Search PubMed⌕ Search

Biomedical subjects

A Prentice

Publications and source records attributed to A Prentice.

At least 19 recordsLinked to original sources
PubMed2006

Blood indices of selenium and mercury, and their correlations with fish intake, in young people living in Britain.

Relationships between Se and Hg in erythrocytes, and between these indices and intakes of fish and other foods, were studied as an adjunct to the British National Diet and Nutrition Survey (NDNS) of young people aged 4-18 years. Hg was measured in 965 packed erythrocyte samples by inductively coupled plasma mass spectrometry. Fe measurements permitted the calculation of whole-blood Hg. Erythrocyte and plasma Se, and 7 d weighed dietary intake estimates, were available. Erythrocyte Hg was positively skewed, normalised by log-transformation. It was 20 % higher in girls than boys (3.17 v. 2.65 nmol/l, P=0.004), and increased with age in boys but not girls. It was directly and strongly correlated with erythrocyte or plasma Se. Hg and Se concentrations were directly correlated with fish intake. Certain other food groups were also directly correlated with Se and Hg concentrations, but less strongly than for fish. The strength and consistency of the relationship between erythrocyte Hg and Se suggests an important chemical link. Previous studies suggest that Se protects against the toxicity of Hg, and that fish is an important source of both. No toxic levels of Hg were found, which is reassuring because of the known health benefits of fish consumption, especially oily fish. Hg intakes need to be monitored, especially in women of child-bearing age, to ensure that Food Standards Agency guidelines are met.

Adolescent↗
PubMed2005

Non-steroidal anti-inflammatory drugs for pain in women with endometriosis.

BACKGROUND: Endometriosis is a common gynaecological condition that affects women and can lead to painful symptoms and infertility. It affects women's quality of life greatly, impacting on their careers, everyday activities, sexual and non-sexual relationships, and fertility. Non-steroidal anti-inflammatory drugs (NSAIDs) are the most commonly used first-line treatment for endometriosis. OBJECTIVES: To assess the effects of NSAIDs for the management of pain in women with endometriosis compared to placebo, other NSAIDs, other pain management drugs, or no treatment. SEARCH STRATEGY: We searched the Cochrane Menstrual Disorders and Subfertility Group Specialised Trials Register (May 2005) published in the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (1966 to May 2005), EMBASE (1980 to May 2005) and the reference lists from relevant publications. Experts in the field were also contacted for information about possible studies. SELECTION CRITERIA: We included all randomized controlled trials (RCTs) describing the use of NSAIDs in the treatment of endometriosis in women of all ages. DATA COLLECTION AND ANALYSIS: Two review authors (CA and SH) independently read and extracted data from each of the included studies. Crossover trials were analysed using the inverse variance method in RevMan to calculate the odds ratio for binary outcomes. MAIN RESULTS: Two trials were identified but only one trial, with 24 women, was included in the analysis. Comparing NSAIDs (naproxen) to placebo, there was no evidence of a positive effect on pain relief (odds ratio (OR) 3.27, 95% CI 0.61 to 17.69) in women with endometriosis. There was also inconclusive evidence to indicate whether women taking NSAIDs (naproxen) were less likely to require additional analgesia (OR 0.12, 95% CI 0.01 to 1.29) or experience side effects (OR 0.46, 95% CI 0.09 to 2.47) when compared to placebo. AUTHORS' CONCLUSIONS: There is inconclusive evidence to show whether NSAIDs (naproxen) are effective in managing pain caused by endometriosis. There is no evidence to show whether any individual NSAID is more effective than another. As shown in other Cochrane reviews, women using NSAIDs need to be aware of the possibility that these drugs may cause unintended effects.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed2005

Ethnic differences in osteocalcin gamma-carboxylation, plasma phylloquinone (vitamin K1) and apolipoprotein E genotype.

