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Biomedical subjects

A J Sinclair

Publications and source records attributed to A J Sinclair.

At least 37 records · Page 2Linked to original sources
PubMed2001

Prevalence of diabetes in care home residents.

OBJECTIVE: To determine the prevalence of known and undetected diabetes diagnosed either by an elevated fasting baseline sample or by a 2-h post-glucose load sample in a group of residents of care homes in an urban-district setting. RESEARCH DESIGN AND METHODS: We completed individual interviews with patients and caregivers in 30 care homes (both residential and nursing homes) in two metropolitan districts of Birmingham, West Midlands, U.K. All care homes were under the supervision of primary care physicians (general practitioners). We carried out 75-g oral glucose tolerance tests (OGTTs) in consenting residents without previous known diabetes. Criteria for diagnosis of diabetes were obtained from the World Health Organization (1998) and the American Diabetes Association (1997). RESULTS: Of 636 residents available for study, 76 residents (12.0%) were known to have diabetes; of the 560 remaining residents, 286 either refused to participate or were deemed too ill or unavailable to undergo testing. Complete data on 274 OGTTs were obtained (median age 83 years, range 45-101). A total of 46 subjects were diagnosed as having diabetes and 94 as having impaired glucose tolerance. Allowing for subjects who refused or were unable to participate, the calculated total prevalence (which includes known and newly detected diabetes) was 26.7% (95% CI 21.9-32.0). The calculated overall prevalence of impaired glucose tolerance was 30.2% (25.2-35.6). CONCLUSIONS: In a group of care home residents not known to have diabetes and able to undergo testing, a substantial proportion have undetected diabetes based on a 2-h postglucose load. These residents warrant further study as they may be at higher cardiovascular risk and require an intervention.

Aged↗
PubMed2001

Effect of dietary modification of muscle long-chain n-3 fatty acid on plasma insulin and lipid metabolites, carcass traits, and fat deposition in lambs.

In a previous study we showed that feeding fish meal significantly increased muscle long chain n-3 fatty acids (FA) and hot carcass weight. In this study we compared the effect of fish meal and fish oil on increasing muscle long-chain FA. We also investigated whether the increase in carcass weight was due to the effect of dietary enrichment of muscle long-chain n-3 FA on muscle membrane phospholipids and(or) to rumen by-pass protein provided by fish meal. Forty crossbred ([Merino x Border Leicester] x Poll Dorset) wether lambs between 26 and 33 kg BW were randomly assigned to one of five treatments: 1) basal diet of oaten:lucerne chaff (Basal); 2) Basal + fish meal (9% DM) = FM; 3) Basal + fish oil (1.5% DM) with protected sunflower meal (9% DM ) = FOSMP; 4) Basal + fish oil (1.5% DM) = FO; or 5) Basal + protected sunflower meal (10.5% DM) = SMP. Daily intake of ME (9.60 - 10.5 MJ ME/d) and CP (150 to 168 g/d) in all treatments was kept similar by varying the ratio of oaten:lucerne chaff and by feeding the animals at 90% ad libitum intake. Blood samples were collected at the start of the experiment and on the day (d 42) prior to slaughter. Lambs were then slaughtered at a commercial abattoir. At 24 h postmortem carcass traits were measured and longissimus thoracis muscle taken for analysis of FA of phospholipid and triglyceride fractions. Lambs fed FO and FOSMP showed a marked increase in muscle longchain n-3 FA (P < 0.001) and a reduction in magnitude of the rise in insulin concentration (P < 0.001) after feeding compared with lambs fed Basal and SMP diets. Lambs in FM had a moderate increase (P < 0.001) in muscle long-chain n-3 FA content. Compared with Basal diet, both plasma total cholesterol (P < 0.02) and high-density lipoprotein cholesterol (P < 0.001) levels were greater in SMP and less in FO and FOSMP treatments. The i.m. fat content was reduced (P < 0.05) in FM and FO treatments, but carcass weight was increased only with fish meal (P < 0.03). Adding SMP to FO produced muscle with an intermediate level of i.m. fat, whereas muscle long-chain n-3 FA, i.m. fat, and insulin concentration were unchanged with SMP treatment. These results indicate that an increase in carcass weight in FM may be due to the supply of ruminally undegraded protein. They also suggest that fish oil along with fish meal can increase long-chain n-3 FA content in phospholipid of muscle membrane. This may be associated with reduced i.m. fat content and altered insulin action and lipoprotein metabolism.

