The transient hypercholesterolemia of major weight loss

Serum lipoproteins, body composition, and adipose cholesterol contents of six obese women were studied during and after major weight loss by very-low-calorie diets (VLCDs). Subjects started at 168 +/- 11% of ideal body weight, lost 30.3 +/- 3.7 kg in 5-7 mo, followed by 2+ mo in weight maintenance. Serum cholesterol fell from a prediet (baseline) value of 5.49 +/- 0.32 to 3.62 +/- 0.31 mmol/L (P less than 0.01) after 1-2 mo of VLCDs (nadir), after which it rose to 5.95 +/- 0.36 mmol/L (peak, P less than 0.01 compared with nadir and baseline) as weight loss continued. With weight maintenance, serum cholesterol fell to 4.92 +/- 0.34 mmol/L (P less than 0.05 compared with peak). Adipose cholesterol content did not change in peripheral (arm and leg) biopsy sites but rose significantly in abdominal adipose tissue with weight loss. We conclude that major weight loss was associated with a late rise in serum cholesterol, possibly from mobilization of adipose cholesterol stores, which resolved when weight loss ceased.     

Resting energy expenditure in patients with chronic obstructive pulmonary disease

Resting energy expenditure (REE) was measured in 68 patients with stable chronic obstructive pulmonary disease (COPD) and in 34 weight-stable, age-matched (65 +/- 8 y; means +/- SD) healthy control subjects. Fat-free mass (FFM) determined by bioelectrical resistance explained 84% of the variation in REE in the control group but only 34% in the COPD patients. REE could not reliably be predicted from regression equations either developed in healthy subjects or in COPD patients. REE adjusted for FFM was significantly higher (P less than 0.05) in weight-losing (n = 34) than in weight-stable (n = 34) patients (6851 +/- 781 and 6495 +/- 650 kJ/d, respectively). Pulmonary function was more compromised in weight-losing patients. Adjusted REE in weight-stable patients was significantly higher (P less than 0.01) than in the healthy control group (6131 +/- 405 kJ/d). In patients with COPD, factors in addition to FFM are important determinants of REE. A disease-related increase in REE develops, which may contribute to weight loss in COPD in combination with a lack of an adaptive response to undernutrition in weight-losing patients.     

Nutrition labels in bar graph format deemed most useful for consumer purchase decisions using adaptive conjoint analysis

This study estimated the effects of changing multiple levels and combinations of nutrition information format, load, expression, and order on consumers' perceptions of label usefulness in purchase decisions using adaptive conjoint analysis. A shopping mall intercept survey, which was administered by a marketing research firm, assessed consumer preferences for 12 label alternatives produced on Campbell's soup cans to portray nutrition information realistically; 252 of 258 respondents completed the computer interactive interview. Consumers significantly preferred the bar graph format to the bar graph/nutrient density and traditional label formats. Consumers considered the bar graph/nutrient density format to be as useful as the traditional label format. There was a highly significant difference among the three levels of information load; the most information load was preferred regardless of nutrient importance. Consumers significantly preferred nutrition information stated in absolute numbers and percentages vs in absolute numbers only in traditional, or in percentages only expressions. There was a significant difference between consumer preferences for the two types of information order. The findings indicate that consumers clearly preferred the nutrition label that displayed all nutrient values using a bar graph format, offered the most information load, and expressed nutrient values using both absolute numbers and percentages. Consumers also preferred nutrition information rearranged in an order that grouped nutrients that should be consumed in adequate amounts on the top, calories in the middle, and nutrients that should be consumed in lesser amounts on the bottom of the label.     

Adipose tissue fatty acid composition and its relations to diet and plasma lipid concentrations in hemodialysis patients

Adipose tissue fatty acid composition, serum lipid profile, and dietary intake of 37 patients on maintenance hemodialysis were studied. In August 1982, 1984, and 1986, analyses were carried out in 15 normotriglyceridemic (NTG) and 22 hypertriglyceridemic (HTG; type IV hyperlipidemia) patients. No correlations were found between dietary intake of polyunsaturated fatty acids (PUFAs), ratio of polyunsaturated to saturated fatty acids (P-S ratio), and carbohydrate content on the one hand and serum lipid concentrations on the other in the two groups. Adipose tissue linolenic acid correlated negatively with serum cholesterol in both groups. Strong correlations were found between dietary intake of PUFAs and adipose tissue linoleic acid content, between PUFAs and the double-bond index, between P-S ratio and adipose tissue linoleic acid content, and between P-S ratio and the double-bond index. No significant differences in dietary intake or adipose tissue fatty acid composition were observed between NTG and HTG patients. Thus, no evidence was found for exogenous dietary influences on serum lipid concentrations. The adipose tissue linoleic acid content did reflect the dietary intake of PUFAs.     