OBJECTIVE: To investigate plasma osteocalcin gamma-carboxylation and its relationship to plasma phylloquinone concentration and apolipoprotein E (apoE) genotype in women from three ethnic groups with differing osteoporotic fracture risk. DESIGN AND SUBJECTS: Fasted blood samples were collected from postmenopausal Gambian (n=50), British (n=31) and Chinese women (n=23), and 11 premenopausal women in each group from three cross-sectional studies. RESULTS: After adjustment for total osteocalcin, plasma undercarboxylated osteocalcin (adjusted ucOC) was lowest in Chinese and highest in British women postmenopause (British vs Chinese 103% higher, P<0.0001; Gambian vs Chinese 66% higher, P<0.01). No differences were observed premenopause. Within each ethnic group, adjusted ucOC was similar pre- and postmenopause. Postmenopause, plasma phylloquinone was higher in Chinese women (1.0 ng/ml) than in British (0.31 ng/ml) and Gambian women (0.36 ng/ml) (P<0.0001). Premenopause, plasma phylloquinone was higher in Gambian and Chinese women (0.6 ng/ml) than in British women (0.3 ng/ml; P=0.01). Plasma phylloquinone and adjusted ucOC were inversely related in postmenopausal British women (R2=32.4%; P=0.0008). ApoE4 frequency was Gambian 32.6%, British 13.8% and Chinese 6%. A lower adjusted ucOC was associated with apoE2 genotype in British and Chinese women. Ethnic differences in adjusted ucOC persisted after adjustment for phylloquinone and apoE genotype. CONCLUSION: These preliminary data indicate suboptimal vitamin K status in postmenopausal British compared to Chinese and Gambian women. Ethnic differences in apoE genotype may also influence osteocalcin gamma-carboxylation status. The study highlights the need for larger epidemiological investigations of ethnic differences in vitamin K status and the possible implications to bone health.

Adult↗
PubMed2005

Intake and sources of phylloquinone (vitamin K(1)) in 4-year-old British children: comparison between 1950 and the 1990s.

OBJECTIVES: To compare dietary intake and sources of phylloquinone (vitamin K1) in 4-year-old British children between 1950 and the 1990s, and report their variation by sociodemographic factors. DESIGN: Nationally representative samples of 4-year-olds from the longitudinal Medical Research Council National Survey of Health and Development (NSHD) (1950) and the cross-sectional National Diet and Nutrition Surveys (NDNS, 1992/93 and 1997). SETTING: Great Britain. SUBJECTS: Subjects were 4599 children born on 3-9 March 1946 (NSHD) and 307 children in the 1990s (NDNS). RESULTS: Geometric mean dietary phylloquinone intake was significantly higher in 1950 (39 mug day(-1), 95% confidence interval (CI) 37, 40) compared with the 1990s (24 mug day(-1), 95% CI 22, 25) (P<0.001). This difference remained when intake was expressed per MJ energy intake and per kilogram body weight, and after accounting for sex, region and occupational social class of the family. In 1950, phylloquinone intake in Scotland was significantly lower than in the rest of Britain. By the 1990s these regional differences had disappeared. Food sources of phylloquinone intake changed significantly between 1950 and the 1990s, with fats and oils contributing more and vegetables less, although vegetables contributed most (60% and 48%, respectively) to phylloquinone intake in both surveys. CONCLUSIONS: Phylloquinone intakes of children have decreased significantly since 1950. With the suggested need for adequate phylloquinone intake for optimal development and maintenance of bone and the cardiovascular system, the substantially lower phylloquinone intakes reported in children of the 1990s, compared with 1950, may have implications for the health of these two systems in later adulthood.

Antifibrinolytic Agents↗
PubMed2005

An evidence-based evaluation of important aspects of empirical antibiotic therapy in febrile neutropenic patients.