Adipose Tissue↗
PubMed2000

Hypoxia/hypoglycemia-induced amino acid release is decreased in vitro by preconditioning.

The aim of this study was to investigate the effects of preconditioning on amino acid neurotransmitter release, induced by hypoxia/hypoglycaemia, from rat brain cortical slices. Tissue, perfused with artificial cerebrospinal fluid (aCSF) at 37 degrees C with zero glucose and gassed with 95% nitrogen and 5% carbon dioxide, showed a fivefold increase in glutamate release with little effect on gamma-aminobutyric acid (GABA) release. Preconditioning, with three 5-min periods of hypoxia/hypoglycaemia preceding continuous hypoxia/hypoglycaemia, significantly decreased glutamate release whilst significantly elevating GABA release. These results suggest that GABA may reduce the release of glutamate and consequently decrease the neurotoxic effects of glutamate.

Amino Acids↗
PubMed2000

p27KIP1 is down-regulated by two different mechanisms in human lymphoid cells undergoing apoptosis.

The cyclin-dependent kinase inhibitor p27KIP1 is a crucial component of the mammalian restriction point, and as such is subject to multiple regulatory mechanisms. It has recently been shown that the abundance of p27KIP1 is also regulated during apoptosis; p27KIP1 is cleaved by a Z-VAD-fmk-sensitive caspase during apoptosis induced by growth factor deprivation in endothelial cells, and also following exposure of myeloid leukaemia cells to etoposide. Here, we investigate p27KIP1 regulation in B- and T-lymphoid cells undergoing apoptosis. We observe that p27KIP1 is down-regulated following exposure to a variety of apoptotic stimuli including an agonistic anti-Fas antibody, cycloheximide and etoposide. Further investigation revealed the existence of two different routes of p27KIP1 regulation in lymphoid cells undergoing apoptosis. The first pathway is utilized by lymphoid cells stimulated through Fas, is abrogated in a caspase-8-deficient T-cell line, and is blocked by the caspase inhibitors Z-VAD-fmk and Boc-D-fmk. In contrast, the loss of p27KIP1 in cells exposed to cycloheximide and etoposide occurs in the absence of caspase-8 or any Z-VAD-fmk- or Boc-D-fmk-sensitive caspase activities. Thus the down-regulation of p27KIP1 is a common occurrence in lymphoid cells undergoing apoptosis but, depending on the apoptotic trigger, this can be affected by two different mechanisms.

Amino Acid Chloromethyl Ketones↗
PubMed2000

The effect of low alpha-linolenic acid diet on glycerophospholipid molecular species in guinea pig brain.

The changes in guinea pig brain (cerebrum) glycerophospholipid molecular species resulting from a low-alpha linolenic acid (ALA) diet are described. Two groups of six guinea pigs were raised from birth to 16 wk of age on either an n-3 deficient diet containing 0.01 g ALA/100 g diet or n-3 sufficient diet containing 0.71 g ALA/100 g diet. Molecular species of diradyl glycerophosphoethanolamine (GroPEtn), glycerophosphocholine, glycerophosphoserine, and glycerophosphoinositol were analyzed by high-performance liquid chromatography with on-line electrospray ionization mass spectrometry (HPLC/ESI/MS). Alkenylacyl GroPEtn species were determined by comparing spectra before and after mild acid treatment while diacyl- and alkylacyl species were distinguished by HPLC/ESI/MS. The proportions of phospholipid classes and of the diradyl GroPEtn subclasses were not altered by diet changes. The main polyunsaturated molecular species of diradyl GroPEtn subclasses and of phosphatidyl choline and phosphatidylserine (PtdSer) contained 16:0, 18:0, or 18:1 in combination with docosahexaenoic acid (DHA, 22:6n-3), docosapentaenoic (DPA, 22:5n-6), or arachidonic acid (ARA, 20:4n-6). A significant proportion of DPA containing species were present in both diet groups, but in n-3 fatty acid deficiency, the proportion of DPA increased and DHA was primarily replaced by DPA. The combined value of main DHA and DPA containing species in the n3 deficient group ranged from 91-111% when compared with the n-3 sufficient group, indicating a nearly quantitative replacement. The n-3 fatty acid deficiency did not lower the content of ARA containing molecular species of PtdSer of the guinea pig brain as reported previously for the rat brain. The molecular species of phosphatidylinositol were not altered by n-3 fatty acid deficiency. The present data show that the main consequence of a low ALA diet is the preferential replacement of DHA-containing molecular species by DPA-containing molecular species in alkenylacyl- and diacyl GroPEtn and PtdSer of guinea pig brain.

