Beyond calories: other benefits of macronutrient substitutes. Effects on chronic disease.
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Although recognized since the 1930s, slow infections have only recently received considerable attention. There are three types, group A (related to the type C RNA viruses), group B (bizarre agents such as scrapie and kuru) and group C (viruses such as measles which normally produce acute infections but which are behaving here in an unusual fashion). These viruses are only united in that they produce disease with excessively long incubation periods. Many slow infections result in neurological diseases and these will be discussed, together with some possible explanations of their action.
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Apolipoprotein (apo) E is an important circulating and tissue protein involved in cholesterol homeostasis and many other functions. The common polymorphism in the coding region of the gene, four polymorphisms in the promoter region, other additional single nucleotide polymorphisms, as well as several apo E variants have been identified. The common coding polymorphism strongly influences the lipid metabolism and the circulating concentration of apo E itself. This polymorphism is at the origin of the implication of apo E in cardiovascular and neurodegenerative diseases, but also of the relation of apo E with longevity. Probably due to its many metabolic and functional consequences, apo E polymorphism has been shown to influence the responses of patients to several drugs (fibrates, statins, hormone replacement therapy, anti-Alzheimer drugs) or environmental interventions (black tea, alcohol, diet). Apo E genotyping may be clinically helpful in defining the risk of patients and their responses to therapeutics. Finally, circulating apo E concentration appears to be altered in diseases and can be modulated by some of the drugs cited above. This parameter can thus also give interesting clinical information and could be a therapeutic target, providing it is validated. At the present time, we cannot exclude that apo E concentration may be the most prominent apo E parameter to be considered in health and disease, while apo E polymorphisms would represent only secondary parameters influencing apo E concentration.
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A population-based health interview and examination survey of 8 Inuit communities in the Kivalliq region of Nunavut, Canada, during the early 1990s has resulted in an increased understanding of the burden and extent of cardiovascular diseases and diabetes and their risk factors such as genetics, obesity, lipids, blood pressure and fatty acids. A recent national health interview survey which included a sample from Nunavut indicates that the Inuit still enjoy some advantages relative to other Canadians (lower level of self-reported diabetes and hypertension) and disadvantages (higher level of smoking, obesity, and heavy drinking). The pattern of health and disease among the Inuit is rapidly evolving, as the traditional lifestyle becomes further eroded. A long-term prospective cohort study that monitors this trend, investigates the etiology, and identifies potential interventions is urgently needed.
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