Febrile neutropenia is still associated with a high mortality rate, making timely and efficient empirical antibiotic therapy absolutely vital. For these reasons, evidence-based guidelines are urgently needed. The guidelines published so far are mainly based on clinical experience and selective citation. This review summarises studies and meta-analyses concerning empirical antibiotic therapy in high-risk neutropenic patients: (1) No benefit results from the addition of an aminoglycoside to the initial empirical therapy. On the contrary, patients who received an aminoglycoside had a significantly higher rate of adverse events, especially nephrotoxicity. (2) The empirical addition of a glycopeptide after 3-4 days of persistent fever was evaluated in two randomised controlled trials. Combined analysis demonstrates that in clinically stable patients without resistant or skin/soft tissue infections, the use of a glycopeptide can be delayed for another 3-4 days. (3) The choice of drugs for monotherapy is currently being evaluated; preliminary results demonstrate that ceftazidime has a significantly inferior response rate (without modification) to other evaluated antibiotics. In conclusion, guidelines should be based on the systematic evaluation of all relevant clinical trials. The analysis of the existing data leads to the recommendation of monotherapy, without aminoglycoside, using piperacillin-tazobactam, cefepime, meropenem or imipenem-cilastin, any of which may be continued for up to 7 days in persistently febrile, clinically stable patients without skin/soft tissue infections. The choice of drug as standard first-line therapy should depend on drug costs, local resistance rates and the potential for resistance induction.

Anti-Bacterial Agents↗
PubMed2004

Nimesulide, a COX-2 inhibitor, does not reduce lesion size or number in a nude mouse model of endometriosis.

BACKGROUND: Women with endometriosis have elevated levels of cyclooxygenase-2 (COX-2) in peritoneal macrophages and endometriotic tissue. Inhibition of COX-2 has been shown to reduce inflammation, angiogenesis and cellular proliferation. It may also downregulate aromatase activity in ectopic endometrial lesions. Ectopic endometrial establishment and growth are therefore likely to be suppressed in the presence of COX-2 inhibitors. We hypothesized that COX-2 inhibition would reduce the size and number of ectopic human endometrial lesions in a nude mouse model of endometriosis. METHODS: The selective COX-2 inhibitor, nimesulide, was administered to estrogen-supplemented nude mice implanted with human endometrial tissue. Ten days after implantation, the number and size of ectopic endometrial lesions were evaluated and compared with lesions from a control group. Immunohistochemical assessment of vascular development and macrophage and myofibroblast infiltration in control and treated lesions was performed. RESULTS: There was no difference in the number or size of ectopic endometrial lesions in control and nimesulide-treated nude mice. Nimesulide did not induce a visually identifiable difference in blood vessel development or macrophage or myofibroblast infiltration in nude mouse explants. CONCLUSION: The hypothesized biological properties of COX-2 inhibition did not influence lesion number or size in the nude mouse model of endometriosis.

Adult↗
PubMed2004

Positive, site-specific associations between bone mineral status, fitness, and time spent at high-impact activities in 16- to 18-year-old boys.

The incidence of hip and forearm fracture in elderly men in the United Kingdom is a public health issue, but there is limited knowledge on lifestyle factors affecting male bone health. The aim of this cross-sectional study was to evaluate the relationships between whole body and regional bone mineral status and self-reported participation time in no-, low-, moderate-, and high-impact activities and fitness measurements in 16- to 18-year-old boys. One hundred twenty-eight boys underwent absorptiometry (DXA) measurements (Hologic QDR 1000W) of bone mineral content (BMC), bone area (BA), and bone mineral density (BMD) at the whole body, hip, spine, and forearm. They also completed the EPIC (European Prospective Investigation of Cancer) physical activity questionnaire, which allowed categorization of activities according to impact and aerobic intensity. Fitness and strength were assessed in each subject using estimated VO2 max, grip strength, and back strength. Significant positive relationships were found between BMC, BA, and BMD and the fitness and strength measurements and participation time in high-impact sports at most skeletal sites. The relationships were further examined after adjustment of BMC for height, weight, and bone area, thereby minimizing the influence of body and bone size on these relationships. VO2 max was a significant positive determinant of size-adjusted BMC at the whole body, the ultradistal and one-third radius, and all the hip sites, except the trochanter. Size-adjusted BMC at the forearm sites and trochanter was significantly positively associated with grip strength. Size-adjusted BMC at the whole body and all the hip sites was significantly positively associated with time spent at high-impact activities. Differences in size-adjusted BMC across thirds of time spent at high-impact activities were also examined. Boys in the highest third of high-impact activity had significantly greater size-adjusted whole body BMC and total hip BMC compared to subjects in the lowest third [+3.4 (1.2)% for whole body and +8.5 (2.2)% for hip, both P = 0.001]. Boys in the highest third of high-impact activity spent most activity time jogging, playing tennis, football and rugby, basketball, and exercising with weights. Back strength and lean mass were significantly greater in subjects in the highest third compared to those in the middle (P = 0.02) and lowest third (P = 0.03). No significant differences were found between subjects in each third of high-impact activity for potential confounders including TV viewing, calcium intake, body fat, and height. These findings indicate that participation of male adolescents in a range of high-impact activities for 1 h or more a day is associated with greater bone size and mineral content, especially at the hip.

