused our attention on 4 major habits of smoking, drinking, exercise and diets, and collected data on the Japanese to conduct a meta-analysis of their relationship with serum lipids and lipoproteins, which are the metabolic risk factors most closely related to atherosclerosis. 1) The percentage of smokers was 54.0% in adult males and 14.5% in adult females in 1999. In the data of 7,256 subjects (mean age 47 years) in 16 papers, smoking increased triglycerides by 13 mg/dl (0.15 mmol/L) or in 559 non-drinkers with a mean age of 49 years in 3 papers by 18 mg/dl (0.20 mmol/L), and decreased HDL-cholesterol by 3.5 mg/dl (0.09 mmol/L) with every 20 cigarettes smoked according to the regression equation. 2) As for drinking, the annual ethanol consumption per adult was 8.5L in 1996. The effects of alcohol on serum lipids were analyzed in 27,035 males (mean age 47 years) in 24 studies. Drinking elevated triglycerides by a mean of 10 mg/dl (0.11 mmol/L), and also HDL-cholesterol by 2.5 mg/dl (0.06 mmol/L) per 23 g of alcohol intake (corresponding to 1 go of sake or 1 large bottle of beer). 3) Concerning exercise habit, 25% of males and 21% of females (mean age 47 years) regularly performed exercise such as jogging, swimming, aerobics, and tennis. However, walking was regarded as an easy exercise to be practiced by subjects of all ages. The effects of walking on serum lipids were studied in a total of 46,074 subjects (mean age 47 years) in 8 populations. Triglycerides were significantly lower by 10 mg/dl (0.11 mol/L), and HDL-cholesterol higher by 3 mg/dl (0.08 mmol/L) in those who walked 6,000 or more steps/day than in those who walked less than 2,000 steps/day. The effects of harder exercise like jogging or swimming were analyzed in 2,242 subjects in 14 papers (mean age 44 years). Triglycerides decreased by 10 mg/dl (0.11 mmol/L), and HDL-cholesterol elevated by 5 mg/dl (0.13 mmol/L) with an increase in the exercise intensity by one level of about 300 kcal. In exercise therapy, triglycerides were decreased by a mean of 20 mg/dl (0.23 mmol/L), and HDL cholesterol increased by a mean of 10 mg/dl (0.26 mmol/L) by exercise at a mean heart rate of about 135 bpm, which is equivalent to 50% VO2max for 30 minutes x 3 times/week. 4) In nutritional trends, the mean energy intake in 52 postwar years averaged 2,116+/-84 kcal with no marked changes according to nutritional surveys. However, the percentage of fat in total energy intake was lowest at 7% in 1946, increased thereafter until it exceeded 20% in 1973, and surpassed 25% in 1988. The mean total cholesterol level of the Japanese increased by 28 mg/dl (0.72 mmol/L) in the past 30 years and reached 204 mg/dl (5.28 mmol/L) in a survey in 1990. 5) Concerning dietary habits, total cholesterol was lower by a mean of 13 mg/dl (0.34 mmol/L), triglycerides lower by 40 mg/dl (0.45 mmol/L), and HDL-cholesterol higher by 5 mg/dl (0.13 mmol/L) in the group who ate 7 or more Japanese-style meals in the 9 meals during 3 days than in the group who ate 3 or less Japanese-style meals in the 9 meals. When serum lipids were compared among individuals living in cities (8 groups; 3,613 subjects; mean age 51 years), agricultural villages (13 groups; 5,364 subjects; mean age 51 years), and fishing villages (9 groups; 1,071 subjects; mean age 52 years). Total cholesterol was lower by a mean of 10 mg/dl (0.26 mmol/L) in fishing villages than in cities, and triglycerides lower by a mean of 15 mg/dl (0.17 mmol/L) in fishing villages than in cities and agricultural villages. HDL-cholesterol was 5 mg/dl (0.13 mmol/L) higher in agricultural villages and 3 mg/dl (0.08 mmol/L) higher in fishing villages than in cities. 6) The effects of dietary therapy or guidance were evaluated in 585 subjects (mean age, 53 years) in 12 papers. Total cholesterol was reduced by 20 mg/dl (0.52 mmol/L), triglycerides by a mean of 40 mg/dl (0.45 mmol/L), and HDL-cholesterol was increased by 5 mg/dl (0.13 mmol/L) by restriction of fat intake or restriction of the intake of saturated fat and dietary cholesterol. The results of these meta-analyses are considered to indicate the extent to which abnormalities of serum lipids are caused by a distorted life-style and the extent to which they are improved by correction of the life-style and exercise or dietary therapy. Correction of the life-style as a non-drug therapy may clearly improve hyperlipidemias or hypo-HDL-cholesterolemia so that this approach should be aggressively employed as part of the prevention and treatment for hyperlipidemias.     

