Biomedical subjects

W Karmally

Publications and source records attributed to W Karmally.

7 recordsLinked to original sources

PubMed1990

Reduction of plasma cholesterol levels in normal men on an American Heart Association Step 1 diet or a Step 1 diet with added monounsaturated fat.

The design of diets to achieve optimal changes in plasma lipid levels is controversial. In a randomized, double-blind trial involving 36 healthy young men, we evaluated the effects on plasma lipid levels of both an American Heart Association Step 1 diet (in which 30 percent of the total calories were consumed as fat: 10 percent saturated, 10 percent monounsaturated, and 10 percent polyunsaturated fats, with 250 mg of cholesterol per day) and a monounsaturated fat-enriched Step 1 diet (with 38 percent of the calories consumed as fat: 10 percent saturated, 18 percent monounsaturated, and 10 percent polyunsaturated fats, with 250 mg of cholesterol per day). The effects of these diets were then compared with those of an average American diet, in which 38 percent of the total calories were consumed as fat: 18 percent saturated, 10 percent monounsaturated, and 10 percent polyunsaturated fats, with 500 mg of cholesterol per day. The men consumed the average American diet for 10 weeks before random assignment to one of the two Step 1 diets or to continuation of the average diet for an additional 10 weeks. Caloric intake was adjusted to maintain a constant body weight. As compared with the mean (+/- SD) change in the plasma total cholesterol level in the group that followed the average American diet throughout the study (-0.05 +/- 0.36 mmol per liter), there were statistically significant reductions (P less than 0.025) in the plasma total cholesterol level in the group on the Step 1 diet (-0.37 +/- 0.27 mmol per liter) and in the group on the monounsaturated fat-enriched Step 1 diet (-0.46 +/- 0.36 mmol per liter). There were parallel reductions in the plasma low-density lipoprotein cholesterol levels in these two groups. Neither the plasma triglyceride levels nor the high-density lipoprotein cholesterol concentrations changed significantly with any diet. We conclude that enrichment of the Step 1 diet with monounsaturated fat does not alter the beneficial effects of the Step 1 diet on plasma lipid concentrations.

Adult↗

PubMed1987

Treating hyperlipidemia, Part III: Drug therapy.

In elderly patients at increased risk for cardiovascular disease due to lipid abnormalities, numerous medications are available for altering such abnormalities. Most of these drugs have side effects which, in the elderly, may necessitate lower dosing than usual. For persons with severe elevations of triglycerides, nicotinic acid (Niacin) and gemfibrozil (Lopid) may be used. For those who need a reduction in the LDL cholesterol, choices include bile acid-binding resins, nicotinic acid, HMG CoA reductase inhibitors, probucol (Lorelco), and neomycin.

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PubMed1987

Treating hyperlipidemia, Part I: Whether and when in the elderly.

There are elderly persons at increased risk of coronary heart disease due to elevated LDL cholesterol, lowered HDL cholesterol, or both. Risk difference data seem to indicate that the reduction in risk of coronary artery disease by lowering elevated cholesterol values is the same in the elderly as it is in younger persons. hence we recommend screening for total cholesterol in the elderly, followed by a fasting lipid profile in those with screening cholesterol values over 200 mg/dl (230 mg/dl by certain methods). Comparative LDL and HDL cholesterol values, as well as L/H ratios, are presented for assisting in assessment of results and for planning therapeutic strategy.

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PubMed1987

Treating hyperlipidemia, Part II: Making dietary control work in the elderly.

Changing lifestyle behaviors and eating habits are the most important recommendations a physician can make in controlling adverse lipid levels in the elderly. One may improve HDL cholesterol levels through encouraging smoking cessation, ideal weight maintenance, and aerobic exercise. This article discusses new dietary recommendations for lowering LDL cholesterol and provides a table of dietary tips for patients.

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PubMed1985

Coronary heart disease and the consumption of diets high in wheat and other grains.

Diets high in cereal grains, legumes and other vegetables are consistently associated with a reduced incidence of cardiovascular disease. This appears to be due primarily to the associated reduction in serum cholesterol and low density lipoprotein cholesterol. Replacement of animal fats and specifically the saturated fat and cholesterol components with complex carbohydrates and with unsaturated fat from vegetable sources appear to be the major reasons for the reduced levels of serum cholesterol. Additional effects of the high carbohydrate diets from vegetable sources may be caused by certain plant fibers including lignin, pectin and gums. Vegetable proteins may also have an intrinsic cholesterol reducing effect as compared to certain animal proteins, such as casein. A habitual increase in vegetable grains in the western diet should produce a sustained reduction in the risk of cardiovascular disease without a sacrifice of nutritional adequacy.

Adult↗

PubMed1984

Diet and the decrease of coronary heart disease.

Total plasma cholesterol is a powerful predictor of death related to coronary heart disease (CHD). Strong evidence indicates that reducing the plasma cholesterol level results in in a decrease in the expected incidence of CHD. The decline in the death rate from CHD in the U.S. population over the past 2 decades has occurred simultaneously with a reduction in the consumption of cholesterol and saturated fat and a dramatic increase in the use of unsaturated vegetable oils. Over the same period, the mean cholesterol level has decreased at least 5%. This finding explains up to one-third of the decline in CHD mortality observed since 1968.

Adult↗

PubMedDate not supplied

Randomized, controlled trial of diabetic patient education: improved knowledge without improved metabolic status.

We randomized 749 insulin-treated patients on the rolls of the Mount Sinai Medical Center Diabetes Clinic in a controlled trial of diabetic patient education; 345 agreed to participate, of whom 165 were assigned to the education group and 180 to the control group. Cognitive scores increased from 5.3 +/- 1.6 to 5.8 +/- 1.6 in the education group, but there was no change in the control group, whose score was 5.3 +/- 1.7 before and after the intervention (P = .0073). HbA1c fell from 6.8 +/- 2.1 to 6.1 +/- 2.0% in the education group and from 6.6 +/- 2.0 to 6.3 +/- 2.0% in the control group, an insignificant difference (P = .1995). The fasting blood glucose decreased from 223 +/- 94 to 179 +/- 73 mg/dl in the education group and from 199 +/- 81 to 185 +/- 76 mg/dl in the controls (P = .1983). Triglycerides, high- and low-density lipoprotein cholesterol, and insulin dosage also failed to show significant variation among groups. The foot-lesion score showed similar progression in the education and control groups. Neither diastolic nor systolic blood pressure showed significantly greater change in the education or the control group, with falls noted, particularly in diastolic pressures, in both patient groups. Differences between the groups were not significant for sick days, hospitalizations, emergency room visits, or outpatient visits. The sample sizes of the study and control populations were sufficiently large to detect a difference in means between the education and control groups in the HbA1c, the primary outcome variable, of greater than 1.0%, with alpha = .05 and a power of .95. Thus, our study suggests that patient education may not be an efficacious therapeutic intervention in most adults with insulin-treated diabetes mellitus.

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