Adolescent↗
PubMed2004

Does hip strength analysis explain the lower incidence of hip fracture in the People's Republic of China?

To explore whether there are ethnic differences in calculated hip strength that might explain the low incidence of hip fracture in China, we used Lunar DPX 'beta' version of hip strength analysis (HAS) and hip axis length (HAL) programs to compare hip geometry, calculated strength and densitometric values from Chinese subjects in Shenyang to those of Caucasian subjects in Oslo and Leuven participating in the European Prospective Osteoporosis Study (EPOS). Subjects were 210 Chinese and 403 Caucasian men and women aged 53-77 years. Parameters investigated included bone mineral density (BMD), bone mineral content (BMC), bone area (BA), cross-sectional moment of inertia (CSMI) and section modulus (both indicating strength and rigidity of the femoral neck), HAL, neck length (NL), neck diameter, tensile stress (Tstress) and compressive stress (Cstress) (indicating the stress in the femoral neck at its weakest cross section arising from walking or a standard fall, respectively), safety factor (SF, indicating the resistance to fracture for forces generated during walking) and fall index (FI, indicating the resistance to fracture from force generated during a fall in the greater trochanter). The Chinese men and women were significantly shorter and lighter than their Caucasian counterparts (P<0.01) and had significantly lower BMD, BMC and BA of the femoral neck (P<0.01). After adjusting for BA, weight and height, there was no significant ethnic difference in either gender in BMC. CSMI and section modulus were significantly lower, and HAL, NL and neck diameter were significantly shorter in the Chinese men and women (P<0.01). These differences all remained after adjusting for weight and height. There were no significant differences in Tstress, Cstress, SF and FI between ethnic groups in either gender. Most of the parameters of calculated hip strength in the Chinese subjects were similar to or poorer than those in the Caucasian subjects. There was no evidence to indicate that Shenyang Chinese have superior BMD or BMC or better calculated hip strength. The short HAL and NL of the population, however, could be an independent factor contributing to the low incidence of hip fracture.

Aged↗
PubMed2004

Zinc and vitamin A intake and status in a national sample of British young people aged 4-18 y.

OBJECTIVE: To examine zinc and vitamin A intake and status and associated dietary, socio-demographic, lifestyle and physiological factors in British young people. DESIGN: National Diet and Nutrition Survey of young people aged 4-18 y. SETTING: Great Britain, 1997. SUBJECTS: Complete 7-day weighed dietary records were provided by 1520 participants, while 1193 provided blood samples. RESULTS: A total of 13 and 11% of participants respectively reported low dietary intakes of zinc and vitamin A (retinol equivalents), relative to the UK lower reference nutrient intake. These percentages were not altered significantly by including contributions to intake from supplements, mainly containing vitamin A (as retinol). Likelihood of low zinc and/or vitamin A intake was more often associated with age, sex and likely under-reporting of food consumption than with other socio-demographic and lifestyle factors. Low zinc and vitamin A intakes were generally less likely in those with higher consumption of dairy foods (mainly milk). Zinc and vitamin A status (assessed by plasma zinc and retinol concentrations) were adequate in almost all participants. Plasma zinc concentration was not significantly associated with zinc intake. Plasma retinol concentration was correlated with vitamin A intake (overall r=0.17, P<0.001; adjusted for age and plasma alpha(1)-antichymotrypsin concentration) and increased significantly with age (P<0.001) in both sexes. A significant association was found between plasma zinc and retinol concentrations in boys only (r=0.17, P=0.001). CONCLUSION: Zinc and vitamin A intakes and status were generally adequate in this national sample of British young people.