Animals↗
PubMed2000

Increased alpha-linolenic acid intake increases tissue alpha-linolenic acid content and apparent oxidation with little effect on tissue docosahexaenoic acid in the guinea pig.

The essential fatty acids do not have identical roles in nutrition. Linoleic acid (LA) accumulates throughout the body of most mammals, whereas alpha-linolenic acid (ALA) is rarely found in tissue lipids to the same extent as LA. It has been argued that this is the result of metabolism of ALA to docosahexaenoic acid (DHA) or that ALA is rapidly beta-oxidized to acetyl CoA and CO2. In this study, we consider the effect of high and low ALA levels on the tissue distribution of ALA and other n-3 polyunsaturated fatty acids (PUFA) in all tissues. Guinea pigs were fed one of two defined diets for 3 wk from weaning with both diets containing 1.8% (by weight) of LA and either 1.7% ALA or 0.03% ALA. The high ALA diet was associated with significantly increased ALA levels in all tissues except the brain and significantly increased levels of long-chain n-3 PUFA in all tissues except intestines, brain, carcass, and skin. The long-chain n-3 PUFA content of the whole body was less than 5% of that of the ALA content in both diet groups, and the major long-chain n-3 PUFA (>66% of total) in the body was 22:5n-3. The brain was the only tissue where the DHA content exceeded that of 22:5n-3. On the low ALA diet, there appeared to be conservation of ALA based on a comparison of the ratio of LA to ALA in the tissues compared with that in the diet. On the high ALA diet there was a loss of ALA relative to LA in the tissues compared with the diet. These studies suggest that the low levels of tissue ALA in the guinea pig are likely the result of beta-oxidation or excretion via the skin and fur rather than metabolism to DHA.

Animals↗
PubMed2000

Cognitive dysfunction in older subjects with diabetes mellitus: impact on diabetes self-management and use of care services. All Wales Research into Elderly (AWARE) Study.

OBJECTIVE: To determine whether cognitive impairment is associated with changes in self-care behaviour and use of health and social services in older subjects with diabetes mellitus. RESEARCH DESIGN AND METHODS: This was a community based, case-control study of subjects registered with general practices participating in the All Wales Research into Elderly (AWARE) Diabetes Study. The 396 patients aged 65 years or older with known diabetes mellitus were compared with 393 age- and sex-matched, non-diabetic controls. Adjusted odds ratio estimates of normal performance on Mini-Mental State Examination (MMSE) and Clock Drawing Test (numbers and hands) were determined. Information on self-care behaviours and use of services was obtained. RESULTS: A total of 283 (71%) diabetic subjects scored 24 or more on MMSE, compared with 323 (88%) of controls (OR 0.54, P<0.0005). The mean (S.D.) scores were 24.5 (5.1) and 25.7 (4.3), respectively (difference between means 1.22; 95% CI 0.56, 1.88; P<0. 001). Clock testing demonstrated that 257 (65%) and 286 (72%) diabetic subjects correctly placed the numbers and hands, respectively, compared with 299 (76%) and 329 (84%) of controls (OR 0.59, P<0.001 and P<0.52, P<0.0005, respectively). Both test scores declined with increasing age, earlier school leaving age and deteriorating visual acuity. Of other variables examined, only need for oral hypoglycaemic drugs or insulin, history of stroke, dementia or Parkinson's disease and symptoms of autonomic neuropathy significantly impaired one or more cognitive test scores. The odds ratios (95% CI) for normal cognitive test results in subjects with diabetes after adjusting for all significant variables was 0.74 (0. 56, 0.97), P=0.029 for MMSE scores and 0.63 (0.44, 0.93), P=0.019, and 0.58 (0.38, 0.89), P=0.013, for the numbers and hands parts of the clock test, respectively. In comparison with diabetic subjects with no evidence of cognitive impairment, diabetic subjects with an MMSE score <23 were significantly less likely to be involved in diabetes self-care (P<0.001) and diabetes monitoring (P<0.001). A low MMSE score was also significantly associated with higher hospitalisation in the previous year (P=0.001), reduced ADL (activities of daily living) ability (P<0.001) and increased need for assistance in personal care (P=0.001). CONCLUSIONS: Elderly subjects with predominantly Type 2 diabetes mellitus display significant excess of cognitive dysfunction, associated with poorer ability in diabetes self-care and greater dependency. Routine screening of cognition in older subjects with diabetes is recommended.