Effects of low and high dose oral contraceptives on blood coagulation and thrombogenesis induced by vascular subendothelium exposed to flowing human blood.

We investigated the effect of oral contraceptives with low and high estrogen concentration on blood coagulation and thrombogenesis, induced by vascular subendothelium of rabbit aorta exposed to flowing human blood. Twenty healthy women intending to take oral contraceptives were studied [1] before drug ingestion (control), and subsequently during the intake of oral contraceptives with [2] low estrogen content (20 micrograms ethinyl estradiol and 150 micrograms desogestrel per day) and [3] high estrogen content (50 micrograms ethinyl estradiol and 125 micrograms desogestrel per day). All experiments were performed between day 17 and 21 of the menstrual cycle and drug effects were studied during the third tablet cycle. Deposition of fibrin, platelets and platelet thrombi on vascular subendothelium was tested at a defined blood flow and wall shear rate (10 ml/min, 650 s-1) and was quantified by morphometrical techniques. Treatment with the low and high dose contraceptive increased the plasma levels of ethinyl estradiol (728 +/- 139 and 1438 +/- 212 vs. 0 fmol/l [low and high dose vs. control], means +/- SEM, P less than 0.001) and fibrinogen (2.3 +/- 0.1 and 2.6 +/- 0.1 vs. 2.0 +/- 0.1 g/l, P less than 0.05); and decreased antithrombin III activity (95 +/- 3 and 92 +/- 3 vs. 101 +/- 3 %, P less than 0.05). Fibrin deposition on vascular subendothelium was enhanced by the high dose contraceptive only (47 +/- 4 vs. 35 +/- 4 % coverage of the subendothelial surface with fibrin, high dose vs. control, P less than 0.05). The subendothelial deposition of platelets and platelet thrombi was not changed by contraceptive treatment. These results indicate that treatment with high dose contraceptives leads to an increase of fibrin-subendothelial interactions, whereas low dose contraceptives do not significantly alter the blood-subendothelium interactions. observed in this ex vivo model of thrombogenesis.     

An experiment in medical education. A critical analysis using traditional criteria

In 1984, in addition to its standard traditional curriculum, Rush Medical College (Chicago, Ill) developed a Socratic problem-based method of teaching basic science material called the alternative curriculum. As part of an evaluation of this new curriculum, students in the two curricula were compared using three traditional measurements: (1) test scores from the National Board of Medical Examiners, Part I; (2) test scores from the National Board of Medical Examiners, Part II; and (3) performance on an oral examination. Alternative curriculum students did not differ significantly from their traditional curriculum classmates on National Board of Medical Examiners, Part I and Part II total scores, although their subset scores on Part I did tend to be lower, reaching significance in one subset area. Differences in performance favoring the traditional curriculum were primarily seen in the early years of the program. Alternative curriculum students in the class matriculated in 1987 scored significantly higher in three of five categories on the oral examination.     

Autosomal recessive nonsyndromal profound childhood deafness in a large pedigree. Audiometric features of the affected persons and the obligate carriers

Nonsyndromal autosomal recessive profound childhood deafness will affect about one in 4000 children in western Europe. A nonsyndromal autosomal recessive type of profound childhood deafness was thought to be the cause of deafness in at least eight and probably 12 children from a large family with various consanguineous matings and other family interrelations. Audiograms of all affected deaf children showed a profound childhood deafness with only a very slight variation. Audiometric examinations, such as pure-tone audiometry, high-frequency audiometry, stapedial reflexes, and Bekesy audiometry, of ten obligate or presumed carriers did not show any significant findings that would allow identification of carriers of this autosomal recessive gene. Families like this one seem to be very rare. Large clinically well-studied families like this one are indispensable for gene linkage studies of nonsyndromal autosomal recessive types of profound childhood deafness. Such studies should make it possible to trace the origin of these types of childhood deafness at an early age. In consequence, carrier detection should also become available.