Adolescent↗
PubMed2004

Dietary acid-base balance and intake of bone-related nutrients in Cambridge teenagers.

OBJECTIVES: To evaluate the diet of 16-18-y-old boys and girls with particular reference to intakes of nutrients believed to affect bone health and dietary acid-base balance. DESIGN: A 7-day food diary was completed between the months of October and December. SETTING: Cambridge, UK. SUBJECTS: A total of 111 boys and 101 girls aged 16-18 y who were recruited into the Cambridge Bone Studies. MAIN OUTCOME MEASURES: Mean daily intakes of foods and selected nutrients (protein, calcium, phosphorus, magnesium, potassium, vitamins C and K) were calculated. Two estimates of acid-base balance were calculated from the diet using the formulae of Remer (net acid excretion, estimated indirectly; NAE(ind)) and Frassetto (protein/potassium ratio). RESULTS: Mean calcium and phosphorus intakes were above the UK Reference Nutrient intake (RNI). In all, 39% of the boys and 36% of the girls had vitamin K intakes lower than 1 microg/kg body weight/day. Calcium intake was positively correlated with all other nutrients except vitamins C and K. Boys had a significantly higher estimated net acid excretion (NAE(ind)) than girls (P<0.001). Although a strong correlation (r=0.76, P<0.001) was found between the two methods, at higher acid levels a divergence was observed. A significant positive correlation was found between NAE(ind) and the weight consumed per day of milk, cheese, meat and cereal foods and a negative correlation was found with the weight of potatoes and fruit. Diet composition is such that a lower NAE(ind) is accompanied by a lower calcium intake. CONCLUSIONS: The interpretation of the effects of calcium and other nutrients on bone cannot be considered in isolation from the other components of the diet. These results challenge some of the accepted perceptions about what constitutes an optimal diet for the promotion of bone health in adolescents.

Acid-Base Equilibrium↗
PubMed2004

Gamma-tocopherol as a possible marker for nutrition-related risk: results from four National Diet and Nutrition Surveys in Britain.

Relationships between vitamin E status (alpha and gamma-tocopherol and their ratio in plasma), anthropometric and biochemical indices, and food and nutrient intakes, were studied in four British National Diet and Nutrition Surveys: children aged 1.5-4.5 years, young people aged 4.0-18.0 years, adults 19.0-64.0 years and adults aged > or = 65.0 years. gamma-Tocopherol:alpha-tocopherol ratio declined with age. In older women gamma-tocopherol and gamma-tocopherol:alpha-tocopherol ratios were directly related to indices of obesity. In young men alpha- and gamma-tocopherols were directly correlated with obesity, but gamma-tocopherol:alpha-tocopherol ratio was not. For young people and toddlers, fewer obesity indices were available and relationships were weaker. Other fat- and water-soluble vitamin indices correlated directly with alpha-tocopherol and inversely with gamma-tocopherol and gamma-tocopherol:alpha-tocopherol ratio. Whereas alpha-tocopherol correlated directly with 'healthy' nutrient choices (such as intrinsic sugars, dietary fibre, vitamins and potassium) and inversely with 'unhealthy' choices (extrinsic sugars and monounsaturated fats, i.e. avoidance of polyunsaturated fat), gamma-tocopherol and the gamma-tocopherol:alpha-tocopherol ratio related inversely with 'healthy' choices. Food groups had analogous relationships; thus, alpha-tocopherol related directly to use of polyunsaturated fats, fresh fruits and fruit juices, and inversely to non-polyunsaturated fats and extrinsic sugar. The reverse was true for gamma-tocopherol and gamma-tocopherol:alpha-tocopherol ratio. Although the mechanisms underlying these relationships are obscure, the gamma-tocopherol:alpha-tocopherol ratio may reveal poor dietary choices, status predictors and a propensity for obesity in later life, especially in women.

