Eating disorders and associated mental health comorbidities in female veterans

Eating disorders (EDs) remain understudied among veterans, possibly due to the perception that primarily male population does not suffer from EDs. However, previous research suggests that male and female veterans do experience EDs. The high rates of posttraumatic stress disorder (PTSD), depression, and obesity observed among veterans may make this group vulnerable to disordered eating. Retrospective chart review was used to obtain data from 492 female veterans who were presented to a women?s primary care center at a large, urban VA medical center between 2007 and 2009. A total of 2.8% of this sample had been diagnosed with an ED. In bivariate analyses, presence of PTSD and depression were significantly associated with having an ED diagnosis. However, when these two disorders were included in a multivariate model controlling for age, only depression diagnosis and lower age were significantly related to ED status. In sum, the rate of EDs in this sample is comparable to prevalence estimates of EDs in the general population. Current findings underscore the importance of assessing for EDs among VA patients and the need for further research among veterans.     

High-intensity intermittent cycling increases purine loss compared with workload-matched continuous moderate intensity cycling

Purpose

Exercise at 50–60 % of peak oxygen consumption (VO_{2 peak}) stimulates maximal fat oxidation rates. Despite a lower estimated work performed; high-intensity intermittent exercise (HIIE) training produces greater fat mass reductions when compared with workload-matched continuous (CON) steady state exercise. No metabolic basis has been documented nor mechanisms offered to explain this anomaly. This study investigated the physiological and metabolic responses of two different workload-matched exercise protocols.

Methods

On separate occasions and at least 1 week apart, eight apparently healthy males cycled for 30 min at either 50 % VO_{2 peak} (CON) or performed repeated 20 s bouts of supramaximal exercise at 150 %VO_{2 peak} separated by 40 s rest (HIIE).

Results

The average heart rate, oxygen consumption, plasma glycerol and free fatty acid concentrations were not different during exercise and recovery between the trials. Plasma lactate and hypoxanthine (Hx) concentrations were elevated and urinary excretion rates of Hx and uric acid were greater following HIIE as compared to CON (P < 0.05).

Conclusion

Exercise-induced plasma Hx accumulation and urinary purine excretion are greater following HIIE and indirectly represents a net loss of adenosine triphosphate (ATP) from the muscle. The subsequent restorative processes required for intramuscular de novo replacement of ATP may contribute to a negative energy balance and in part, account for the potential accelerated fat loss observed with HIIE when compared with CON training programs.     

Length of ovarian stimulation does not impact live birth rate in fresh donor oocyte cycles: a SART CORS study

PurposeTo evaluate the effect of controlled ovarian hyperstimulation length and total gonadotropin (GN) dose on recipient live birth rate (LBR) in fresh donor oocyte cycles.MethodsData was obtained from SART CORS on all fresh donor oocyte GnRH antagonist cycles (n = 1049) between 2014 and 2015 which resulted in a single embryo transferred. Donor and recipient demographic information and cycle characteristics were extracted. Binomial regression was used to estimate LBR with respect to days of stimulation (DOS) and total GN dose. Multivariate analysis was performed to evaluate these relationships after controlling for confounders.ResultsOverall LBR in fresh donor oocyte cycles was 57%. Average stimulation length was 14.3 ± 4.9 days, and total GN dose was 2464 ± 1062 IU. On univariate analysis, neither days of stimulation (p = 0.5) nor total GN dose (p = 0.57) was independently correlated with LBR. However, in prolonged stimulations (> 15 days) with high total GN dose (> 3000 IU), as both the cycle length and total GN dose increased, LBR significantly decreased from 63.81 to 48.15% (p = 0.02) and from 67.61 to 48.15% (p = 0.01), respectively. Multivariate analysis showed no significant effect of either DOS or total GN dose on LBR.ConclusionsLBR is significantly decreased in fresh donor oocyte cycles when cycles are prolonged with high total GN dose. However, after controlling for confounders neither DOS nor total GN dose significantly affects LBR.     

Adenomyosis — an unusual cause of sciatic pain

Summary We report the case of a female patient who presented with a 5-month history of sciatic pain. She was referred to us for investigation and eventual surgical treatment of a suspected herniated lumbar intervertebral disc. Because of an ill-defined clinical picture at admission, she was treated conservatively. After 2 weeks without any improvement, imaging of the spine by MR was performed. No signs of a herniated disc or intraspinal, space-occupying lesion were apparent, but a right paramedian pelvic mass was seen. Ultrasonography confirmed an enlarged, irregular uterus. Hysterectomy abolished the symptoms.     