Activities of Daily Living↗
PubMed2000

The effects of supporting discharge from hospital to home in older people.

OBJECTIVE: to investigate the effects of supported discharge after an acute admission in older people with undifferentiated clinical problems. DESIGN: a systematic review of randomized controlled trials. METHODS: we searched MEDLINE, CINAHL, the Cochrane Library, PsycLit and the Social Science Citation Index up to the end of 1997. This was augmented by hand-searching, follow-up of bibliographies and.direct enquiry of authors of included studies. Application of inclusion decisions, quality assessment and data abstraction were carried out independently by at least two of the reviewers. We tabulated the results of the included studies and used meta-analysis where appropriate to refine conclusions. RESULTS: we finally included nine studies in the review, assessment of which revealed that bias was present, dictating the need for caution in interpreting results. Despite this, there was relative certainty that the proportion of those at home 6-12 months after admission is greater with supported discharge (odds ratio 1.4, 95% confidence interval 1.1- 2.0). This was associated with a consistent pattern of reduction in admission to long-stay care over the same period, without apparent increases in mortality. There was uncertainty about the effect of supported discharge on hospitalization. There were no rigorous research data on functional status, patient and carer satisfaction, and, in consequence, uncertainty about the overall effectiveness of supported discharge. CONCLUSIONS: we believe that the results of this review provide reassurance that supporting discharge from hospital to home is of value. However, important sources of uncertainty remain, suggesting the need for further research.

Aged↗
PubMed2000

Older adults, diabetes mellitus and visual acuity: a community-based case-control study.

MAIN OBJECTIVES: to screen for impaired distance visual acuity in older adults living at home, both with and without diabetes mellitus to determine whether diabetes increases the likelihood of visual impairment and to identify associated factors. DESIGN: case-control study. SETTINGS: three districts of Wales: North Clwyd, Powys and South Glamorgan, with assessments in subjects' homes. SUBJECTS: 385 with diabetes mellitus and 385 age- and sex-matched controls. MAIN OUTCOME MEASURES: visual acuity measures, short form (SF)-36 quality of life scores RESULTS: we observed impairment of visual acuity in 40% of those with diabetes mellitus and 31% of controls. Diabetes was associated with an increased risk of visual impairment [odds ratio 1.50 (95% confidence interval 1.09-2.05), P = 0.013]. The pinhole test identified uncorrected refractive error in 11% of the 63 patients with diabetes and 12% of the 49 controls who wore glasses, and in 51% of the 91 patients and 84% of the 69 controls who did not wear glasses (P < 0.001). Increasing age (P < 0.001) and female sex (P = 0.014) were significantly associated with visual impairment in both groups, whilst history of foot ulceration (P = 0.001), duration of diabetes (P = 0.018) and treatment with insulin (P < 0.001) were significantly associated with visual impairment in subjects with diabetes. We observed a significant association between impaired visual acuity and five domains of the SF-36 (physical and social functioning, mental health, vitality, and health perceptions; P < 0.01 in each case). CONCLUSION: older adults living at home have a high prevalence of uncorrected visual impairment. Diabetes mellitus is associated with significantly increased risk of visual loss. This impairment is associated with detriments in health-related quality of life. We recommend earlier use of optometry services and assessment of visual acuity by clinicians.