Influence of low protein diet on nonthyroidal illness syndrome in chronic renal failure

Renal failure causes alterations in thyroid hormone metabolism known as nonthyroidal illness syndrome. In the present study we have examined the effect of a low protein diet (LPD) on circulating levels of hormones of the pituitary-thyroid axis, and tumor necrosis factor alpha (TNF-alpha) in patients with chronic renal failure. Seventeen subjects with conservatively treated chronic renal failure (estimated creatinine clearance 39.5+/-11.1 mL/min) were studied before and after 8 wk of dietary intervention (0.6 g/kg of ideal body mass protein, 30% of calories derived from fat, 62% of calories derived from carbohydrates, and 10 mg/kg of phosphorus). Body fat and fat-free mass remained unchanged. Urea and TNF-alpha serum concentrations significantly decreased, whereas T3 and total and free T4 serum concentrations increased significantly. Triiodothyronine level after treatment correlated negatively with baseline urea level. Changes in T3, T4, and fT4 serum concentrations as well as calculated peripheral deiodinase activity correlated negatively with their baseline values. Alterations in TNF-alpha correlated positively with protein intake, whereas changes in T4 and T4/TSH were inversely related to vegetal protein intake. In conclusion, low protein, low phosphorus diet, which is often prescribed to patients with moderate impairment of renal function, exerts a beneficial effect on low T3 syndrome coexisting with renal failure. The effect of low protein diet on the pituitary-thyroid axis is dependent on the degree of renal functional impairment and LPD-induced decrease in TNF-alpha may also contribute to the observed effects of dietary treatment.     

Serum immunoglobulins in leprosy.

Serum immunoglobulins were quantitated by radial immunodiffusion in 25 cases each of tuberculoid and lepromatous leprosy. Immunoglobulins estimated from 50 normal healthy adults were the control. Serum IgG was markedly raised in both tuberculoid (mean 2420 mg/dl) and lepromatous leprosy (mean 2493 mg/dl) when compared with the controls (mean 1288 mg/dl) and the difference was significant (p less than 0.01). However the difference in serum IgM and IgA levels in cases as compared to controls were not statistically significant. Serum IgM was slightly raised, the mean values obtained being 222 mg/dl in tuberculoid leprosy, 221 mg/dl in lepromatous leprosy and 202 mg/dl in control. Serum IgA was reduced in lepromatous leprosy (mean 129 mg/dl) as compared to the controls (mean 168 mg/dl) and the cases of tuberculoid leprosy (mean 165 mg/dl). The range of values obtained in both groups of patients showed greater scatter than the controls and a few cases of both forms of leprosy showed very low values of both serum IgA and IgM.     

Effect of bacterial antigen lysate on IgG and IgA levels in children with recurrent infections and hypogammaglobulinemia.

To evaluate the effect of bacterial antigen lysate on serum immunoglobulin (Ig) levels, we studied 14 children with recurrent infections and hypogammaglobulinemia (IgG and IgA levels below 2 standard deviations for age). Patients were treated for a 60-90 day period with OM-85 BV and reevaluated both clinically and by measuring serum Ig levels at the end of follow-up. The control group consisted of 10 children with recurrent infections who received a placebo. Serum Ig levels were also compared with the reference values for age. The Wilcoxon and Mann-Whitney tests were used for statistical analysis. In the study group, IgG (pretreatment: 707 mg/dl; post-treatment: 1,022 mg/dl; p < 0.004) and IgA levels (pretreatment: 41 mg/dl; post-treatment: 83 mg/dl; p < 0.018) increased significantly. Furthermore, 13/14 children reached normal IgG levels, and 12/14 children reached normal age levels for serum IgA. Similarly, when comparing the pre- and post-treatment levels in the study group with the levels in the control group, they were significant for IgG (p < 0.002) as well as IgA levels (p < 0.04). The overall clinical response was favorable in all patients in the treated group. These results suggest an immunostimulant effect of OM-85 BV, both improving Ig levels and reducing recurrent infections.