Comprehensive rehabilitation of the child with osteogenesis imperfecta

Children with osteogenesis imperfecta (OI) that results in considerable deformity are often viewed as poor candidates for aggressive physical therapy and rehabilitation. To determine if this view is realistic, we have entered almost 50 children with OI type III and OI type IV into a comprehensive graduated rehabilitation program, based at the National Institutes of Health, but designed to be implemented by continuing involvement of community resources. Children are begun in the program early with emphasis on gain of head and trunk control and progression to sitting and walking, if possible, with the aid of a variety of phsysical supports, including internal and external bracing. Although not conducted in a randomized fashion, the program's success in bringing children into graded exercise regimes and fostering their increased involvement in school and social situations suggest that aggressive physical therpy and rehabilitation have a major place in the overall care of the infants and children with OI.     

Moderate Amounts of Fructose Consumption Impair Insulin Sensitivity in Healthy Young Men: A randomized controlled trial

OBJECTIVE

Adverse effects of hypercaloric, high-fructose diets on insulin sensitivity and lipids in human subjects have been shown repeatedly. The implications of fructose in amounts close to usual daily consumption, however, have not been well studied. This study assessed the effect of moderate amounts of fructose and sucrose compared with glucose on glucose and lipid metabolism.

RESEARCH DESIGN AND METHODS

Nine healthy, normal-weight male volunteers (aged 21–25 years) were studied in this double-blind, randomized, cross-over trial. All subjects consumed four different sweetened beverages (600 mL/day) for 3 weeks each: medium fructose (MF) at 40 g/day, and high fructose (HF), high glucose (HG), and high sucrose (HS) each at 80 g/day. Euglycemic-hyperinsulinemic clamps with [6,6]-²H₂ glucose labeling were used to measure endogenous glucose production. Lipid profile, glucose, and insulin were measured in fasting samples.

RESULTS

Hepatic suppression of glucose production during the clamp was significantly lower after HF (59.4 ± 11.0%) than HG (70.3 ± 10.5%, P < 0.05), whereas fasting glucose, insulin, and C-peptide did not differ between the interventions. Compared with HG, LDL cholesterol and total cholesterol were significantly higher after MF, HF, and HS, and free fatty acids were significantly increased after MF, but not after the two other interventions (P < 0.05). Subjects’ energy intake during the interventions did not differ significantly from baseline intake.

CONCLUSIONS

This study clearly shows that moderate amounts of fructose and sucrose significantly alter hepatic insulin sensitivity and lipid metabolism compared with similar amounts of glucose.In the U.S., the consumption of fructose increased by more than 25% between 1970 and 1997 as the total sugar intake of the population rose (1). During the same period, the prevalence of obesity rose dramatically, paralleling the increase in fructose consumption and the introduction of high-fructose corn syrup (2). Whether there is a causal relationship between those developments, however, remains unclear. Total fructose consumption from natural and added sources, estimated from food disappearance data, was estimated to be 97 g/person/day in 1997 in the U.S. (1) and 83 g/person/day in 1998 in Switzerland (3).Epidemiologic and intervention studies of fructose and other caloric sweeteners have shown detrimental effects on health. In a cross-sectional study in U.S. adults, for example, the consumption of caloric sweeteners was associated with increased dyslipidemia (4) and in the Health Professionals Follow-up Study, high intakes of sugar-sweetened beverages (SSB) increased the risk for type 2 diabetes (5). Intervention trials have provided evidence that high- to very high–fructose doses led to increases in de novo lipogenesis, blood triglycerides, and hepatic insulin resistance (6–8).Not all of these studies found consistent effects for all parameters, however. In the study by Lê et al. (6), where 1.5 g fructose/kg body weight were consumed during a 4-week period, fasting lipids and glucose were affected, but insulin resistance, as determined by a euglycemic-hyperinsulinemic clamp, did not change. However, their study only tested fructose, without comparison with other sugars. Furthermore, relatively high amounts of fructose were consumed in most of these studies, reaching up to 25% of total energy intake. In a recent intervention study in healthy Swiss men, we found adverse effects of low to moderate amounts of fructose—but also glucose and sucrose—on fasting glucose and inflammatory markers, whereas only beverages containing fructose seemed to negatively affect LDL particle size. Even though fasting glucose was altered, none of the interventions showed any effect on glucose tolerance or on indices of insulin sensitivity calculated during an oral glucose tolerance test (9).The aim of the current study was therefore to assess the effect of moderate amounts of fructose and sucrose, compared with the same amounts of glucose, specifically on hepatic insulin sensitivity but also on lipid profiles of healthy human subjects using euglycemic-hyperinsulinemic clamps with [6,6]-²H₂ labeled glucose.