Adolescent↗
PubMed2004

Diet, nutrition and the prevention of osteoporosis.

OBJECTIVE: To review the evidence on diet and nutrition relating to osteoporosis and provide recommendations for preventing osteoporosis, in particular, osteopototic fracture. APPROACH: Firstly, to review the definition, diagnosis and epidemiology of osteoporosis, to discuss the difficulties in using bone mineral density to define osteoporosis risk in a world-wide context and to propose that fragility fracture should be considered as the disease endpoint. Secondly, to provide an overview of the scientific data, the strengths and weaknesses of the evidence and the conceptual difficulties in interpreting studies linking diet, nutrition and osteoporosis. The following were considered: calcium, vitamin D, phosphorus, magnesium, protein and fluorine. Other potential dietary influences on bone health were also discussed, including vitamins, trace elements, electrolytes, acid-base balance, phyto-oestrogens, vegetarianism and lactose intolerance. CONCLUSIONS: There is insufficient knowledge linking bone mineral status, growth rates or bone turnover in children and adolescents to long-term benefits in old age for these indices to be used as markers of osteoporotic disease risk. For adults, the evidence of a link between intakes of any dietary component and fracture risk is not sufficiently secure to make firm recommendations, with the exception of calcium and vitamin D. For other aspects of the diet, accumulating evidence suggests that current healthy-eating advice to decrease sodium intake, to increase potassium intake, and to consume more fresh fruits and vegetables is unlikely to be detrimental to bone health and may be beneficial.

Biomarkers↗
PubMed2004

Vitamin B12 and folate deficiency in later life.

OBJECTIVES: to examine the prevalence of vitamin B12 deficiency and folate deficiency in later life in representative samples of the elderly population in the United Kingdom. DESIGN: a population-based cross-sectional analysis of 3,511 people aged 65 years or older from three studies was used to estimate the age-specific prevalence of vitamin B12 deficiency and of folate deficiency. Vitamin B12 deficiency is conventionally diagnosed if serum vitamin B12 < 150 pmol/l ('low vitamin B12'). We defined 'metabolically significant vitamin B12 deficiency' as vitamin B12 < 200 pmol/l and blood total homocysteine >20 micro mol/l. Folate deficiency, which usually refers to serum folate <5 nmol/l, was defined as 'metabolically significant' if serum folate was <7 nmol/l and homocysteine >20 micro mol/l. RESULTS: the prevalence of vitamin B12 deficiency, whether defined as low vitamin B12 or metabolically significant vitamin B12 deficiency increased with age in all three studies, from about 1 in 20 among people aged 65-74 years to 1 in 10 or even greater among people aged 75 years or greater. The prevalence of folate deficiency also increased with age, and was similar to that for vitamin B12 deficiencies, but only about 10% of people with low vitamin B12 levels also had low folate levels. CONCLUSION: the high prevalence of vitamin B12 and folate deficiency observed in older people indicates a particular need for vigilance for deficiency of these vitamins. Reliable detection and treatment of vitamin deficiency could reduce the risk of deficiency-related disability in old age.

Age Factors↗
PubMed2004

Nutrient intakes; biochemical and risk indices associated with Type 2 diabetes and glycosylated haemoglobin, in the British National Diet and Nutrition Survey of people aged 65 years and over.