Aged↗
PubMed2000

Novel pathway of metabolism of alpha-linolenic acid in the guinea pig.

Docosahexaenoic acid (DHA) plays an important role in the nervous system. The capacity of the infant to use the essential fatty acid alpha-linolenic acid (ALA) as a substrate for neural DHA has been the subject of much debate recently. In this study, we explored the metabolic fate of an oral dose of 14C-labeled ALA in guinea pigs fed a defined diet for 3 wk from weaning. Of the 14C-labeled ALA administered, more than 46% was associated with the skin and fur lipids, mostly in the FFA fraction, and less than 0.1% was in brain lipids. About 39% of the label was not recovered in the body lipids and was assumed to be expired as CO2 or unabsorbed. The fur and skin were almost equally labeled; however, because of the very low mass of ALA in the fur, the specific activity of the fur was very high. These data identify a new route of metabolism of ALA in this species, presumably through the sebaceous glands onto fur. If this pathway exists in other species, including humans, it may account for the poor efficiency of conversion of ALA to DHA, because dietary ALA would not be available for anabolic pathways such as DHA synthesis. The relevance of these data to infants is that ALA may play an important hitherto unidentified role in the skin related to barrier function or epidermal integrity. This calls for more research into the importance of ALA as an essential fatty acid in its own right in human infants.

Animals↗
PubMed2000

Reduced baroreflex sensitivity in elderly humans is not due to efferent autonomic dysfunction.

A progressive decline in baroreflex sensitivity (BRS) is a characteristic feature of human aging, the basis of which is poorly understood. The purpose of the present study was to determine whether alterations in efferent baroreflex function might contribute to the age-related decrease in BRS. We studied 10 healthy young (mean age 30.5 years; age range 22-40 years; six male) and 10 healthy elderly (mean age 70.7 years; age range 67-75 years; five male) volunteers. We tested efferent cardiac vagal function using the bradycardiac response to the cold face test, and efferent sympathetic function using heart rate and blood pressure responses to four stress tests: (i) low-level cognitive stress, (ii) high-level cognitive stress, (iii) hand immersion in ice water (cold pressor test) and (iv) isometric sustained hand-grip. Haemodynamic responses to these stresses are mediated via efferent baroreflex pathways, whereas the afferent components of each reflex response are independent of afferent baroreflex pathways. BRS was measured from simultaneous Finapres-derived continuous blood pressure and digital ECG R-R interval data using the sequence analysis paradigm. As expected, BRS was significantly reduced in the elderly group (7. 29+/-0.74 ms/mmHg; mean+/-S.E.M.) compared with the young group (13. 84+/-1.13 ms/mmHg; P<0.001). However, neither the bradycardiac responses to the cold face test nor the efferent sympathetically mediated heart rate/blood pressure responses to the stress test battery were significantly different between the young and elderly groups. We conclude that the age-related decrease in BRS is not attributable to impairments in the efferent sympathetic or parasympathetic system components of the baroreceptor reflex pathway.

Adult↗
PubMed2000

Marine lipids: overview "news insights and lipid composition of Lyprinol".

The omega 3 polyunsaturated fatty acids have had a major impact on thinking in medicine in the last twenty years. The parent fatty acid in the omega 3 fatty acid family is alpha-linolenic acid (ALA) which is an essential fatty acid found in high concentrations in certain plant oils, such as flaxseed oil, walnut oil and canola oil. Several longer chain or derived omega 3 fatty acids are formed from alpha-linolenic acid and these are mainly found in fish, fish oils and from other marine organisms. The main marine omega 3 fatty acids are eicosapentaenoic acid (EPA), docosapentaenoic acid and docosahexaenoic acid (DHA). It is of interest that DHA is specifically localised in the retina and the brain in humans and other mammals. The longer chain omega 3 fatty acids are rapidly incorporated into cell membrane phospholipids where it is regarded they influence the metabolism/metabolic events within the cells. The mechanisms by which these changes occur include alteration in the fluidity of membranes such that there are subtle changes in receptor function, alteration in cell signalling mechanisms, membrane-bound enzymes, regulation of the synthesis of eicosanoids, and regulation of gene expression. In this chapter, we report a comparison between the composition of the oil derived from the New Zealand Green Lipped Mussel (Lyprinol') and two other oils rich in omega 3 fatty acids, namely flaxseed oil and tuna oil. The main lipid classes in Lyprinol' were sterol esters, triglycerides, free fatty acids, sterols and phospholipids while triglycerides were the main lipids in the other two oils. The main omega 3 fatty acids in Lyprinol' were EPA and DHA, while in flaxseed oil and tuna oil the main omega 3 fatty acids were ALA and DHA, respectively. The main sterols in Lyprinol' were cholesterol and desmosterol/brassicasterol, while in flaxseed oil and tuna oil the main sterols were beta-sitosterol and cholesterol, respectively. Epidemiological observations, populations' studies and basic research indicate the possibility of influencing the outcome of cardiovascular disease, inflammatory disorders and neural function by ingestion of the omega 3 polyunsaturated fatty acids.

Animals↗
PubMed1999

The effects of dietary alpha-linolenic acid compared with docosahexaenoic acid on brain, retina, liver, and heart in the guinea pig.

The aim of this study was to compare two different strategies to elevate brain, retina, liver, and heart docosahexaenoic acid (DHA) levels in guinea pigs. First, we used an increasing dose of alpha-linolenic acid (ALA) relative to a constant linoleic acid (LA) intake, and second, we used two levels of dietary DHA provided in conjunction with dietary arachidonic acid (AA). The percentage DHA and AA of total phospholipids in retina, liver, and heart, and in the brain phosphatidylethanolamine and phosphatidylcholine was studied in female pigmented guinea pigs (3 wk old) fed one of five semisynthetic diets containing 10% (w/w) lipid for 12 wk. The LA content in the diets was constant (17% of total fatty acids), with the ALA content varying from 0.05% (diet SFO), to 1% (diet Mix), and to 7% (diet CNO). Two other diets (LCP1 and LCP3) had a constant LA/ALA ratio (17.5:1) but varied in the levels of dietary AA and DHA supplementation. Diet LCP1 was structured to closely replicate the principal long chain polyunsaturated fatty acids (PUFA) found in human breast milk and contained 0.9% AA and 0.6% DHA (% of total fatty acids) whereas diet LCP3 contained 2.7% AA and 1.8% DHA. At the end of the study, animals were sacrificed and tissues taken for fatty acid analyses. We found no significant effects of diets on the growth of guinea pigs. Diets containing ALA had profoundly different effects on tissue fatty acid compositions compared with diets which contained the long chain PUFA (DHA and AA). In the retina and brain phospholipids, high-ALA diets or dietary DHA supplementation produced moderate relative increases in DHA levels. There was no change in retinal or brain AA proportions following dietary AA supplementation, even at the highest level. This was in contrast to liver and heart where tissue DHA proportions were low and AA predominated. In these latter tissues, dietary ALA had little effect on tissue DHA proportions although the proportion of AA was slightly depressed at the highest dietary ALA intake, but dietary DHA and AA supplements led to large increases (up to 10-fold) in the proportions of these PUFA. Tissue uptake of dietary AA and DHA appeared maximal for the LCP1 diet (replicate of breast milk) in the heart. There were no significant changes in the plasma levels of 11-dehydrothromboxane B2 (a thromboxane A2 metabolite) for any diet. The data confirm that dietary ALA is less effective than dietary DHA supplementation (on a gram/gram basis) in increasing tissue DHA levels and that tissues vary greatly in their response to exogenous AA and DHA, with the levels of these long chain metabolites being most resistant to change in the retina and brain compared with liver and heart. Dietary DHA markedly increased tissue DHA proportions in both liver and heart, whereas the major effect of dietary AA was in the liver. Future studies of the effects of dietary DHA and AA supplementation should examine a variety of tissues rather than focusing only on neural tissue.

Animals↗