AIMS: To characterize nutritional differences between survey participants diagnosed with Type 2 diabetes; those without diabetes, and those with "undiagnosed diabetes" based on glycosylated haemoglobin (HbA(1c)). SUBJECTS AND METHODS: The 1994/5 British National Diet and Nutrition Survey, of people aged 65 years and over (mean age 78 years), included 73 respondents with diagnosed Type 2 diabetes [mean (sd) HbA(1c) = 7.06 (2.05)%], and 30 with "undiagnosed diabetes" (defined as HbA(1c) > 6.3%; mean (sd) HbA(1c) = 7.40 (1.66)%], among a representative sample of 1038 with anthropometry; 4-day weighed diet; blood and urine status measurements. RESULTS: The prevalence of Type 2 diabetes (diagnosed + undiagnosed) was 10%. In subjects without diagnosis of diabetes, those with HbA(1c) > 6.3% had on average a significantly higher body weight (73.6 vs. 67.9 kg), higher waist circumference (99.8 vs. 91.8 cm), higher body mass index (28.6 vs. 25.9 kg/m(2)) and higher white cell counts (7.64 vs. 7.09 x 10(9)/l), than those with mean HbA(1c) < or = 6.3%. Diagnosed diabetic subjects had significantly higher energy-adjusted intakes of protein, fibre, vitamins and minerals than those not in this category (P < 0.01). In contrast, those with undiagnosed diabetes (HbA(1c) > 6.3%) were nutritionally "at risk", having low plasma concentrations of lycopene (0.13 vs. 0.24 micromol/l) and high density lipoprotein cholesterol (0.99 vs. 1.27 micromol/l) and a trend towards low vitamin C (24 vs. 36 micromol/l) which was significant (P < 0.01) for men. HbA(1c) was positively correlated with white cell count, plasma fasting triglycerides, plasma alkaline phosphatase and homocysteine (all P < 0.01 overall), being particularly striking amongst men. CONCLUSIONS: Among older British citizens, those with diagnosed diabetes had healthier nutritional profiles than those undiagnosed with high HbA(1c). Important health-promoting benefits are therefore predicted following early diagnosis and nutritional advice for people with Type 2 diabetes.

Aged↗
PubMed2004

Nutritional characteristics of people with impaired mental capacity from a nationally representative survey of British people aged 65 years and over.

BACKGROUND: Mentally impaired older people are frequently excluded from population surveys for practical reasons; thus their nutritional characteristics are poorly delineated. OBJECTIVE: To describe the nutritional characteristics of those who, through mental impairment, were considered to require proxy consent and/or proxy information-givers, within a National Diet and Nutrition Survey (NDNS) of people aged 65 years and over, in the UK. DESIGN AND METHODS: 2043 participants in the NDNS in mainland Britain during 1994-95 were studied. Proxy consent and/or proxy information was provided by the next-of-kin or a carer for 3% of people living in the community and for 35% of people in institutions. A four-day weighed diet estimate and a single blood sample for nutritional status and clinical chemistry indices were obtained. RESULTS: Inclusion of people requiring proxy consent and/or information was acceptable to NHS local research ethics committees. These participants differed in certain food choices, nutrient intakes and biochemical status indices, from those not requiring a proxy. They ate more sugary and milky foods. They had lower blood concentrations of haemoglobin, retinol, cholesterol; and higher plasma levels of urea and creatinine. CONCLUSIONS: Older people who require proxy consent or information-givers can be studied in population surveys. They are nutritionally vulnerable and may need special assistance to ensure acceptable nutritional intake and status.

Aged↗
PubMed2003

In a population study, can parathyroid hormone aid the definition of adequate vitamin D status? A study of people aged 65 years and over from the British National Diet and Nutrition Survey.

The British National Diet and Nutrition Survey of people aged 65 years and over in 1994-5 provided nationally representative estimates of food and nutrient intakes and biochemical status indices. In a further analysis study, parathyroid hormone (PTH) concentrations were measured in plasma samples from 773 subjects and were analyzed with the existing data on vitamin D intake, plasma 25-hydroxyvitamin D (25OHD), total plasma calcium and albumin. As predicted, a strong inverse relationship was observed between PTH and 25OHD. In the free-living respondents aged 65-84 years (n=507) there was a continuous decline in PTH with increasing 25OHD and no plateau, whereas in free-living people aged 85+ years (n=86) there was a significant deviation from a simple inverse relationship, with unexpectedly high PTH values in some people with satisfactory 25OHD status. There was a relationship between both PTH (inverse) and plasma 25OHD (direct) with calcium intake. A direct relationship between 25OHD and total plasma calcium was not significant when calcium was corrected for albumin. Geographically, 25OHD, and to a lesser extent PTH, exhibited a north-south gradient, and 25OHD was associated with self-reported health status. Both 25OHD and PTH were associated with self-reported physical activity. Low calcium intake and 25OHD was associated with receipt of state benefits. The relationship between plasma 25OHD and vitamin D intake revealed a striking seasonal cycle. 25OHD was strongly influenced by vitamin D intake in the winter in free-living subjects, but this was not observed in the summer. In people living in institutions such as nursing homes, who are less likely to be exposed to sunlight throughout the year, plasma 25OHD levels were lower throughout the year.

Aged↗
PubMed2003

Gonadotrophin-releasing hormone analogues for endometriosis: bone mineral density.

BACKGROUND: Gonadotrophin-releasing hormone analogues (GnRHas) are generally well tolerated, and are effective in relieving the symptoms of endometriosis (Prentice 2003). Unfortunately the low oestrogen state that they induce is associated with adverse effects including an acceleration in bone mineral density (BMD) loss. OBJECTIVES: To determine the effect of treatment with gonadotrophin-releasing hormone analogues (GnRHas) on the bone mineral density of women with endometriosis, compared to placebo, no treatment, or other treatments for endometriosis, including GnRHas with add-back therapy. SEARCH STRATEGY: We searched the Cochrane Menstrual Disorders and Subfertility Group's specialised register of controlled trials (23rd October 2002) and the Cochrane Central Register of Controlled Trials (Cochrane Library, issue 4, 2002). We also carried out electronic searches of MEDLINE (1966 - March Week 2 2003) and EMBASE (1980 - March Week 2 2003). We also searched the reference lists of articles and contacted researchers in the field. SELECTION CRITERIA: Prospective, randomised controlled studies of the use of GnRHas for the treatment of women with endometriosis were considered, where bone density measurements were an end point. The control arm of the studies was either placebo, no treatment, another medical therapy for endometriosis, or GnRHas with add-back therapy. DATA COLLECTION AND ANALYSIS: Two reviewers (JF and MS) independently assessed trial quality and extracted data. Study authors were contacted for additional information. MAIN RESULTS: Thirty studies involving 2,391 women were included, however only 15, involving 910 women, could be included in the meta-analysis. The meta-analysis showed that danazol and progesterone + oestrogen add-back are protective of BMD at the lumbar spine both during treatment and for up to six and twelve months after treatment, respectively. Between the groups receiving GnRHa and the groups receiving danazol/gestrinone, there was a significant difference in percentage change of BMD after six months of treatment, the GnRH analogue producing a reduction in BMD from baseline and danazol producing an increase in BMD (SMD -3.43, 95 % CI -3.91 to -2.95). Progesterone only add-back is not protective; after six months of treatment absolute value BMD measurements of the lumbar spine did not differ significantly from the group receiving GnRH analogues (SMD 0.15, 95 % CI -0.21 to 0.52). In the comparison of GnRHa versus GnRHa + HRT add-back, that is oestrogen + progesterone or oestrogen only, there was a significantly bigger BMD loss in the GnRHa only group (SMD -0.49, 95 % CI -0.77 to -0.21). These numbers reflect the absolute value measurements at the lumbar spine after six months of treatment. Due to the small number of studies in the comparison we are unable to conclude whether calcium-regulating agents are protective. No difference was found between low and high dose add-back regimes but again only one study was identified for this comparison. Only one study comparing GnRH analogues with placebo was identified, but the study gave no data. No studies comparing GnRH with the oral contraceptive pill (OCP) or progestagens were identified. REVIEWER'S CONCLUSIONS: Both danazol and progesterone + oestrogen add-back have been shown to be protective of BMD, while on treatment and up to six and 12 months later, respectively. However, by 24 months of follow-up there was no difference in BMD in those women who had HRT add-back. Studies of danazol versus GnRHa did not report long-term follow-up. The significant side effects associated with danazol limit its use.

Bone Density↗